Up for Debate: Re-Envisioning the Journal Club with an Article-Centric Student Debate

  Effective utilization of evidence-based medicine requires skillful development of a critical literature evaluation process. Although traditional journal club activities are a common modality to teach and refine these skills, they may limit a learner’s motivation to perform a well-rounded critique of primary literature. Innovation: In response to the challenges with these traditional formats, we describe a novel approach to refining critical literature evaluation skills in an Advanced Pharmacy Practice Experience (APPE) setting utilizing a focused, article-centric journal club debate. Students, in pairs, are assigned a single article and are tasked with building critical arguments for both pro and con sides of the article, which culminates in a one-on-one debate. Key Findings: The debate has been well received by students and faculty for increasing engagement in the critical literature evaluation process. The article-centric nature of the debate pushes students to a deeper understanding of an article’s merits and pitfalls. Ongoing limitations include significant faculty assessment burden and lack of a standardized, debate-specific evaluation rubric. Next Steps: Future efforts should focus on evaluating student performance and perceptions of the debate compared to traditional journal club formats utilizing pre- and post- surveys.  The creation of a debate-specific grading rubric may streamline the evaluation process and reduce faculty assessment burden.   Article Type:  Not

The multiplicative effect of combining alcohol with energy drinks on adolescent gambling

Purpose: There has been increased concern about the negative effects of adolescents consuming a combination of alcohol mixed with energy drinks (AmED). To date, few studies have focused on AmED use and gambling. The present study analyzed the multiplicative effect of AmED consumption, compared to alcohol alone, on the likelihood of at-risk or problem gambling during adolescence. Methods: Data from the ESPAD®Italia 2015 study, a cross-sectional survey conducted in a nationally representative sample of students (ages 15 to 19 years) were used to examine the association between self-reported AmED use (≥ 6 times, ≥ 10 times, and ≥ 20 times during the last month) and self-reported gambling severity. Multivariate models were used to calculate adjusted prevalence ratios to evaluate the association between alcohol use, AmED use, and gambling among a representative sample of adolescents who reported gambling in the last year and completed a gambling severity scale (n = 4495). Results: Among the 19% students classed as at-risk and problem gamblers, 43.9% were classed as AmED consumers, while 23.6% were classed as alcohol consumers (i.e. did not mix alcohol with energy drinks). In multivariate analyses that controlled for covariates, AmED consumers were three times more likely to be at-risk and problem gamblers (OR = 3.05) compared to non-consuming adolescents, while the effect became less pronounced with considering those who consumed alcohol without the addition of energy drinks (OR = 1.37). Conclusions: The present study clearly established that consuming AmED might pose a significantly greater risk of experiencing gambling-related problems among adolescents

Echocardiographic Parameters for Risk Prediction in Borderline Right Ventricle: Review with Special Emphasis on Pulmonary Atresia with Intact Ventricular Septum and Critical Pulmonary Stenosis

The aim of the present review is to highlight the strengths and limitations of echocardiographic parameters and scores employed to predict favorable outcome in complex congenital heart diseases (CHDs) with borderline right ventricle (RV), with a focus on pulmonary atresia with intact ventricular septum and critical pulmonary stenosis (PAIVS/CPS). A systematic search in the National Library of Medicine using Medical Subject Headings and free-text terms including echocardiography, CHD, and scores, was performed. The search was refined by adding keywords “PAIVS/CPS”, Ebstein’s anomaly, and unbalanced atrioventricular septal defect with left dominance. A total of 22 studies were selected for final analysis; 12 of them were focused on parameters to predict biventricular repair (BVR)/pulmonary blood flow augmentation in PAIVS/CPS. All of these studies presented numerical (the limited sample size) and methodological limitations (retrospective design, poor definition of inclusion/exclusion criteria, variability in the definition of outcomes, differences in adopted surgical and interventional strategies). There was heterogeneity in the echocardiographic parameters employed and cut-off values proposed, with difficultly in establishing which one should be recommended. Easy scores such as TV/MV (tricuspid/mitral valve) and RV/LV (right/left ventricle) ratios were proven to have a good prognostic accuracy; however, the data were very limited (only two studies with <40 subjects). In larger studies, RV end-diastolic area and a higher degree of tricuspid regurgitation were also proven as accurate predictors of successful BVR. These measures, however, may be either operator and/or load/pressure dependent. TV Z-scores have been proposed by several authors, but old and heterogenous nomograms sources have been employed, thus producing discordant results. In summary, we provide a review of the currently available echocardiographic parameters for risk prediction in CHDs with a diminutive RV that may serve as a guide for use in clinical practice

Features and uses of high-fidelity medical simulations that lead to effective learning: A BEME systematic review.

Review date: 1969 to 2003, 34 years. Background and context: Simulations are now in widespread use in medical education and medical personnel evaluation. Outcomes research on the use and effectiveness of simulation technology in medical education is scattered, inconsistent and varies widely in methodological rigor and substantive focus. Objectives: Review and synthesize existing evidence in educational science that addresses the question, 'What are the features and uses of high-fidelity medical simulations that lead to most effective learning?'. Search strategy: The search covered five literature databases (ERIC, MEDLINE, PsycINFO, Web of Science and Timelit) and employed 91 single search terms and concepts and their Boolean combinations. Hand searching, Internet searches and attention to the 'grey literature' were also used. The aim was to perform the most thorough literature search possible of peer-reviewed publications and reports in the unpublished literature that have been judged for academic quality. Inclusion and exclusion criteria: Four screening criteria were used to reduce the initial pool of 670 journal articles to a focused set of 109 studies: (a) elimination of review articles in favor of empirical studies; (b) use of a simulator as an educational assessment or intervention with learner outcomes measured quantitatively; (c) comparative research, either experimental or quasi-experimental; and (d) research that involves simulation as an educational intervention. Data extraction: Data were extracted systematically from the 109 eligible journal articles by independent coders. Each coder used a standardized data extraction protocol. Data synthesis: Qualitative data synthesis and tabular presentation of research methods and outcomes were used. Heterogeneity of research designs, educational interventions, outcome measures and timeframe precluded data synthesis using meta-analysis. Headline results: Coding accuracy for features of the journal articles is high. The extant quality of the published research is generally weak. The weight of the best available evidence suggests that high-fidelity medical simulations facilitate learning under the right conditions. These include the following: providing feedback-51 (47%) journal articles reported that educational feedback is the most important feature of simulation-based medical education; repetitive practice-43 (39%) journal articles identified repetitive practice as a key feature involving the use of high-fidelity simulations in medical education; curriculum integration-27 (25%) journal articles cited integration of simulation-based exercises into the standard medical school or postgraduate educational curriculum as an essential feature of their effective use; range of difficulty level-15 (14%) journal articles address the importance of the range of task difficulty level as an important variable in simulation-based medical education; multiple learning strategies-11 (10%) journal articles identified the adaptability of high-fidelity simulations to multiple learning strategies as an important factor in their educational effectiveness; capture clinical variation-11 (10%) journal articles cited simulators that capture a wide variety of clinical conditions as more useful than those with a narrow range; controlled environment-10 (9%) journal articles emphasized the importance of using high-fidelity simulations in a controlled environment where learners can make, detect and correct errors without adverse consequences; individualized learning-10 (9%) journal articles highlighted the importance of having reproducible, standardized educational experiences where learners are active participants, not passive bystanders; defined outcomes-seven (6%) journal articles cited the importance of having clearly stated goals with tangible outcome measures that will more likely lead to learners mastering skills; simulator validity-four (3%) journal articles provided evidence for the direct correlation of simulation validity with effective learning. Conclusions: While research in this field needs improvement in terms of rigor and quality, high-fidelity medical simulations are educationally effective and simulation-based education complements medical education in patient care settings

Feasibility of real-time three-dimensional stress echocardiography: pharmacological and semi-supine exercise

<p>Abstract</p> <p>Background</p> <p>Real time three dimensional (RT3D) echocardiography is an accurate and reproducible method for assessing left ventricular shape and function.</p> <p>Aim</p> <p>assess the feasibility and reproducibility of RT3D stress echocardiography (SE) (exercise and pharmacological) in the evaluation of left ventricular function compared to 2D.</p> <p>Methods and results</p> <p>One hundred eleven patients with known or suspected coronary artery disease underwent 2D and RT3DSE. The agreement in WMSI, EDV, ESV measurements was made off-line.</p> <p>The feasibility of RT-3DSE was 67%. The inter-observer variability for WMSI by RT3D echo was higher during exercise and with suboptimal quality images (good: k = 0.88; bad: k = 0.69); and with high heart rate both for pharmacological (HR < 100 bpm, k = 0.83; HR ≥ 100 bpm, k = 0.49) and exercise SE (HR < 120 bpm, k = 0.88; HR ≥ 120 bpm, k = 0.78). The RT3D reproducibility was high for ESV volumes (0.3 ± 14 ml; CI 95%: -27 to 27 ml; p = n.s.).</p> <p>Conclusions</p> <p>RT3DSE is more vulnerable than 2D due to tachycardia, signal quality, patient decubitus and suboptimal resting image quality, making exercise RT3DSE less attractive than pharmacological stress.</p

Texture control of PbTiO3 and Pb(Zr,Ti)O-3 thin films with TiO2 seeding

The nature and the role of 1 to 5 nm thick TiO2 seed layers for the growth of textured PbTiO3 and Pb(Zr, Ti)O-3 thin films on textured Pt(111) thin film substrates have been studied. Under otherwise identical in situ sputter deposition process conditions, the PbTiO3 texture could be turned from (100) to (111) orientation by adding the seed layer. This is demonstrated by patterning the TiO2 film. Auger electron spectroscopy and x-ray photoemission spectroscopy showed that the seed layer was a continuous TiO2 film. X-ray photoelectron diffraction measurements revealed epitaxial ordering in the seed layer. As there is no azimutal order among the Pt grains, the reduced information of azimutally averaged polar cuts is obtained. These give strong evidence for a strained rutile (110) structure. Various deposition experiments indicated that the TiO2 is effective only when it is ordered before the PbTiO3 nucleation starts. The epitaxial relationship between PbTiO3(111) and Pt(111) is thus mediated by the intermediate, epitaxial TiO2 film, which is dissolved of transformed to PbTiO3 afterwards. The observed growth behavior is discussed in terms of surface and interface energies. (C) 1998 American Institute of Physics. [S0021-8979(98)03607-X]

Why simulation can be efficient: on the preconditions of efficient learning in complex technology based practices

<p>Abstract</p> <p>Background</p> <p>It is important to demonstrate learning outcomes of simulation in technology based practices, such as in advanced health care. Although many studies show skills improvement and self-reported change to practice, there are few studies demonstrating patient outcome and societal efficiency.</p> <p>The objective of the study is to investigate if and why simulation can be effective and efficient in a hi-tech health care setting. This is important in order to decide whether and how to design simulation scenarios and outcome studies.</p> <p>Methods</p> <p>Core theoretical insights in Science and Technology Studies (STS) are applied to analyze the field of simulation in hi-tech health care education. In particular, a process-oriented framework where technology is characterized by its devices, methods and its organizational setting is applied.</p> <p>Results</p> <p>The analysis shows how advanced simulation can address core characteristics of technology beyond the knowledge of technology's functions. Simulation's ability to address skilful device handling as well as purposive aspects of technology provides a potential for effective and efficient learning. However, as technology is also constituted by organizational aspects, such as technology status, disease status, and resource constraints, the success of simulation depends on whether these aspects can be integrated in the simulation setting as well. This represents a challenge for future development of simulation and for demonstrating its effectiveness and efficiency.</p> <p>Conclusion</p> <p>Assessing the outcome of simulation in education in hi-tech health care settings is worthwhile if core characteristics of medical technology are addressed. This challenges the traditional technical versus non-technical divide in simulation, as organizational aspects appear to be part of technology's core characteristics.</p