Development, behaviour and temperament: a prospective study of infants conceived through in-vitro fertilization

The development, behaviour and temperament of 65 singleton infants conceived through in-vitro fertilization (IVF) and 63 matched controls were compared at 1 year postpartum. Primiparous women were recruited during pregnancy and their infants' development was assessed at 1 year. In addition, test-taking behaviour was evaluated by an examiner using the Bayley behaviour rating scale and mothers completed a behaviour problem checklist and temperament scale. Mental, motor, speech and social development were appropriate for age, with no significant group differences. While receptive language development was in the normal range, IVF infants scored lower than control infants. Across both groups, mothers reported low levels of behaviour difficulty and mean temperament ratings were in the general population range. There were no group differences in observed test-taking behaviour. However, IVF mothers rated their children at a higher level of behaviour difficulty and more reactive than the ratings given by control mothers. Overall, singleton children conceived through IVF demonstrate appropriate general development at 1 year of age. The higher reported behaviour difficulty experienced by IVF mothers may reflect their concerns about the well-being and adjustment of their child during the first year.      

A review of the evaluation of clinical teaching: new perspectives and challenges

PURPOSE: This article discusses the importance of the process of evaluation of clinical teaching for the individual teacher and for the programme. Measurement principles, including validity, reliability, efficiency and feasibility, and methods to evaluate clinical teaching are reviewed. CONTEXT: Evaluation is usually carried out from the perspective of the learner. This article broadens the evaluation to include the perspectives of the teacher, the patient and the institutional administrators and payers in the health care system and recommends evaluation strategies. RESULTS: Each perspective provides specific feedback on factors or attributes of the clinical teacher's performance in the domains of medical expert, professional, scholar, communicator, collaborator, patient advocate and manager. Teachers should be evaluated in all domains relevant to their teaching objectives; these include knowledge, clinical competence, teaching effectiveness and professional attributes. CONCLUSIONS AND IMPLICATIONS: Using this model of evaluation, a connection can be made between teaching and learning about all the expected roles of a physician. This can form the basis for systematic investigation into the relationship between the quality of teaching and the desired outcomes, the improvement of student learning and the achievement of better health care practice. It is suggested that the extent of effort and resources devoted to evaluation should be commensurate with the value assigned to the evaluation process and its outcomes.     

One-stage individual participant data meta-analysis models for continuous and binary outcomes: Comparison of treatment coding options and estimation methods

A one-stage individual participant data (IPD) meta-analysis synthesizes IPD from multiple studies using a general or generalized linear mixed model. This produces summary results (eg, about treatment effect) in a single step, whilst accounting for clustering of participants within studies (via a stratified study intercept, or random study intercepts) and between-study heterogeneity (via random treatment effects). We use simulation to evaluate the performance of restricted maximum likelihood (REML) and maximum likelihood (ML) estimation of one-stage IPD meta-analysis models for synthesizing randomized trials with continuous or binary outcomes. Three key findings are identified. First, for ML or REML estimation of stratified intercept or random intercepts models, a t-distribution based approach generally improves coverage of confidence intervals for the summary treatment effect, compared with a z-based approach. Second, when using ML estimation of a one-stage model with a stratified intercept, the treatment variable should be coded using “study-specific centering” (ie, 1/0 minus the study-specific proportion of participants in the treatment group), as this reduces the bias in the between-study variance estimate (compared with 1/0 and other coding options). Third, REML estimation reduces downward bias in between-study variance estimates compared with ML estimation, and does not depend on the treatment variable coding; for binary outcomes, this requires REML estimation of the pseudo-likelihood, although this may not be stable in some situations (eg, when data are sparse). Two applied examples are used to illustrate the findings.     

Distinct roles of GPVI and integrin alpha(2)beta(1) in platelet shape change and aggregation induced by different collagens

1. Various platelet membrane glycoproteins have been proposed as receptors for collagen, in some cases as receptors for specific collagen types. In this study we have compared the ability of a range of collagen types to activate platelets. 2. Bovine collagen types I-V, native equine tendon collagen fibrils and collagen-related peptide (CRP) all induced platelet aggregation and shape change. 3. Responses were abolished in FcRgamma chain-deficient platelets, which also lack GPVI, indicating a critical dependence on the GPVI/FcRgamma chain complex. 4. Responses to all collagens were unaffected in CD36-deficient platelets. 5. A monoclonal antibody (6F1) which binds to the alpha(2) integrin subunit of human platelets had a minimal effect on the rate and extent of aggregation induced by the collagens; however, it delayed the onset of aggregation following addition of all collagens. For shape change, 6F1 abolished the response induced by collagen types I and IV, substantially attenuated that to collagen types II, III and V, but only partially inhibited Horm collagen. 6. Simultaneous blockade of the P2Y(1) and P2Y(12) receptors, and inhibition of cyclo-oxygenase demonstrated that CRP can activate platelets independently of ADP and TxA(2); however, responses to the collagens were dependent on these mediators. 7. This study confirms the importance of the GPVI/FcRgamma chain complex in platelet responses induced by a range of collagen agonists, while providing no evidence for collagen type-specific receptors. It also provides evidence for a modulatory role of alpha(2)beta(1), the significance of which depends on the collagen preparation.     

Faculty development for teaching and evaluating professionalism: from programme design to curriculum change

INTRODUCTION: The recent emphasis on the teaching and evaluation of professionalism for medical students and residents has placed significant demands on medicine's educational institutions. The traditional method of transmitting professional values by role modelling is no longer adequate, and professionalism must be taught explicitly and evaluated effectively. However, many faculty members do not possess the requisite knowledge and skills to teach this content area and faculty development is therefore required. PROGRAMME DESCRIPTION: A systematic, integrated faculty development programme was designed to support the teaching and evaluation of professionalism at our institution. The programme consisted of think tanks to promote consensus and "buy-in", and workshops to convey core content, examine teaching strategies and evaluation methods, and promote reflection and self-awareness. PROGRAMME EVALUATION: The programme was evaluated using a CIPP (context, input, process, product) analysis. The institution supported this initiative and local expertise was available. A total of 152 faculty members, with key educational responsibilities, attended 1 or more faculty development activities. Faculty participation resulted in agreement on the cognitive base and attributes of professionalism, consensus on the importance of teaching and evaluating professionalism, and self-reported changes in teaching practices. This initiative also led to the development of new methods of evaluation, site-specific activities and curriculum change. DISCUSSION: A faculty development programme designed to support the teaching and evaluation of professionalism can lead to self-reported changes in teaching and practice as well as new educational initiatives. It can also help to develop more knowledgeable faculty members, who will, it is hoped, become more effective role models.     

Health and social care costs for young adults with epilepsy in the UK

Maintaining contact with services will help improve clinical and social outcomes as children with epilepsy move into their adult lives. This study has collated evidence on the extent to which young adults with epilepsy are supported by health and social care services posttransition, and the costs of such support. UK prevalence and service use data were taken from policy and research literature, as well as national data sets and reports. Costs were attached to these data to arrive at agency and overall total costs. There are approximately 42 000 young adults (18–25 years) with epilepsy costing the UK health and social care budgets £715.3 million per annum, on average £17 000 per young adult with epilepsy. A further £61 million falls to the social security budget. Most young adults with epilepsy will rarely use these services, but those with additional health needs have high and often long‐term support needs, including supported accommodation and personal care. Current resources used by these young adults are summarised but deficits in service availability can mean long waiting times and sub‐optimal treatment. Young adults also want more support to help them take advantage of education and employment opportunities and more information about managing the impacts of epilepsy on their lives. Improving services will cost money, but has the potential to lead to better outcomes for young adults.     

Maternal risk factors for fetal alcohol syndrome in the Western cape province of South Africa: a population-based study

OBJECTIVES: We defined risk factors for fetal alcohol syndrome (FAS) in a region with the highest documented prevalence of FAS in the world. METHODS: We compared mothers of 53 first-grade students with FAS (cases) with 116 randomly selected mothers of first-grade students without FAS (controls). RESULTS: Differences between case and control mothers in our study population existed regarding socioeconomic status, religiosity, education, gravidity, parity, and marital status. Mothers of children with FAS came from alcohol-abusing families in which heavy drinking was almost universal; control mothers drank little to no alcohol. Current and past alcohol use by case mothers was characterized by heavy binge drinking on weekends, with no reduction of use during pregnancy in 87% of the mothers. Twenty percent of control mothers drank during pregnancy, a rate that declined to 12.7% by the third trimester. The percentage who smoked during pregnancy was higher for case mothers than for control mothers (75.5% vs 30.3%), but the number of cigarettes smoked was low among case mothers. The incidence of FAS in offspring of relatively young women (28 years) was not explained by early drinking onset or years of drinking (mean, 7.6 years among case mothers). In addition to traditional FAS risk factors, case mothers were smaller in height, weight, head circumference, and body mass index, all anthropomorphic measures that indicate poor nutrition and second-generation fetal alcohol exposure. CONCLUSIONS: Preventive interventions are needed to address maternal risk factors for FAS.