A near-peer teaching program designed, developed and delivered exclusively by recent medical graduates for final year medical students sitting the final objective structured clinical examination (OSCE)

Abstract Background The General Medical Council states that teaching doctors and students is important for the care of patients. Our aim was to deliver a structured teaching program to final year medical students, evaluate the efficacy of teaching given by junior doctors and review the pertinent literature. Methods We developed a revision package for final year medical students sitting the Objective Structured Clinical Examination (OSCE). The package was created and delivered exclusively by recent medical graduates and consisted of lectures and small group seminars covering the core areas of medicine and surgery, with a focus on specific OSCE station examples. Students were asked to complete a feedback questionnaire during and immediately after the program. Results One hundred and eighteen completed feedback questionnaires were analysed. All participants stated that the content covered was relevant to their revision. 73.2% stated that junior doctors delivered teaching that is comparable to that of consultant - led teaching. 97.9% stated the revision course had a positive influence on their learning. Conclusions Our study showed that recent medical graduates are able to create and deliver a structured, formal revision program and provide a unique perspective to exam preparation that was very well received by our student cohort. The role of junior doctors teaching medical students in a formal structured environment is very valuable and should be encouraged.</p

Outcome of intracerebral hemorrhage associated with different oral anticoagulants

Objective: In an international collaborative multicenter pooled analysis, we compared mortality, functional outcome, intracerebral hemorrhage (ICH) volume, and hematoma expansion (HE) between non-vitamin K antagonist oral anticoagulation-related ICH (NOAC-ICH) and vitamin K antagonist-associated ICH (VKA-ICH). Methods: We compared all-cause mortality within 90 days for NOAC-ICH and VKA-ICH using a Cox proportional hazards model adjusted for age; sex; baseline Glasgow Coma Scale score, ICH location, and log volume; intraventricular hemorrhage volume; and intracranial surgery. We addressed heterogeneity using a shared frailty term. Good functional outcome was defined as discharge modified Rankin Scale score 33% or >6 mL from baseline within 72 hours. Results: We included 500 patients (97 NOAC-ICH and 403 VKA-ICH). Median baseline ICH volume was 14.4 mL (interquartile range [IQR] 3.6-38.4) for NOAC-ICH vs 10.6 mL (IQR 4.0-27.9) for VKA-ICH (p = 0.78). We did not find any difference between NOAC-ICH and VKA-ICH for all-cause mortality within 90 days (33% for NOAC-ICH vs 31% for VKA-ICH [p = 0.64]; adjusted Cox hazard ratio (for NOAC-ICH vs VKA-ICH) 0.93 [95% confidence interval (CI) 0.52-1.64] [p = 0.79]), the rate of HE (NOAC-ICH n = 29/48 [40%] vs VKA-ICH n = 93/140 [34%] [p = 0.45]), or functional outcome at hospital discharge (NOAC-ICH vs VKA-ICH odds ratio 0.47; 95% CI 0.18-1.19 [p = 0.11]). Conclusions: In our international collaborative multicenter pooled analysis, baseline ICH volume, hematoma expansion, 90-day mortality, and functional outcome were similar following NOAC-ICH and VKA-ICH.Peer reviewe

Neuroimaging and clinical outcomes of oral anticoagulant-associated intracerebral hemorrhage

Objective Methods Whether intracerebral hemorrhage (ICH) associated with non-vitamin K antagonist oral anticoagulants (NOAC-ICH) has a better outcome compared to ICH associated with vitamin K antagonists (VKA-ICH) is uncertain. We performed a systematic review and individual patient data meta-analysis of cohort studies comparing clinical and radiological outcomes between NOAC-ICH and VKA-ICH patients. The primary outcome measure was 30-day all-cause mortality. All outcomes were assessed in multivariate regression analyses adjusted for age, sex, ICH location, and intraventricular hemorrhage extension. Results Interpretation We included 7 eligible studies comprising 219 NOAC-ICH and 831 VKA-ICH patients (mean age = 77 years, 52.5% females). The 30-day mortality was similar between NOAC-ICH and VKA-ICH (24.3% vs 26.5%; hazard ratio = 0.94, 95% confidence interval [CI] = 0.67-1.31). However, in multivariate analyses adjusting for potential confounders, NOAC-ICH was associated with lower admission National Institutes of Health Stroke Scale (NIHSS) score (linear regression coefficient = -2.83, 95% CI = -5.28 to -0.38), lower likelihood of severe stroke (NIHSS > 10 points) on admission (odds ratio [OR] = 0.50, 95% CI = 0.30-0.84), and smaller baseline hematoma volume (linear regression coefficient = -0.24, 95% CI = -0.47 to -0.16). The two groups did not differ in the likelihood of baseline hematoma volume <30cm(3) (OR = 1.14, 95% CI = 0.81-1.62), hematoma expansion (OR = 0.97, 95% CI = 0.63-1.48), in-hospital mortality (OR = 0.73, 95% CI = 0.49-1.11), functional status at discharge (common OR = 0.78, 95% CI = 0.57-1.07), or functional status at 3 months (common OR = 1.03, 95% CI = 0.75-1.43). Although functional outcome at discharge, 1 month, or 3 months was comparable after NOAC-ICH and VKA-ICH, patients with NOAC-ICH had smaller baseline hematoma volumes and less severe acute stroke syndromes. Ann Neurol 2018;84:702-712Peer reviewe

Breeding Value of Cocoa (&lt;i&gt;Theobroma cacao&lt;/i&gt; L.) for Pod and Bean Traits: A Consequential Advance in Nigerian Cocoa Breeding Program

The understanding of the generated hybrids’ breeding value gives a measure of probable advances in a breeding program. Four cocoa genotypes (testers) were crossed with two distinct lines (T65/7 and T86/2). The parents and the hybrids were separately established in randomized complete block design with six replications. The fourteen genotypes were evaluated for pod length (PL), weight (PW), beans/pod (NoB), bean length (BL), width (Bwi) and thickness (BT). The treatment, parent, crosses and Line x Tester sources of variation were significant (P ≤ 0.05). Hybrids from the same maternal parent differed significantly (P &lt; 0.05) for the six traits. Contribution to the total variance of PL, PW and Bwi were in the following order: Tester &gt; Line x Tester &gt; Lines. The highest general combining ability (0.42) occurred in T65/7 for PW; the least (-0.081) occurred in T86/2 for PL. Cross combination T65/7xT57/22 produced the highest specific ability of combination (4.33) for NoB. Variance of GCA and SCA were significant (P &lt; 0.05) for the six traits. The GCA/SCA ratios revealed the inheritance of PL, PW, Bwi and BT to be additive. Non-additive gene effect controlled NoB and BL. Heterosis for the six traits ranged between -17.82% for BT (T65/7xT57/22) to 52.40% for PW (T65/7xT53/8). Increased productivity in cocoa is possible through hybrid breeding programs

Breeding Value of Cocoa (<i>Theobroma cacao</i> L.) for Pod and Bean Traits: A Consequential Advance in Nigerian Cocoa Breeding Program

The understanding of the generated hybrids’ breeding value gives a measure of probable advances in a breeding program. Four cocoa genotypes (testers) were crossed with two distinct lines (T65/7 and T86/2). The parents and the hybrids were separately established in randomized complete block design with six replications. The fourteen genotypes were evaluated for pod length (PL), weight (PW), beans/pod (NoB), bean length (BL), width (Bwi) and thickness (BT). The treatment, parent, crosses and Line x Tester sources of variation were significant (P &#8804; 0.05). Hybrids from the same maternal parent differed significantly (P &lt; 0.05) for the six traits. Contribution to the total variance of PL, PW and Bwi were in the following order: Tester &gt; Line x Tester &gt; Lines. The highest general combining ability (0.42) occurred in T65/7 for PW; the least (-0.081) occurred in T86/2 for PL. Cross combination T65/7xT57/22 produced the highest specific ability of combination (4.33) for NoB. Variance of GCA and SCA were significant (P &lt; 0.05) for the six traits. The GCA/SCA ratios revealed the inheritance of PL, PW, Bwi and BT to be additive. Non-additive gene effect controlled NoB and BL. Heterosis for the six traits ranged between -17.82% for BT (T65/7xT57/22) to 52.40% for PW (T65/7xT53/8). Increased productivity in cocoa is possible through hybrid breeding programs