Background Poor patient uptake of cardiac rehabilitation (CR) remains a challenge for multiple reasons including geographic, time, cultural, cost, and psychological constraints. Objective We evaluated the impact on CR participation rates associated with the addition of the option of mobile app–based CR (Cardihab) for patients declining conventional CR. Methods A total of 204 consecutive patients were offered CR following angioplasty; of these, 99 were in cohort 1 (offered conventional CR only) and 105 were in cohort 2 (app-based CR offered to those declining conventional CR). Patients in each cohort were followed throughout a 6-week CR program and participation rates were compared for both groups. Patients in cohort 2 declining both forms of CR were interviewed to assess reasons for nonparticipation. Results CR participation improved from 21% (95% CI 14%-30%) to 63% (95% CI 53%-71%) with the addition of the app (P<.001). Approximately 25% (9/39) of the group declining the app-based program identified technology issues as the reason for nonparticipation. The remainder declined both CR programs or were ineligible due to frailty or comorbidities. Conclusions Providing patients with the additional option of an app-based CR program substantially improved CR participation. Technology and psychological barriers can limit CR participation. Further innovation in CR delivery systems is required to improve uptake.
Background: Anatomy teaching at medical schools has undergone significant changes in philosophy, and reduction in content, in recent years. Senior clinicians and speciality training Colleges have raised concerns regarding these changes and questioned their impact on 'anatomical competence' and adequacy of training for safe clinical practice. The literature on the perceptions of medical school anatomy teaching among those preparing to enter postgraduate training (i.e. towards a specialist qualification) is sparse. Aim: To assess the motivations for study, and experiences of training, in junior doctors undertaking an intensive postgraduate anatomy training program. Methods: A sample of candidates (13/119, 10%) undertaking the University of Melbourne Graduate Diploma in Surgical Anatomy were recruited for interview. These interviews were recorded, transcribed and then analysed using a combination of thematic and contextual approaches. Key themes were identified and explored. Results: Participant responses fell into two broad categories-motivations for enrolling into the course and their actual experiences of the course. The primary motivation for enrolling into the course was the perceived career requirement to do so, with participants asserting that attending such courses was perceived as mandatory for success in specialty training. Once enrolled, participants valued the teaching and learning and enjoyed the academic pursuit of high-level anatomy study. These benefits, however, were offset by a range of undesirable outcomes associated with undertaking the course. Participants identified the financial cost of the course, the unwillingness of employers to provide rostered study leave and the negative impact on work-life balance as the most significant challenges. Conclusions: Understanding the concerns and expectations of junior doctors preparing for a speciality training program by increasing their anatomy knowledge has implications for both Colleges and medical educators. The participants in this study recognised the limitations in their anatomy knowledge and actively sought additional training at significant financial and personal cost to themselves. This was counterbalanced by the perceived benefits to their career, and an opportunity to enter a specialist training program, by completing additional study.
The apparent suddenness of the reformation in Scotland has sometimes been considered difficult to understand, but more difficul has been the abandonment, seemingly at the eleventh hour, of the old Church by some of those who held key positions in it. The desertion to die reform movement of John Wynram, sub-prior of the St. Andrews Augustinians and dean of die Faculty of Divinity, has recendy called forth this caustic comment from Dr McRoberts, ‘One would very much like to know what religious convictions he really held, if any’. In a footnote McRoberts adds ‘He is reminiscent of his contemporary, Hermann von Wied, archbishop of Cologne, who was described by the Emperor Charles V as “neither a Protestant nor a Catholic but a proper headien’”. The linking of Wynram's name widi rfiat of the archbishop elector, as we shall see, is not widiout foundation, although not necessarily on account of the judgments of the emperor or the monseigneur. No doubt similar comments could be passed on John Douglas, principal of St. Mary's College and rector of die University, who shared widi Wynram, Knox, and odiers in drawing up in 1560 die Scots Confession and the First Book of Discipline.
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