One-year transitional programme increases knowledge to level sufficient for entry into the fourth year of the medical curriculum

BACKGROUND: To cope with a lack of doctors and in anticipation of the Bachelor-Master structure for Medicine, several Dutch universities offer graduate entry programmes for students with degrees in areas related to Medicine. The graduate entry programme is a four-year programme: after a transition period of one year students enroll in the fourth year of the regular six-year training programme. AIM: The research questions in this study were (1) whether and when graduate entry students' knowledge reached a level comparable to that of regular medical students and (2) whether there were differences in knowledge levels between graduate entry students with a university or HBO (college) degree. METHODS: The progress test results of ninety graduate entry students who were enrolled in the transitional programme between 2002 and 2004 were compared to those of regular third-year students. RESULTS: Initially, graduate entry students scored significantly lower on the progress tests, but differences disappeared within a year. No differences were found between graduate entry students with a university or HBO degree. CONCLUSIONS: The results of this study indicate that the increase in knowledge after a one-year transitional period is sufficient to enroll students with related degrees in the fourth year of the regular medical training programme

Global health education in the Dutch Caribbean:50 years of a unique Groningen-Curaçao clinical clerkship program

The globalization of healthcare has had a significant impact on healthcare delivery and human workforce development in many countries. Consequently, many educational institutions have had to revise the content of their medical curricula to focus on training and preparing future doctors to effectively cater to the needs of the “modern patient”. The focus covers broader aspects of medicine that include environmental and professional culture and the impact of socioeconomic inequalities on the delivery of healthcare. Therefore, in most global health (GH) education programs described, students undertake a specific part of their clinical rotation in a foreign (non-western) educational setting to facilitate authentic learning experiences within a resource-constrained environment. In this paper we present a unique Global Health program for medical interns between the University Medical Center Groningen, Netherlands and the Sint Elisabeth Hospital, Curaçao, Dutch Caribbean that has, for more than 50 years, been providing a one-year internship program as part of the formal Groningen curriculum. The program we describe, illustrates the essential requirements for best practice in GH education that fully complies with recently proposed GH program objectives and competencies. The characteristics of our long running program show the basic requirements necessary for sustainable and successful health education collaboration between institutions in high- and low/middle income countries. Finally, this program, which is part of a Dutch medical curriculum, not only provided unique global health learning experiences for the interns, but importantly also contributed to improving the general healthcare delivery services on the island of Curaçao as well.</p

Long-term follow-up, quality of life, and survival of patients with Lambert-Eaton myasthenic syndrome

ObjectiveTo study survival and to characterize long-term functional impairments and health-related quality of life (HRQOL) of patients with Lambert-Eaton myasthenic syndrome (LEMS).MethodsIn this observational study, survival of patients with LEMS, separately for nontumor (NT) and small cell lung cancer (SCLC), was compared to that of the Dutch general population and patients with SCLC. Disease course in patients with LEMS was recorded retrospectively. Several scales for functional impairments and health-related quality of life were assessed.ResultsWe included 150 patients with LEMS. Survival was similar to that of the general population in 65 patients with NT-LEMS. Tumor survival was significantly longer in 81 patients with SCLC-LEMS compared to patients with non-LEMS SCLC (overall median survival 17 vs 7.0 months, p <0.0001). At diagnosis, 39 (62%) of 63 patients with complete follow-up data were independent for activities of daily living, improving to 85% at the 1-year follow-up. The physical HRQOL composite score (55.9) was significantly lower than in the general population (76.3, p <0.0001) and comparable to that of patients with myasthenia gravis (60.5). The mental HRQOL composite score was 71.8 in patients with LEMS, comparable to that of the general population (77.9, p = 0.19) and patients with myasthenia gravis (70.3).ConclusionsThis study shows that patients with NT-LEMS have normal survival. Patients with SCLC-LEMS have an improved tumor survival, even after correction for tumor stage. A majority of patients with LEMS report a stable disease course and remain or become independent for self-care after treatment

The state as a stimulator of wastewater treatment policy: a comparative assessment of three subnational cases in central Mexico

River basin management and decentralisation reforms are promoted worldwide for solving water pollution problems. In Mexico, governmental efforts have been made to operate wastewater treatment plants countrywide, but federal administrations have not achieved their intended outcomes. Acknowledging the role of governance in the implementation of wastewater treatment policy, this paper analyses three cases in central Mexico and addresses the question: How does the governance context affect the implementation of the wastewater treatment policy in central Mexico? A governance assessment tool is applied to answer the question. The assessment allows an understanding of the governance context and is paired with a comparative case study design. Data was collected through semi-structured interviews and documents reviews. The results indicate that the governance context mainly restricts the implementation of the wastewater treatment policy. In all subnational three cases, the river basin management and decentralisation reforms have not reached their objectives. By comparing the three cases, we found that the state level can play a relevant role to decrease fragmentation and to increase the coherence of the wastewater treatment policy. Therefore, strengthening the involvement of the state government and the improvement of mechanisms that limit political machinations can increase the supportiveness of the governance context

Vibration threshold in non-diabetic subjects

Measuring vibration perception threshold (VPT) accurately classifies and quantifies the severity of loss of vibration perception. A biothesiometer (Bio-thesiometer®; Bio Medical Instrument Co, Ohio, USA) appears to be the most suitable tool to determine VPT due to its low inter-rater variability and low occurence of adaption to the sensation. Different VPT values for a biothesiometer have been described, however, specification on age, height and different measurement locations is currently lacking. The objective of our study was to identify determinants of vibration perception in non-diabetic subjects, in order to provide individualized normal values of VPTs for clinical practice. Measurements of the vibration perception were performed on the big toes, insteps, lateral malleoli, and wrists. A total of 205 healthy subjects were included (108 (52.7%) males) with a median [interquartile range] age of 59 [51;64] (range 21-80) years. Mean height was 174.45 ± 9.20 cm and mean weight was 82.94 ± 14.84 kg, resulting in a mean BMI of 27.19 ± 4.00 kg/m2. In stepwise forward linear regression analyses, age (st. β = 0.51, p < 0.001) and height (st. β = 0.43, p < 0.001) were found to be the independent unmodifiable determinants of the VPT at the big toe. Regression coefficients for quantiles of the determinants age and height were incorporated in the corresponding regression equations. This study provides equations to calculate age- and height-specific normal values for VPT that can be used in clinical practice and in large research studies

Neurofilament light chain, a biomarker for polyneuropathy in systemic amyloidosis

OBJECTIVE: To study serum neurofilament light chain (sNfL) in amyloid light chain (AL) amyloidosis patients with and without polyneuropathy (PNP) and to corroborate previous observations that sNfL is increased in hereditary transthyretin-related (ATTRv) amyloidosis patients with PNP. METHODS: sNfL levels were assessed retrospectively in patients with AL amyloidosis with and without PNP (AL/PNP+ and AL/PNP-, respectively), patients with ATTRv amyloidosis and PNP (ATTRv/PNP+), asymptomatic transthyretin (TTR) gene mutation carriers (TTRv carriers) and healthy controls. Healthy controls (HC) were age- and sex-matched to both AL/PNP- (HC/AL) and TTRv carriers (HC/TTRv). The single-molecule array (Simoa) assay was used to assess sNfL levels. RESULTS: sNfL levels were increased both in 10 AL/PNP+ patients (p  I) had the highest sNfL levels compared to patients with early PNP (PND-score I) (p = .05). sNfL levels did not differ between TTRv carriers and HC/TTRv individuals. In the group comprising all healthy controls and in the group of TTRv carriers, sNfL levels correlated with age. CONCLUSION: sNfL levels are increased in patients with PNP in both AL and ATTRv amyloidosis and are related to severity of PNP in ATTRv amyloidosis. sNfL is a promising biomarker to detect PNP, not only in ATTRv but also in AL amyloidosis