Simulation Learning: Effectiveness and Stressfulness in Medical Student Teaching

This article was migrated. The article was not marked as recommended. Introduction: The aims of this study were to assess the effectiveness of different modalities of simulation learning in medical students and the resulting stress response. Methods: Students were randomised into two groups for simulation learning, on the assessment and management of acutely ill patients. Group 1 performed assessments in a static individual format, whilst group 2 performing assessments in a dynamic group format. The stress response was measured by heart rate monitors worn by students, and performance was graded by a final simulator assessment. Results: The stress response did not significantly vary between groups, but there was a significant increase in heart rate in all students during the simulation learning; with a mean increase of 34 beats per minute in group 1 and 38 beats per minute in group 2. Performance in the final simulator assessment was significantly better in group 2, with a mean score of 21.5 points, compared to 16.2 points in group 1. Conclusion: A dynamic group simulation learning strategy is more effective in teaching medical students than simulations performed individually. Simulation learning, however; results in a significant stress response in all students, which must be carefully managed when delivering this type of learning.</ns4:p

NOV story: the way to CCN3

The principal aim of this historical review- the first in a new series- is to present the basic concepts that led to the discovery of NOV and to show how our ideas evolved regarding the role and functions of this new class of proteins. It should prove particularly useful to the new comers and to students who are engaged in this exciting field. It is also a good opportunity to acknowledge the input of those who participated in the development of this scientific endeavou

NOV/CCN3 attenuates inflammatory pain through regulation of matrix metalloproteinases-2 and -9

<p>Abstract</p> <p>Background</p> <p>Sustained neuroinflammation strongly contributes to the pathogenesis of pain. The clinical challenge of chronic pain relief led to the identification of molecules such as cytokines, chemokines and more recently matrix metalloproteinases (MMPs) as putative therapeutic targets. Evidence points to a founder member of the matricial CCN family, NOV/CCN3, as a modulator of these inflammatory mediators. We thus investigated the possible involvement of NOV in a preclinical model of persistent inflammatory pain.</p> <p>Methods</p> <p>We used the complete Freund's adjuvant (CFA)-induced model of persistent inflammatory pain and cultured primary sensory neurons for <it>in vitro </it>experiments. The mRNA expression of NOV and pro-inflammatory factors were measured with real-time quantitative PCR, CCL2 protein expression was assessed using ELISA, MMP-2 and -9 activities using zymography. The effect of drugs on tactile allodynia was evaluated by the von Frey test.</p> <p>Results</p> <p>NOV was expressed in neurons of both dorsal root ganglia (DRG) and dorsal horn of the spinal cord (DHSC). After intraplantar CFA injection, NOV levels were transiently and persistently down-regulated in the DRG and DHSC, respectively, occurring at the maintenance phase of pain (15 days). NOV-reduced expression was restored after treatment of CFA rats with dexamethasone. <it>In vitro</it>, results based on cultured DRG neurons showed that siRNA-mediated inhibition of NOV enhanced IL-1β- and TNF-α-induced MMP-2, MMP-9 and CCL2 expression whereas NOV addition inhibited TNF-α-induced MMP-9 expression through β₁integrin engagement. <it>In vivo</it>, the intrathecal delivery of MMP-9 inhibitor attenuated mechanical allodynia of CFA rats. Importantly, intrathecal administration of NOV siRNA specifically led to an up-regulation of MMP-9 in the DRG and MMP-2 in the DHSC concomitant with increased mechanical allodynia. Finally, NOV intrathecal treatment specifically abolished the induction of MMP-9 in the DRG and, MMP-9 and MMP-2 in the DHSC of CFA rats. This inhibitory effect on MMP is associated with reduced mechanical allodynia.</p> <p>Conclusions</p> <p>This study identifies NOV as a new actor against inflammatory pain through regulation of MMPs thus uncovering NOV as an attractive candidate for therapeutic improvement in pain relief.</p

Patients With Cervical Metastasis and Neoplastic Pachymeningitis are Less Likely to Improve Neurologically After Surgery

BACKGROUND: Although many patients with cervical spine metastases are treated surgically, it is unknown whether certain subsets achieve better pain relief and improvement of neurologic function. QUESTIONS/PURPOSES: (1) Does tumor removal with reconstruction improve the neurologic status? (2) Is any subset of patients more likely to have neurological recovery from palliative surgery? (3) What is the rate of surgery-related complications? PATIENTS AND METHODS: We retrospectively reviewed 46 patients who had palliative surgery for metastatic solid tumor metastases of the subaxial cervical spine. Indications were neurologic deficits, life expectancy longer than 6 months, and a Karnofsky Performance Score of 50 to 70. Surgery consisted of anterior tumor removal and reconstruction with titanium mesh cages and/or tricortical iliac crest allograft plus plate fixation or of a combined procedure with adjunctive posterior decompression and stabilization with lateral mass screw fixation. Postoperatively, neurologic Frankel score grade, Karnofsky Performance Score, and complications were recorded. RESULTS: Five of 18 nonambulatory patients (Frankel B/C) became ambulatory again (Frankel D). No patients were Frankel Grade E preoperatively, whereas 19 of 46 gained Frankel Grade E after surgery. One patient worsened neurologically and died 4 months after surgery. Patients with neoplastic pachymeningitis had less neurologic recovery than those without. Complications included dural tears (three), wound infection (three), and tumor relapse at the same or an adjacent level (four). Two of these four patients had instrumentation-related complications. CONCLUSIONS: Surgery improved clinical and neurologic status according to Frankel score; patients with neoplastic pachymeningitis are likely to experience less neurologic recovery. LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence

Sorpcja miedzi w glebie inkubowanej z resztkami roslinnymi

Celem przeprowadzonych badań było określenie sorpcji miedzi w glebie w następstwie jej inkubacji z resztkami roślinnymi o zróżnicowanej zawartości azotu (lucerna, słoma sojowa i pszenna). Wielkość sorpcji oceniono za pomocą parametrów sorpcji wg pojedynczego i podwójnego równania Langmuir'a. Ilość zasorbowanej miedzi zmniejszyła się w następstwie wprowadzenia do gleby resztek roślinnych bogatych w azot. Przyczyną jej spadku był wzrost zawartości amonowej formy azotu w glebie. Przewaga ujemnych zależności korelacyjnych między amax, b oraz zawartością formy amonowej azotu sugeruje istnienie konkurencji o miejsce wiązania między kationem amonowym powstającym w procesie rozkładu resztek roślinnych a miedzią.The objective of this work was to determine adsorption of copper in soils incubated with crop residues such alfaalfa, soybean and wheat straw. Adsorption of copper was assessed by means of sorption parameters of the single and double Langmuir equations. Copper adsorption in the soil has been decreased due to incorporation of crop residues rich in nitrogen. The main reason of the decreased amount of adsorbed copper was the increse of ammonium nitrogen content in the soil. The negative values of correlations between the amount of adsorbed copper and the amount of ammonium nitrogen in the soil incubated with plant residues suggest occurence of antagonism between these cations

reduced length of stay with minimally invasive repair of ruptured achilles tendon

ntroduction: Minimally invasive techniques to repair ruptured achilles tendons have been developed to enhance recovery following tendon repair and decrease wound complications associated with open repair. We investigated outcomes of minimally invasive and open repair of acutely ruptured achilles tendons at our institution. Method:  We reviewed all cases of achilles tendon repair at our department, over a two year period. Length of stay and operating time was recorded, as were any complication rates, including tendon re-rupture. Post-operatively functional outcome questionnaires were sent to all patients.  Results: In total 39 patients underwent open repair and 26 underwent minimally invasive repair. Length of stay was significantly shorter in the minimally invasive group, with 58% of minimally invasive cases performed as a day case, compared to 31.1% of open cases (p=0.02). There was no difference in complication rates, including re-rupture, or functional outcome scores. Conclusions: Minimally invasive repair of ruptured achilles tendons results in reduced length of stay, compared to open repair. There is no evidence of weaker tendon repairs with minimally invasive techniques. Overall functional outcomes between both groups appear similar.