A collaborative teaching strategy for enhancing learning of evidence-based clinical decision-making.

The educational literature cites a lack of student motivation to learn how to use research evidence in clinical decision-making because the students do not observe clinicians using evidence. This lack of motivation presents a challenge to educators as they seek to instill the value of evidence-based clinical decision-making (EBCD) in students. One problem is that students in entry-level programs do not have the experience needed to know what to look for, and secondly, clinical decision-making is contextually based in a patient problem. Our approach offers one solution to bridging the gap between classroom teaching and real-world implementation of EBCD through a three-phase collaborative approach. Occupational and physical therapy students are partnered with clinicians to find and appraise evidence to answer the real-world questions posed by these therapists. This paper describes the implementation of the partnership, teaching/learning outcomes, logistics, and implications for clinicians. We found this approach increased student motivation and greatly enhanced the learning experience. Future directions include implementing a framework which allows for the assessment of the strategy on the facility and creates opportunities to integrate the use of EBCD in all aspects of facility practice.

Agrococcus citreus sp. nov., isolated from a medieval wall painting of the chapel of Castle Herberstein (Austria).

A bacterial strain, D-1/1aT, isolated from a medieval wall painting of the chapel of Herberstein (Styria, Austria) was characterized by a polyphasic approach. Strain D-1/1aT shared 98.1% 16S rRNA sequence similarity to Agrococcus jenensis. The chemotaxonomic characteristics including polar lipid pattern, whole cell sugars, quinone system, polyamine pattern, cell wall composition and fatty acid profile were in good agreement with those of Agrococcus jenensis. The G+C content of the DNA was determined to be 74 mol%. The value of 47% DNA reassociation obtained after DNA-DNA hybridization between DNA of Agrococcus jenensis and strain D-1/1aT as well as differences in the amino acid composition of the peptidoglycan and in physiological characteristics demonstrate that the isolate represents a new species of the genus Agrococcus. The name Agrococcus citreus sp. nov. is proposed for the new species harbouring isolate D-1/1aT. The type strain is DSM 12453T.

The use of patient symptoms to screen for serious back problems.

Even when a patient is referred by a physician, the physical therapist must remain alert to the possibility that the patient may require medical care outside the realm of physical therapy. Physical therapists must be able to screen low back pain patients to identify those who have serious low back problems which require additional diagnostic evaluation and treatment by a physician. It is important for physical therapists to know which symptoms and signs or combination of symptoms and signs best indicate the likelihood of a serious problem. The purpose of this study was to test the sensitivity and specificity of low back pain symptoms in distinguishing individuals with a benign low back problem from those requiring surgical or medical intervention. Demographic and clinical data were collected retrospectively from a standardized low back pain questionnaire located in the medical records of 174 low back pain patients. Patients were classified as having a benign low back problem (N = 41) or a serious low back problem (N = 133) based on surgical findings or long term follow-up. Some individual symptoms had high specificity, but none had high sensitivity. To improve sensitivity while attempting to maintain moderate specificity, a number of symptoms were considered in parallel. The highest combination of sensitivity (.87) and specificity (.50) was obtained by combining in parallel the symptoms of unable to sleep, awakened and unable to fall back to sleep, medication required to sleep, and pain worsened by walking.