Faculty development: a ‘Field of Dreams’?

Objectives  Participants in faculty development workshops often comment that 'those who need faculty development the most attend the least'. The goals of this study were to explore the reasons why some clinical teachers do not participate in centralised faculty development activities and to learn how we can make faculty development programmes more relevant to teachers' needs.
Methods  In 2006, we conducted focus groups with 16 clinical teachers, who had not participated in faculty development activities, to ascertain their perceptions of faculty development, reasons for non-participation and perceived barriers to involvement. Content analysis and team consensus guided the data interpretation.
Results  Focus group participants were aware of faculty development offerings and valued the goals of these activities. Important reasons for non-participation emerged: clinical reality, which included volume of work and lack of (protected) time; logistical issues, such as timing and the central location of organised activities; a perceived lack of financial reward and recognition for teaching, and a perceived lack of direction from, and connection to, the university.
Conclusions  Clinical reality and logistical issues appeared to be greater deterrents to participation than faculty development goals, content or strategies. Moreover, when asked to discuss faculty development, teachers referred to their development as faculty members in the broadest sense, which included personal and career development. They also expressed the desire for clear guidance from the university, financial rewards and recognition for teaching, and a sense of 'belonging'. Faculty development programmes should try to address these organisational issues as well as teachers' personal and professional needs.     

放线瑞香宁碱的解热镇痛作用

从青藤科植物黑吹风(Illigera sp)总生物碱中分离出一个单体,经化学鉴定命名为放线瑞香宁碱(actinodapbnine简称Ac)。分子式C_(18)H_(17)NO_4,为10-甲氧基-1,2-(次甲二氧基)-6-去甲阿朴菲-9-醇(图1)。动物实验表明,Ac具有解痉、镇痛、局麻及降低小鼠体温等作用,并证明其镇痛作用系非中枢性。本文进一步研究其镇痛作用和对不同动物正常     

Student perceptions of effective small group teaching

PURPOSE: The goal of this study was to assess student perceptions of effective small group teaching during preclinical training in a medical school that promotes an integrated, systems-based undergraduate curriculum. In particular, students were asked to comment on small group goals, effective tutor behaviours, pedagogical materials and methods of evaluation. METHODS: Six focus groups were held with 46 Year 1 and 2 medical students to assess their perceptions of effective small group teaching in the 'Basis of Medicine' component of the undergraduate curriculum. Ethnographic content analysis guided the interpretation of the focus group data. RESULTS: Students identified tutor characteristics, a non-threatening group atmosphere, clinical relevance and integration, and pedagogical materials that encourage independent thinking and problem solving as the most important characteristics of effective small groups. Tutor characteristics included personal attributes and the ability to promote group interaction and problem solving. Small group teaching goals providing included opportunities to ask questions, to work as a team, and to learn to problem solve. CONCLUSION: This study highlighted the benefits of soliciting student impressions of effective small group teaching. The students' emphasis on group atmosphere and facilitation skills underscored the value of the tutor as a 'guide' to student learning. Similarly, their comments on effective cases emphasised the importance of clinical relevance, critical thinking and the integration of basic and clinical sciences. This study also suggested future avenues for research, such as a comparison of student and teacher perceptions of small group teaching as well as an analysis of perceptions of effective small group learning across the educational continuum, including undergraduate, postgraduate and continuing professional education.     

师范院校贫困新生与非贫困新生心理健康状况的比较

目的:比较师范院校贫困新生与非贫困新生的心理健康状况。方法:于2005-10在衡阳师范学院完成调查。采用整群抽样横断面调查方法,以衡阳师范学院2005级3089名新生为调查对象,运用症状自评量表对其进行集体测查。在统一指导语下,学生根据最近1周内的自我感觉答题,独立完成,当场收卷。结果数据运用光电阅读机(OMR2000)输入计算机心理测评工具箱标准版V3.0系统进行总分和因子分的统计。量表中没有回答的项目记为"没有",5个以上项目未答者视为问卷无效以及总分低于95分的问卷因缺乏可靠性均不进行分析。所有数据输入电脑后用SPSS11.0软件进行统计分析;群体差异比较用t和Z检验。结果:共发放3089份问卷,收回有效答卷2994份,有效率为96.92%,其中贫困新生有效答卷510份,占17.03%。问卷结果显示,师范院校贫困新生在人际关系、偏执和精神病性3项因子上的得分分别为1.86±0.54,1.70±0.48和1.58±0.43,明显高于非贫困新生(1.78±0.51,1.65±0.46,1.53±0.39,t=3.34,2.02,2.92,P<0.05)。从阳性因子的人数比率来看,师范院校贫困新生在总分阳性的人数比率为0.28,明显低于非贫困新生(0.33,Z=-2.27,P<0.05);而在人际关系、偏执和精神病性3项因子阳性的人数比率分别为0.35,0.30,0.16,明显高于非贫困新生(0.31,0.24,0.13,Z=1.73,2.72,1.71,P<0.05)。结论:师范院校贫困新生的整体心理健康状况并不比非贫困新生差,但是在人际关系敏感、偏执和精神病性3个问题上明显比非贫困新生要严重。     

A novel function for transglutaminase 1: Attachment of long-chain ω-hydroxyceramides to involucrin by ester bond formation

Transglutaminases (TGases) are defined as enzymes capable of forming isopeptide bonds by transfer of an amine onto glutaminyl residues of a protein. Here we show that the membrane-bound form of the TGase 1 enzyme can also form ester bonds between specific glutaminyl residues of human involucrin and a synthetic analog of epidermal specific omega-hydroxyceramides. The formation of a approximately 5-nm-thick lipid envelope on the surface of epidermal keratinocytes is an important component of normal barrier function. The lipid envelope consists of omega-hydroxyceramides covalently linked by ester bonds to cornified envelope proteins, most abundantly to involucrin. We synthesized an analog of natural omega-hydroxyceramides N-[16-(16-hydroxyhexadecyl)oxypalmitoyl]sphingosine (lipid Z). When recombinant human TGase 1 and involucrin were reacted on the surface of synthetic lipid vesicles containing lipid Z, lipid Z was attached to involucrin and formed saponifiable protein-lipid adducts. By mass spectroscopy and sequencing of tryptic lipopeptides, the ester linkage formation used involucrin glutamine residues 107, 118, 122, 133, and 496 by converting the gamma-carboxamido groups to lipid esters. Several of these residues have been found previously to be attached to ceramides in vivo. Mass spectrometric analysis after acetonide derivatization also revealed that ester formation involved primarily the omega-hydroxyl group of lipid Z. Our data reveal a dual role for TGase 1 in epidermal barrier formation and provide insights into the pathophysiology of lamellar ichthyosis resulting from defects of TGase 1 enzyme.     

Failed intubation with case reports

Failed intubation in three patients is reported. All three patients suffered sudden, extreme impaired of mask-ventilation. Twice a coniotomy with subsequent tracheostomy proved to be life saving and without permanent injury. In the other patient tracheostomy had been attempted without success, and subsequent, successful, coniotomy could not prevent cerebral ischemia. Coniotomy is the only correct emergency operation for failed intubation with impaired mask ventilation. It must be followed by a standard tracheostomy with closure of the coniotomy wound to prevent permanent laryngeal damage.     

Neodymium:YAG laser anterior vitreolysis for Irvine-Gass cystoid macular edema

Twenty-nine consecutive patients with vitreous incarceration in the wound after cataract surgery and cystoid macular edema (Irvine-Gass syndrome) were treated with Nd:YAG laser anterior vitreolysis. Fifty-five percent (55%) achieved two or more lines of stable visual improvement; 17% improved but with fluctuating levels of vision and persistent edema; 28% failed to improve, half of them because of coexisting ocular pathology. Visual improvement was achieved an average of 3.5 months after treatment. Persistent macular edema was associated with several types of anterior chamber intraocular lenses.     

克隆测序确认HLA新等位基因B*3712

目的：由于技术原理的限制，目前尚不能对所有的HLA等位基因进行严格的区分，特别是以往没有发现的新基因序列只能通过测序的方法解决，然而，当遇到等位基因杂合时，测序给出的结果仍然无法确认新的序列改变发生在等位基因的哪一侧，这时需要用分子生物学方法分离杂合子然后进行测序才能确定新的基因序列。采用基因克隆方法确认HLA新等位基因。 方法：实验于2006-01／05在河南省红十字血液中心HLA实验室，美国海军骨髓库HLA实验室完成。造血干细胞血样由中华骨髓库提供。采用荧光微珠HLA分型方法对中华骨髓库捐献者血样进行HLA分型检测，无法给出确切结果的摸棱两可结果标本用基因克隆（TOPO TA Cloning）、DNA测序的方法确认新的HLA基因序列。 结果：通过克隆分离杂合等位基因，再进行测序确认发现新的序列与B^＊3709相比，出现4个核苷酸改变：1．355nt C〉A，2．363nt C〉G，3．412nt G〉A，4．477ntC〉G，而且均发生在H哺B基因外显子3（exon3）。4处改变引起氨基酸编码改变：①编码95CTC〉ATC，氨基酸改变L〉1（亮氨酸〉异亮氨酸）。②97AGC〉AGG．S〉R（丝氨酸〉精氨酸）。③114GAC〉AACD〉N（天门冬氨酸〉天冬酰胺）。（9135GCC〉GCGA=A无氨基酸改变。 结论：①新的基因序列已经在GenBnak注册，被WHO的HLA因子命名委员会得到正式命名为HLA-B^＊3712基因。②基因克隆是确认HLA新基因的根本方法。     

Snapping elbow caused by hypertrophic synovial plica in the radiohumeral joint: a report of three cases and review of literature

The snapping elbow caused by hypertrophic synovial radiohumeral plica is a rare form of lateral elbow impingement. In this article we report on hypertrophic radiohumeral synovial folds in three male patients, aged 54, 65 and 27 years. All three patients suffered isolated lateral elbow pain, painful snapping and unsuccessful conservative treatment over at least 5 months (range 5–9 months, mean 7.7 months) prior to surgical treatment. None of the patients had lateral epicondylitis, instability, osteochondrosis dissecans, loose bodies, arthritis or neurological disorders. Upon clinical examination the range of motion in the respective painful elbows was found to be normal in all three cases, but a painful snapping occurred between 80° and 100° of flexion with the forearm in pronation. While there were no pathologic findings in standard radiographs, magnetic resonance imaging (MRI) revealed hypertrophic synovial plicae in the radiohumeral joints associated with effusion in each of the diseased elbows. Arthroscopic examinations confirmed the presence of a hypertrophic synovial plica in all three radiocapitellar joints, and revealed a transient interposition and compression of the folds in the articulation from extension until 90°–100° elbow flexion, with replacement beyond 90° elbow flexion with a visible jump. Surgical management in all three cases comprised arthroscopic diagnosis confirmation and removal of the synovial plicae, leading to excellent outcomes at 6–12 months follow-up.     

The importance of physician listening from the patients' perspective: enhancing diagnosis, healing, and the doctor-patient relationship

ObjectiveThe research findings reported here describe the importance and various functions of physician listening according to patients.MethodsFifty-eight patients of the McGill University Health Centre were interviewed using a qualitative, interpretive design approach.ResultsPatients explained why listening was important to them and these findings were organized into three themes: (a) listening as an essential component of clinical data gathering and diagnosis; (b) listening as a healing and therapeutic agent; and (c) listening as a means of fostering and strengthening the doctor–patient relationship. The findings are presented along with a conceptual model on the functions of physician listening.ConclusionElucidating the multiple functions of listening in the clinical encounter from patient perspectives can assist physicians in improving their listening approach.Practice implicationsFor training purposes, we recommend that a module on listening should lead to a discussion not only about the skill required in listening attentively, but also to the values, beliefs, attitudes, and intentions of physicians who choose to listen to their patients. This teaching objective may be facilitated by future research that explores the concept of ‘authenticity’ in a physician's listening approach, which we argue is central to successful clinical outcomes.