Assessing reflective writing on a pediatric clerkship by using a modified Bloom's Taxonomy.

OBJECTIVE: Reflection enables learners to analyze their experiences and capture the wisdom that lies within. Effective teaching requires reliable methods of assessment. Several methods of assessing reflective writing have been described; however, they often require significant training, and reliability has seldom been assessed. This study was designed to determine the interrater reliability of a method of assessing reflective writing by using a modified Bloom's Taxonomy. METHODS: Twenty-one third-year medical students maintained reflective journals throughout their pediatric clerkship. A coding schema based on Bloom's Taxonomy was developed to assess the level of cognitive processing evident in the journals. Journals were independently assessed by 3 raters. Percent agreement, kappa statistics, and intraclass correlation coefficients (ICC [2,1]) were used to assess interrater reliability. RESULTS: Three hundred eight entries from 21 journals were assessed. Percent agreement ranged from 78.2% to 100%. Kappa statistic for each level ranged from 0.57 +/- 0.04 to 0.73 +/- 0.04, and for the highest level of processing evident it ranged from 0.52 +/- .04 to 0.58 +/- 0.04. ICC (2,1) for each level of cognitive processing ranged from 0.62 (F = 6.20; P = .000) to 1.00, and for the highest level of cognitive processing evident, it was 0.79 (F = 12.42; P = .000). Substantial to almost perfect agreement was attained. CONCLUSIONS: Reflective journals allow learners to revisit their experiences for critical analysis and deeper learning. This study describes a reliable method, based on Bloom's Taxonomy, of determining whether learners have achieved higher order thinking through reflective journal writing. This method can provide a baseline for facilitating higher order processing, critical thinking, and reflective practice.     

L-Ala-substituted rat galanin analogs distinguish between hypothalamic and jejunal galanin receptor subtypes

In order to explore which amino acids or which blocks of amino acids in the 29 amino acid neuropeptide galanin are important for recognition of the endogenous ligand by galanin receptor subtypes present in the jejunum and in the hypothalamus, respectively, we have carried out L-Ala substitutions of individual amino acids or of blocks of amino acids in the rat galanin sequence and examined the binding of the obtained analogs to the rat hypothalamic and jejunal galanin receptor subtypes. This study reveals that the galanin sequence YLLGPH^9–14 is essential for recognition of galanin by both the rat hypothalamic and jejunal galanin receptor subtypes. Substitution of the N-terminal amino acids, GWTL^1–4, leads to total loss of affinity of galanin for both hypothalamic and jejunal galanin receptors. The α-helical C-terminal amino acid (25–29) part of galanin has no greater influence on the affinity of galanin to the hypothalamic galanin receptor subtype. L-Ala substitution of the C-terminal amino acids of galanin KHGLT^25–29 shows, however, that this C-terminal motif is essential for the recognition by the jejunal galanin receptor subtype, whereas amino acids in the middle portion of galanin NSAG^5–8 are of importance for binding to the hypothalamic but not to the jejunal receptor. [Ala^5–8] Galanin thus has a more than 100-fold higher affinity to jejunal receptor than to the hypothalamic receptor, while [Ala^25–29] galanin has a more than 100-fold higher affinity for the hypothalamic than for jejunal galanin receptor subtypes. pH dependence of the galanin binding to these receptor subtypes is also different. © Munksgaard 1997.     

First radiological description of Morgagni's hydatid. Laparoscopic confirmation

The authors explain the clinical case of a female patient suffering from secondary sterility; she was submitted, among other test, to the H.S.G. in order to study the possibility of a among other tests, to the H.S.G. in order to study the possibility of a cervical failure. The radiological findings obtained of Morgagni's Hydatis, not described previously in literature and their laparoscopic confirmation justify, we believe, its publication.     

Switching to the bingeing/purging subtype of anorexia nervosa is frequently associated with suicidal attempts

OBJECTIVE: Anorexia nervosa has the highest suicide mortality ratio of psychiatric disorders, suicide being associated with many factors. We assessed the first lifetime occurrence of these factors taking into account their possible overlap. METHOD: Three hundred and four in- and out-patients with anorexia nervosa (DSM-IV) were systematically recruited in three hospitals of Paris suburbs, between December 1999 and January 2003. Patients were assessed by a face-to-face interview (DIGS). Current eating disorder dimensions were measured, and patients interviewed by a trained clinician to assess minimal BMI and, retrospectively, the age at which anorexia nervosa, major depressive disorder, anxiety disorders and switch to bingeing/purging type occurred for the first time, if applicable. RESULTS: Major depressive disorder (p<0.001) and subtype switch from the restrictive to the bingeing/purging type (p<0.001) were the two factors significantly more frequently occurring before suicidal attempts, and remained involved when a multivariate analysis is performed, whether syndromic or dimensional measures are being used. Taking into account lifetime occurrence with a survival analysis, the switch to bingeing/purging type of anorexia appears as a major predictive factor, with a large increase of the frequency of suicidal attempts (OR=15) when compared to patients with neither major depressive disorder nor bingeing/purging type. CONCLUSIONS: Bingeing/purging type of anorexia nervosa is largely associated with suicidal attempts, and may deserve specific attention. If confirmed on a prospectively designed study, these results would argue for early detection and/or more intensive and specific therapeutic intervention on this aspect of bingeing and purging behaviors.     

Thoracoscopic Assisted Pneumonectomy

A lung carcinoma with tumor involving more than one lobe or in close proximity to the mainstem bronchus often requires pneumonectomy for surgical cure. Inflammation, bulky tumors, and dense adhesions limit the operative field of vision and may result in the abandonment of procedures with potential for complete extirpation. This case illustrates the utility of thoracoscopy in visualization of the hilum and other neurovascular structures in a patient with a proximal tumor and dense intrathoracic adhesions. Successful resection was made possible by use of combined open and thoracoscopic modalities.     

Health Experience of Compressed Air Workers during Construction of the Mass Transit Railway in Hong Kong

This paper reports the health experience of compressed air workersduring construction of the Island Line Section of the Mass TransitRailway in Hong Kong. The requirements of CIRIA's Code of Practiceincluding specifications of the Blackpool Tables for decompressionprocedures and the employment of doctors to monitor the healthof exposed workers by regular examination were prescribed bylocal legislation. Over a 3 year period there were 394 716 man-decompressionsfrom pressures between 1 and 3-5 kg/cm² with 2032 cases of acutedecompression sickness giving a bends rate of 0-52 per cent.The epidemiology followed the usual pattern of increase in bendsrate with increase in pressure and length of shift and withage. Most attacks occurred within a short period after decompressionand the majority of limb pains affected the leg. There werealso 10 cases of barotrauma and 22 cases of dysbaric osteonecrosisof which 7 resulted in some disability. The low incidence ofillness was an index of the effectiveness of the Code of Practiceas applied to a large scale compressed air work operation butthe toll of dysbarism, albeit small, underlines the problemthat there are as yet no decompression procedures which willprotect all men at all times and indicates the need for furtherresearch and work-site evaluation. Requests for reprints should be addressed to: W. K. Lo, Occupational Health Division, Labour Department Headquarters, Harbour Building, 38 Pier Road, Central Hong Kong.     

Localized pachydermodactyly in tuberous sclerosis

Pachydermodactyly refers to a rare form of digital fibromatosis involving the proximal portions of the fingers. There are only nine cases reported in the literature, ill idiopathic and occurring in young men. We report a 5-year-old Chinese boy with tuberous sclerosis who presented with localized pachydermodactyly since birth. This congenital form of pachydermodactyly may represent an additional cutaneous sign of tuberous sclerosis.