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Describing the process to develop core entrustable professional activities for entrance into physical therapist practice: Applying a national consensus approach
No full textIntroduction: A component step in developing a competency-based education (CBE) program is to define a set of consensus-driven learner performance outcomes that will meet the physical therapy (PT) needs of society.
Review of literature: Entrustable professional activities (EPAs) represent observable units of practice that integrate critical competencies that must be demonstrated in the care of patients. EPAs serve as a framework for teaching, learning, and assessment of key skills and responsibilities. The purpose of this manuscript is to describe the iterative, four-phase national consensus-based process, capturing multiple perspectives, on a core set of EPAs that Doctor of Physical Therapy (DPT) students should be entrusted to perform independently upon entering clinical practice for the first time, regardless of setting.
Subjects: Fifteen physical therapists served as members of the national EPA drafting group. Purposive selection was used to recruit 190 participants to serve as members of a Reactor Panel.
Methods: A modified Delphi was utilized that included 4 iterative phases. Each phase comprised work completed by the EPA drafting group, supported by experts in EPAs, followed by a reactor panel providing broader community feedback via a modified Delphi to facilitate consensus. Consensus was defined a priori as agreement among \u3e80% of respondents.
Results: Nineteen core EPAs were identified as essential activities that all graduates of entry-level DPT programs should be able to perform safely and without the need for supervision, regardless of the practice setting. Each EPA has 5-7 critical competencies mapped to it that are aligned to learner characteristics required to be entrusted to that essential task.
Discussion: These core entry-level EPAs can serve as the national standard for minimum core performance outcomes required at entrance into clinical practice.
Conclusion: This EPA framework can be used for teaching and assessing the critical competencies necessary for safe and efficient entry-level practice
Metformin treatment: Pediatric weight management experience
No full textMetformin use in non-diabetic youth with obesity may improve weight status and reduce comorbidities. This retrospective review of 161 youth with obesity prescribed lifestyle changes and metformin in a pediatric weight management (PWM) program aims to evaluate patient-reported experiences of metformin use and assess the association between metformin use and changes in weight status. The 3 groups (metformin taken ≥6 months, metformin taken \u3c6 months, and metformin ordered not taken) had similar weight status at the start of the evaluation. Youth taking metformin ≥6 months started metformin at an earlier visit and more often had prediabetes and a parent with diabetes. Overall, 57.1% improved weight status (metformin taken ≥6 months, 69.0%; metformin taken \u3c6 months, 59.4%; and metformin ordered not taken, 32.4%; P \u3c .002). Among those who had taken metformin (n = 127), 35.4% reported side effects that did not vary by group status. This study provides perspective on metformin use for pediatric obesity care
Advances in and clinical experience with subcutaneous infusion pump therapy for pulmonary arterial hypertension
No full textPulmonary arterial hypertension (PAH) is characterized by progressive pulmonary vascular remodeling and a deficiency of endogenous prostacyclin, a potent vasodilator with antiproliferative effects. Prostacyclin analogues (PCAs) target this deficiency and are integral to the PAH treatment algorithm. Parenteral PCA therapy is recommended for patients at intermediate-high and high risk, and early initiation-particularly in combination regimens-is associated with improved survival in real-world and post hoc analyses.The 2002 approval of the parenteral PCA treprostinil (Remodulin®) marked a significant advancement in PCA therapy. Compared with epoprostenol, treprostinil offers greater chemical stability at room temperature and a longer half-life, enabling subcutaneous (SC) infusion and minimizing the complications and challenges associated with intravenous delivery. Despite robust evidence demonstrating its benefits on morbidity and mortality and risk-based guideline recommendations, parenteral PCA therapy remains underutilized. Contributing factors include concerns about the complexity and perceived burden of pump-based delivery systems.Here we review the place for parenteral prostacyclin in PAH therapy, and the evolution of SC PCA pumps over time, with a focus on recent enhancements intended to overcome practical limitations of older devices and thereby improve usability. Key features such as simplified cassette filling, automated priming, a larger and more intuitive touchscreen remote, and expanded flow rate options aim to reduce the perceived challenges of SC therapy and support broader adoption among patients and prescribers. The article also provides perspectives and practical guidance from experienced practitioners on the initiation and maintenance of SC PCA therapy, emphasizing how improvements in pump technology can help overcome barriers to use. Addressing these challenges through improved design, education, and support may help bridge the gap between evidence-based recommendations and real-world practice.Graphical abstract available for this article
Bedtime versus morning dosing of anti-hypertensives: A GRADE-assessed meta-analysis of randomized controlled trials with trial sequential evidence
No full textIntroduction: The timing of anti-hypertensive medication may influence cardiovascular outcomes and blood pressure control, yet the evidence remains inconclusive.
Aim: We conducted a meta-analysis to compare the effects of bedtime versus morning dosing of anti-hypertensives on mortality, cardiovascular events, and ambulatory blood pressure.
Methods: We conducted a meta-analysis of randomized controlled trials (RCTs) comparing bedtime versus morning administration of antihypertensive therapy. A comprehensive literature search was performed in PubMed, Embase, Cochrane Library, Scopus, and Web of Science databases up to June 2025. Pooled risk ratios (RRs) were calculated for categorical outcomes, and mean differences (MDs) for continuous variables. All statistical analyses were performed using R version 4.3.3. PROSPERO registration ID: CRD420251113957.
Results: Pooled analysis of six RCTs with 49,983 patients was included. Bedtime dosing of anti-hypertensive medications resulted in a lower incidence of heart failure (1.3% vs. 2.0%; RR 0.63, 95% CI 0.47-0.85) but not myocardial infarction (1.4% vs. 1.6%; RR 0.87, 95% CI 0.64-1.17), stroke or transient ischemic attack (0.9% vs. 1.3%; RR 0.71, 95% CI 0.49-1.05), all-cause mortality (2.6% vs. 3.1%; RR 0.75, 95% CI 0.53-1.06), or cardiovascular mortality (1.0% vs. 1.5%; RR 0.52, 95% CI 0.22-1.21). For blood pressure, bedtime dosing significantly reduced evening systolic blood pressure (MD - 4.71 mmHg, 95% CI - 6.64 to - 2.78) and evening diastolic blood pressure (MD - 1.66 mmHg, 95% CI - 1.92 to - 1.40), with no significant differences observed in morning readings.
Conclusion: Bedtime administration of anti-hypertensive medications may be associated with reduction in MACE and heart failure incidence. No significant effect was observed in mortality, myocardial infarction, or stroke
Inside Aurora Sinai Medical Center, 2002 May
No full textAurora Sinai Medical Center, Milwaukee, WI: Internal employee newsletter with workplace anniversaries, news, and events.https://institutionalrepository.aah.org/alldocuments/2241/thumbnail.jp
Inside Aurora Sinai Medical Center, 2003 October
No full textAurora Sinai Medical Center, Milwaukee, WI: Internal employee newsletter with workplace anniversaries, news, and events.https://institutionalrepository.aah.org/alldocuments/2256/thumbnail.jp
Inside Aurora Sinai Medical Center, 2003 January
No full textAurora Sinai Medical Center, Milwaukee, WI: Internal employee newsletter with workplace anniversaries, news, and events.https://institutionalrepository.aah.org/alldocuments/2247/thumbnail.jp
Physician shortages in underserved populations: Venezuelan physician perspectives on emigration and professional development
No full textPhenomenon: Physician shortages are common in underserved populations globally, and strategic medical school programs have been associated with increased physician retention. Despite Venezuela\u27s physician emigration crisis and its international impact, there is incomplete understanding of variables influencing emigration decisions and potential solutions to increase retention.
Approach: Between January and June 2023, an anonymous, online questionnaire surveyed recent Venezuelan medical school graduates (2015-2021) living and practicing within and outside of Venezuela. Mixed-methods questions explored perspectives about medical training in Venezuela, desires for alternative medical school programming and professional development opportunities, and factors influencing emigration decisions. Quantitative responses were analyzed with descriptive statistics. Qualitative data were analyzed with a deductive content analysis approach to code for key themes.
Findings: Among 312 respondents representing all eight national universities and 17 specialties, 40% had emigrated. Most respondents agreed that care for underserved communities was a positive aspect of training (83%), but nearly all agreed that insufficient hospital resources negatively affected training (97%) and limited the practice of evidence-based medicine (91%). Desires for new curriculum centered on topics of Medical Informatics & Technology, Research, and Public Health. Of all drivers of migration, 20% were related to medical training (versus individual- and societal-level drivers), including desires for improved professional development opportunities, higher quality of training, and modified work culture.
Insights: This diverse sample of Venezuelan physicians expressed a core tension, common to physicians in low-resourced settings globally, between vocation to serve underserved populations and lack of economic and professional development opportunities. Medical education interventions to stimulate physician retention could include targeted curriculum to prepare students for systems-based practice, programs to address moral distress, and engagement with higher-resourced peer institutions to provide desired clinical and research collaborations