Educational effectiveness of gynaecological teaching associates: a multi-centre randomised controlled trial

This trial was funded by The Medical College St Bartholo-mew’s Hospital Trust (reference number: 8368137)

Online patient simulation training to improve clinical reasoning: a feasibility randomised controlled trial

Online patient simulations (OPS) are a novel method for teaching clinical reasoning skills to students and could contribute to reducing diagnostic errors. However, little is known about how best to implement and evaluate OPS in medical curricula. The aim of this study was to assess the feasibility, acceptability and potential effects of eCREST — the electronic Clinical Reasoning Educational Simulation Tool

Tutoring Multilingual Students: Shattering the Myths

This is the author's accepted manuscript, made available 18 months after publication with the permission of the publisher.The increasing linguistic and cultural diversification of North America has resulted in large numbers of multilingual students attending college and university and seeking curricular and extracurricular support with reading and writing (Ruecker, 2011; Teranishi, C. Suárez-Orozco, & M. Suárez-Orozco, 2011). In the past, learning and writing centers hired “ESL specialists” to provide support. But this model, given the ubiquity of multilingual students in higher education today, is no longer sustainable. Instead, all tutors must learn the skills necessary to support the academic literacy development of these writers, and that means that the way tutors are trained must change. Because the lived reality of the majority of tutors (and center administrators) is monolingual (Bailey, 2012; Barron & Grimm, 2002), examining the myths generally held about multilingual students is essential to both our development as tutors and the development of our students as academic readers and writers of English. Only after raising critical awareness about these “misguided ideas” will training specific to tutoring multilingual students make sense and be put into practice (Gillespie & Lerner, 2008, p. 117). In this article, I present and challenge myths about multilingual writers and myths about how to tutor them

Online patient simulation training to improve clinical reasoning: a feasibility randomised controlled trial

Background Online patient simulations (OPS) are a novel method for teaching clinical reasoning skills to students and could contribute to reducing diagnostic errors. However, little is known about how best to implement and evaluate OPS in medical curricula. The aim of this study was to assess the feasibility, acceptability and potential effects of eCREST — the electronic Clinical Reasoning Educational Simulation Tool. Methods A feasibility randomised controlled trial was conducted with final year undergraduate students from three UK medical schools in academic year 2016/2017 (cohort one) and 2017/2018 (cohort two). Student volunteers were recruited in cohort one via email and on teaching days, and in cohort two eCREST was also integrated into a relevant module in the curriculum. The intervention group received three patient cases and the control group received teaching as usual; allocation ratio was 1:1. Researchers were blind to allocation. Clinical reasoning skills were measured using a survey after 1 week and a patient case after 1 month. Results Across schools, 264 students participated (18.2% of all eligible). Cohort two had greater uptake (183/833, 22%) than cohort one (81/621, 13%). After 1 week, 99/137 (72%) of the intervention and 86/127 (68%) of the control group remained in the study. eCREST improved students’ ability to gather essential information from patients over controls (OR = 1.4; 95% CI 1.1–1.7, n = 148). Of the intervention group, most (80/98, 82%) agreed eCREST helped them to learn clinical reasoning skills. Conclusions eCREST was highly acceptable and improved data gathering skills that could reduce diagnostic errors. Uptake was low but improved when integrated into course delivery. A summative trial is needed to estimate effectiveness

A population-based study of tumor gene expression and risk of breast cancer death among lymph node-negative patients

INTRODUCTION: The Oncotype DX assay was recently reported to predict risk for distant recurrence among a clinical trial population of tamoxifen-treated patients with lymph node-negative, estrogen receptor (ER)-positive breast cancer. To confirm and extend these findings, we evaluated the performance of this 21-gene assay among node-negative patients from a community hospital setting. METHODS: A case-control study was conducted among 4,964 Kaiser Permanente patients diagnosed with node-negative invasive breast cancer from 1985 to 1994 and not treated with adjuvant chemotherapy. Cases (n = 220) were patients who died from breast cancer. Controls (n = 570) were breast cancer patients who were individually matched to cases with respect to age, race, adjuvant tamoxifen, medical facility and diagnosis year, and were alive at the date of death of their matched case. Using an RT-PCR assay, archived tumor tissues were analyzed for expression levels of 16 cancer-related and five reference genes, and a summary risk score (the Recurrence Score) was calculated for each patient. Conditional logistic regression methods were used to estimate the association between risk of breast cancer death and Recurrence Score. RESULTS: After adjusting for tumor size and grade, the Recurrence Score was associated with risk of breast cancer death in ER-positive, tamoxifen-treated and -untreated patients (P = 0.003 and P = 0.03, respectively). At 10 years, the risks for breast cancer death in ER-positive, tamoxifen-treated patients were 2.8% (95% confidence interval [CI] 1.7–3.9%), 10.7% (95% CI 6.3–14.9%), and 15.5% (95% CI 7.6–22.8%) for those in the low, intermediate and high risk Recurrence Score groups, respectively. They were 6.2% (95% CI 4.5–7.9%), 17.8% (95% CI 11.8–23.3%), and 19.9% (95% CI 14.2–25.2%) for ER-positive patients not treated with tamoxifen. In both the tamoxifen-treated and -untreated groups, approximately 50% of patients had low risk Recurrence Score values. CONCLUSION: In this large, population-based study of lymph node-negative patients not treated with chemotherapy, the Recurrence Score was strongly associated with risk of breast cancer death among ER-positive, tamoxifen-treated and -untreated patients

Effects of school-based interventions on mental health stigmatization: a systematic review

Stigmatizing, or discriminatory, perspectives and behaviour, which target individuals on the basis of their mental health, are observed in even the youngest school children. We conducted a systematic review of the published and unpublished, scientific literature concerning the benefits and harms of school-based interventions, which were directed at students 18 years of age or younger to prevent or eliminate such stigmatization. Forty relevant studies were identified, yet only a qualitative synthesis was deemed appropriate. Five limitations within the evidence base constituted barriers to drawing conclusive inferences about the effectiveness and harms of school-based interventions: poor reporting quality, a dearth of randomized controlled trial evidence, poor methods quality for all research designs, considerable clinical heterogeneity, and inconsistent or null results. Nevertheless, certain suggestive evidence derived both from within and beyond our evidence base has allowed us to recommend the development, implementation and evaluation of a curriculum, which fosters the development of empathy and, in turn, an orientation toward social inclusion and inclusiveness. These effects may be achieved largely by bringing especially but not exclusively the youngest children into direct, structured contact with an infant, and likely only the oldest children and youth into direct contact with individuals experiencing mental health difficulties. The possible value of using educational activities, materials and contents to enhance hypothesized benefits accruing to direct contact also requires investigation. Overall, the curriculum might serve as primary prevention for some students and as secondary prevention for others

Individual differences in the cardiac component of the orienting response

Bibliography: pages 30-32.Forty-two male subjects participated in two separate experimental sessions spaced at seven day intervals. The subjects were given the Locus of Control scale. During each session, the subjects viewed multiple presentations of two types of novel stimuli. Heart rate was monitored during a total of forty presentations of four stimulus groups, and for five seconds prior to every stimulus onset. The trials of interest in this experiment were trials one and nine of every stimulus group. Trial one represented orienting/ reorienting trials. Trial nine represented habituation trials. The results indicated that the initial novel stimulus of each group did elicit a decelerative heart rate orienting response. The heart rate response had habituated by the ninth trial of a stimulus set. However, stable individual differences in the cardiac component were not found. The findings of this study also indicated that subjects scoring within the external range of the Locus of Control scale manifested larger heart rate decreases during novel stimuli than did subjects scoring within the internal range of the Locus of Control scale. These findings indicate that heart rate deceleration as a response to novel stimuli may not be a stable individual characteristic over time.M.A. (Master of Arts

Sustainable consumption by product substitution? An exploration of the appropriation of plant-based ‘mylk’ in everyday life

Many mainstream visions of sustainable societies assume that ‘green’ products will come to replace existing ones, reducing the footprint of consumption and enabling daily life to continue relatively undisturbed. However, several sustainable consumption studies have demonstrated that product substitution is not necessarily a straightforward process. This article asks whether the increased consumption of plant-based ‘mylk’, which is marketed as a more sustainable option compared to dairy milk, can be understood as a case of sustainable consumption via product substitution. The study applies a mixed methods approach, combining quantitative data from the National Diet and Nutrition Survey with secondary qualitative data from the Mass Observation Archive. We find that while the consumption of mylk has increased and that of milk decreased, this cannot be characterised as a straightforward case of substitution. Many people consume mylk alongside milk, rather than cutting milk consumption entirely. Rising mylk consumption requires the engagement of new, sometimes conflicting, meanings around health and the environment. In addition, a range of situational factors constitute unequal mylk consumption in society, and provisioning systems present important drivers and barriers that shape mylk consumption. Overall, our account suggests that moving towards sustainable consumption is not a simple process of product substitution as mylk is often consumed in addition to milk, and as this process requires adjustments in practices and meanings, unfolds unevenly within society, and is shaped by production systems rather than just demand

Patterns of glaucoma medication use in urban and rural Victoria

Publisher's version is restricted access in accordance with the publisher's policy.Purpose: The purpose of the present study was to describe patterns of glaucoma medication use among people who self-report a history of glaucoma in a population-based study of age-related eye disease. Methods: The present study was comprised of a population based cluster stratified sample of 5000 Victorians aged 40 years and older. Participants completed an interview regarding demographic characteristics, medical history and use of medications. Participants completed an interview regarding demographic characteristics, medical history and use of medications. Participants also completed orthoptic and dilated fundus examinations, including measurement of the intra-ocular pressure (IOP) and visual fields. Glaucoma history and use of glaucoma medication was self-reported. Glaucoma disease status was confirmed by a specialist consensus group. Results: The most common glaucoma medications used were B-adrenoceptor blocking agents (63%), followed by sympathomimetics (18%) and cholinergic agents (16%). There were no differences in glaucoma medication used by gender, age, years since diagnosis, rural or urban residence or a history of glaucoma surgery. Among participants using medication, 16.1% exceeded 21 mmHg IOP. Conclusion: The high prevalence of the use of B-adrenoceptor blocking agent medication reflects the shift from the use of pilocarpine over the past 20 years. The prevalence of IOP greater than 21 mmHg highlights the difficulty in managing high IOP