Core morphological concepts of disease for second-year medical students

With the increasing emphasis on independent learning and early patient contact, the time in the undergraduate medical curriculum for formal teaching of morphology of disease is decreasing. Thus, we thought it advisable to identify those core morphological entities of disease that should not get lost in the new paradigm. Our approach was to list all disease processes in Robbins Pathologic Basis of Diseases, 5th edition, that have distinguishing gross or microscopic characteristics. Appropriate portions of this list of 952 morphological entities from the Robbins textbook were distributed to 46 clinical specialists and pathology faculty. Each of these was asked to strongly agree, agree, disagree, or strongly disagree with the following for each entry on the list: "For purposes of developing concepts of disease, an M2 physician in training should recognize classical examples or a diagrammatic representation of the following lesions, and distinguish them from each other." Responses resulted in a consensus core list of 63 general disease process lesions and 545 organ system lesions, for a total of 608. These 608 core morphological entities were incorporated into our course by means of (1) a computer program with over 1,022 images and clinical-pathological correlations, and (2) a core list of morphological objectives for each unit in the course. In general, entities were judged noncore material if they were rare or were microscopic lesions of primary interest to pathologists and provided no major pathomorphologic concepts. The computer program as a supplement to glass slides and gross specimens has been very well accepted by students, and satisfactory performance on examinations has been maintained in spite of a 25% reduction in pathology course contact hours.     

Cheating in medical school: a survey of second-year students at 31 schools

This study examined mechanisms by which fluoxetine may reduce energy consumption and body weight. Women with binge-eating disorder (BED; n = 38) and age- and weight-matched women without BED (n = 32) monitored their dietary intake and concurrently recorded mood variables on a hand-held computer for 6 d of baseline and for 6 d after being randomly assigned to receive placebo or fluoxetine (60 mg). Fluoxetine reduced eating more than did the placebo on days 4-6 of treatment. The frequency of episodes was not affected, suggesting that fluoxetine affects satiety, not hunger. Fluoxetine did not preferentially reduce carbohydrate intake, did not affect snack consumption as compared with meal consumption, and did not affect negative-mood eating more than positive-mood eating, nor did fluoxetine affect subjects' mood ratings. Benefits of fluoxetine were of approximately equal magnitude for women with and without BED. However, women who reported higher energy consumption at baseline were more responsive to fluoxetine than were women who reported lower energy consumption at baseline, and binge-eating status was associated with greater energy consumption at all time points, including baseline. Fluoxetine affects dietary intake within 4 d of its consumption, and if future research shows that this remains true on repeated applications, this drug may be useful for short periods when difficulty with overeating is anticipated, such as during vacations.     

Medicaid reform: an opportunity for the osteopathic medical profession

The autoantigen in adjuvant arthritis in Lewis rats is still unknown despite the knowledge that the 65 kDa mycobacterial heat-shock protein (hsp) is involved in the disease process. T cells and antibodies obtained from rats with adjuvant arthritis respond to chondrocyte membrane antigen(s). In Western blots a 65 kDa chondrocyte membrane protein (CH65) is stained by sera from arthritic rats. In addition, spleen cells from rats with adjuvant arthritis proliferate in vitro to chondrocyte membranes and CH65 as antigens. Furthermore, pretreatment of rats with CH65 or mycobacterial hsp65 but not human hsp60, induces a significant retardation of the onset of adjuvant arthritis in Lewis rats. The data suggest that CH65 is a potential autoantigen involved in the pathogenesis of adjuvant arthritis in Lewis rats.     

Assessing the clinical ethical competence of undergraduate medical students

At the University of Newcastle, health law and ethics is taught and assessed in each year of the five-year curriculum. However, the critical question for assessment remains: 'Does teaching ethics have a measurable effect on the clinical activity of medical students who have had such courses?' Those responsible for teaching confront this question each year they sit down to construct their assessment tools. Should they assess what the student knows? Should they assess the student's moral reasoning, that is, what decisions the student makes, and, how these decisions are justified, or should they assess what the student actually does when dealing with patients in the clinical setting, and how he or she does it? From 1982 to 1991, assessment at Newcastle was primarily aimed at determining the quality of the students' ethics knowledge base. This paper describes the strengths and limitations of a purely knowledge-based method of evaluation and why in 1992, we are now attempting to redefine and assess, what we call 'clinical ethical competence' in terms of how students actually apply this knowledge base in a controlled clinical context.     

The use of a structured case presentation examination to evaluate clinical competencies of psychology doctoral students.

Although the evaluation of clinical competence is an essential responsibility for all programs in clinical and counseling psychology, this task presents many conceptual and operational difficulties. The Clinical Proficiency Progress Review (CPPR) was developed to define and evaluate clinical competencies for third-year practicum students. Normative data for 911 students and 52 examiners over 10 years are presented. Outcomes yielded consistent pass/fail rates and positive student feedback. Moreover, the examination represents an important quality assurance procedure for faculty and provides constructive feedback to students. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Models of individual trajectories in computer-assisted instruction for deaf students.

Describes a quantitative theory of student trajectories in a computer-assisted instruction course. The theory rests upon qualitative assumptions about information processing, from which a stochastic differential equation can be derived. The differential equation is characteristic of the course, but the constants of integration are estimated separately for each student. The fit of data from 297 deaf 1st-7th graders to theory is reported in terms of the standard scale of grade placement. The mean of the mean standard errors averaged across Ss was .046, which represents a relatively close fit of data to theory. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

History of computer-assisted data processing in the medical laboratory

Computer-assisted processing of medical laboratory data started in the sixties. The earliest systems, which arose in English- and German-speaking laboratories, pointed the way for the development of laboratory data processing. The significance and evolution of the fundamental components of a laboratory information system, such as the placing of the request to the laboratory, identification of patients and samples, recording of data, quality control, plausibility control and results, are presented. The subject is given a wider perspective by the inclusion of a comprehensive (chronological) literature index.     

Consensus on the clinical use of myeloid growth factors

Bone marrow fibroblasts regulate hematopoiesis by interacting directly (cell-to-cell contact) with hematopoietic cells and by secreting regulatory molecules (such as GM-CSF, M-CSF, IL6 and LIF) that modulate hematopoiesis either in a positive or a negative manner. Several cytokines (such as bFGF, EGF, PDGF and TGF-beta) affect the growth of human marrow fibroblasts in vitro. Further in vivo studies are still required to clarify the role of marrow fibroblasts and their interactions with hematopoietic progenitors during myelofibrosis and leukemic diseases.     

Heart Partners: a strategy for promoting effective diffusion of school health promotion programs

To investigate the mechanism whereby serum dipeptidyl peptidase (DPP) IV activity in oral cancer patients is decreased, we examined the expression of cell surface DPP IV, also known as CD26, in cultured peripheral blood T lymphocytes of these patients and the amounts of DPP IV released into culture medium; values were compared with those found in healthy subjects. When peripheral blood T lymphocytes were cultured in the presence of phytohemagglutinin, concanavalin A and/or interleukin-2, the proliferative response and expression of CD26 (DPP IV) in their plasma membranes were greatly diminished in oral cancer patients as compared with those in healthy subjects. In addition, DPP IV activity in lymphocyte culture medium was reduced more in oral cancer patients than in healthy subjects, indicating decreased shedding of DPP IV from activated T lymphocytes in the patients. Based on these findings, it is suggested that suppression of DPP IV expression in peripheral blood T lymphocytes is one of the important factors involved in the mechanism of decrease of serum DPP IV activity in oral cancer patients.     

Some critical remarks on the use of sex-specific tissue weighting factors for effective dose equivalent calculations

A Bacillus subtilis strain deficient in seven extracellular proteases was used to produce human mast cell chymase and is a viable expression system for serine proteases and other classes of proteins. Chymase is produced at 0.3-0.5 mg/l and is purified by three chromatography steps. Two crystal forms of PMSF-treated chymase were optimized. The first is C2 with a=47.94 A, b=85.23 A, c=174.18 A, beta=96.74 degrees, and diffracts to at least 2.1 A, while the second is P212121, with cell dimensions a=43.93 A, b=58.16 A, and c=86.09 A, and a diffraction limit of approximately 1.9 A. The first crystal form has either three or four molecules/asymmetric unit, while the second has one molecule/asymmetric unit.     

Evaluation of a breaking bad news course for medical students

This paper presents the evaluation of a Breaking Bad News course run for three groups of medical students (fourth and fifth year from the London Hospital Medical College and fourth year from St Bartholomew's Hospital Medical College). The course, which is student centred, uses group discussion, videotape presentations and role-play including actors. All teachers, clinicians and human science tutors, had been through a staff training programme on teaching methods. At the end of the course, students' knowledge of important principles in giving bad news had increased, particularly in relation to interpersonal communication; they were more confident in their ability to break bad news well; and the course learning methods were highly rated. The course was just as well received by fourth year as by fifth year students and several said they would like more of this training. The evaluation shows that if reservations about role-play can be overcome then this experiential learning is highly valued by students.     

Innovative strategies for promoting clinical scholarship: a holistic approach

The article discusses a holistic approach to clinical scholarship by examining dimensions of scholarship and patterns of knowing. Innovative clinical teaching strategies in relation to these dimensions of scholarship and patterns of knowing are identified. Experiential learning, content mapping, and portable patient problem packs are explored. Knowledge building and creativity in the process of educating students are imperative. Nurse educators are challenged to develop new paradigms for nursing education that create a dynamic learning environment and result in enhanced clinical scholarship.     

Epidemiology training for primary health care: the use of computer-assisted distance learning

The Liverpool Epidemiology Programme, based in the Liverpool School of Tropical Medicine, has designed a series of computer-based modules for use in distance learning. The purpose of this paper is to highlight the role of computers in training health workers in epidemiology in developing countries. The aim of the modules is to provide health workers with solutions to problems which they face in their everyday work. The modules are written in hypertext software for IBM compatible machines and interact with the epidemiological software Epi Info. Four modules are described: LEP-Nut which deals with nutritional surveillance, LEP-Ref which looks at the role of epidemiology within a refugee health care programme, LEP-Surv dealing with health surveillance and LEP-Rap which introduces the concept of rapid appraisal. They are also easily distributed, particularly with the development of the Internet. The modules are carefully evaluated before and after distribution. Issues related to their evaluation and subsequent revision are discussed, in particular is the content important, adequate, communicated and useful? A major advantage of computer-based learning materials is that they can be easily updated with new advancements of knowledge and experience from the field.     

Effects of a preventive cardiology curriculum on behavioral cardiovascular risk factors and knowledge of medical students

We evaluated a Preventive Cardiology Academic Award (PCAA) program designed to integrate preventive cardiology concepts into the medical school curriculum. Diet, preventive cardiology knowledge, preventive cardiology attitudes, exercise behavior, and body mass index were compared at entrance to medical school and during the graduation year. Complete data were available on 94 students (65 men and 29 women). Similar data from students who graduated in 1987, prior to the introduction of the PCAA curriculum, served as a control. Women showed a significant enhancement in attitude towards cardiovascular disease (CVD) prevention, while both men and women significantly increased their knowledge about CVD prevention. The frequency of planned physical activity decreased significantly in both sexes and men showed a significant increase in body mass index. Men significantly reduced total calories, percent of calories from fat and saturated fat and dietary cholesterol and increased fiber intake. In women, the only significant reduction was in total calories. In comparison to the control class that did not have the program, men receiving the PCAA curriculum reduced dietary cholesterol, dietary fat, saturated fat and monounsaturated fat. Changes in these dietary parameters were nonsignificant for women in comparison to the control class women. Additional analyses showed no systematic secular trends in dietary or other variables in classes entering from 1986 to 1990. We conclude that the PCAA curriculum changes have favorably affected the preventive cardiology knowledge, attitudes and diet of medical students.