Search

ABSTRACTBackground Critical thinking is essential for the accurate diagnosis and management of patients. It is correlated with academic success.Objective Our objective was to design a novel tool for interactive online learning to improve knowledge and to assess trainees’ critical thinking skills using the framework of the American Philosophical Association (APA).Methods Residents, fellows and students participated in an online, self-directed case-based vignette activity to learn malaria diagnosis and management. Pre and post-tests with multiple choice and open-ended case-based questions assessed knowledge and critical thinking. Comparison between pre and post-test scores across subgroups were performed using paired t-tests or one-way ANOVA.Results Between 4 April 2017 to 14 July 2019, 62 of 75 (82%) eligible subjects completed both the pre and the post-test. Improved post-test scores occurred in 90% of medical students, p=0.001, 77% of residents, p

OBJECTIVES The objective of this study is to better understand the medical student experience with prework to determine what factors influence their motivation to complete prework. INTRODUCTION Medical education has been shifting to more active learning-type sessions such as flipped classrooms but these activities are unsuccessful when students do not complete the associated prework. The literature is lacking on why students do not complete prework and what would motivate them to do so. This qualitative study aims to answer those questions through the view of expectancy-value motivation theory. METHODS Thirteen preclinical medical students participated in a semistructured basic interview study investigating their experience with prework. Interview transcripts were coded, and codes were clustered and analyzed for themes. RESULTS Students develop particular routines they find successful for their studies. They explain how time in their schedules and the amount of time prework takes to complete plays a role in their study environment which must be favorable in order to complete prework. Students view video prework more favorably compared to reading assignments. Students note how the opinions of their peers influence their decision to complete prework. Each of these factors influences student motivation to complete prework. CONCLUSION This study finds that motivation to complete prework is influenced by the environment, format, and use of prework, student interest and prior knowledge, and peer influence. The combination of these factors determines whether a student believes they are capable of completing prework and if they find it valuable. In order to increase motivation to complete prework, faculty should consider how to address these factors in a way that students are able to fit prework into their study routines. This study provides the first step in understanding the medical student experience with prework and suggests directions for future studies to maximize student motivation to complete prework.

Introduction Transition from paediatric to adult care can be challenging for youth living with type 1 diabetes (T1D), as many youth feel unprepared to transfer to adult care and are at high risk for deterioration of glycaemic management and acute complications. Existing strategies to improve transition experience and outcomes are limited by cost, scalability, generalisability and youth engagement. Text messaging is an acceptable, accessible and cost-effective way of engaging youth. Together with adolescents and emerging adults and paediatric and adult T1D providers, we co-designed a text message-based intervention, Keeping in Touch (KiT), to deliver tailored transition support. Our primary objective is to test the effectiveness of KiT on diabetes self-efficacy in a randomised controlled trial.Methods and analysis We will randomise 183 adolescents with T1D aged 17–18 years within 4 months of their final paediatric diabetes visit to the intervention or usual care. KiT will deliver tailored T1D transition support via text messages over 12 months based on a transition readiness assessment. The primary outcome, self-efficacy for diabetes self-management, will be measured 12 months after enrolment. Secondary outcomes, measured at 6 and 12 months, include transition readiness, perceived T1D-related stigma, time between final paediatric and first adult diabetes visits, haemoglobin A1c, and other glycaemia measures (for continuous glucose monitor users), diabetes-related hospitalisations and emergency department visits and the cost of implementing the intervention. The analysis will be intention-to-treat comparing diabetes self-efficacy at 12 months between groups. A process evaluation will be conducted to identify elements of the intervention and individual-level factors influencing implementation and outcomes.Ethics and dissemination The study protocol version 7 July 2022 and accompanying documents were approved by Clinical Trials Ontario (Project ID: 3986) and the McGill University Health Centre (MP-37-2023-8823). Study findings will be presented at scientific conferences and in peer-reviewed publications.Trial registration number NCT05434754.

Following oxycodone (Oxy) conditioned place preference (CPP), delta opioid receptors (DORs) differentially redistribute in hippocampal CA3 pyramidal cells in female and male rats in a manner that would promote plasticity and opioid-associative learning processes. However, following chronic immobilization stress (CIS), males do not acquire Oxy-CPP and the trafficking of DORs in CA3 pyramidal neurons is attenuated. Here, we examined the subcellular distribution of DORs in CA1 pyramidal cells using electron microscopy in these same cohorts. CPP: Saline (Sal)-females compared to Sal-males have more cytoplasmic and total DORs in dendrites and more DOR-labeled spines. Following Oxy-CPP, DORs redistribute from near-plasmalemma pools in dendrites to spines in males. CIS: Control females compared to control males have more near-plasmalemmal dendritic DORs. Following CIS, dendritic DORs are elevated in the cytoplasm in females and near-plasmalemma in males. CIS plus CPP: CIS Sal-females compared to CIS Sal-males have more DORs on the plasmalemma of dendrites and in spines. After Oxy, the distribution of DORs does not change in either females or males. Conclusion: Following Oxy-CPP, DORs within CA1 pyramidal cells remain positioned in naïve female rats to enhance sensitivity to DOR agonists and traffic to dendritic spines in naïve males where they can promote plasticity processes. Following CIS plus behavioral enrichment, DORs are redistributed within CA1 pyramidal cells in females in a manner that could enhance sensitivity to DOR agonists. Conversely, CIS plus behavioral enrichment does not alter DORs in CA1 pyramidal cells in males, which may contribute to their diminished capacity to acquire Oxy-CPP.

Abstract Importance Specialized research networks are essential to achieve drug approvals for rare pediatric diseases. Such networks help realize the potential of global legislation enacted upon the recognition that most children are treated with drugs whose most beneficial dose and regimen have not been established in pediatric patients. The Pediatric Rheumatology Collaborative Study Group (PRCSG) is a North American clinical trials network that is specialized in the performance of clinical trials of new therapies for pediatric populations with rheumatic diseases. This review provides an overview of the strategies employed by this research network to achieve drug and biologic approvals for children with pediatric rheumatic diseases, particularly juvenile idiopathic arthritis. Observations Clinical trial conduct in rare pediatric diseases has required global recruitment. Supported or led by the PRCSG, highly responsive, validated, composite measures have been established to assess drug efficacy. For pediatric orphan diseases with high disease burdens, specialized investigative sites and study designs are needed to complete adequately powered trials at the high standard necessary to enable drug labeling by regulatory agencies. Novel trial designs have been utilized for more efficient testing of innovative drug candidates. All these have been developed or co-developed by the PRCSG research network. Conclusions and relevance Specialized research networks in pediatric rheumatology, such as the PRCSG, have changed the landscape of available therapies and improved overall disease outcomes for children with pediatric rheumatic diseases.

Abstract  Menstrual and reproductive factors may increase breast cancer risk through a pathway that includes increased mammographic density. We assessed whether known or suspected menstrual and reproductive breast cancer risk factors were cross-sectionally associated with mammographic density, by measuring area of radiographic density and total breast area on mammograms from 801 participants in the Study of Women’s Health Across the Nation (SWAN), a multi-ethnic cohort of pre- and early perimenopausal women. From multivariable linear regression, the following menstrual or reproductive factors were independently associated with percent mammographic density (area of dense breast/breast area): older age at menarche (β = 10.3, P 13 vs. β = −3.36, P = 0.02), younger age at first full-term birth (β = −8.12, P β = −6.80, P β = 3.78, P β = −12.2, P  [ABSTRACT FROM AUTHOR]

Abstract  We utilized data from the comparison group of the Women’s Healthy Eating and Living randomized trial to investigate an “a priori” hypothesis suggested by CYP2D6 studies that hot flashes may be an independent predictor of tamoxifen efficacy. A total of 1551 women with early stage breast cancer were enrolled and randomized to the comparison group of the WHEL multi-institutional trial between 1995 and 2000. Their primary breast cancer diagnoses were between 1991 and 2000. At study entry, 864 (56%) of these women were taking tamoxifen, and hot flashes were reported by 674 (78%). After 7.3 years of follow-up, 127 of those who took tamoxifen at baseline had a confirmed breast cancer recurrence. Women who reported hot flashes at baseline were less likely to develop recurrent breast cancer than those who did not report hot flashes (12.9% vs 21%, P = 0.01). Hot flashes were a stronger predictor of breast cancer specific outcome than age, hormone receptor status, or even the difference in the stage of the cancer at diagnosis (Stage I versus Stage II). These findings suggest an association between side effects, efficacy, and tamoxifen metabolism. The strength of this finding suggests that further study of the relationship between hot flashes and breast cancer progression is warranted. Additional work is warranted to clarify the mechanism of hot flashes in this setting. [ABSTRACT FROM AUTHOR]

Abstract  Tumor growth and metastasis is dependent on the formation and assembly of new blood vessels, a process known as neo-angiogenesis. Both pre-existing and circulating vascular cells have been shown to contribute to the assembly of tumor neo-vessels in specific tumors. Mobilization of endothelial progenitor cells (EPCs) from the bone marrow constitutes a crucial step in the formation of de novo blood vessels, and levels of peripheral blood EPCs have been shown to be increased in certain malignant states. However, the role of circulating EPCs in breast cancer is largely unknown. We recruited twenty-five patients with biopsy-proven invasive breast cancer at Weill Cornell Breast Center to participate in a pilot study investigating the correlation of circulating EPCs to extent of disease and initiation of chemotherapy. For each patient, a baseline sample was drawn before systemic treatment, and for seventeen of those patients, a second sample was taken after the first round of chemotherapy. Levels of peripheral blood EPCs, as defined by co-expression of CD133 and VEGFR2, were quantified by flow cytometry. Breast cancer patients with stage III & IV disease had statistically higher levels of circulating EPCs than did patients with stage I & II disease (median = 165,000 EPCs/5 � 106MNCs vs. median = 6,920 EPCs/5 � 106MNCs, respectively, P 6MNCs [pre] vs. median = 117,500 EPCs/5 � 106MNCs [post], P = 0.01). These results suggest that circulating EPCs may serve as a potential tumor biomarker in breast cancer and that EPCs may represent a plausible target for future therapeutic intervention. [ABSTRACT FROM AUTHOR]

Background: The objective of this study was to document the worldwide decline of dracunculiasis (Guinea worm disease, GWD) burden, expressed as disability-adjusted life years (DALYs), from 1990 to 2016, as estimated in the Global Burden of Disease study 2016 (GBD 2016). While the annual number of cases of GWD have been consistently reported by WHO since the 1990s, the burden of disability due to GWD has not previously been quantified in GBD. Methods: The incidence of GWD was modeled for each endemic country using annual national case reports. A literature search was conducted to characterize the presentation of GWD, translate the clinical symptoms into health sequelae, and then assign an average duration to the infection. Prevalence measures by sequelae were multiplied by disability weights to estimate DALYs. Results: The total DALYs attributed to GWD across all endemic countries (n=21) in 1990 was 50,725 (95% UI: 35,265–69,197) and decreased to 0.9 (95% UI: 0.5–1.4) in 2016. A cumulative total of 12,900 DALYs were attributable to GWD from 1990 to 2016. Conclusions: Using 1990 estimates of burden propagated forward, this analysis suggests that between 990,000 to 1.9 million DALYs have been averted as a result of the eradication program over the past 27 years.

Every day, there are unrecognized sex trafficked victims visiting urban academic health systems in the United State, victims who are perhaps hoping against hope that a frontline provider, student, or staff member would ask that one question that would identify them as enslaved or otherwise trapped in an unthinkable situation. Health care providers’ lack of awareness of the relatively hidden population of sex trafficked victims causes missed opportunities to improve public health. Training healthcare providers to recognize and serve sex trafficked victims is critical, but such training will likely be less effective without addressing the institutional capacity of urban academic health systems. Indeed, local sex trafficking industries can thrive in the shadow of urban health systems, many associated with world class universities. This exploratory study aimed to assess and enhance the institutional capacity of an urban academic health system in the United States, and that of its employees, to appropriately serve victims of sex trafficking.

The Canadian Library Association published Leading Learning, a library standards guide for school libraries in 2014. The Quebec School Librarians Network (QSLiN) adapted these standards into a digital badge professional development program. Digital badges are a means for providing online learning, assessment and credentials in an interactive and dynamic way. They allow achievers to gain new knowledge and be recognized for skills and competencies that may otherwise go unnoticed. QSLiN’s digital badge program facilitates the transition of traditional school libraries into school Library Learning Commons. This badge program pilot project hopes to connect the Canadian school library community as well as provide an accessible and user-friendly form of professional development to all school library personnel regardless of their location. Research suggests that the two greatest barriers to professional development are time and money. As such, having a free online program helped to alleviate both barriers. This paper discusses the process we undertook at QSLiN to incorporate digital badges into our professional development initiatives. We will discuss the first phase of this pilot project as well as address future considerations for the program. L’Association canadienne des bibliothèques a publié Leading Learning, un guide sur les normes de bibliothèque, pour les bibliothèques scolaires en 2014. Le Québec School Librarians Network (QSLiN) a adapté ces normes pour créer un programme de développement professionnel de badge numérique. Les badges numériques sont un moyen de fournir l’apprentissage, l’évaluation et la qualification en ligne de manière interactive et dynamique. Ils permettent aux personnes motivées d’acquérir des nouvelles connaissances et d’être reconnues pour des compétences qui pourraient sinon passer inaperçues. Le programme de badge numérique de QSLiN facilite la transition des bibliothèques scolaires traditionnelles en carrefours d’apprentissage. Ce projet pilote espère rapprocher la communauté des bibliothèques scolaires canadiennes ainsi que fournir une forme de développement professionnel qui est accessible et conviviale à tout personnel des bibliothèques scolaires quel que soit l’endroit où on se trouve. Des recherches suggèrent que les deux barrières les plus grandes du développement professionnel sont le temps et l’argent. Par conséquent, avoir un programme gratuit en ligne a aidé à réduire ces deux barrières. Cet article traite du processus que nous, au QSLiN, avons entrepris pour incorporer les badges numériques dans nos initiatives de développement professionnel. Nous discuterons de la première phase de ce projet pilote et aussi des considérations futures pour le programme.

Many epidemiologic studies include symptom checklists assessing recall of symptoms over a specified time period. Little research exists regarding the congruence of short-term symptom recall with daily self-reporting. The authors assessed the sensitivity and specificity of retrospective reporting of vasomotor symptoms using data from 567 participants in the Study of Womens Health Across the Nation (1997–2002). Daily assessments were considered the “gold standard” for comparison with retrospective vasomotor symptom reporting. Logistic regression was used to identify predictors of sensitivity and specificity for retrospective reporting of any vasomotor symptoms versus none in the past 2 weeks. Sensitivity and specificity were relatively constant over a 3-year period. Sensitivity ranged from 78% to 84% and specificity from 85% to 89%. Sensitivity was lower among women with fewer symptomatic days in the daily assessments and higher among women reporting vasomotor symptoms in the daily assessment on the day of retrospective reporting. Specificity was negatively associated with general symptom awareness and past smoking and was positively associated with routine physical activity and Japanese ethnicity. Because many investigators rely on symptom recall, it is important to evaluate reporting accuracy, which was relatively high for vasomotor symptoms in this study. The approach presented here would be useful for examining other symptoms or behaviors. [ABSTRACT FROM AUTHOR]