Patient Simulation as an Active Learning Tool in Medical Education

Active learning techniques encourage students to participate in acquiring skills and knowledge. One technique that encourages active learning is patient simulation. Patient simulation tools can range from simple part-task trainers to complex high-fidelity simulators. A variety of human simulators can be used to teach basic patient care skills or more complex skills such as trauma management. Simulation research has demonstrated students can improve scores on standardized tests as well as improve their confidence. Research is still needed to address the long-term impact of patient simulation training. Although simulations have gained popularity, researchers caution that they should always be used as part of clinical education and not as a substitute.     

Effects of ethanol on hippocampal function during adolescence: a look at the past and thoughts on the future

It has been demonstrated by several laboratories that ethanol, both acute and chronic, produces effects that are age dependent. Specifically, adolescent rats are less sensitive to the hypnotic and motor-impairing effects of ethanol but are more sensitive to the hypothermic effects of the drug. However, the results on hippocampal function are not as clear. For example, there have been mixed findings regarding adolescent sensitivity of hippocampal-dependent (spatial) memory in response to ethanol. The current review explores the present state of the field as it relates to ethanol's effects in the hippocampus, particularly as it relates to spatial memory. In addition, we review potential neurobiological mechanisms that might underlie the age-dependent effects of ethanol in the hippocampus. Finally, future directions are proposed that will advance the state of the field as it relates to ethanol's effect during this developmental period.     

Derivation and Validation of a Prediction Rule for Identifying Heavy Consumers of Alcohol

Using two population-based cohorts of men aged 45-59, we sought to derive and validate a prediction rule for identifying heavy consumers of alcohol. Eighty-five percent of eligible men on electoral rolls in Caerphilly, Wales (derivation set, N = 2512) and 90% of eligible men on the practice lists of 16 Speedwell, England, general practitioners participated (validation set, N = 2348). Alcohol consumption was assessed by questionnaire with heavy alcohol consumption defined as the top 10% of the Caerphilly population's alcohol usage (greater than 525 cc ethanol per week). The prediction rule, Score = (mean corpuscular volume x 1.00) + (body mass index x 0.31) + (systolic blood pressure x 0.08) + HDL-cholesterol x 9.24) + (fasting triglyceride x 2.20) was derived by multiple linear regression in the Caerphilly cohort and validated in the Speedwell cohort. Comparing the lower 20% of the Score distribution with the upper 5%, likelihood ratios increased from 0.15 to 5.29 and 0.06 to 7.42 in the Caerphilly and Speedwell cohorts, respectively. Having a score of 136.30 or greater yielded a relative risk of being a heavy drinker of 23.1 (95% Cl = 10.1-53.0) in Caerphilly and 99.3 (95% Cl = 12.8-769.5) in Speedwell. The derived prediction rule is a valid diagnostic aid to help clinicians identify heavy alcohol consumers.     

Risk factors associated with the development of intestinal metaplasia in first-degree relatives of gastric cancer patients.

Family relatives of gastric cancer patients have a higher risk of gastric cancer and premalignant gastric lesions. We sought to determine the risk factors associated with the presence of intestinal metaplasia in a large cohort of gastric cancer relatives. First-degree relatives of gastric cancer patients were invited for screening gastroscopy. Endoscopic gastric biopsies were obtained from the antrum and corpus. Gastric biopsies were analyzed for Helicobacter pylori infection, severity of inflammation, and presence of intestinal metaplasia. Stepwise logistic regressions were used to identify for risk factors associated with presence of intestinal metaplasia in cancer relatives. Two hundred seventy cancer relatives underwent screening endoscopy (median age, 42; 47% male and 48% siblings). Among them, 161 (59.6%) were H. pylori positive and 81 (30%) had confirmed intestinal metaplasia. The following factors were found to be associated with the presence of intestinal metaplasia: age, male sex, H. pylori infection, birth order, alcohol use, siblings with stomach cancer, childhood living conditions, and water supply. Individuals with intestinal metaplasia had more severe acute and chronic inflammation in the antrum and corpus (P < 0.003). With multiple logistic regression, H. pylori infection [odds ratio (OR), 3.23], male gender (OR, 2.09), age (OR, 1.07), and a history of gastric cancer in siblings (OR, 1.91) were independent factors associated with the development of intestinal metaplasia in cancer relatives. In conclusion, we have identified risk factors associated with gastric intestinal metaplasia in stomach cancer relatives, which may be useful in the understanding of gastric carcinogenesis in these high-risk individuals.     

NAOMI: The trials and tribulations of implementing a heroin assisted treatment study in North America

Background  

Opioid addiction is a chronic, relapsing disease and remains a major public health challenge. Despite important expansions of access to conventional treatments, there are still significant proportions of affected individuals who remain outside the reach of the current treatment system and who contribute disproportionately to health care and criminal justice costs as well as to public disorder associated with drug addiction.     

The role of couples' interacting world assumptions and relationship adjustment in women's postdisaster PTSD symptoms

This study examined 58 heterosexual couples' interacting assumptions about the world and relationship adjustment in predicting wives' posttraumatic stress disorder (PTSD) symptoms after severe flooding. Both partners completed the World Assumptions Scale (Janoff‐Bulman, 1989), and wives reported on their intimate relationship adjustment and PTSD symptomatology. Neither husbands' nor wives' assumptions alone predicted wives' PTSD symptoms. However, the interaction of husbands' and wives' benevolent world assumptions significantly predicted wives' PTSD symptoms. When husbands held less benevolent world assumptions, there was a negative association between wives' assumptions and PTSD symptoms. Additionally, wives' relationship adjustment predicted their PTSD symptomatology when taking into account individual and interacting self‐worth assumptions. Implications for understanding the role of intimate relationships in postdisaster mental health and interpersonally oriented prevention efforts are discussed.