Evaluation of an evidence-based medicine educational intervention in a regional medical campus

Background Enhanced educational activities were developed by a regional medical campus (RMC) in order to incorporate evidence-based medicine (EBM) practice in the learning process of medical students. This study aimed to measure the effectiveness of these activities. Methods The experimental group was made up of third-year students from the RMC. The comparison group included students from the main campus of the medical school and another of its RMCs. The experimental group received additional training on EBM: one additional hour in class, plus skills development exercises throughout the semester. During the regular academic sessions, clinical questions requiring EBM literature searching skills were incorporated in the curriculum. Tests on knowledge and self-assessment of competencies were administered to all participants at the beginning and at the end of the semester. Data were analyzed using repeated measures analysis of variance and post hoc tests for within and between groups comparison. Results The Friedman test demonstrated a statistically significant effect of the intervention on knowledge (p <0.0001). The score of the knowledge test was significantly higher for the experimental group, when compared with baseline testing and with the comparison group (p <0.0001). Repeated measures analysis of variance demonstrated a statistically significant effect of the intervention on the score of the self-assessment of competencies (p=0.032). The score for the self-assessment of competencies was significantly higher for the experimental group when compared to baseline score (p <0.0001), but not with respect to the comparison group. Conclusion Our study demonstrated the effectiveness of additional training and longitudinal integrated skills development leading to an increase in medical student knowledge and self-perception of competencies in EBM practice

Modulation of Plasma and Milk Sphingolipids in Dairy Cows Fed High-Starch Diets

Bovine milk is a significant source of sphingolipids, dietary compounds that can exert anti-inflammatory actions, and which can modulate the host’s microbiome. Because sphingolipid synthesis can be modified by diet, we hypothesized that dietary conditions which reduced FFA availability may result in reduced sphingolipid synthesis. Twelve ruminally cannulated cows (120 ± 52 DIM; 35.5 ± 8.9 kg of milk/d; mean ± SD) were randomly assigned to treatment in a crossover design with 21-d periods. Treatments were (1) High starch (HS), (2) Control. The HS diet contained 29% starch, 24% NDF, and 2.8% fatty acids (FA), whereas the Control diet contained 20% starch, 31% NDF, and 2.3% FA. Plasma and milk samples were obtained on d 21 of each period and sphingolipids were quantified using targeted metabolomics. Univariate and multivariate analyses of generalized log-transformed and Pareto-scaled data included ANOVA (fixed effects of treatment) and discriminant analysis. The lipidomics analysis detected 71 sphingolipids across plasma and milk fat, including sphinganines (n = 3), dihydro-ceramides (n = 8), ceramides (Cer; n = 15), sphingomyelins (SM; n = 17), and glycosylated ceramides (n = 28). Followed by Cer, SM were the most abundant sphingolipids detected in milk and plasma, with a preponderance of 16:0-, 23:0-, and 24:0-carbon sidechains. Although no effects of HS diets were observed on plasma sphingolipids, we detected consistent reductions in the concentrations of several milk Cer (e.g., 22:0- and 24:0-Cer) and SM (17:0- and 23:0-SM) in response to HS. Discriminant analysis revealed distinct metabolite separation of HS and Control groups, with several Cer and SM being distinctively predictive of dietary treatment. We conclude that HS diets can reduce the secretion of milk Cer and SM, even in the absence of changes in circulating sphingolipids.https://doi.org/10.3390/metabo1110071