How are "teaching the teachers" courses in evidence based medicine evaluated? A systematic review

Background

Teaching of evidence-based medicine (EBM) has become widespread in medical education. Teaching the teachers (TTT) courses address the increased teaching demand and the need to improve effectiveness of EBM teaching. We conducted a systematic review of assessment tools for EBM TTT courses. To summarise and appraise existing assessment methods for teaching the teachers courses in EBM by a systematic review.

Methods

We searched PubMed, BioMed, EmBase, Cochrane and Eric databases without language restrictions and included articles that assessed its participants. Study selection and data extraction were conducted independently by two reviewers.

Results

Of 1230 potentially relevant studies, five papers met the selection criteria. There were no specific assessment tools for evaluating effectiveness of EBM TTT courses. Some of the material available might be useful in initiating the development of such an assessment tool.

Conclusion

There is a need for the development of educationally sound assessment tools for teaching the teachers courses in EBM, without which it would be impossible to ascertain if such courses have the desired effect.     

How to optimize administration of cefoxitin for the treatment of extended spectrum producing Enterobacteriaceae-related infection?

European Journal of Clinical Microbiology & Infectious Diseases - Pharmacological and clinical data regarding cefoxitin for the treatment of ESBL-producing Enterobacteriaceae-related infections...     

Walking campaign: a model for developing participation in physical activity? Experiences from three campaign periods of the Stockholm Diabetes Prevention Program (SDPP)

The Stockholm Diabetes Prevention Program (SDPP) is implementing a model for community-based intervention of type 2 diabetes in three municipalities, of which one has focused on increasing physical activity among the inhabitants. The purpose was to emphasize the integration of walking into daily routines. The campaign was promoted throughout residential areas, organizations and local media. Leaders for organized walking were recruited as volunteers by advertising in local media. After a short education in leadership, practice, and first aid, the 27 volunteers ran organized walking groups in several residential areas. During three of seven walking campaigns the participants were followed and evaluated. The study showed that those individuals who participated one to three times a week were predominantly married women with a good health and regular physical activity. Nevertheless, more important was that one third of the participants had never been exercising regularly before. Most remarkable was to find the voluntary leaders so easily recruited and their great interest to remain as leaders for walking tours.     

How do infants adapt to loading of the limb during the swing phase of stepping?

Previous results from this laboratory have shown that human infants (<12 mo old) respond appropriately to transient changes in sensory input during stepping. We examined how infants adapted to a more enduring change in sensory input by applying load to one limb during stepping. A small weight (500-900 g) was strapped around the lower leg of infants aged 3-11 mo. Stepping with the weight on was recorded on the treadmill for a period of 0.5-3 min. The weight was then quickly detached during stepping, and the immediate response to unexpected loss of the weight recorded. Three-segment dynamic analysis of leg motion was used to estimate hip, knee, and ankle torques during swing in the sagittal plane. All infants adapted to the additional load on the leg by immediately increasing the generation of hip and knee flexor muscle torques. When the weight was removed, 7 of the 22 infants tested exhibited an after-effect (high stepping) in the first step after removal of the weight. The after-effect was manifested as an increase in toe trajectory height and hip flexion and coincided with higher hip flexor muscle torque in early swing. In an additional series of control experiments using seven infants, after-effects were shown to be unrelated to a sudden change in cutaneous input with removal of the weight. The presence of an after-effect indicates that some infants made an enduring adaptation to their stepping pattern that is revealed with the unexpected removal of the weight.     

Is the teaching of Immediate Life Support useful in the medium term for medical students?

IntroductionImmediate Life Support training is under-represented in medical degrees and little information is available on the medium-term effectiveness of its teaching. Our aim was to analyse the forgetting curve in medical students who received specific training in the three main procedural competencies of Immediate Life Support.Material and methodsA prospective 3-month longitudinal study was conducted on final year medical students at a Spanish university. The items assessed were grouped into three competencies: the performance of cardiopulmonary resuscitation (nine items), instrumentalised airway management with a supraglottic device (five items) and the identification of basic arrhythmias responsible for cardiorespiratory arrest (four items). All measurements were assessed immediately after the training programme and at three months. McNemar's tests were used for statistical analyses.ResultsThe medical students recruited showed high rates of correct execution of the manoeuvres for all assessed items, both immediately after the programme and at three months. Over 90% of students performed all the manoeuvres correctly at three months, except for appropriate cardiac massage frequency (85.71%). No significant differences were appreciated between the two assessments.ConclusionThe 3-month forgetting curve in Immediate Life Support was non-existent for medical students, suggesting that these programmes are effective in the medium term. This study provides further evidence on a discipline that is undertrained in medical degrees and that is scarcely studied in the current literature.     

What future for dissection in courses of human topographical anatomy in universities in the UK?

In the United Kingdom most medical schools have traditionally included dissection as a major component of their anatomy courses. There is a dearth of substantive literature which can be used to demonstrate the educational values of dissection, although many authors have expressed opinions. Current scrutiny of the role of dissection has been prompted by many influences acting on medical schools in the UK, including changes in the medical curriculum promoted by the General Medical Council, changes in the mechanisms of funding for universities and their courses, and the introduction of research assessments and appraisal of teaching. It is probable that in the UK dissection will continue to decline but that its reduced role will be prompted by the interactions of many complicated processes, only some of which will be educationally driven. © 1995 WiIey-Liss, Inc.     

How relevant is the impairment of smell for the quality of life in allergic rhinitis?

PURPOSE OF REVIEW: In the present review, the authors try to evaluate how relevant smell impairment is in patients suffering from allergic rhinitis and how it affects their quality of life. Smell dysfunction has a significant impact on the quality of life as it can lead to a wrong choice of food and intake, a reduction in appetite and eventually to weight loss, malnutrition, immunity reduction and worsening of medical illness. Patients with smell impairment are reported to use larger quantities of sugar and salt to highlight flavours, thus worsening their general health condition and increasing the risk of developing diabetes and hypertension. RECENT FINDINGS: Recent studies estimate that a complete loss of the sense of smell can be found in at least 1% of the US population, and that an impairment in the olfactory function can be highlighted in about 24% of individuals aged 53-97 years and 19% of individuals aged 20-92 years. Despite the high prevalence, subjective complaints do not accurately reflect the real disturbance experienced by the patient, and usually go unnoticed. SUMMARY: Current information in literature highlights the need for additional studies that concentrate on the impact of olfactory dysfunction on the quality of life of patients affected by allergic rhinitis.     

How Far Are We from Understanding the Genetic Basis of Hashimoto's Thyroiditis?

Hashimoto's thyroiditis (HT), an autoimmune thyroid disease (AITD), is becoming more and more prevalent in the recent years. Data on family and twin studies carry evidence for strong genetic influence on AITD susceptibility and development. The most common approaches to unravel the background of those diseases are whole genome screening and candidate gene analysis. Common Hashimoto's thyroiditis and Graves’ disease (GD) genes have been identified, as well as genes that are characteristic for only one of those diseases. Because of the complex nature of AITD, caused by their polygenic nature and a complex mode of inheritance, there are still more questions to be answered than answers that can be given, especially about the nature of Hashimoto's thyroiditis. There are plenty of papers concerning the pathogenesis of AITD. However, not seldom do they end up in conclusions about GD, because the results for this disease are far clearer and more unambiguous than those obtained for HT. Similarly, meta-analyses and especially reviews most often concentrate on AITD in general or on GD alone. In this review, Hashimoto's thyroiditis is the main player. It aims to review the state of the art about the background of the development of this disease.     

How does the threshold score to enter a major depression trial influence the size of the available patient population for study?

BACKGROUND: This paper describes the relationship between entry criteria and eligible population for inclusion in Major Depression (MD) clinical trials. Inclusion criteria for a MD study typically require patients to pass a threshold score on a depression rating scale, most commonly the HAM-D or MADRS. A Score To Enter (STE) of > or = 17 on the HAM-D 17-item scale is a typical value, although higher values (i.e. > or = 22 or even > or = 25 points) are often used. It is commonly supposed that patients with higher baseline scores form a more sensitive sample for discriminating active drug from placebo. METHOD: We present data from a sample of depressed hospital outpatients and describe their general characteristics. We then introduce a model, based upon this sample, which predicts the impact of STE on eligible trial population. RESULTS AND CONCLUSION: A small increase in STE has a marked effect on eligible population: an increase in HAM-D (17 item) STE from 17 to 21 and 25 reduces the eligible population by 42 and 76%, respectively. These predictions are reasonably robust when our model is validated with known clinical trial data. CLINICAL RELEVANCE: Our findings have major implications for planning and managing Major Depression trials as higher STEs substantially restrict the proportion of patient eligible for study.     

Emergence of a Signal from Background Noise in the “Memory of Water” Experiments: How to Explain It?

After more than 20 years, the case of the "memory of water" still has not been resolved satisfactorily. After the affair with the journal Nature, Benveniste extended his results on high dilutions to an "electromagnetic biology" and then to a "digital biology," where electromagnetic signals supposed to be emitted from biologically active solutions were said to be stored on magnetic memories. Although the results obtained by Benveniste and coworkers were obvious, the difficulties in reproducibility by other teams created doubt of the reality of the alleged phenomenon. In a first step, we analyzed a set of experiments obtained by Benveniste's team in the 1990s. We quantified the relationship between "expected" effects (ie, labels of the tested samples) and apparatus outcomes, and we defined the experimental conditions to observe significant correlations. We concluded that the results of these experiments were related to experimenter-dependent correlations, which did not support the initial "memory of water" hypothesis. The fact that a signal emerged from background noise, however, remained puzzling. Therefore, in a second step, we described Benveniste's experiments according to the relational interpretation of quantum physics of C. Rovelli. In this interpretation, the state of a system is observer-dependent and the collapse of the wave function appears only in the states relative to a given observer. This interpretation allowed us to elaborate a model describing Benveniste's experiments in which the emergence of a signal from background noise was described by the entanglement of the experimenter with the observed system. In conclusion, the pursuit of the experimental "proof" to support the "memory of water" hypothesis has prevented other interpretations. Although our hypothesis does not definitely dismiss the possibility of "memory of water," the experimenter-dependent entanglement could be an attractive alternative interpretation of Benveniste's experiments.     

How to determine the bone mineral density of the distal humerus with radiographic tools?

Introduction

The aim of this study was to investigate three methods of prediction of the bone quality of the distal humerus: dual-energy X-ray absorptiometry (DEXA), Ct-Scan and plain radiographs.

Materials and methods

The bone mineral density (BMD) of 21 cadaveric distal humerus was determined using DEXA at two levels. Then a CT-scan and anteroposterior radiographs were taken. The cancellous density was estimated with the CT-scan. The cortico-medullar index (CMI) was calculated as cortical thickness divided by total bone thickness on AP views.

Results

A significant positive correlation was found between the BMD of the epiphysis and the CMI of r = 0.61. The mean BMD of the distal humerus was 0.559 g/cm². Male specimens showed a significantly higher BMD than females. The mean CMI of diaphysis was 1.431 and the mean BMD of the metaphysis region was 0.444 g/cm².

Discussion

More than a direct evaluation of the bone density with a CT-scan, the CMI of the distal humerus diaphysis is a predictor of the bone quality of the distal humerus. This should be of great help for the surgeon’s decision making in case of fracture of the distal humerus, as open Reduction and Internal Fixation (ORIF) of fractures of the distal humerus can lead to failure due to poor bone quality.

Level of evidence

Basic Science Study, Anatomic Cadaver Study.

     

Pregenomic RNA: How to assist the management of chronic hepatitis B?

Pregenomic RNA (pgRNA) is an emerging serological marker for chronic hepatitis B virus (HBV) infection. While pgRNA is principally the template for viral proteins and viral DNAs, additional novel functions for the serum pgRNA have recently been described. These results extend for pgRNA a regulatory function in the viral life cycle and potentially a role in pathogenesis. Here, we review the diverse roles of pgRNA in HBV replication and pathogenesis, emphasizing how the unique structure of this RNA is key to its various functions. We focus in particular on the role of HBV pgRNA in guiding antiviral therapy including nucleot(s)ide analog interruption and role as a marker of cure with new curative therapies. We also briefly allude to the emerging niche for new direct‐acting or indirect‐acting antivirals targeting pgRNA.     

How robust is the evidence for viruses in the induction of type 1 diabetes?

Viruses associated with type 1 diabetes have eluded definition as causal, with the exception of rubella virus. False-negative results may have occurred due to the focus on subjects at symptomatic onset, who may be heterogeneous and differently affected by viruses. In addition, assays have not always been sufficiently sensitive to deal with transient infections, and pancreatic tissue is scarce. Longitudinal studies of at-risk subjects and more sensitive DNA techniques now reveal that at initiation of islet autoimmunity, enteroviruses have only a small role, but are more likely to be important at symptomatic onset. Rotaviruses remain associated with initiation of islet autoimmunity, and generate strong T cell responses in the young.