Notes

Need to Interventional Cardiologists Super-Subspecialize?: Transferring Via Affected individual Choice to be able to Operator Choice.
function and better physical function performance with the strongest association among Digit Symbol Substitution Task scores.
Older adults with heterogeneous health conditions showed a consistent pattern between better cognitive function and better physical function performance with the strongest association among Digit Symbol Substitution Task scores.
Recent Medicare home health payment changes reduce reimbursement for care provided to patients without a preceding hospitalization. Beneficiaries may enter home health without a preceding hospitalization via referral from a community provider or through incurring multiple episodes of home health care. We assess potential implications of this change by examining the characteristics of patients accessing Medicare home health through each of these pathways.

Nationally representative retrospective cohort study of 1,224 (weighted
= 5,913,080) older adults who participated in the National Health and Aging Trends Study between 2011 and 2015 and received Medicare-funded home health within 1 year of interview. Patient characteristics before home health were drawn from the National Health and Aging Trends Study, while characteristics during home health, referral source, and number of episodes incurred were drawn from linked Outcomes and Assessment Information Set and Medicare claims. We tested for differences inial vulnerability and/or medical complexity.
Greater social vulnerability and care needs before home health were associated with community referral, while greater clinical severity during home health was associated with incurring multiple episodes of care. Findings suggest that recent payment changes may threaten home health access among beneficiaries with greater social vulnerability and/or medical complexity.
Despite growing diversity among the aging population and extensive previous research on racial/ethnic minority caregivers, little research has been conducted on the potentially unique experiences and outcomes of informal caregivers of foreign-born care recipients. Using nationally representative data and the Stress Process Model, the current study examined the differences in caregiver outcomes (care burden, psychological well-being, and self-rated health) by care recipient nativity status (U.S.-born vs. foreign-born) and the extent to which caregiver outcomes vary by care recipient nativity status and caregiver race/ethnicity (non-Hispanic white, non-Hispanic black, Hispanic, and Others).

The current study used Round 5 of the National Health and Aging Trends Study and the National Study of Caregiving (
= 1,436). We conducted ordinary least squares regression to analyze the differences in caregiver's outcomes by care recipient nativity status and caregiver race/ethnicity and to investigate the impacts ofinform needed changes to structural barriers.
Hopelessness-a state of despair characterized by a negative outlook towards the future and a belief in insurmountable challenges-is a risk factor for major depression, cardiovascular disease, and all-cause mortality among older adults. It is also an understudied consequence of discrimination. Older blacks disproportionately report experiencing discrimination and, as a result, may be at greater risk of feeling hopeless. However, social and religious resources may protect against the adverse effects of discrimination. The current study examines whether social support, social engagement, religious attendance, and religiosity buffer the effects of self-reported everyday discrimination on hopelessness among a nationally representative sample of blacks.

Using data from the 2010/2012 psychosocial assessment of the Health and Retirement Study, we regressed hopelessness on everyday discrimination, stratifying by 2 age groups, ages 51-64, representing middle-age (
= 1,302), and age 65 and older, representing old opelessness among middle-aged and older blacks but social and religious resources may counterbalance its effects, in age-specific ways, to protect against hopelessness. Religiosity may be especially important for older blacks as a buffer against the negative consequences of discrimination on hopelessness.
Findings suggest that self-reported everyday discrimination increases hopelessness among middle-aged and older blacks but social and religious resources may counterbalance its effects, in age-specific ways, to protect against hopelessness. Religiosity may be especially important for older blacks as a buffer against the negative consequences of discrimination on hopelessness.Structural biology often focuses primarily on three-dimensional structures of biological macromolecules, deposited in the Protein Data Bank (PDB). This resource is a remarkable entity for the world-wide scientific and medical communities, as well as the general public, as it is a growing translation into three-dimensional space of the vast information in genomic databases, e.g. GENBANK. There is, however, significantly more to understanding biological function than the three-dimensional coordinate space for ground-state structures of biomolecules. The vast array of biomolecules experiences natural dynamics, interconversion between multiple conformational states, and molecular recognition and allosteric events that play out on timescales ranging from picoseconds to seconds. This wide range of timescales demands ingenious and sophisticated experimental tools to sample and interpret these motions, thus enabling clearer insight into functional annotation of the PDB. NMR spectroscopy is unique in its ability to sample this range of timescales at atomic resolution and in physiologically relevant conditions using spin relaxation methods. The field is constantly expanding to provide new creative experiments, to yield more detailed coverage of timescales, and to broaden the power of interpretation and analysis methods. This review highlights the current state of the methodology and examines the extension of analysis tools for more complex experiments and dynamic models. The future for understanding protein dynamics is bright, and these extended tools bring greater compatibility with developments in computational molecular dynamics, all of which will further our understanding of biological molecular functions. These facets place NMR as a key component in integrated structural biology.[This corrects the article DOI 10.1093/biomethods/bpaa006.].
The cost of health care in the US is rapidly rising. Understanding the financial cost of medical care is an important competency for physicians and physicians-in-training. Medical students in their clinical clerkships are being exposed to health care decision-making often for the first time and are forming habits they will carry throughout their training and careers. Teaching high-value care (HVC) principles is crucial for students as they will be the future leaders in health care.

This 1-hour workshop was interactive and aimed to prepare medical students to apply HVC when making medical decisions. The topic of HVC was initially introduced by eliciting tests that students want to order and highlighting the concept of whether or not a test changes the management of the patient. This exercise was followed by a PowerPoint presentation which discussed HVC, Choosing Wisely guidelines in pediatrics, and how to communicate with parents and patients about this topic.

Of third-year medical students, 125 participated in the workshop, with a survey response rate of 90% (
= 112). Ninety-nine percent reported that this workshop was helpful, and 97% reported that they will change their practice to reflect more cost-conscious care. Most students reported that their knowledge of HVC improved after the session, with 88% reporting scores of 3 (
) or 4 (
).

This ready-to-implement workshop offered students an understanding of how the cost of medical care impacts patients and families and how to practice cost-conscious care in pediatrics.
This ready-to-implement workshop offered students an understanding of how the cost of medical care impacts patients and families and how to practice cost-conscious care in pediatrics.
The majority of older adults with advanced dementia (AD) develop difficulties with eating and swallowing, often prompting concerns about nutrition and quality of life. Employing a palliative approach requires providers to attain skills in addressing symptoms and communicating with family caregivers about the trajectory of AD and associated dysphagia, as well as to elicit goals of care. Research suggests internal medicine (IM) residents often perceive minimal education during training addressing skills needed to care for patients with AD.

We developed and piloted a small-group interactive seminar utilizing a trigger video depicting a family meeting addressing eating problems in a patient with AD. Case-based learning, small-group discussion, and learner reflection were employed. We assessed the impact on 82 of the 106 IM, medicine-pediatrics, and neurology residents who participated in the seminar.

Participant evaluation indicated residents showed high satisfaction and perceived the educational content ofe residents' ability to care for older adults with AD in their future careers.
There is a paucity of simulation literature and curricula addressing cognitive bias and the skills necessary to overcome this common source of clinical error. We designed a scenario for emergency medicine (EM) residents with the intent to trigger an anchoring bias as a nidus for conversation about metacognition.

We implemented this case for teams of two to three PGYs 1-5, including both EM and EM/internal medicine residents within a longitudinal simulation curriculum. The case was designed to simulate a major trauma wherein evaluation according to standard advanced trauma life support principles failed to identify a traumatic injury to explain the patient's hemodynamic instability. Residents had to reorient their thought process towards other etiologies of shock, ultimately identifying sepsis as the driving force behind the trauma. The scenario ran over 10-15 minutes followed by a 30-minute debrief. Case satisfaction and the success of various learning objectives were assessed via a postsimulation survey.

Forty-four EM and combined EM/IM residents ranging from PGY 1-5 participated in the simulation over a 5-week period. Nearly 82% of respondents expressed an overall satisfaction with the case. About 76% felt the case succeeded in contributing to their understanding of cognitive biases.

The implementation of misdirection in this simulation was an effective means by which to engage learners in education about cognitive biases.
The implementation of misdirection in this simulation was an effective means by which to engage learners in education about cognitive biases.
Health care professionals who identify as members of underrepresented and racial minority groups may experience bias from patients and patient families. These occurrences disrupt the educational and therapeutic environments, distress the targeted individuals and allies, and create potential legal liability. Yet there are few educational opportunities for individuals to brainstorm and implement strategies for responding professionally during such instances.

Presented first as a grand rounds, then an invited workshop, and finally an invited series, this educational activity was developed in a stepwise manner over the course of a year. Each format was sequentially modified based on feedback from participants-more than 200 physicians and other health care professionals-using evaluation forms that were voluntary and anonymous. The educational activity used an adaptation of forum theater, in which participants role-played an instance of oppression with a goal of altering the ultimate outcome. This approach provided participants with the opportunity to develop and rehearse responses to workplace bias in a way that preserved the provider-patient relationship.
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