Early Predictors of Performance Deficiencies in Academic Faculty: Pre-Employment Red Flags.

OBJECTIVE: To determine whether faculty who had red flags (unprofessional behavior, delayed response to queries, or delayed submission of required documentation) during pre-employment were more likely to have performance deficiencies than faculty who did not have red flags. METHODS: The study included 187 faculty consecutively hired in a Department of Pediatrics in a large academic health system from 2013 to 2018. Faculty with and without pre-employment red flags were compared to identify the proportion who had subsequent performance deficiencies related to documentation, unprofessional behavior, performance, or premature departure from the faculty. RESULTS: Most of the hired faculty were female (127, 0.68), physicians (136, 0.73), and clinicians or clinician-educators (124, 0.67). Sixteen faculty (0.09) had pre-employment red flags. In the 3 years after hiring, 31 (0.17) of the faculty cohort had at least 1 performance deficiency. Faculty with pre-employment red flags were more than 4 times as likely to experience a performance deficiency during follow-up (0.56 vs 0.13, P < .001). The hazard ratio for performance deficiency comparing faculty with pre-employment red flags to those without was 5.98 (95% confidence interval 2.73-13.1, P < .0001). CONCLUSIONS: Faculty who had pre-employment red flags were significantly more likely to experience subsequent performance deficiencies. Given the substantial investment that individuals and academic medical centers make in recruiting and hiring new faculty, efforts to identify and assist faculty members at risk provide academic departments opportunities to provide the best environment for success for all faculty.

The Effect of the Move More Pack on the Physical Activity of Cancer Survivors: Protocol for a Randomized Waiting List Control Trial with Process Evaluation.

BACKGROUND: Physical activity can improve many common side effects of cancer treatment as well as improve physical function and quality of life (QOL). In addition, physical activity can improve survival rate and reduce cancer recurrence. Despite these benefits, only 23% of cancer survivors in England are active to recommended levels. Cancer survivors are interested in lifestyle behavior change. Home-based interventions offer a promising means for changing physical activity behavior. Prediagnosis levels of physical activity and self-efficacy have been reported to be predictors of physical activity behavior change. The Move More Pack, which has undergone revision, is a printed resource with supporting Internet-based tools that aims to increase the physical activity of cancer survivors in the United Kingdom. The revised Move More Pack is underpinned by the theory of planned behavior and the social cognitive theory. OBJECTIVE: The aim of this proposed study was to investigate the effect of the revised Move More Pack, supported by Internet-based tools, on physical activity, self-efficacy, and health-related QOL (HRQOL) of cancer survivors in the United Kingdom. METHODS: This study is a two-arm waiting list randomized control trial with embedded process evaluation. A sample of 99 participants per arm will be recruited by invitation through an email database of cancer survivors held by UK charity Macmillan Cancer Support and an advert placed on the Macmillan Cancer Support Facebook page. Each participant is randomized to receive brief physical activity information and the UK guidelines for physical activity, or brief physical activity information and the revised Move More Pack with supporting Internet-based tools. The intervention and control arm will be followed up at 12 weeks to identify changes in self-reported physical activity, self-efficacy, and HRQOL based on Web-based questionnaires. The control arm will receive the revised Move More Pack at 12 weeks with follow-up at 24 weeks. The intervention arm is followed up at 24 weeks to determine maintenance of reported changes. Subgroup analyses will be completed based on participants' prediagnosis level of physical activity and baseline self-efficacy as possible predictors of positive changes. Use of each component of the revised Move More Pack will be assessed using a 4-point Likert scale. Semistructured phone interviews will evaluate the use and perceived usefulness of the revised Move More Pack. RESULTS: Participant recruitment started in March 2017. Projected completion of this study is October 2018. CONCLUSIONS: This study's findings will identify if the proposed low-cost broad reach intervention improves physical activity, self-efficacy, and the HRQOL of cancer survivors. The process evaluation is designed to contextualize the use and perceived usefulness of the revised Move More Pack, help augment its efficient distribution, and identify potential improvements to its design.

Physical activity levels and barriers to exercise referral among patients with cancer.

OBJECTIVE: Physical activity after cancer is associated with a lower rate of adverse effects and better survival. The objectives of this study were to assess the exercise levels of people living with and beyond cancer attending a local oncology unit, and explore their attitudes to supervised exercise referral. METHODS: 134 patients attending the oncology unit over a 2 month period were approached to complete a questionnaire about their exercise levels and barriers to exercise. RESULTS: 12 of 114 (11%) patients were classed as active according to the General Practice Physical Activity Questionnaire. Despite receiving written and verbal explanations about the benefits of exercise, 44% of eligible patients declined exercise referral, with health concerns, time pressures, and the perception that they were already adequately exercising stated as the most common justifications. Overall, 82% met one or more of the current indications for the National Exercise Referral Scheme, so even in regions where the inclusion criteria have not been broadened to include cancer, this scheme is a practical option for most. CONCLUSION: It is clear from these results that we are failing to motivate cancer patients into healthier lifestyles. PRACTICE IMPLICATIONS: Further efforts are needed to determine and implement behavioural change strategies.

Non-specific mechanisms in orthodox and CAM management of low back pain (MOCAM): theoretical framework and protocol for a prospective cohort study.

INTRODUCTION: Components other than the active ingredients of treatment can have substantial effects on pain and disability. Such 'non-specific' components include: the therapeutic relationship, the healthcare environment, incidental treatment characteristics, patients' beliefs and practitioners' beliefs. This study aims to: identify the most powerful non-specific treatment components for low back pain (LBP), compare their effects on patient outcomes across orthodox (physiotherapy) and complementary (osteopathy, acupuncture) therapies, test which theoretically derived mechanistic pathways explain the effects of non-specific components and identify similarities and differences between the therapies on patient-practitioner interactions. METHODS AND ANALYSIS: This research comprises a prospective questionnaire-based cohort study with a nested mixed-methods study. A minimum of 144 practitioners will be recruited from public and private sector settings (48 physiotherapists, 48 osteopaths and 48 acupuncturists). Practitioners are asked to recruit 10-30 patients each, by handing out invitation packs to adult patients presenting with a new episode of LBP. The planned multilevel analysis requires a final sample size of 690 patients to detect correlations between predictors, hypothesised mediators and the primary outcome (self-reported back-related disability on the Roland-Morris Disability Questionnaire). Practitioners and patients complete questionnaires measuring non-specific treatment components, mediators and outcomes at: baseline (time 1: after the first consultation for a new episode of LBP), during treatment (time 2: 2 weeks post-baseline) and short-term outcome (time 3: 3 months post-baseline). A randomly selected subsample of participants in the questionnaire study will be invited to take part in a nested mixed-methods study of patient-practitioner interactions. In the nested study, 63 consultations (21/therapy) will be audio-recorded and analysed quantitatively and qualitatively, to identify communication practices associated with patient outcomes. ETHICS AND DISSEMINATION: The protocol is approved by the host institution's ethics committee and the NHS Health Research Authority Research Ethics Committee. Results will be disseminated via peer-reviewed journal articles, conferences and a stakeholder workshop.

Structural magnetic resonance imaging-derived biomarkers for Alzheimer's disease.

The development and validation of biomarkers for prediction, diagnosis and tracking of progression of Alzheimer's disease are both increasingly important. As potential pharmaceutical agents are developed for Alzheimer's disease, their efficacy needs to be assessed. When medications become available, those subjects who may derive most benefit from such treatments need to be selected and their response to treatment monitored. As such, there has been much research into biomarkers in recent years, with many showing promise in all areas of biomarker utility. This review focuses on the potential of structural imaging as a biomarker in Alzheimer's disease.