Postgraduate medical education: Modifying trainees’ study approaches by changing the examination

The Membership examination of the Royal College of General Practitioners— taken by most U.K. postgraduate trainees planning a career in general practice— was changed in 1990 to include a “Critical Reading Question paper”; in an effort to encourage study and criticism of original papers. To measure possible change in physicians’ study approaches, questionnaire surveys of samples of registrands for the examination were undertaken in 1990 and 1991 (before and after the change). The use of three learning approaches increased markedly (p < .0001)—critically discussing papers and reading the British Medical Journal and the British Journal of General Practice. The use of two other learning approaches decreased similarly—reading undergraduate‐type textbooks (p < .001) and summaries in the free medical press (p < .01). Substantial change in learner behavior in the desired directions was thus associated with the restructuring of the examination.     

Current Strategic Thinking for the Development of a Trivalent Alphavirus Vaccine for Human Use

Vaccinations against the encephalitic alphaviruses (western, eastern, and Venezuelan equine encephalitis virus) are of significant interest to biological defense, public health, and agricultural communities alike. Although vaccines licensed for veterinary applications are used in the Western Hemisphere and attenuated or inactivated viruses have been used under Investigational New Drug status to protect at-risk personnel, there are currently no licensed vaccines for use in humans. Here, we will discuss the need for a trivalent vaccine that can protect humans against all three viruses, recent progress to such a vaccine, and a strategy to continue development to Food and Drug Administration licensure.     

Community‐acquired infections associated with increased risk of lymphoplasmacytic lymphoma/Waldenström macroglobulinaemia

Emerging evidence supports the role of immune stimulation in the development of lymphoplasmacytic lymphoma/Waldenström Macroglobulinaemia (LPL/WM). Using the population‐based Surveillance, Epidemiology End Results‐Medicare database we investigated the exposure to 14 common community‐acquired infections and subsequent risk of LPL/WM in 693 LPL/WM cases and 200 000 controls. Respiratory tract infections, bronchitis [odds ratio (OR) 1·56], pharyngitis (OR 1·43), pneumonia (OR 1·42) and sinusitis (OR 1·33) and skin infection, herpes zoster (OR 1·51) were all significantly associated with subsequent increased risk of LPL/WM. For each of these infections, the findings remained significantly elevated following the exclusion of more than 6 years of Medicare claims data prior to LPL/WM diagnosis. Our findings may support a role for infections in the development of LPL/WM or could reflect an underlying immune disturbance that is present several years prior to diagnosis and thereby part of the natural history of disease progression.