Efficacy and efficiency of information retrieval of community family physicians at the point of care: exploring the associations with information and computer literacy.

Objective: This study aimed to measure the association between the efficacy/efficiency of digital information retrieval among community family physicians at the point of care and information and computer literacy. Methods: This study is a part of a cross-sectional anonymous online survey-based study among community family physicians who reported no affiliation with an academic institution in eight Arab countries. Results: A total of 72 physicians were included. The mean total score for the information literacy scale was 59.8 out of 91 (SD = 11.4). The mean score was 29.3 (SD = 5.6) out of 55 on the computer literacy scale. A one-way ANOVA revealed a statistically significant association between information literacy and information retrieval efficacy (F (2,69) = 4.466, p = 0.015) and efficiency of information retrieval (F (2.69) = 4.563, p = 0.014). Computer literacy was not associated with information retrieval efficacy or efficiency. Conclusion: The information and computer literacy scores of community family physicians in eight Arab countries are average. Information literacy, rather than computer literacy, is positively associated with the efficacy and efficiency of information retrieval at the point of care. There is room for improvement in evidence-based medicine curricula and continuous professional development to improve information literacy for better information retrieval and patient care.

Information retrieval at the point of care of community family physicians in Arab countries.

This study is based on Jumana Antoun's PhD thesis at Walden University, USA examining the information retrieval behaviour of 72 community family physicians' at the point of care in eight Arab countries in the Eastern Mediterranean. The key findings were that participants looked for digital clinical information at the point of care on average 14.0 times per week with the majority (80.3%) using a mobile phone. Clinical information about medication dosage and side effects was the most sought clinical question, and patient education was the least. Almost half of the participants considered that they often found relevant (55.6%), useful (56.9%) and unbiased (58.3%) information. Whilst none of the factors examined predicted the physicians' self-reported effectiveness and efficiency at information retrieval, the implication for practice points clearly to the barriers and the need for curricula to focus on search strategies using free resources at the point of care.

The Role of the Advocate in Cyber Schools during the COVID-19 Pandemic.

Existing research on facilitators in K-12 schools has focused on supplemental online programs where on-site personnel work with online students in a local brick-and-mortar school. While some insightful research exists focused on online facilitators at full-time cyber schools, additional research is needed to examine facilitators using synchronous support. The purpose of this study was to determine whether and how the role of a facilitator in a full-time cyber school could help to address students' cognitive, behavioral, and affective engagement needs during the COVID-19 pandemic. We conducted qualitative interviews with two administrators and four advocates during Spring 2020, using the Academic Communities of Engagement Framework as a lens to understand the advocates' role. Findings confirmed the need for a facilitator role to support online student engagement. This type of research will provide insights to full-time cyber schools and will be insightful to those seeking to engage students during emergency remote learning.

Identifying the differentiation practices of virtual school teachers.

Despite a large increase in enrollments of students in online courses at the K-12 level, there is very little research on the use of differentiation in fully online (called "virtual") schools. This study asked virtual teachers from two different types of schools to discuss their differentiation practices, and compared differentiation practices of teachers across these schools. Nineteen focus groups consisting of 92 teachers were conducted. Data were analyzed using Tomlinson's differentiation framework. Results showed that the large majority of teacher comments about differentiation definitions, assessments, curriculum, grouping and strategies fell in the novice category, and that newer virtual school teachers may struggle in developing skills in differentiation in an online environment.

The changing landscape of america's health care system and the value of emergency medicine.

The Patient Protection and Affordable Care Act (ACA), passed in 2010, has important implications for emergency physicians (EPs). In addition to dramatically reducing the number of uninsured in the United States, this comprehensive health care reform legislation seeks to curb the escalating costs of health care delivery, optimize resource utilization, eliminate waste, and improve the quality of service delivered by the health care system. At the annual Association of American Medical Colleges (AAMC) meeting on November 5, 2011, an expert panel from public health, emergency medicine, and health services research was convened by the Association of Academic Chairs of Emergency Medicine (AACEM) and the Society for Academic Emergency Medicine (SAEM) to discuss possible future models for the emergency care system and academic emergency medicine in the era of the ACA.

Episodes of care: is emergency medicine ready?

Optimizing resource use, eliminating waste, aligning provider incentives, reducing overall costs, and coordinating the delivery of quality care while improving outcomes have been major themes of health care reform initiatives. Recent legislation contains several provisions designed to move away from the current fee-for-service payment mechanism toward a model that reimburses providers for caring for a population of patients over time while shifting more financial risk to providers. In this article, we review current approaches to episode of care development and reimbursement. We describe the challenges of incorporating emergency medicine into the episode of care approach and the uncertain influence this delivery model will have on emergency medicine care, including quality outcomes. We discuss the limitations of the episode of care payment model for emergency services and advocate retention of the current fee-for-service payment model, as well as identify research gaps that, if addressed, could be used to inform future policy decisions of emergency medicine health policy leaders. We then describe a meaningful role for emergency medicine in an episode of care setting.

The future of emergency medicine.

BACKGROUND: The specialty of emergency medicine (EM) continues to experience a significant workforce shortage in the face of increasing demand for emergency care. SUMMARY: In July 2009, representatives of the leading EM organizations met in Dallas for the Future of Emergency Medicine Summit. Attendees at the Future of Emergency Medicine Summit agreed on the following: 1) Emergency medical care is an essential community service that should be available to all; 2) An insufficient emergency physician workforce also represents a potential threat to patient safety; 3) Accreditation Council for Graduate Medical Education/American Osteopathic Association (AOA)-accredited EM residency training and American Board of Medical Specialties/AOA EM board certification is the recognized standard for physician providers currently entering a career in emergency care; 4) Physician supply shortages in all fields contribute to-and will continue to contribute to-a situation in which providers with other levels of training may be a necessary part of the workforce for the foreseeable future; 5) A maldistribution of EM residency-trained physicians persists, with few pursuing practice in small hospital or rural settings; 6) Assuring that the public receives high quality emergency care while continuing to produce highly skilled EM specialists through EM training programs is the challenge for EM's future; 7) It is important that all providers of emergency care receive continuing postgraduate education.

The future of emergency medicine.

Physician shortages are being projected for most medical specialties. The specialty of emergency medicine continues to experience a significant workforce shortage in the face of increasing demand for emergency care. The limited supply of emergency physicians, emergency nurses, and other resources is creating an urgent, untenable patient care problem. In July 2009, representatives of the leading emergency medicine organizations met in Dallas, TX, for the Future of Emergency Medicine Summit. This consensus document, agreed to and cowritten by all participating organizations, describes the substantive issues discussed and provides a foundation for the future of the specialty.

Transitions of Care Consensus policy statement: American College of Physicians, Society of General Internal Medicine, Society of Hospital Medicine, American Geriatrics Society, American College Of Emergency Physicians, and Society for Academic Emergency Medicine.

The American College of Physicians, Society of Hospital Medicine, and Society of General Internal Medicine convened a multi-stakeholder consensus conference in July 2007 to address the quality gaps in the transitions between inpatient and outpatient settings and to develop consensus standards for these transitions. Over 30 organizations sent representatives to the Transitions of Care Consensus Conference. Participating organizations included medical specialty societies from internal medicine as well as family medicine and pediatrics, governmental agencies such as the Agency for Healthcare Research and Quality and the Centers for Medicare and Medicaid Services, performance measure developers such as the National Committee for Quality Assurance and the American Medical Association Physician Consortium on Performance Improvement, nurse associations such as the Visiting Nurse Associations of America and Home Care and Hospice, pharmacist groups, and patient groups such as the Institute for Family-Centered Care. The Transitions of Care Consensus Conference made recommendations for standards concerning the transitions between inpatient and outpatient settings for future implementation. The American College of Physicians, Society of Hospital Medicine, Society of General Internal Medicine, American Geriatric Society, American College of Emergency Physicians, and Society for Academic Emergency Medicine all endorsed this document.

Transitions of Care Consensus Policy Statement American College of Physicians-Society of General Internal Medicine-Society of Hospital Medicine-American Geriatrics Society-American College of Emergency Physicians-Society of Academic Emergency Medicine.

The American College of Physicians (ACP), Society of Hospital Medicine (SHM), Society of General Internal Medicine (SGIM), American Geriatric Society (AGS), American College of Emergency Physicians (ACEP) and the Society for Academic Emergency Medicine (SAEM) developed consensus standards to address the quality gaps in the transitions between inpatient and outpatient settings. The following summarized principles were established: 1.) Accountability; 2) Communication; 3.) Timely interchange of information; 4.) Involvement of the patient and family member; 5.) Respect the hub of coordination of care; 6.) All patients and their family/caregivers should have a medical home or coordinating clinician; 7.) At every point of transitions the patient and/or their family/caregivers need to know who is responsible for their care at that point; 9.) National standards; and 10.) Standardized metrics related to these standards in order to lead to quality improvement and accountability. Based on these principles, standards describing necessary components for implementation were developed: coordinating clinicians, care plans/transition record, communication infrastructure, standard communication formats, transition responsibility, timeliness, community standards, and measurement.

An anatomical study of tibial metaphyseal/diaphyseal mismatch during revision total knee arthroplasty.

This cadaveric study determines the relationship of the tibial metaphysis and intramedullary canal of the tibia (diaphysis), particularly relating to revision knee arthroplasty. A total knee arthroplasty was performed in 20 cadaveric tibiae using revision instrumentation with a canal-filling uncemented stem. The offset, which is the distance between the center of the tibial canal and the center of the tibial metaphysis, was measured using the revision system offset bushing. The average distance between the center of the tibial metaphysis and the center of the tibial diaphysis was 4.1 mm (+/-2.9 mm) with an average angle of 105 degrees (0 degrees -70 degrees ). The mean offset was 4.1 mm (+/-2.9) and the mean offset angle was 105 degrees (0 degrees -350 degrees ). The study confirms the center of the tibial diaphysis is not congruous with the center of the metaphysis with wide variations in offsets among individuals. A wide range of offsets are necessary for optimum placement of implants.

Hybrid external fixation of the proximal tibia: strategies to improve frame stability.

OBJECTIVE: To determine the specific frame construction strategies that can increase the stability of hybrid (ring with tensioned wires proximally connected by bars to half-pins distally) external fixation of proximal tibia fractures. DESIGN Repeated measures biomechanical testing. SETTING: Laboratory. SPECIMENS: Composite fiberglass tibias. METHODS: Using the Heidelberg and Ilizarov systems, external fixators were tested on composite fiberglass tibias with a 1-cm proximal osteotomy (OTA fracture classification 41-A3.3) in seven frame configurations: unilateral frames with 5-mm diameter half-pins and 6-mm diameter half-pins; hybrid (as described above), with and without a 6-mm anterior proximal half-pin; a "box" hybrid (additional ring group distal to the fracture connected by symmetrically spaced bars to the proximal rings) with and without an anterior, proximal half-pin; and a full, four-ring configuration. Each configuration was loaded in four positions (central, medial, posterior, and posteromedial). MAIN OUTCOME MEASUREMENTS: Displacement at point of loading of proximal fragment. RESULTS: The "box" hybrid was stiffer than the standard hybrid for all loading positions. The addition of an anterior half-pin stiffened the standard hybrid and the "box" hybrid. CONCLUSIONS: The most dramatic improvements in the stability of hybrid frames used for proximal tibial fractures result from addition of an anterior, proximal half-pin.

Review article: diagnostic ultrasonography: applications in orthopaedic surgery.

Diagnostic ultrasonography of musculoskeletal diseases in the United States has been used most often for detection of rotator cuff tears or developmental dysplasia of the hip. Diagnostic ultrasonography also is useful in imaging the periarticular soft tissues about the knee, hip, ankle, occult pediatric fractures, muscle injury, bone healing, and foreign bodies. Recent technologic improvements have made this imaging modality increasingly more accurate while providing significant benefits over traditional modalities such as magnetic resonance imaging, particularly regarding cost, patient satisfaction, and ease of usage. Increasing use in the future of diagnostic ultrasonography for musculoskeletal conditions is likely as acceptance grows. This review focuses on recent, practical applications of diagnostic ultrasonography of the musculoskeletal system.