Mcgeemclean8415

BACKGROUND Clinical reasoning refers to the cognitive processes used by individuals as they formulate a diagnosis or treatment plan. Clinical reasoning is dependent on formal and experiential knowledge. check details Developing the ability to acquire and recall knowledge effectively for both analytical and non-analytical cognitive processing has patient safety implications. This realist review examines the way educational interventions develop analytical and non-analytical reasoning ability in undergraduate education. A realist review is theory-driven, seeking not only to identify if an intervention works, but also understand the reasons why, for whom, and in what circumstances. AIM To develop understanding about the way educational interventions develop effective analytical and non-analytical clinical reasoning ability, when they do, for whom and in what circumstances. METHODS Literature from a scoping search, combined with expert opinion and researcher experience was synthesised to generate an initial programme theory (I However, factors such as pre-existing knowledge and self-confidence influence their effectiveness, especially among individuals with 'low knowledge'. Promoting non-analytical reasoning once novices acquire more clinical knowledge is important for the development of clinical reasoning in undergraduate education. This article is protected by copyright. All rights reserved.BACKGROUND/PURPOSE Educators and researchers recently implemented developmental progress assessment (DPA) in the context of competency-based education. To reap its anticipated benefits, much still remains to be understood about its implementation. In this study, we aimed to determine the nature and extent of the current evidence on DPA, in an effort to broaden our understanding of the major goals and intended outcomes of DPA as well as the lessons learned from how it has been executed in, or applied across, educational contexts. METHODS We conducted a scoping study informed by Arksey and O'Malley's methodology. Our search strategy yielded 2494 articles. Two team members screened them for inclusion/exclusion (90% agreement), and extracted numerical and qualitative data from 56 articles based on a pre-defined set of charting categories. The thematic analysis of the qualitative data was completed with iterative consultations and discussions until consensus was achieved for the interpretation of the results. RESULTS Tools used to document DPA include scales, milestones, and portfolios. Performances were observed in clinical or standardized contexts. We identified seven major themes in our qualitative thematic analysis 1- Underlying aims of DPA, 2- Sources of information, 3- Barriers, 4- Contextual factors that can act as barriers or facilitators to the implementation of DPA, 5- Facilitators, 6- Observed outcomes, and 7- Documented validity evidences. DISCUSSION Developmental progress assessment seems to fill a need in the training of future competent health professionals. However, moving forward with a widespread implementation of DPA, factors such as lack of access to user-friendly technology and time to observe performance may render its operationalisation burdensome in the context of CBME. This article is protected by copyright. All rights reserved.Plants have evolved resource-conservative and resource-acquisitive strategies to deal with variability in rainfall, but interactions with dominant invasive species may undermine these adaptations. To investigate the relative effect of invaders on species with these two strategies, we manipulated rainfall and invasive grass presence and measured demographic rates in three resource-acquisitive and three resource-conservative native annual forbs. We found that invasive grasses were harmful to all of the target species, but especially the resource-acquisitive ones, and that these effects were stronger under experimental drought. Invasive grass presence under drought lowered per capita population growth rates of acquisitive natives through increased mortality and decreased seed set. While invasive grasses also decreased per capita growth rates of resource-conservative natives, they did so by increasing mortality under experimental watering and by limiting the production of seed under experimental drought. Invasive species can thus interact with climatic fluctuations to make bad years worse for resource-acquisitive natives and good years less good for resource-conservative natives, and they may generally tend to undermine the acquisitive strategy more than the conservative one. © 2020 by the Ecological Society of America.BACKGROUND After surgery for head and neck squamous cell carcinoma (HNSCC), decisions regarding adjuvant radiotherapy (RT) or chemoradiotherapy (CRT) are based on staging and the presence of high-risk pathology. Because higher mutant allele tumor heterogeneity (MATH; a measure of intratumor genetic heterogeneity) is associated with shorter overall survival (OS) in patients with HNSCC, the authors sought to determine whether MATH analysis might further inform these decisions. METHODS Adjuvant therapy-associated relationships between MATH and OS were analyzed for 389 patients with HNSCC who were treated surgically. Data were obtained from The Cancer Genome Atlas and analyzed with Cox proportional hazards multiple regression accounting for 7 other patient characteristics. RESULTS The relationship between MATH and OS differed with adjuvant therapy in a way that could inform therapy decisions. Adjuvant RT alone was found to provide substantial benefit for patients having high-MATH tumors (RT vs no adjuvant therapy hazard ratio, 0.29 [95% CI, 0.17-0.51]) but no benefit for those having low-MATH tumors. In contrast, adjuvant CRT provided no benefit beyond that of adjuvant RT for patients with high-MATH tumors but substantially improved OS among patients with low-MATH tumors (CRT vs no adjuvant therapy hazard ratio, 0.34 [95% CI, 0.15-0.78]). CONCLUSIONS The results of the current analysis suggested that patients with HNSCC with high-MATH tumors who underwent surgical treatment could benefit from adjuvant RT, even when current clinical guidelines indicate otherwise. The addition of adjuvant chemotherapy for patients with high-MATH tumors would not be indicated. Adding chemotherapy might be necessary to radiosensitize low-MATH tumors to adjuvant RT. This potential predictive role of tumor MATH analysis should be evaluated in prospective clinical trials. © 2020 American Cancer Society.