搜索结果：Journal of CME

OBJECTIVES: Despite the broad range of continuing medical education (CME) offerings aimed at educating practicing physicians through the provision of up-to-date clinical information, physicians commonly overuse, under-use, and misuse therapeutic and diagnostic interventions. It has been suggested that the ineffective nature of CME either accounts for the discrepancy between evidence and practice or at a minimum contributes to this gap. Understanding what CME tools and techniques are most effective in disseminating and retaining medical knowledge is critical to improving CME and thus diminishing the gap between evidence and practice. The purpose of this review was to comprehensively and systematically synthesize evidence regarding the effectiveness of CME and differing instructional designs in terms of knowledge, attitudes, skills, practice behavior, and clinical practice outcomes. REVIEW METHODS: We formulated specific questions with input from external experts and representatives of the Agency for Healthcare Research and Quality (AHRQ) and the American College of Chest Physicians (ACCP) which nominated this topic. We systematically searched the literature using specific eligibility criteria, hand searching of selected journals, and electronic databases including: MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews, The Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Database of Abstracts of Reviews of Effects (DARE), PsycINFO, and the Educational Resource Information Center (ERIC). Two independent reviewers conducted title scans, abstract reviews, and then full article reviews to identify eligible articles. Each eligible article underwent double review for data abstraction and assessment of study quality. RESULTS: Of the 68,000 citations identified by literature searching, 136 articles and 9 systematic reviews ultimately met our eligibility criteria. The overall quality of the literature was low and consequently firm conclusions were not possible. Despite this, the literature overall supported the concept that CME was effective, at least to some degree, in achieving and maintaining the objectives studied, including knowledge (22 of 28 studies), attitudes (22 of 26), skills (12 of 15), practice behavior (61 of 105), and clinical practice outcomes (14 of 33). Common themes included that live media was more effective than print, multimedia was more effective than single media interventions, and multiple exposures were more effective than a single exposure. The number of articles that addressed internal and/or external characteristics of CME activities was too small and the studies too heterogeneous to determine if any of these are crucial for CME success. Evidence was limited on the reliability and validity of the tools that have been used to assess CME effectiveness. Based on previous reviews, the evidence indicates that simulation methods in medical education are effective in the dissemination of psychomotor and procedural skills. CONCLUSIONS: Despite the low quality of the evidence, CME appears to be effective at the acquisition and retention of knowledge, attitudes, skills, behaviors and clinical outcomes. More research is needed to determine with any degree of certainty which types of media, techniques, and exposure volumes as well as what internal and external audience characteristics are associated with improvements in outcomes.

The continuing medical education (CME) program in Plastic and Reconstructive Surgery began in 1999. Why? The Editorial Board of the Journal wanted to offer an updated compendium of all topics in plastic and reconstructive surgery, written by the current leaders in the field on each topic. As a result, the Journal began publishing monthly CME articles to meet a need among plastic surgeons. Convenience and the offer of 1 hour of Category 1 Credit resulted in the program's initial and ongoing success. The CME program moved along more or less under the general guidance of the Journal's editorial office until October of 2008. In that month's issue, Don Lalonde et al. unveiled a formal, unified, and comprehensive plan for the CME program.1 That editorial served as his first “state of the union” statement on the CME; Dr. Lalonde had just been confirmed as the Journal's CME/Maintenance of Certification (MOC) section editor. He provided a history of the CME program in the Journal, delineated the difference between CME credit and MOC-Plastic Surgery credit and CMEs, and looked forward to the formal creation of a new series of 36 CME articles that would cover the spectrum of plastic and reconstructive surgery (including cosmetic surgery). That new CME series started in April of 2010. HOW IS THE NEW CME SERIES DIFFERENT? The following list details how the new CME series is different from that which preceded it. Up to 40 minutes of video learning from the experts with every article. Watch Fred Menick perform nasal reconstruction in the first new CME article in the April 2010 issue.3 You can watch this master of nasal surgery perform three different phases of reconstruction and describe his technique in three videos with just a click on the www.PRSJournal.com Web site. These videos are 5 to 10 minutes long and provide the latest educational delivery capabilities of surgical techniques. Single sign-on for all American Society of Plastic Surgeons (ASPS) members. No cumbersome multiple logins are needed to view a CME article and take a CME test. Extensive posttest answer discussions and references. Just as with the ASPS in-service examination, all of the new series of CME articles provide posttest discussions of the questions and answers, complete with references. Because of the posttest discussions, the CME articles, answer discussions, and references are ideal study guides for board examinations. Automatic recording of CME credits for members. All members of the ASPS who successfully complete a CME test activity have credit for that activity automatically recorded with the ASPS. All third-party record keeping is eliminated, and certificates for successful completion of CME activities can be easily generated. Convenience of obtaining credit. As in the past, each CME test continues to represent a convenient way to obtain 1 hour of Category 1 CME credit. Members take the tests online; they can take tests in the privacy of their own offices or at home any time, day or night, any day of the year. No travel to an educational course (along with associated travel costs and course registration fees) is necessary. Because test taking is conducted through the ASPS Online Education Center, there is no messy or cumbersome (or slow) filling out of any forms and faxing in of hard-copy test answers, and recording of credit occurs instantaneously. Wide range of topics. The CME tests cover a wide variety of topics, spanning the breadth and depth of plastic and reconstructive surgery in a 3-year rotating cycle. Quality content and tests. Every Plastic and Reconstructive Surgery CME article and test has been rigorously peer reviewed and represents the highest quality in articles and test content. Articles present current, state-of-the-art material for the most up-to-date information. TOPICS AND VIDEO HIGHLIGHTS Three essential components of the new CME program are (1) comprehensive topics that cover the entire spectrum of plastic surgery; (2) CME authors who are recognized surgical experts in their designated article topics; and (3) critical educational content that is provided in a multimedia format. A sampling of the topics and authors is provided in Table 1. Reconstructive and cosmetic topics in addition to those shown in Table 1 include:Table 1: CME Topics and Authors: A Sampling Cosmetic medicine: fat injection, facial resurfacing, fillers Cleft lip and velopharyngeal incompetence Craniofacial syndromes and surgery Head and neck reconstruction Scalp, skull, orbit, and maxilla reconstruction Ear deformities and reconstruction Burns and burn reconstruction Body contouring Augmentation mammaplasty Breast reduction Breast reconstruction after breast cancer Lower extremity and perineal reconstruction Nerve entrapment, repair, and brachial plexus disorders Wrist surgery Hand fractures/joint injuries Safe perioperative management in plastic surgery Just as important as providing comprehensive coverage of critical topics by subject experts is the highly educational, multimedia delivery of CME article content.2 The new CME articles take full advantage of the new PRSJournal.com Web site platform to provide figure-rich articles. Absolutely essential to these new CME articles is the integral incorporation of online videos. Each CME article offers numerous stand-alone videos, so you can see the operations instead of imagining them. The videos free up the written part of the articles to provide “pearls” to keep you out of trouble, as the written word no longer has to describe the surgery you can see live on film. Procedural videos, surgical techniques, and running commentaries by the authors progressively download to your computer screen at the click of your mouse. Where else can you see live the crux of a nasal reconstruction as masterfully done by Fred Menick? Where else can you watch Mark Codner complete a blepharoplasty so elegantly? Nowhere! The new CME articles represent one of the real jewels of Plastic and Reconstructive Surgery and of all of plastic surgery as a specialty. The Journal editors, staff, authors, publisher, and the ASPS Online Education team have all worked diligently in concert to create a highly intuitive, enjoyable, and incredibly educational experience for you. The CME program represents a quiet culmination of much of what is good and possible in plastic surgery, and it's all there for you for the reading and watching. We urge you to go online, read the articles, view the videos, and take the CME tests. As you do, you can rest assured that we are continuing to refine and improve the CME program, so that it will be ever better and better.

Anesthesiology's journal-based CME program is open to all readers. Members of the American Society of Anesthesiologists participate at a preferred rate, but you need not be an ASA member or a journal subscriber to take part in this CME activity. Please complete the following steps:The American Society of Anesthesiologists is approved by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing medical education for physicians.The American Society of Anesthesiologists designates this continuing medical education program for a maximum of 1 hour of Category 1 credit toward the AMA's Physician Recognition Award. Each physician should claim only those hours of credit actually spent in the activity.Purpose: The focus of the journal-based CME program, and the articles chosen for the program, is to educate readers on current developments in the science and clinical practice of the specialty of Anesthesiology.Target Audience: Physicians and other medical professionals whose medical specialty is the practice of anesthesia.Learning Objectives: After reading this article, participants should have a better understanding of what unplanned admission to an intensive care unit can tell us about the process of care and health care safety in patients having surgery.Authors –Guy Haller, M.D., Paul S. Myles, M.B.B.S., M.P.H., M.D., F.C.A.R.C.S.I., F.A.N.Z.C.A., Rory Wolfe, B.Sc., Ph.D., Anthony M. Weeks, M.B.B.S., F.A.N.Z.C.A., Johannes Stoelwinder, M.B.B.S., M.D., F.R.C.A.M.A., F.A.C.H.S.E., F.F.P.H.M., and John McNeil, M.B.B.S., Ph.D., F.R.A.C.P.Grants or research support: Supported by the Swiss National Science Foundation, Bern, Switzerland; the Count Eugenio Litta Foundation, Vaduz, Liechtenstein; a Monash University Postgraduate Research Scholarship, Melbourne, Australia (to Dr. Haller); and an Australian National Health and Medical Research Council Practitioner's Fellowship, Canberra, Australia (to Dr. Myles).Consultantships or honoraria: NoneQuestion Writer –Peter L. Bailey, M.D. Dr. Bailey has no grants, research support, or consultant positions, nor does he receive any honoraria from outside sources, which may create conflicts of interest concerning this CME program.Based on the article by Haller et al. entitled “Validity of unplanned admission to an intensive care unit as a measure of patient safety in surgical patients”http://content.wkhealth.com/linkback/openurl/trusted?issn=0003-3022&volume=103&issue=6&spage=1121&part=fulltext in the December issue of Anesthesiology, choose the one correct answer for each question:1. Which of the following is least likely to provide useful information concerning the process of care when patients suffer an adverse outcome?A. Critical incident analysis techniquesB. Monitoring mortality ratesC. Organizational safety culture assessmentD. Incident reporting2. A “near miss” is an incident where an act of commission or omission could have harmed a patient but did not. Which of the following is least likely to explain why a potentially harmful incident results only in a near miss?A. Chance alone prevented harm from being caused.B. Steps were taken to prevent harm.C. Steps were taken to reduce any harm.D. Other more serious outcomes rendered the near miss irrelevant.3. Which of the following statements concerning the analysis of patient care when unintended admission to an intensive care unit occurs after surgery is most likely true?A. It can provide specific information on the safety of patient care.B. It requires the use of risk-adjusted models.C. Peer review is necessary in order to properly determine a relationship between adverse outcomes and a safety issue.D. An electronic information system is necessary for proper analysis.4. Which of the following is least likely to be associated with increased risk of an unplanned intensive care unit admission after surgery?A. Duration of surgeryB. Time of day of surgeryC. Female genderD. Obesity5. Which of the following statements concerning patients who experience an unplanned intensive care unit admission after surgery is least likely true?A. Overall, they will experience a significant increase in mortality.B. They frequently (50% of the time) will have had an intraoperative near miss.C. The impact of the unplanned intensive care unit admission will be most negligible for patients who had minor surgery.D. For patients undergoing most surgeries, the hospital length of stay increases significantly.6. Unplanned intensive care unit admission after surgery is least likely to involve which of the following?A. Complications of vascular line insertionB. HypothermiaC. HypotensionD. Uncontrolled hypertension

We study the interaction of two successive coronal mass ejections (CMEs) during the 2010 August 1 events using STEREO/SECCHI COR and HI data. We obtain the direction of motion for both CMEs by applying several independent reconstruction methods and find that the CMEs head in similar directions. This provides evidence that a full interaction takes place between the two CMEs that can be observed in the HI1 field-of-view. The full de-projected kinematics of the faster CME from Sun to Earth is derived by combining remote observations with in situ measurements of the CME at 1 AU. The speed profile of the faster CME (CME2; (is) approximately 1200 km s1) shows a strong deceleration over the distance range at which it reaches the slower, preceding CME (CME1; (is) approximately 700 km s1). By applying a drag-based model we are able to reproduce the kinematical profile of CME2 suggesting that CME1 represents a magnetohydrodynamic obstacle for CME2 and that, after the interaction, the merged entity propagates as a single structure in an ambient flow of speed and density typical for quiet solar wind conditions. Observational facts show that magnetic forces may contribute to the enhanced deceleration of CME2. We speculate that the increase in magnetic tension and pressure, when CME2 bends and compresses the magnetic field lines of CME1, increases the efficiency of drag.

BACKGROUND: CPD educators and CME providers would benefit from further insight regarding barriers and supports in obtaining CME, including sources of information about CME. To address this gap, we sought to explore challenges that clinicians encounter as they seek CME, and time and monetary support allotted for CME. METHODS: In August 2018, we surveyed licensed US clinicians (physicians, nurse practitioners, and physician assistants), sampling 100 respondents each of family medicine physicians, internal medicine and hospitalist physicians, medicine specialist physicians, nurse practitioners, and physician assistants (1895 invited, 500 [26.3%] responded). The Internet-based questionnaire addressed barriers to obtaining CME, sources of CME information, and time and monetary support for CME. RESULTS: The most often-selected barriers were expense (338/500 [68%]) and travel time (N = 286 [57%]). The source of information about CME activities most commonly selected was online search (N = 348 [70%]). Direct email, professional associations, direct mail, and journals were also each selected by > 50% of respondents. Most respondents reported receiving 1-6 days (N = 301 [60%]) and $1000-$5000 (n = 263 [53%]) per year to use in CME activities. Most (> 70%) also reported no change in time or monetary support over the past 24 months. We found few significant differences in responses across clinician type or age group. In open-ended responses, respondents suggested eight ways to enhance CME: optimize location, reduce cost, publicize effectively, offer more courses and content, allow flexibility, ensure accessibility, make content clinically relevant, and encourage application. CONCLUSIONS: Clinicians report that expense and travel time are the biggest barriers to CME. Time and money support is limited, and not increasing. Online search and email are the most frequently-used sources of information about CME. Those who organize and market CME should explore options that reduce barriers of time and money, and creatively use online tools to publicize new offerings.

INTRODUCTION: Medical journal reading is a standard method of increasing awareness among physicians of evidence-based approaches to medical care. Theories of physician learning and practice change have suggested that journal reading may be more influential at some stages of behavioral change than at others, but it is not clear how journal reading may influence the learning process that can lead to behavioral change. METHODS: A random sample of 170 continuing medical education (CME) participants who had read three journal articles and completed a CME evaluation form received a CME credit certificate with a brief survey appended. The survey asked participants to report their stage of learning on each article topic before and after reading the three articles. RESULTS: Of the 170 CME participants, 138 (81.2%) responded to the survey. Most (106 of 138; 76.8%) reported a progression in stage of learning on the topic of at least one of the three articles read for CME credit. More than one-fourth of the respondents (37 of 138; 26.8%) made a commitment to change practice related to the topic of one or more articles. CME participants were more likely (relative risk 1.14; 95% confidence interval 1.06-1.22) to report a progression in stage of learning if they had recorded a commitment to change practice related to the same article topic on the CME evaluation form. DISCUSSION: Journal-based CME activities may be educational at all stages of the learning process, and journal-based learning episodes may result in commitments to change practice.

Dual colour total internal reflection fluorescence microscopy is a powerful tool for decoding the molecular dynamics of clathrin-mediated endocytosis (CME). Typically, the recruitment of a fluorescent protein-tagged endocytic protein was referenced to the disappearance of spot-like clathrin-coated structure (CCS), but the precision of spot-like CCS disappearance as a marker for canonical CME remained unknown. Here we have used an imaging assay based on total internal reflection fluorescence microscopy to detect scission events with a resolution of ∼ 2 s. We found that scission events engulfed comparable amounts of transferrin receptor cargo at CCSs of different sizes and CCS did not always disappear following scission. We measured the recruitment dynamics of 34 types of endocytic protein to scission events: Abp1, ACK1, amphiphysin1, APPL1, Arp3, BIN1, CALM, CIP4, clathrin light chain (Clc), cofilin, coronin1B, cortactin, dynamin1/2, endophilin2, Eps15, Eps8, epsin2, FBP17, FCHo1/2, GAK, Hip1R, lifeAct, mu2 subunit of the AP2 complex, myosin1E, myosin6, NECAP, N-WASP, OCRL1, Rab5, SNX9, synaptojanin2β1, and syndapin2. For each protein we aligned ∼ 1,000 recruitment profiles to their respective scission events and constructed characteristic "recruitment signatures" that were grouped, as for yeast, to reveal the modular organization of mammalian CME. A detailed analysis revealed the unanticipated recruitment dynamics of SNX9, FBP17, and CIP4 and showed that the same set of proteins was recruited, in the same order, to scission events at CCSs of different sizes and lifetimes. Collectively these data reveal the fine-grained temporal structure of CME and suggest a simplified canonical model of mammalian CME in which the same core mechanism of CME, involving actin, operates at CCSs of diverse sizes and lifetimes.

Context. Type II radio bursts are evidence of shocks in the solar atmosphere and inner heliosphere that emit radio waves ranging from sub-meter to kilometer lengths. These shocks may be associated with coronal mass ejections (CMEs) and reach speeds higher than the local magnetosonic speed. Radio imaging of decameter wavelengths (20–90 MHz) is now possible with the Low Frequency Array (LOFAR), opening a new radio window in which to study coronal shocks that leave the inner solar corona and enter the interplanetary medium and to understand their association with CMEs. Aims. To this end, we study a coronal shock associated with a CME and type II radio burst to determine the locations at which the radio emission is generated, and we investigate the origin of the band-splitting phenomenon. Methods. Thetype II shock source-positions and spectra were obtained using 91 simultaneous tied-array beams of LOFAR, and the CME was observed by the Large Angle and Spectrometric Coronagraph (LASCO) on board the Solar and Heliospheric Observatory (SOHO) and by the COR2A coronagraph of the SECCHI instruments on board the Solar Terrestrial Relation Observatory(STEREO). The 3D structure was inferred using triangulation of the coronographic observations. Coronal magnetic fields were obtained from a 3D magnetohydrodynamics (MHD) polytropic model using the photospheric fields measured by the Heliospheric Imager (HMI) on board the Solar Dynamic Observatory (SDO) as lower boundary. Results. The type II radio source of the coronal shock observed between 50 and 70 MHz was found to be located at the expanding flank of the CME, where the shock geometry is quasi-perpendicular with θ Bn ~ 70°. The type II radio burst showed first and second harmonic emission; the second harmonic source was cospatial with the first harmonic source to within the observational uncertainty. This suggests that radio wave propagation does not alter the apparent location of the harmonic source. The sources of the two split bands were also found to be cospatial within the observational uncertainty, in agreement with the interpretation that split bands are simultaneous radio emission from upstream and downstream of the shock front. The fast magnetosonic Mach number derived from this interpretation was found to lie in the range 1.3–1.5. The fast magnetosonic Mach numbers derived from modelling the CME and the coronal magnetic field around the type II source were found to lie in the range 1.4–1.6.

Abstract Thanks to the work of a number of scientists who made it known that severe space weather can cause extensive social and economic disruptions in the modern high‐technology society. It is therefore important to understand what determines the severity of space weather and whether it can be predicted. We present results obtained from the analysis of coronal mass ejections (CMEs), solar energetic particle (SEP) events, interplanetary magnetic field (IMF), CME‐magnetosphere coupling, and geomagnetic storms associated with the major space weather events since 1998 by combining data from the ACE and GOES satellites with geomagnetic parameters and the Carrington event of 1859, the Quebec event of 1989, and an event in 1958. The results seem to indicate that (1) it is the impulsive energy mainly due to the impulsive velocity and orientation of IMF B z at the leading edge of the CMEs (or CME front) that determine the severity of space weather. (2) CMEs having high impulsive velocity (sudden nonfluctuating increase by over 275 km s −1 over the background) caused severe space weather (SvSW) in the heliosphere (failure of the solar wind ion mode of Solar Wind Electron Proton Alpha Monitor in ACE) probably by suddenly accelerating the high‐energy particles in the SEPs ahead directly or through the shocks. (3) The impact of such CMEs which also show the IMF B z southward from the leading edge caused SvSW at the Earth including extreme geomagnetic storms of mean Dst MP < −250 nT during main phases, and the known electric power outages happened during some of these SvSW events. (4) The higher the impulsive velocity, the more severe the space weather, like faster weather fronts and tsunami fronts causing more severe damage through impulsive action. (5) The CMEs having IMF B z northward at the leading edge do not seem to cause SvSW on Earth, although, later when the IMF B z turns southward, they can lead to super geomagnetic storms of intensity ( Dst min ) less than even −400 nT.

Abstract Accurate forecasting of the properties of coronal mass ejections (CMEs) as they approach Earth is now recognized as an important strategic objective for both NOAA and NASA. The time of arrival of such events is a key parameter, one that had been anticipated to be relatively straightforward to constrain. In this study, we analyze forecasts submitted to the Community Coordinated Modeling Center at NASA's Goddard Space Flight Center over the last 6 years to answer the following questions: (1) How well do these models forecast the arrival time of CME‐driven shocks? (2) What are the uncertainties associated with these forecasts? (3) Which model(s) perform best? (4) Have the models become more accurate during the past 6 years? We analyze all forecasts made by 32 models from 2013 through mid‐2018, and additionally focus on 28 events, all of which were forecasted by six models. We find that the models are generally able to predict CME‐shock arrival times—in an average sense—to within ±10 hr, but with standard deviations often exceeding 20 hr. The best performers, on the other hand, maintained a mean error (bias) of −1 hr, a mean absolute error of 13 hr, and a precision (standard deviation) of 15 hr. Finally, there is no evidence that the forecasts have become more accurate during this interval. We discuss the intrinsic simplifications of the various models analyzed, the limitations of this investigation, and suggest possible paths to improve these forecasts in the future.

Solar eruptive phenomena embrace a variety of eruptions, including flares, solar energetic particles, and radio bursts. Since the vast majority of these are associated with the eruption, development, and evolution of coronal mass ejections (CMEs), we focus on CME observations in this review. CMEs are a key aspect of coronal and interplanetary dynamics. They inject large quantities of mass and magnetic flux into the heliosphere, causing major transient disturbances. CMEs can drive interplanetary shocks, a key source of solar energetic particles and are known to be the major contributor to severe space weather at the Earth. Studies over the past decade using the data sets from (among others) the SOHO, TRACE, Wind, ACE, STEREO, and SDO spacecraft, along with ground-based instruments, have improved our knowledge of the origins and development of CMEs at the Sun and how they contribute to space weather at Earth. SOHO, launched in 1995, has provided us with almost continuous coverage of the solar corona over more than a complete solar cycle, and the heliospheric imagers SMEI (2003–2011) and the HIs (operating since early 2007) have provided us with the capability to image and track CMEs continually across the inner heliosphere. We review some key coronal properties of CMEs, their source regions and their propagation through the solar wind. The LASCO coronagraphs routinely observe CMEs launched along the Sun-Earth line as halo-like brightenings. STEREO also permits observing Earth-directed CMEs from three different viewpoints of increasing azimuthal separation, thereby enabling the estimation of their three-dimensional properties. These are important not only for space weather prediction purposes, but also for understanding the development and internal structure of CMEs since we view their source regions on the solar disk and can measure their in-situ characteristics along their axes. Included in our discussion of the recent developments in CME-related phenomena are the latest developments from the STEREO and LASCO coronagraphs and the SMEI and HI heliospheric imagers.

OBJECTIVE: To review the literature relating to the effectiveness of education strategies designed to change physician performance and health care outcomes. DATA SOURCES: We searched MEDLINE, ERIC, NTIS, the Research and Development Resource Base in Continuing Medical Education, and other relevant data sources from 1975 to 1994, using continuing medical education (CME) and related terms as keywords. We manually searched journals and the bibliographies of other review articles and called on the opinions of recognized experts. STUDY SELECTION: We reviewed studies that met the following criteria: randomized controlled trials of education strategies or interventions that objectively assessed physician performance and/or health care outcomes. These intervention strategies included (alone and in combination) educational materials, formal CME activities, outreach visits such as academic detailing, opinion leaders, patient-mediated strategies, audit with feedback, and reminders. Studies were selected only if more than 50% of the subjects were either practicing physicians or medical residents. DATA EXTRACTION: We extracted the specialty of the physicians targeted by the interventions and the clinical domain and setting of the trial. We also determined the details of the educational intervention, the extent to which needs or barriers to change had been ascertained prior to the intervention, and the main outcome measure(s). DATA SYNTHESIS: We found 99 trials, containing 160 interventions, that met our criteria. Almost two thirds of the interventions (101 of 160) displayed an improvement in at least one major outcome measure: 70% demonstrated a change in physician performance, and 48% of interventions aimed at health care outcomes produced a positive change. Effective change strategies included reminders, patient-mediated interventions, outreach visits, opinion leaders, and multifaceted activities. Audit with feedback and educational materials were less effective, and formal CME conferences or activities, without enabling or practice-reinforcing strategies, had relatively little impact. CONCLUSION: Widely used CME delivery methods such as conferences have little direct impact on improving professional practice. More effective methods such as systematic practice-based interventions and outreach visits are seldom used by CME providers.

Abstract Predicting the magnetic field within an Earth‐directed coronal mass ejection (CME) well before its arrival at Earth is one of the most important issues in space weather research. In this article, we compare the intrinsic flux rope type, that is, the CME orientation and handedness during eruption, with the in situ flux rope type for 20 CME events that have been uniquely linked from Sun to Earth through heliospheric imaging. Our study shows that the intrinsic flux rope type can be estimated for CMEs originating from different source regions using a combination of indirect proxies. We find that only 20% of the events studied match strictly between the intrinsic and in situ flux rope types. The percentage rises to 55% when intermediate cases (where the orientation at the Sun and/or in situ is close to 45°) are considered as a match. We also determine the change in the flux rope tilt angle between the Sun and Earth. For the majority of the cases, the rotation is several tens of degrees, while 35% of the events change by more than 90°. While occasionally the intrinsic flux rope type is a good proxy for the magnetic structure impacting Earth, our study highlights the importance of capturing the CME evolution for space weather forecasting purposes. Moreover, we emphasize that determination of the intrinsic flux rope type is a crucial input for CME forecasting models.

CME Journal of Geriatric Medicine (CMEGM) is an international peer-reviewed open-access journal dedicated to improve the quality of care and outcomes of patients by publishing original research articles, clinical cases, review articles and perspectives relevant to research in and the practice of perioperative, critical care, and pain medicine.

This CME activity is expired. For more CME activities, visit CMEInstitute.com. Find more articles on this and other psychiatry and CNS topics: The Journal of Clinical Psychiatry The Primary Care Companion for CNS Disorders Article AbstractSchizophrenia follows afairly consistent natural history and longitudinal course of illness, and itcan be described in the context of four specific clinical stages—the premorbid,prodromal, deterioration, and chronic/residual stages. Many patients treated intheir first episode of schizophrenia respond well to treatment and achieve somesymptom remission and level of recovery, but recurrent episodes, often broughton by treatment nonadherence or insufficient treatment, lead to moresubstantial and lasting neurologic deterioration. This presentation describesthe clinical stages of schizophrenia and discusses the possibility forprevention of clinical deterioration with early detection and treatment of theillness and sustained maintenance treatment after episodic remission. This CME activity is expired. For more CME activities, visit cme.psychiatrist.com. Find more articles on this and other psychiatry and CNS topics: The Journal of Clinical Psychiatry The Primary Care Companion for CNS Disorders

This CME activity is expired. For more CME activities, visit CMEInstitute.com. Find more articles on this and other psychiatry and CNS topics: The Journal of Clinical Psychiatry The Primary Care Companion for CNS Disorders Article Abstract Background: Despite a resurgence of interest inthe treatment of bipolar depression, there have been fewcontrolled studies of the clinical characteristics of thiscondition. Identification of any distinctive clinical"signatures" of bipolar depression would be helpful indetermining treatment options in the clinical setting. Method: From a cohort of 270 inpatients andoutpatients assessed in detail during a DSM-IV major depressiveepisode, 39 bipolar I disorder patients were identified andclosely matched with 39 major depressive disorder patients forgender, age, and the presence or absence of DSM-IV melancholicsubtype. Patients were compared on a broad range of parametersincluding the Hamilton Rating Scale for Depression (depressionseverity), 54 depressive symptoms, the Newcastle EndogenousDepression Diagnostic Index, 3 family history items, 2 physicalhealth items, the CORE scale (psychomotor disturbance), and 5history items. Results: Although the bipolar patients were nomore severely depressed than the major depressive disordercontrols, they were more likely to demonstratepsychomotor-retarded melancholic and atypical depressive featuresand to have had previous episodes of psychotic depression. Thesefindings were largely duplicated even when the population wasconfined to those with DSM-IV melancholia. Conclusion: The clinical admixture ofpsychomotor-retarded melancholic signs and symptoms,"atypical" features, and (less frequently) psychosismay provide a "bipolar signature" in clinical scenarioswhen there is uncertainty concerning the polarity of a depressivepresentation.

INTRODUCTION: The objective was to review the effect of Internet-based continuing medical education (CME) interventions on physician performance and health care outcomes. METHODS: Data sources included searches of MEDLINE (1966 to January 2004), CINAHL (1982 to December 2003), ACP Journal Club (1991 to July/August 2003), and the Cochrane Database of Systematic Reviews (third quarter, 2003). Studies were included in the analyses if they were randomized controlled trials of Internet-based education in which participants were practicing health care professionals or health professionals in training. CME interventions were categorized according to the nature of the intervention, sample size, and other information about educational content and format. RESULTS: Sixteen studies met the eligibility criteria. Six studies generated positive changes in participant knowledge over traditional formats; only three studies showed a positive change in practices. The remainder of the studies showed no difference in knowledge levels between Internet-based interventions and traditional formats for CME. DISCUSSION: The results demonstrate that Internet-based CME programs are just as effective in imparting knowledge as traditional formats of CME. Little is known as to whether these positive changes in knowledge are translated into changes in practice. Subjective reports of change in physician behavior should be confirmed through chart review or other objective measures. Additional studies need to be performed to assess how long these new learned behaviors could be sustained. eLearning will continue to evolve as new innovations and more interactive modes are incorporated into learning.