Search

During clinical reasoning case conferences, a learner-centered approach using teleconferencing can create a psychologically safe environment and help learners speak up. This study aims to measure the psychological safety of students who are supposed to self-explain their clinical reasoning to conference participants. This crossover study compared the effects of two clinical reasoning case conference methods on medical students’ psychological safety. The study population comprised 4th-5th year medical students participating in a two-week general medicine clinical clerkship rotation, from September 2019 to February 2020. They participated in both a learner-centered approach teleconference and a traditional, live-style conference. Teleconferences were conducted in a separate room, with only a group of students and one facilitator. Participants in group 1 received a learner-centered teleconference in the first week and a traditional, live-style conference in the second week. Participants assigned to group 2 received a traditional, live-style conference in the first week and a learner-centered approach teleconference in the second week. After each conference, Edmondson’s Psychological Safety Scale was used to assess the students’ psychological safety. We also counted the number of students who self-explained their clinical reasoning processes during each conference. Of the 38 students, 34 completed the study. Six out of the seven psychological safety items were significantly higher in the learner-centered approach teleconferences (p

Background: Deep tendon reflexes (DTR) are a prerequisite skill in clinical clerkships. However, many medical students are not confident in their technique and need to be effectively trained. We evaluated the effectiveness of a flipped classroom for teaching DTR skills. Methods: We recruited 83 fifth-year medical students who participated in a clinical clerkship at the Department of General Medicine, Chiba University Hospital, from November 2018 to July 2019. They were allocated to the flipped classroom technique (intervention group, n=39) or the traditional technique instruction group (control group, n=44). Before procedural teaching, while the intervention group learned about DTR by e-learning, the control group did so face-to-face. A 5-point Likert scale was used to evaluate self-confidence in DTR examination before and after the procedural teaching (1=no confidence, 5=confidence). We evaluated the mastery of techniques after procedural teaching using the Direct Observation of Procedural Skills (DOPS). Unpaired t-test was used to analyze the results of the 5-point Likert scale and DOPS. We assessed self-confidence in DTR examination before and after procedural teaching using a free description questionnaire in the two groups. Additionally, in the intervention group, focus group interviews (FGI) (7 groups, n=39) were conducted to assess the effectiveness of the flipped classroom after procedural teaching.Results: Pre-test self-confidence in the DTR examination was significantly higher in the intervention group than in the control group (2.8 vs. 2.3, P=0.005). Post-test self-confidence in the DTR examination was not significantly different between the two groups (3.9 vs. 4.1, P=0.31), and so was mastery (4.3 vs. 4.1, P=0.68). The questionnaires before the procedural teaching revealed themes common to the two groups, including “lack of knowledge” and “lack of self-confidence.” Themes about prior learning, including “acquisition of knowledge” and “promoting understanding,” were specific in the intervention group. The FGI revealed themes including “application of knowledge,” “improvement in DTR technique,” and “increased self-confidence.” Conclusions: Teaching DTR skills to medical students in flipped classrooms improves readiness for learning and increases self-confidence in performing the procedure at a point before procedural teaching.

Objective This case series aimed to investigate the clinical and pathological characteristics of persistent postural perceptual dizziness (PPPD). Methods We retrospectively examined the medical records of patients with chronic dizziness in our department, and tracked the percentage of PPPD, the age and sex, disorder duration, exacerbating factors for dizziness, and duration of momentary worsening dizziness. We also examined the duration of momentary worsening dizziness in cases of depression, anxiety disorder, and somatic symptom disorder. Results Among 229 patients with chronic dizziness, 14.4% (33/229) met the diagnostic criteria for PPPD. PPPD was the second most common disorder of patients with chronic dizziness after depression. The median age of patients with PPPD was 75 (75.8% female) and the median duration of the disorder was 60 months (range: 3-360 months). The exacerbating factors were motion without regard to direction or position (90.9%), upright posture (66.7%), and exposure to moving visual stimuli or complex visual patterns (30.3%). While the duration of momentary worsening dizziness was less than 10 minutes in 93.9% of patients with PPPD, the duration in patients with depression, anxiety disorder, and somatic symptom disorder were 3.6 % (2/55), 16.1% (5/31), and 0% (0/11), respectively. When the duration was less than 10 minutes, the odds ratios of PPPD for depression and anxiety disorder were 46.5 (95% CI: 6.1-362.0) and 40.3 (95% CI: 7.4-219.3), respectively. Conclusion Short episodes of momentary worsening dizziness constitute a distinctive feature of PPPD that may be useful for differentiating PPPD from other types of psychogenic dizziness.

Background Frequent and repeated visits from patients with mental illness or free medical care recipients may elicit physicians’ negative emotions and influence their clinical decision making. This study investigated the impact of the psychiatric or social background of such patients on physicians’ decision making about whether to offer recommendations for further examinations and whether they expressed an appropriate disposition toward the patient. Methods A randomized, controlled multi-centre study of residents in transitional, internal medicine, or emergency medicine was conducted in five hospitals. Upon randomization, participants were stratified by gender and postgraduate year, and they were allocated to scenario set 1 or 2. They answered questions pertaining to decision-making based on eight clinical vignettes. Half of the eight vignettes presented to scenario set 1 included additional patient information, such as that the patient had a past medical history of schizophrenia or that the patient was a recipient of free care who made frequent visits to the doctor (biased vignettes). The other half included no additional information (neutral vignettes). For scenario set 2, the four biased vignettes presented to scenario set 1 were neutralized, and the four neutral vignettes were rendered biased by providing additional information. After reading, participants answered decision-making questions regarding diagnostic examination, interventions, or patient disposition. The primary analysis was a repeated-measures ANOVA on the mean management accuracy score, with patient background information as a within-subject factor (no bias, free care recipients, or history of schizophrenia). Results A total of 207 questionnaires were collected. Repeated-measures ANOVA showed that additional background information had influence on mean accuracy score (F(7, 206) = 13.84, p p Conclusions Additional background information on past medical history of schizophrenia increased physicians’ mistakes in decision making. Patients’ psychiatric backgrounds should not bias physicians’ decision-making. Based on these findings, physicians are recommended to avoid being influenced by medically unrelated information.

We experienced a case of a subtype of spontaneous hemopneumothorax caused by external forces associated with a seat-belt injury. A female aged 39 years sustained a minor collision with an oncoming car while she was driving. Although pneumothorax was not detected, hemothorax and bleeding from the area surrounding the subclavian artery were observed on contrast-enhanced chest computed tomography (CT). After confirming continuous bleeding into the thoracic cavity after superselective arterial embolization, we performed emergency open surgery. We found a bulla in the apex of the lung, and the thoracic stump of the bulla was considered the source of bleeding. In this case, the direct cause of hemothorax was considered to be the external force associated with the seat-belt injury. When a bulla in the apex of the lung and continuous bleeding are both observed on CT, spontaneous hemopneumothorax should be suspected, necessitating open chest surgery in cases where pneumothorax is not observed.

Human macrophage dectin-1, a type II transmembrane β-glucan receptor, was expressed as a fusion protein with an N-terminal hexahistidine tag in a baculovirus–silkworm expression system and assayed for binding activity. Recombinant dectin-1 specifically bound to some β-glucans, and the neck domain and N-linked oligosaccharide chains of human dectin-1 did not affect the ligand binding activity and specificity of the receptor.

Planarians are useful animals for regenerative and neuroscience research at the molecular level. Previously, we have reported the distribution and function of neurotransmitter-synthesizing neurons in the planarian central nervous system. In order to understand the neural projections and connections, it is important to understand the distribution of neurotransmitter receptors. In this study, we isolated a serotonin receptor gene and named it DjSER-7 (Dugesia japonica serotonin receptor type 7). DjSER-7-expressing cells were distributed in the planarian brain. According to electrophysiological analysis using Xenopus oocytes, current response was detected upon exposure to serotonin, but not other neurotransmitters in oocytes that were co-injected with mRNAs of both DjSER-7 and Galpha chimera B-2, which can interact with either Gq-, Gs- or Gi-coupled receptor. In contrast, current response was not detected after exposure to neurotransmitters in oocytes injected with only DjSER-7 mRNA. Our results indicated that DjSER-7 responds to serotonin, as indicated by electrophysiological analysis using Xenopus oocytes.

Recent global efforts to resolve environmental issues are required in sheet metal forming. For this reason, some research projects have been focused on unlubricated processes as well as on the use of volatile lubricants. However, low formability due to poor lubrication conditions is still a matter of concern. In this study, in order to improve the friction conditions, a new algorithm for controlling blank holding force (BHF) and punch speed (SPD) was proposed. The concept is to separate the wrinkle eliminating process from drawing process. That is, the process proceeds with an extremely low BHF until a wrinkle sufficiently grows, and the wrinkle is eliminated by BHF loading without punch penetration. Its effectiveness was investigated by finite element (FE) simulation, in which two blank models (0.5mm and 1.0mm thickness) were used. As a result, the maximum forming forces decreased by 5.33%(0.5mm) and 1.55%(1.0mm) compared with those of the uncontrolled model at a constant minimum BHF. In addition, a thinner blank sheet is better for the algorithm on the basis of the result that cup height decreases and thickness distribution increases in the case of 0.5mm thickness.

Pain is a multidimensional conscious experience including sensory and negative affective components. The neural systems of the sensory component of pain have been extensively studied, while those of the negative affective component are less clear. The amygdala is a forebrain structure composed of several distinct nuclei including the basolateral (BLA) and central (CeA) nuclei, and is thought to be a key neural substrate underlying emotional responses. Recently, we reported that intraplantar (i.pl.) injection of formalin as a chemical somatic noxious stimulus increased c-fos mRNA expression in the BLA, but not CeA, while intraperitoneal (i.p.) injection of acetic acid as a chemical visceral noxious stimulus induced it highly in the CeA, and hardly in BLA [Nakagawa et al. (2003) Neurosci. Lett., 344, 197-200]. In this study, we examined the effects of discrete bilateral excitotoxic lesions of the BLA or CeA on the sensory and negative affective components of the two types of pain in Sprague-Dawley rats. In the place-conditioning paradigm, both i.pl. formalin and i.p. acetic acid produced conditioned place aversion. The i.pl. formalin-induced conditioned place aversion was abolished by the lesion of the BLA or CeA, while the i.p. acetic acid-induced conditioned place aversion was abolished by the CeA-, but not BLA-lesion. On the other hand, the BLA- or CeA-lesion failed to reduce the i.pl. formalin- and i.p. acetic acid-produced nociceptive behaviours. Taken together, these results suggest that activation of distinct amygdaloid nuclei could differentially contribute to chemical somatic and visceral noxious stimuli-induced negative affective, but not sensory components of pains.

Pain includes a negative affective component, although the neural system is unclear. The amygdala including the lateral (La), basolateral (BL) and central (Ce) nuclei is thought to play a key role in emotional responses. In this study, we analyzed the c-fos mRNA expression, as a marker of neuronal activity, induced by two types of pain, chemical somatic and visceral noxious stimuli, in each amygdaloid nucleus in unanesthetized rats. We found that intraplantar injection of formalin as a chemical somatic noxious stimulus increased c-fos mRNA expression in the La and BL, but not Ce. On the other hand, intraperitoneal injection of acetic acid as a chemical visceral noxious stimulus induced it highly in the Ce, moderately in La and hardly in BL. These results suggest that distinct amygdaloid nuclei are activated by chemical somatic and visceral noxious stimuli, which might differentially contribute to emotional responses by them.

3,4-Methylenedioxymethamphetamine (MDMA) selectively releases serotonin (5-HT) from neurons after uptake by the serotonin transporter (SERT) and causes psychostimulant effects accompanied by hyperthermia. Since rapid increases in CNS lactate levels are suggested in response to MDMA, we investigated the effects of the physiologically-relevant increase in H(+) concentration on the two conducting states of SERT expressed in Xenopus oocytes. Perfusion with SERT substrates at pH 7.4 dose-dependently evoked a transport-associated inward current response with the following rank order of potency: 5-HT>MDMA>dopamine>>norepinephrine. In the absence of transport substrates, a step hyperpolarization pulse activated a transient Na(+) leak current, which was inhibited by SERT substrates with the same rank, as well as by a SERT inhibitor, citalopram. At pH 6.4, the K(m) values of 5-HT and dopamine for the transport-associated current were not altered, while that of MDMA was three-fold lower. In contrast, the K(i) values of all these substrates for transient leak current were unchanged at pH 6.4, suggesting that the affinities to SERT binding sites are not influenced. These results suggest that the effect of MDMA on SERT is enhanced by acidic conditions.