Leukotriene A4 hydrolase inhibition improves age-related cognitive decline via modulation of synaptic function

Leukotrienes, a class of inflammatory bioactive lipids, are well studied in the periphery, but less is known of their importance in the brain. We identified that the enzyme leukotriene A4 hydrolase (LTA4H) is expressed in healthy mouse neurons, and inhibition of LTA4H in aged mice improves hippocampal dependent memory. Single-cell nuclear RNA sequencing of hippocampal neurons after inhibition reveals major changes to genes important for synaptic organization, structure, and activity. We propose that LTA4H inhibition may act to improve cognition by directly inhibiting the enzymatic activity in neurons, leading to improved synaptic function. In addition, LTA4H plasma levels are increased in both aging and Alzheimer's disease and correlated with cognitive impairment. These results identify a role for LTA4H in the brain, and we propose that LTA4H inhibition may be a promising therapeutic strategy to treat cognitive decline in aging related diseases.

Interprofessional collaborative reasoning by residents and nurses in internal medicine: Evidence from a simulation study

Clinical reasoning has been studied in residents or nurses, using interviews or patient-provider encounters. Despite a growing interest in interprofessional collaboration, the notion of collaborative reasoning has not been well studied in clinical settings. Our study aims at exploring resident-nurse collaborative reasoning in a simulation setting. We enrolled 14 resident-nurse teams from a general internal medicine division in a mixed methods study. Teams each managed one of four acute case scenarios, followed by a stimulated-recall session. A qualitative, inductive analysis of the transcripts identified five dimensions of collaborative reasoning: diagnostic reasoning, patient management, patient monitoring, communication with the patient, and team communication. Three investigators (two senior physicians, one nurse) assessed individual and team performances using a five-point Likert scale, and further extracted elements supporting the collaborative reasoning process. Global assessment of the resident-nurse team was not simply an average of individual performances. Qualitative results underlined the need to improve situational awareness, particularly for task overload. Team communication helped team members stay abreast of each other's thoughts and improve their efficiency. Residents and nurses differed in their reasoning processes, and awareness of this difference may contribute to improving interprofessional collaboration. Understanding collaborative reasoning can provide an additional dimension to interprofessional education.

Development and evaluation of a community immersion program during preclinical medical studies: a 15-year experience at the University of Geneva Medical School

BACKGROUND

Significant changes in medical education have occurred in recent decades because of new challenges in the health sector and new learning theories and practices. This might have contributed to the decision of medical schools throughout the world to adopt community-based learning activities. The community-based learning approach has been promoted and supported by the World Health Organization and has emerged as an efficient learning strategy. The aim of the present paper is to describe the characteristics of a community immersion clerkship for third-year undergraduate medical students, its evolution over 15 years, and an evaluation of its outcomes.

METHODS

A review of the literature and consensus meetings with a multidisciplinary group of health professionals were used to define learning objectives and an educational approach when developing the program. Evaluation of the program addressed students' perception, achievement of learning objectives, interactions between students and the community, and educational innovations over the years.

RESULTS

The program and the main learning objectives were defined by consensus meetings among teaching staff and community health workers, which strengthened the community immersion clerkship. Satisfaction, as monitored by a self-administered questionnaire in successive cohorts of students, showed a mean of 4.4 on a five-point scale. Students also mentioned community immersion clerkship as a unique community experience. The learning objectives were reached by a vast majority of students. Behavior evaluation was not assessed per se, but specific testimonies show that students have been marked by their community experience. The evaluation also assessed outcomes such as educational innovations (eg, students teaching other students), new developments in the curriculum (eg, partnership with the University of Applied Health Sciences), and interaction between students and the community (eg, student development of a website for a community health institution).

CONCLUSION

The community immersion clerkship trains future doctors to respond to the health problems of individuals in their complexity, and strengthens their ability to work with the community.

Permanent genetic resources added to Molecular Ecology Resources Database 1 August 2010-30 September 2010

This article documents the addition of 229 microsatellite marker loci to the Molecular Ecology Resources Database. Loci were developed for the following species: Acacia auriculiformis × Acacia mangium hybrid, Alabama argillacea, Anoplopoma fimbria, Aplochiton zebra, Brevicoryne brassicae, Bruguiera gymnorhiza, Bucorvus leadbeateri, Delphacodes detecta, Tumidagena minuta, Dictyostelium giganteum, Echinogammarus berilloni, Epimedium sagittatum, Fraxinus excelsior, Labeo chrysophekadion, Oncorhynchus clarki lewisi, Paratrechina longicornis, Phaeocystis antarctica, Pinus roxburghii and Potamilus capax. These loci were cross-tested on the following species: Acacia peregrinalis, Acacia crassicarpa, Bruguiera cylindrica, Delphacodes detecta, Tumidagena minuta, Dictyostelium macrocephalum, Dictyostelium discoideum, Dictyostelium purpureum, Dictyostelium mucoroides, Dictyostelium rosarium, Polysphondylium pallidum, Epimedium brevicornum, Epimedium koreanum, Epimedium pubescens, Epimedium wushanese and Fraxinus angustifolia.

Diagnostic single nucleotide polymorphisms for identifying westslope cutthroat trout (Oncorhynchus clarki lewisi), Yellowstone cutthroat trout (Oncorhynchus clarkii bouvieri) and rainbow trout (Oncorhynchus mykiss)

We describe 12 diagnostic single nucleotide polymorphism (SNP) assays for use in species identification among rainbow and cutthroat trout: five of these loci have alleles unique to rainbow trout (Oncorhynchus mykiss), three unique to westslope cutthroat trout (O. clarkii lewisi) and four unique to Yellowstone cutthroat trout (O. clarkii bouvieri). These diagnostic assays were identified using a total of 489 individuals from 26 populations and five fish hatchery strains.

Twelve microsatellite loci for lake trout (Salvelinus namaycush)

We describe 12 microsatellite loci isolated from lake trout (Salvelinus namaycush). The number of alleles at these loci ranged from two to 11 with an average of 5.3 alleles per locus. The expected heterozygosity ranged from 0.29 to 0.76, with an average of 0.68. Accidental (or illegal) introductions of lake trout into watersheds are decimating native trout populations in the northern Rocky Mountains, and these loci will be useful for identifying the source of these introductions and for estimating the number of founding individuals.

Developing and evaluating the student assessment system in the preclinical problem-based curriculum at Sherbrooke

BACKGROUND

Students' learning was used as an outcome measure in the first phases of the major curriculum reform started in 1987 by the Université de Sherbrooke Faculty of Medicine, which shifted from a traditional to a student-centered, problem-based learning (PBL) and community-oriented program. The system for evaluating preclinical students' learning is intended to reinforce the integration of basic and clinical sciences.

METHOD

To discover whether the evaluation system was fulfilling its intended goals, the authors used data from the classes of 1991-1993 to assess the reliability and validity of three evaluation instruments. The three instruments were (1) written examinations composed of multiple-choice questions (MCQs), short-answer questions (SAQs), and problem-analysis questions (PAQs); (2) PBL tutor rating forms that evaluate students' reasoning skills, communication and group-interaction skills, and autonomy and humanism; and (3) clinical skills evaluations, including objective structured clinical examinations (OSCEs). The weights allocated to the instruments reflected how the faculty valued each evaluation dimension in each of the three phases of the preclinical curriculum.

RESULTS

Reliability indexes improved throughout the system implementation. The written examinations proved to have content validity according to the PBL learning objectives. As evaluated by students, the PAQs were found to be at a taxonomic level that assessed ability to analyze information a third of the time in the first year of implementation of the PBL curriculum and 17% in the second year. Variations and correlations of students' mean performances across instructional units and between the evaluation instruments led to the development of a student longitudinal performance profile to be used before yearly promotion decisions are proposed. The profile was introduced in the fifth year of PBL implementation.

CONCLUSION

The system allows students to learn higher-taxonomic-level content and fulfills the institution's social responsibility of judging program outcomes and promoting qualified students, although evaluation by PBL tutors is still psychometrically questionable and the measurement of students' reasoning and ability to analyze problems is still an unfinished evaluation task.

Comparing checklists and databases with physicians' ratings as measures of students' history and physical-examination skills

PURPOSE

To compare two methods of rating students' performances on history and physical examination: (1) by using checklists completed by standardized patients (SPs) and databases completed by students, and (2) by using ratings of students by three physicians for each SP-student encounter.

METHOD

Four cases were chosen for the study, and 30 students were examined per case. The students were all in their fourth year at the Southern Illinois University School of Medicine in the spring of 1991. Two of the cases had both checklists and databases, and the remaining two had databases only. Each SP-student encounter was videotaped and was viewed independently by three physicians unfamiliar with the contents of the checklists and databases. The physicians' pooled ratings were then compared with the checklist and database scores. Uncorrected and corrected correlations were obtained, with the generalizability coefficient used as the index of reliability.

RESULTS

Interrater generalizability of physicians' ratings was very good, ranging from .65 to .93 for overall ratings. Generalizability of physicians' ratings pooled across the four cases was .85. Checklist scores tended to correlate higher with physicians' ratings than did database scores: across the cases, correlation coefficients between physicians' ratings and checklist scores and database scores were .65 and .39, respectively.

CONCLUSION

The checklist scores correlated strongly with the physicians' ratings of history and physical-examination skills, providing some evidence of validity for their use. The checklist scores correlated much better with the physicians' ratings than did the database scores. Possible explanations for this finding are discussed.

Clinical performance-based test sensitivity and specificity in predicting first-year residency performance

To assess the use of a standardized-patient-based postclerkship examination (PCX) to predict students' performances in their first year of residency, the authors used data from 202 students of the classes of 1987, 1988, and 1990 at the Southern Illinois University School of Medicine. The PCX was found to be more sensitive than specific in that it identified more correctly those students who received high ratings in their first year of residency than those who received low ratings. Consequently, while the rate of false negatives was low across the three classes, the rate of false positives was relatively high. Analyses of the supervisors' written comments on residents' performances indicated that more than half of the false positives and false negatives resulted mostly from problems found with the supervisors' ratings, rather than from the inaccuracy of the PCX in predicting students' residency performances. The supervisors' ratings did not always match their written comments and did not always represent pure assessments of the residents' cognitive performances. Finally, because of the large number of missing residency performance ratings among the graduates who had performed unsatisfactorily on the PCX, it is expected that the sensitivity of the PCX may be overestimated and its specificity underestimated. Overall, the results suggest that the standardized-patient-based PCX is a useful indicator of students' readiness for and performance in residency.

Effects of examinee gender, standardized-patient gender, and their interaction on standardized patients' ratings of examinees' interpersonal and communication skills

PURPOSE

To assess the effects of examinee gender, standardized-patient (SP) gender, and, in particular, their interaction on ratings made by SPs of examinees' interpersonal and communication skills in a performance-based examination of clinical competence.

METHOD

The examination was administered to four classes of senior medical students (about 70 per class) at Southern Illinois University School of Medicine, 1988-1991. The skill dimensions tested were clarity of communication, thoroughness of explanation, professional manner, personal manner, and overall patient satisfaction. Split-plot analyses of variance were used.

RESULTS

There was no interaction of examinee gender and SP gender for any of the five rating scales. There was no main effect of examinee gender for four of the five scales; however, for personal manner, women students were rated slightly higher than men students. There was a main effect of SP gender, but the effect was not consistent from rating scale to rating scale or from class to class. Nevertheless, differences in ratings given by men and women SPs should not be of psychometric concern, since the ratings of men and women examinees are necessarily affected alike.

CONCLUSIONS

Except for the women examinee's higher performance in personal manner, the men and women examinees generally performed equally well with respect to interpersonal and communication skills, and they performed equally well regardless of the gender of the SP.

Test security in examinations that use standardized-patient cases at one medical school

The use of performance-based examinations consisting of standardized-patient (SP) cases has increased greatly in recent years. These examinations are typically long and thus require the presentation of the same SP cases to several consecutive examinee groups. Consequently, concerns have arisen about the potential for violations of test security whereby students who were tested early in the examination period pass on information to students tested later. These concerns are addressed using data from the SP-based examinations administered to five classes (1986-1990) of senior medical students at Southern Illinois University School of Medicine. Because of the length of the examinations, each class was randomly divided into five groups and the examination was administered to one group at a time, requiring three days of testing time per group and three weeks of testing time per class. The results showed no consistent, systematic changes in case means across the five groups tested at different times throughout the examination period, and thus provide no evidence of serious, widespread violations of test security.

How medical students learn

With recent concerns over and attempts to address issues regarding medical students' processes of learning and development of lifelong learning habits, a question often asked is: How do medical students learn in the present medical curriculum? In this study, the authors directly attempt to answer that question--they assess the learning behaviors of 254 students in two medical schools, one with an objectives-based mastery and one with a traditional curricula, and discuss whether the students' adopted behaviors are conducive to the development of effective, analytic, and independent learning. Most students of both medical schools reported very similar effective and ineffective learning behaviors. The students' behaviors were found to dispose them more to analytic learning than to independent learning. Suggestions to restructure the curriculum for better development of students' independent learning habits are proposed.

The effect of clinical experiences in medical school on specialty choice decisions

Medical students' specialty choice decisions are usually made by the middle or end of the clinical year. In the study here, the authors investigated the extent to which various factors during clinical clerkships affected specialty choice. Debts, other financial considerations, and length of residency had little overall effect on students' choices. The order of clerkships was of particular significance for the undecided students. Members of the clinical teaching faculty exercised a strong role-modeling effect throughout medical school. During clerkships, however, the greatest influence on specialty choice came first from the interplay of faculty members and experiences and second from faculty members by themselves; experiences alone affected few students. The influence of faculty members and clerkship experiences was greatest among students who chose psychiatry. Additionally, most students who selected psychiatry had originally intended to enter other specialties. The large majority of those who chose family practice, internal medicine, and surgery had made their decision prior to emerging clerkships and, therefore, clinical experiences and the faculty tended to affect them the least.

Medical problem-solving assessment: a review of methods and instruments

The purpose of this article is to review and discuss the different methods and instru ments created to assess medical problem- solving. Discussions and comparisons of various features of the instruments and suggestions for additional data to be collected were provided in order to insure maximum efficiency in the choice of the instruments.