Development of a Program to Educate Physician Assistant Students on Performance of a Comprehensive Breast Exam

ABSTRACT Purpose: The purpose of this study was to develop a new program to educate physician assistant (PA) students on the performance of a comprehensive breast exam and to test its effectiveness as compared to the previous program. Methods: The preexisting educational program for the performance of a clinical breast exam was evaluated during the term prior to the start of clinical rotations for the class of 2015. Baseline data were obtained from this control group by evaluation of student competency using a skills examination, utilizing a Nasco Advanced Breast Exam Simulator, and using a female standardized patient. An innovative program educating the PA class of 2016 on the performance and interpretation of a comprehensive breast exam was instituted, incorporating a new palpation technique, new models, and simulated patients. Both classes were directly compared in terms of their breast examination skills at 5 months post-training by administering the same skills examination. Nested, mixed, generalized, and linear models were created to look for differences between the two classes. Each model was adjusted by covariates to account for variation in student ability. Results: The PA class of 2016 showed statistically better performance in breast inspection, lymph node palpation, breast palpation, breast mass detection, and documentation of findings compared to the PA class of 2015. Conclusion: The new educational program on the clinical breast exam using a well-organized laboratory session with subsequent skills testing was found to be very efficacious

Increased Vulnerability to Demyelination in Streptozotocin Diabetic Rats

Demyelination is a prominent feature in nerve biopsies of patients with diabetic neuropathy. The mechanism is unknown because diabeticrodents, unlike humans, do not consistently develop segmental demyelination. We examined how diabetes influences toxicant-induced demyelination, remyelination, Schwann cell nerve growth factor receptor (p75) expression, and endoneurial macrophage apolipoprotein E (apo E) synthesis in diabetic rats. Postnatal day 17 (P17) rats were given 110 mg/kg streptozotocin intraperitoneally and then fed a diet containing metallic tellurium (Te) from P20 to P27 to induce demyelination. Transverse electron micrographs and immunostained longitudinal cryosections were prepared from sciatic nerve during demyelination and remyelination. Diabetic rats had a mean serum glucose concentration of 490 mg/dl and consumed equivalent doses of peroral Te. The number of demyelinated fibers in electron micrographs was increased significantly by 17% (P \u3c .0011). Endoneurial density of p75-stained Schwann cells was increased in diabetic rats in proportion to the increased number of injured internodes. Density of apo E- and ED1-positive macrophages also was significantly increased in diabetes. There was no delay in macrophage myelin clearance. and remyelination was not compromised. Increased Schwann cell vulnerability to stress, by increasing the turnover rate of myelinated units, may explain why myelin defects accumulate after long-standing diabetes

Demyelination , Remyelination, Macrophage Apo E and Schwann Cell Nerve Growth Factor Receptor in Diabetic Rats

Demyelination is a prominent feature in nerve biopsies of patients with diabetic neuropathy. The mechanism is unknown because diabeticrodents, unlike humans, do not consistently develop segmental demyelination. We examined how diabetes influences toxicant-induced demyelination, remyelination, Schwann cell nerve growth factor receptor (p75) expression, and endoneurial macrophage apolipoprotein E (apo E) synthesis in diabetic rats. Postnatal day 17 (P17) rats were given 110 mg/kg streptozotocin intraperitoneally and then fed a diet containing metallic tellurium (Te) from P20 to P27 to induce demyelination. Transverse electron micrographs and immunostained longitudinal cryosections were prepared from sciatic nerve during demyelination and remyelination. Diabetic rats had a mean serum glucose concentration of 490 mg/dl and consumed equivalent doses of peroral Te. The number of demyelinated fibers in electron micrographs was increased significantly by 17% (P \u3c .0011). Endoneurial density of p75-stained Schwann cells was increased in diabetic rats in proportion to the increased number of injured internodes. Density of apo E- and ED1-positive macrophages also was significantly increased in diabetes. There was no delay in macrophage myelin clearance. and remyelination was not compromised. Increased Schwann cell vulnerability to stress, by increasing the turnover rate of myelinated units, may explain why myelin defects accumulate after long-standing diabetes

Enhancing Teaching Through Music and Student Interactive Learning

INTRODUCTION: Incorporation of music in teaching allows professors to “strike a chord” with students. PURPOSE: Identify methods of incorporating music in the classroom or online to help students learn. METHODOLOGY: Music has been utilized by singing medical subject matter set to familiar tunes to students, motivating them to participate. RESULTS: The use of medical melodies has been favorably critiqued through student evaluations. CONCLUSIONS: A plan that helps professors utilize music in a creative fashion to enhance PA student learning will be presented

Disseminated Conidiobolus Infection With Endocarditis in a Cocaine Abuser.

A crack cocaine abuser developed disseminated infection caused by a species of Conidiobolus not known to cause disease in vertebrates. The fungus gained entry via skin abrasions on the lower extremities, spread through the hematogenous route, and caused endocarditis. There was evidence of fungal infection in the lungs, heart, kidneys, skeletal muscles, and brain. An additional complication was extensive rhabdomyolysis, with a marked elevation of creatine kinase of up to 1.2 million U/L

Retinoic Acid Inhibition of Serum-Induced C-Fos Transcription in a Fibrosarcoma Cell Line.

We investigated the mechanism by which retinoic acid causes growth arrest and flat reversion of SSV-NRK, simian sarcoma virus-transformed normal rat kidney cells. Northern analysis revealed that both chronic (7 days) and acute (6 h) retinoic acid treatment of serum-stimulated SSV-NRK cells caused a 6-fold decrease in c-fos mRNA levels. In addition, nuclear run-on experiments showed that retinoic acid regulated c-fos expression in SSV-NRK cells at the transcriptional initiation level. Attenuation of c-fos transcription was equal in both retinoic acid-treated and control cells, and no increased c-fos mRNA turnover was detected in retinoic acid-treated cells. Furthermore, there was no observed change in the c-fos mRNA levels after only 30 min of retinoic acid treatment, suggesting that a mechanism involving the interruption of the signal transduction mechanism at the membrane level is unlikely. Because it has been shown that c-fos expression plays a pivotal role in mitogenesis of quiescent fibroblasts, we conclude that the retinoic acid-mediated down-regulation of c-fos expression is a mechanism for growth inhibition in SSV-NRK cells