Effects of reflection and immediate feedback to improve clinical reasoning of medical students in the assessment of dermatologic conditions: a randomised controlled trial

There are few studies that directly compared different interventions to improve medical students clinical reasoning for dermatologic conditions. To investigate the effectiveness of adding practice with reflection and immediate feedback on traditional dermatology electives in improving medical students ability in evaluating skin lesions. The participants were fourth-year medical students of Seoul National University College of Medicine, Korea, who were enrolled to take a 2-week dermatology elective course (n = 87). Students were assigned to one of the three educational interventions: 2-h training involving 10 written clinical cases (experimental); 1-h lecture and 1-h outpatient clinic (lecture); and 2-h outpatient clinic (no intervention). Before and at the end of rotation, diagnostic accuracy was estimated using 20 written clinical cases with photographs (10 novel cases presented in diagnostic training [training set], 10 cases with diagnoses not included in training [control set]). There was a significant interaction effect of intervention×set×time. A post hoc analysis indicated that the students in the experimental group outperformed students in the other two groups only in the training set of the final tests; after completing the 2-week rotation, for the training set, the mean score was higher in the experimental group (7.5 ± 1.3) than in the lecture (5.7 ± 1.6) and no intervention (5.6 ± 1.3) groups, producing an effect size of 1.2 standard deviation (SD) and 1.5 SD, respectively. Practicing written clinical cases with reflection and feedback is superior to a lecture-based approach and yields additional benefits to a dermatology elective, thereby enhancing medical students ability to accurately diagnose skin lesions. ClinicalTrials.gov, NCT03472001. Registered 21 March 2018.This work was supported by a clinical research grant-in-aid from the Seoul Metropolitan Government Seoul National University (SMG-SNU) Boramae Medical Center (03–2018-7). The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publicatio

Aortic Dissection Presenting with Secondary Pulmonary Hypertension Caused by Compression of the Pulmonary Artery by Dissecting Hematoma: A Case Report

The rupture of an acute dissection of the ascending aorta into the space surrounding the pulmonary artery is an uncommon occurrence. No previous cases of transient pulmonary hypertension caused by a hematoma surrounding the pulmonary artery have been documented in the literature. Herein, we report a case of acute aortic dissection presenting as secondary pulmonary hypertension

Satellite radiance data assimilation for binary tropical cyclone cases over the western North Pacific

A total of three binary tropical cyclone (TC) cases over the Western North Pacific are selected to investigate the effects of satellite radiance data assimilation on analyses and forecasts of binary TCs. Two parallel cycling experiments with a 6 h interval are performed for each binary TC case, and the difference between the two experiments is whether satellite radiance observations are assimilated. Satellite radiance observations are assimilated using the Weather Research and Forecasting Data Assimilation (WRFDA)'s three-dimensional variational (3D-Var) system, which includes the observation operator, quality control procedures, and bias correction algorithm for radiance observations. On average, radiance assimilation results in slight improvements of environmental fields and track forecasts of binary TC cases, but the detailed effects vary with the case. When there is no direct interaction between binary TCs, radiance assimilation leads to better depictions of environmental fields, and finally it results in improved track forecasts. However, positive effects of radiance assimilation on track forecasts can be reduced when there exists a direct interaction between binary TCs and intensities/structures of binary TCs are not represented well. An initialization method (e.g., dynamic initialization) combined with radiance assimilation and/or more advanced DA techniques (e.g., hybrid method) can be considered to overcome these limitations

Endovascular Management of Immediate Procedure-Related Complications of Failed Hemodialysis Access Recanalization

Endovascular procedures are becoming the standard type of care for the management of hemodialysis vascular access dysfunction. As with any type of medical procedure, these techniques can result in procedure-related complications, although the expected number of complications is low. The clinical extent of these complications varies from case to case. Management of these cases depends on the clinical presentation. Major complications such as vein rupture, arterial embolism, remote site bleeding or hematoma, symptomatic pulmonary embolism and puncture site complications necessitating treatment require major therapy. Minor complications such as non-flow compromising small puncture site hematoma or pseudoaneurysms require little or no therapy. It is essential that the interventionist be prepared to manage these complications appropriately when they arise

Epigallocatechin-3-gallate protects toluene diisocyanate-induced airway inflammation in a murine model of asthma

AbstractEpigallocatechin-3-gallate (EGCG), a major form of tea catechin, has anti-allergic properties. To elucidate the anti-allergic mechanisms of EGCG, we investigated its regulation of matrix metalloproteinase (MMP-9) expression in toluene diisocyanate (TDI)-inhalation lung tissues as well as TNF-α and Th2 cytokine (IL-5) production in BAL fluid. Compared with untreated asthmatic mice those administrated with EGCG had significantly reduced asthmatic reaction. Also, increased reactive oxygen species (ROS) generation by TDI inhalation was diminished by administration of EGCG in BAL fluid. These results suggest that EGCG regulates inflammatory cell migration possibly by suppressing MMP-9 production and ROS generation, and indicate that EGCG may be useful as an adjuvant therapy for bronchial asthma

Good Glycemic Control Is Associated with Better Survival in Diabetic Patients on Peritoneal Dialysis: A Prospective Observational Study

BACKGROUND: The effect of glycemic control after starting peritoneal dialysis (PD) on the survival of diabetic PD patients has largely been unexplored, especially in Asian population. METHODS: We conducted a prospective observational study, in which 140 incident PD patients with diabetes were recruited. Patients were divided into tertiles according to the means of quarterly HbA1C levels measured during the first year after starting PD. We examined the association between HbA1C and all-cause mortality using Cox proportional hazards models. RESULTS: The mean age was 58.7 years, 59.3% were male, and the mean follow-up duration was 3.5 years (range 0.4-9.5 years). The mean HbA1C levels were 6.3%, 7.1%, and 8.5% in the 1(st), 2(nd), and 3(rd) tertiles, respectively. Compared to the 1(st) tertile, the all-cause mortality rates were higher in the 2(nd) [hazard ratio (HR), 4.16; 95% confidence interval (CI), 0.91-18.94; p = 0.065] and significantly higher in the 3(rd) (HR, 13.16; 95% CI, 2.67-64.92; p = 0.002) tertiles (p for trend = 0.005), after adjusting for confounding factors. Cardiovascular mortality, however, did not differ significantly among the tertiles (p for trend = 0.682). In contrast, non-cardiovascular deaths, most of which were caused by infection, were more frequent in the 2(nd) (HR, 7.67; 95% CI, 0.68-86.37; p = 0.099) and the 3(rd) (HR, 51.24; 95% CI, 3.85-681.35; p = 0.003) tertiles than the 1(st) tertile (p for trend = 0.007). CONCLUSIONS: Poor glycemic control is associated with high mortality rates in diabetic PD patients, suggesting that better glycemic control may improve the outcomes of these patients

Effectiveness of a Mobile Wellness Program for Nurses with Rotating Shifts during COVID-19 Pandemic: A Pilot Cluster-Randomized Trial

Nurses with rotating shifts, including night shifts, have suffered from low physical activity during the COVID-19 pandemic and lower sleep quality due to the disruption of their circadian rhythm. This study aimed to develop and examine the effectiveness of a mobile wellness program on daily steps, sleep quality, exercise self-efficacy, intrinsic motivation for exercise, self-rated fatigue, and wellness. A cluster randomized controlled trial design was used to examine the effectiveness of the mobile wellness program for nurses with rotating shifts. Sixty nurses from one university hospital participated and were allocated to an intervention group and a control group. The intervention group received a 12-week mobile wellness program to improve their physical activity and sleep quality, and the control group was only given a Fitbit to self-monitor their health behaviors. There were significant differences between the two groups in daily steps (p = 0.000), three components (subjective sleep quality, sleep disturbance, daytime dysfunction) of the PSQI, exercise self-efficacy, intrinsic motivation for exercise, and wellness. In conclusion, this study provides meaningful information that the mobile wellness program using Fitbit, online exercise using Zoom, online health coaching on a Korean mobile platform, and motivational text messages effectively promoted physical activity and sleep quality for nurses with rotating shifts during the COVID-19 pandemic. © 2022 by the authors. Licensee MDPI, Basel, Switzerland.1

Confirmation of the performance of exfoliated graphite nanoplatelets for pollutant reduction rate on wood panel

Abstract Exfoliated graphite nanoplatelets have been used as an additive for the improvement of a variety of properties. Nowadays, it is used as an adsorbent for pollutants, especially volatile organic compounds and formaldehyde. Additionally, exfoliated graphite nanoplatelets have been used as an additive in wood composites, because wood composites have a higher thermal conductivity than timber or typical wood-based panels. Therefore, exfoliated graphite nanoplatelets have been applied to high-density fiberboard which is a core material of wood flooring for the emission rate reduction of volatile organic compounds and formaldehyde and for increasing the thermal conductivity of wood flooring in radiant floor heating systems. Volatile organic compound emissions have been reduced significantly in wood composite boards according to the addition of exfoliated graphite nanoplatelets. The properties of formaldehyde emission and thermal conductivity decreased when 2% exfoliated graphite nanoplatelets are added to high-density fiberboard. However, these properties increased with the increase in the addition of exfoliated graphite nanoplatelets from 2% to 4%