Development, Implementation, And Evaluation Of An End Of Life Care Online Module For Pre-Clinical Students

Basic palliative and end-of-life care skills are necessary for all physicians regardless of their field of specialty. Education should begin during the early stages of medical training, as early as medical school, to ensure that all physicians acquire a basic understanding of these aspects of medical care. At the Yale School of Medicine, the End-of-Life and Palliative Care Curriculum was formalized in 2008 to address this need and was expanded in 2012 to include an original educational online module. This new module was designed specifically for second-year medical students, who had the opportunity to visit hospice patients but do not have dedicated learning prior, to introduce them to specific topics in end-of-life and palliative care in preparation for third-year clerkship rotations during which they are likely to encounter and care for dying patients. Life, Death & Medicine: The Dying Process, Hospice Care, and Terminal Care was developed as a 30-45 minute interactive web-based module that focused on three topics: 1) the physiological signs and stages of the dying process; 2) the common terminal symptoms and their treatments; and 3) the eligibility and services of hospice care. The educational content is literature-based with reference citations embedded within the module. Several interactive features augment this online module, including multiple-choice questions with individualized feedback, drag-and-drop pairing exercises, video clips, and supplementary materials accessed via web-links. To evaluate the effectiveness of the module, a knowledge-and-attitudes survey was created and administered to second-year Yale medical students randomized to either have or not have access to the module prior to a required half-day hospice/palliative care rotation. A total of 152 students (51% response rate; 62 students in 2012; 66 in 2013; and 24 in 2014) participated in the survey between September 2012 to November 2014, of which 56 students had completed the online module and 85 had not (control group). Multinomial logistic regression was used to analyze the students\u27 knowledge performance based on a series of multiple-choice questions. Multivariate ANOVA was used to analyze the students\u27 attitudes based on their degree of agreement to a series of attitude-assessing statements. Students who completed the online module scored higher (p\u3c.05) on five out of eight of the knowledge-assessing questions. Overall, the students expressed that they felt somewhat uncomfortable caring for dying patients, though they regarded it as part of the physician\u27s duty, and that palliative care education is important in medical curricula. The attitudes did not differ between the students who completed the module and those who did not. Life, Death & Medicine: The Dying Process, Hospice Care, and Terminal Care is a promising tool to introduce pre-clinical medical students to key concepts of terminal care. The application of this online module can be extended to other medical schools to augment teaching of palliative and end-of-life care

Ligand-Dependent TrkA Activity in Brain Differentially Affects Spatial Learning and Long-Term Memory

ABSTRACT In the central nervous system, the nerve growth factor (NGF) receptor TrkA is expressed primarily in cholinergic neurons that are implicated in spatial learning and memory, whereas the NGF receptor p75 NTR is expressed in many neuronal populations and glia. We asked whether selective TrkA activation may have a different impact on learning, short-term memory, and long-term memory. We also asked whether TrkA activation might affect cognition differently in wild-type mice versus mice with cognitive deficits due to transgenic overexpression of mutant amyloid-precursor protein (APP mice). Mice were treated with wild-type NGF (a ligand of TrkA and p75 NTR ) or with selective pharmacological agonists of TrkA that do not bind to p75 NTR . In APP mice, the selective TrkA agonists significantly improved learning and short-term memory. These improvements are associated with a reduction of soluble A␤ levels in the cortex and AKT activation in the cortex and hippocampus. However, this improved phenotype did not translate into improved long-term memory. In normal wild-type mice, none of the treatments affected learning or short-term memory, but a TrkA-selective agonist caused persistent deficits in long-term memory. The deficit in wild-type mice was associated temporally, in the hippocampus, with increased AKT activity, increased brain-derived neurotrophic factor precursor, increased neurotrophin receptor homolog-2 (p75-related protein), and long-term depression. Together, these data indicate that selective TrkA activation affects cognition but does so differently in impaired APP mice versus normal wild-type mice. Understanding mechanisms that govern learning and memory is important for better treatment of cognitive disorders

Meta-analysis Followed by Replication Identifies Loci in or near CDKN1B, TET3, CD80, DRAM1, and ARID5B as Associated with Systemic Lupus Erythematosus in Asians

Systemic lupus erythematosus (SLE) is a prototype autoimmune disease with a strong genetic involvement and ethnic differences. Susceptibility genes identified so far only explain a small portion of the genetic heritability of SLE, suggesting that many more loci are yet to be uncovered for this disease. In this study, we performed a meta-analysis of genome-wide association studies on SLE in Chinese Han populations and followed up the findings by replication in four additional Asian cohorts with a total of 5,365 cases and 10,054 corresponding controls. We identified genetic variants in or near CDKN1B, TET3, CD80, DRAM1, and ARID5B as associated with the disease. These findings point to potential roles of cell-cycle regulation, autophagy, and DNA demethylation in SLE pathogenesis. For the region involving TET3 and that involving CDKN1B, multiple independent SNPs were identified, highlighting a phenomenon that might partially explain the missing heritability of complex diseases

Robust estimation of bacterial cell count from optical density

Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals <1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data

Health Confidence Is Associated With Disease Outcomes and Health Care Utilization in Inflammatory Bowel Disease: A Nationwide Cross-sectional Study

Background: We aimed to examine the associations between health confidence (one’s belief on the degree of control on their health and disease), inflammatory bowel disease (IBD) outcomes, and health care utilization among adults with IBD. Methods: In total, 17,205 surveys were analyzed from a cross-sectional sample of IBD patients at 23 gastroenterology (GI) practices participating in the Crohn’s and Colitis Foundations’ IBD Qorus Learning Health System. We used bivariate analyses and multivariable logistic regression to examine associations between health confidence and disease activity, opioid use, glucocorticoid use, well-being, and health care utilization. We used receiver operating curve analysis to determine a clinically relevant cutoff for health confidence (0-10 Likert scale). Results: Health confidence was highly correlated with patients’ well-being, symptomatic disease activity, opioid use, and glucocorticoid use (all P 4 times/month (adjusted odds ratio [aOR], 10.3; 95% CI, 6.1-17.3; P < .0001), 3-4 times more likely to have an IBD-related ED visit (aOR, 4.0; 95% CI, 2.9, 5.4. P < .0001), or hospitalization (aOR, 3.0, 95% CI, 2.1, 4.1, P < .0001) compared with patients with high health confidence (≥8). Conclusions: In a large, national sample of adults with IBD, there were strong associations between patients’ health confidence and multiple disease outcome measures. Health confidence scores <8 on a 0-10 Likert scale may be clinically useful to screen for patients who are at risk for ED visits and hospitalizations