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

The Nature Index: A General Framework for Synthesizing Knowledge on the State of Biodiversity

The magnitude and urgency of the biodiversity crisis is widely recognized within scientific and political organizations. However, a lack of integrated measures for biodiversity has greatly constrained the national and international response to the biodiversity crisis. Thus, integrated biodiversity indexes will greatly facilitate information transfer from science toward other areas of human society. The Nature Index framework samples scientific information on biodiversity from a variety of sources, synthesizes this information, and then transmits it in a simplified form to environmental managers, policymakers, and the public. The Nature Index optimizes information use by incorporating expert judgment, monitoring-based estimates, and model-based estimates. The index relies on a network of scientific experts, each of whom is responsible for one or more biodiversity indicators. The resulting set of indicators is supposed to represent the best available knowledge on the state of biodiversity and ecosystems in any given area. The value of each indicator is scaled relative to a reference state, i.e., a predicted value assessed by each expert for a hypothetical undisturbed or sustainably managed ecosystem. Scaled indicator values can be aggregated or disaggregated over different axes representing spatiotemporal dimensions or thematic groups. A range of scaling models can be applied to allow for different ways of interpreting the reference states, e.g., optimal situations or minimum sustainable levels. Statistical testing for differences in space or time can be implemented using Monte-Carlo simulations. This study presents the Nature Index framework and details its implementation in Norway. The results suggest that the framework is a functional, efficient, and pragmatic approach for gathering and synthesizing scientific knowledge on the state of biodiversity in any marine or terrestrial ecosystem and has general applicability worldwide

Proposal for design of a Norwegian Monitoring Network for Reference Sites

The present report is a proposal for a preliminary design of a monitoring programme for reference sites for all surface water categories compatible with the requirements in the EU Water Framework Directive. The proposal includes preliminary recommendations of number of sites, parameters, sampling frequency and monitoring intervals. The total number of sites proposed is approximately 400 lakes, 250 river sites and 250 coastal water sites distributed in different ecoregions and types. A tentative budget suggests annual costs for the initial 6-years’ period of 140 mill. NOK, with 30, 20 and 90 mill. NOK for lakes, rivers and coastal waters respectively. For the consequtive monitoring periods, the annual costs decrease to ca. 28 mill. NOK, in which lakes, rivers and coastal waters require respectively 7.5, 5 and 15 mill. NOK. The costs can be further reduced by combining the reference network with ongoing and planned monitoring in Norway and in other Nordic countries

Short-term culturing of teleost crystalline lenses combined with high-resolution optical measurements

Culturing whole lenses is a frequently used method for studying regulatory events on the lens in controlled environments. The evaluation methods used often fall under two categories, molecular or optical. The main benefit from optical measurements is that they directly detect changes in the lens’ main function, i.e. refracting light. However, these measurements often have rather low resolution or yield results open for subjective interpretation. Here we present a short-term crystalline lens culturing technique combined with a high-resolution optical measuring method. There are two main advantages of using teleost lenses compared to mammalian lenses. Teleost tissue generally has a higher tolerance than mammalian tissue with regard to temperature and nutrient fluctuations. Teleost lenses are structurally more robust and can be excised from the eye without disturbing form or function. The technique is developed for short-term culturing (3 h), however, the lenses appear viable for at least 24 h and longer culturing may be possible. The technique is resistant to small variations in osmolarity and yields quantitative datasets for further analyses and statistical treatment