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1.  Teachers’ perceptions of aspects affecting seminar learning: a qualitative study 
BMC Medical Education  2013;13:22.
Many medical schools have embraced small group learning methods in their undergraduate curricula. Given increasing financial constraints on universities, active learning groups like seminars (with 25 students a group) are gaining popularity. To enhance the understanding of seminar learning and to determine how seminar learning can be optimised it is important to investigate stakeholders’ views. In this study, we qualitatively explored the views of teachers on aspects affecting seminar learning.
Twenty-four teachers with experience in facilitating seminars in a three-year bachelor curriculum participated in semi-structured focus group interviews. Three focus groups met twice with an interval of two weeks led by one moderator. Sessions were audio taped, transcribed verbatim and independently coded by two researchers using thematic analysis. An iterative process of data reduction resulted in emerging aspects that influence seminar learning.
Teachers identified seven key aspects affecting seminar learning: the seminar teacher, students, preparation, group functioning, seminar goals and content, course coherence and schedule and facilities. Important components of these aspects were: the teachers’ role in developing seminars (‘ownership’), the amount and quality of preparation materials, a non-threatening learning climate, continuity of group composition, suitability of subjects for seminar teaching, the number and quality of seminar questions, and alignment of different course activities.
The results of this study contribute to the unravelling of the ‘the black box’ of seminar learning. Suggestions for ways to optimise active learning in seminars are made regarding curriculum development, seminar content, quality assurance and faculty development.
PMCID: PMC3576232  PMID: 23399475
Seminar learning; Undergraduate (veterinary) medical education; Focus groups; Faculty development
2.  Development, implementation and evaluation of a pain management and palliative care educational seminar for medical students 
One of the best ways to improve pain management for patients with chronic pain is to increase the emphasis on this topic during the education of health care professionals. The authors of this study developed a seminar that was presented to medical students at the University of Toronto (Toronto, Ontario). The utility of the seminar was assessed using a test administered both before the seminar, immediately after the seminar and up to one year later.
Despite calls for the development and evaluation of pain education programs during early medical student training, little research has been dedicated to this initiative.
To develop a pain management and palliative care seminar for medical students during their surgical clerkship and evaluate its impact on knowledge over time.
A multidisciplinary team of palliative care and pain experts worked collaboratively and developed the seminar over one year. Teaching methods included didactic and case-based instruction, as well as small and large group discussions. A total of 292 medical students attended a seminar during their third- or fourth-year surgical rotation. A 10-item test on knowledge regarding pain and palliative care topics was administered before the seminar, immediately following the seminar and up to one year following the seminar. Ninety-five percent (n=277) of students completed the post-test and 31% (n=90) completed the follow-up test.
The mean pretest, post-test and one-year follow-up test scores were 51%, 75% and 73%, respectively. Mean test scores at post-test and follow-up were significantly higher than pretest scores (all P<0.001). No significant difference was observed in mean test scores between follow-up and post-test (P=0.559), indicating that students retained knowledge gained from the seminar.
A high-quality educational seminar using interactive and case-based instruction can enhance students’ knowledge of pain management and palliative care. These findings highlight the feasibility of developing and implementing pain education material for medical students during their training.
PMCID: PMC4197749  PMID: 24851239
Chronic pain; Knowledge about pain; Pain; Pain education; Palliative care
3.  Characteristics of drug users who witness many overdoses: Implications for overdose prevention 
Drug and alcohol dependence  2011;120(1-3):168-173.
Programs to improve response of drug users when witnessing an overdose can reduce overdose mortality. Characteristics of drug users may be associated with the number of overdoses ever witnessed. This information could inform overdose prevention programs.
Participants in New York City, who were age 18 and older with heroin and/or with cocaine use in the past two months, were administered structured interviews (n = 1,184). Survey topics included overdose response, drug use behavior, treatment history, and demographic information.
In a multivariable negative binomial regression model, those persons who are male (IRR [Incidence Rate Ratio] = 1.7, CI [95% Confidence Interval] = 1.4,2.2), have experienced homelessness (IRR = 1.9, CI= 1.4,2.6), have used heroin (IRR = 2.0, CI = 1.3,3.2), have overdosed themselves (IRR = 1.9, CI = 1.6,2.4), and have attended Narcotics Anonymous (IRR = 1.3, CI = 1.1,1.6) witnessed a greater count of overdoses in their lifetime. Those persons who have witnessed more overdoses were less likely to have sought medical assistance (OR [Odds Ratio] = 0.7) and more likely to report counter-productive or ineffective actions (ORs between 1.9 and 2.4) at the last overdose they witnessed compared to persons who had only ever witnessed one or two overdoses.
Persons at high risk for overdose are likely to witness more overdoses. Persons who had witnessed more overdoses were more likely to report taking ineffective action at the last overdose witnessed; individuals who have witnessed many overdoses are likely key targets of overdose response training.
PMCID: PMC3229655  PMID: 21839588
overdose; heroin; cocaine; prevention
4.  Circumstances and witness characteristics associated with overdose fatality 
Annals of emergency medicine  2009;54(4):618-624.
Emergency physicians have an opportunity to provide overdose fatality prevention interventions to individuals at risk for experiencing or witnessing an overdose to reduce fatality. The present study uses data about the most recent overdose observed by a sample of inner-city drug users to determine the circumstances of overdose that are associated with overdose fatality.
Participants (n = 690), age 18+, were recruited using targeted street outreach. All participants had used heroin and/or cocaine in the prior 2 months, and had witnessed at least one overdose. Survey data included the circumstances of the last overdose witnessed, including actions taken, drug use behavior, the location of the event, and whether or not the overdose was fatal (the outcome measure).
152 (21.7%) of the witnessed overdoses were fatal. Witness powder cocaine use (Adjusted Odds Ratio [AOR] = 1.64, 95% Confidence Interval [CI] 1.03–2.60) and injection drug history (AOR = 0.55, 95% CI 0.32–0.90) were associated with the last witnessed overdose being fatal. Witnessed overdoses that occurred in public or abandoned buildings, compared to homes, were more likely to be fatal (AOR = 1.90, 95% CI 1.03–3.02), as were overdoses where witnesses sought outside medical help (AOR = 1.46, 95% CI 1.01–2.13).
Future prevention interventions may fruitfully target users of powder cocaine, drug users without a history of injecting, and individuals who use drugs in public or abandoned buildings for brief interventions on responding when witnessing an overdose to reduce mortality.
PMCID: PMC2763413  PMID: 19540622
drug overdose; fatality; emergency medical services
5.  Immunogenetic Mechanisms Driving Norovirus GII.4 Antigenic Variation 
PLoS Pathogens  2012;8(5):e1002705.
Noroviruses are the principal cause of epidemic gastroenteritis worldwide with GII.4 strains accounting for 80% of infections. The major capsid protein of GII.4 strains is evolving rapidly, resulting in new epidemic strains with altered antigenic potentials. To test if antigenic drift may contribute to GII.4 persistence, human memory B cells were immortalized and the resulting human monoclonal antibodies (mAbs) characterized for reactivity to a panel of time-ordered GII.4 virus-like particles (VLPs). Reflecting the complex exposure history of the volunteer, human anti-GII.4 mAbs grouped into three VLP reactivity patterns; ancestral (1987–1997), contemporary (2004–2009), and broad (1987–2009). NVB 114 reacted exclusively to the earliest GII.4 VLPs by EIA and blockade. NVB 97 specifically bound and blocked only contemporary GII.4 VLPs, while NBV 111 and 43.9 exclusively reacted with and blocked variants of the GII.4.2006 Minerva strain. Three mAbs had broad GII.4 reactivity. Two, NVB 37.10 and 61.3, also detected other genogroup II VLPs by EIA but did not block any VLP interactions with carbohydrate ligands. NVB 71.4 cross-neutralized the panel of time-ordered GII.4 VLPs, as measured by VLP-carbohydrate blockade assays. Using mutant VLPs designed to alter predicted antigenic epitopes, two evolving, GII.4-specific, blockade epitopes were mapped. Amino acids 294–298 and 368–372 were required for binding NVB 114, 111 and 43.9 mAbs. Amino acids 393–395 were essential for binding NVB 97, supporting earlier correlations between antibody blockade escape and carbohydrate binding variation. These data inform VLP vaccine design, provide a strategy for expanding the cross-blockade potential of chimeric VLP vaccines, and identify an antibody with broadly neutralizing therapeutic potential for the treatment of human disease. Moreover, these data support the hypothesis that GII.4 norovirus evolution is heavily influenced by antigenic variation of neutralizing epitopes and consequently, antibody-driven receptor switching; thus, protective herd immunity is a driving force in norovirus molecular evolution.
Author Summary
Noroviruses are the principal cause of epidemic gastroenteritis worldwide with GII.4 strains accounting for 80% of infections. The major capsid protein of GII.4 strains is evolving rapidly, resulting in new epidemic strains with altered antigenic sites. To define these sites we prepared the first human monoclonal antibodies (Hu mAbs) against GII.4 noroviruses by immortalizing memory B cells and characterizing antibody reactivity and carbohydrate blockade responses across a ∼20 year panel of time-ordered GII.4 virus-like particles (VLPs). Reflecting the complex exposure history of the patient, human anti-GII.4 mAbs grouped into three VLP reactivity patterns: broad (1987–2009), contemporary (2004–2009), and ancestral (1987–2002). We also identified the location of several defined epitopes which evolve over time and drive antigenic change. Our data indicate that antibodies targeting these sites block carbohydrate binding and likely select for the emergence of new strains that escape herd immunity and recognize unique carbohydrates for entry, resulting in new outbreaks of disease in vulnerable human populations. Importantly, these studies critically inform the rational design of broadly active vaccines and immunotherapeutics for the treatment of norovirus disease.
PMCID: PMC3355092  PMID: 22615565
6.  MED23/404: The KASUS-Platform for Problem-Oriented Learning Groups: Using a digital camera and a Palm Pilot II to document clinical cases and share them over the WWW 
In addition to regular seminars, the department for Internal Medicine at the Heart Center Leipzig uses Bedside-Teaching and Problem-Oriented Learning (POL) to teach medical students. The advantages of those teaching methods consist in their ability to foster active student inquiry and critical thinking. To have the chance to record interesting cases and reuse them for later seminars, the department beta-tested the PC/WWW-Platform KASUS. Acquiring a case and implementing it into the KASUS database for future use is achieved with a simple system consisting of a palmtop computer and a digital camera. Sharing the cases with other groups learning in the POL-format is possible with the KASUS ONLINE application and the WWW-based "Studentencafe", which allows students to share and discuss cases in different forums.
The Platform ( consists of two modules: One module is intended for case presentation and case-workup. A second module is intended for case material sharing, POL-group preceptor discussion and information exchange on POL. Both modules use static/dynamic HTML and can be used local or over a TCP/IP network. For the case acquirement a normal Palm Pilot II and a digital camera were used to document case histories and findings. The Palm Pilot II was equipped with a Jfile database which can be synchronized with the KASUS-Database.
Material for single cases could be acquired and the material could be presented in students´ seminars successfully. The Palm Pilot II performed good, but showed not to be fast enough to type in the case material. For digital case-documentation and the adequate case-authoring for POL-groups guidelines were put up. A small library with Acrobat Reader Files linked e.g. with recorded heart/lung sounds was collected for modular use with the system. The "Studentencafe" was launched in the internet. Existing POL groups at the University of Leipzig and the FU Berlin started using this module for information exchange and serve as content providers.
With the combination of a palmtop computer and digital camera, case documentation and implementation in a case database is fast and effective. The advantages of the established platform lie in its utilization of the universal accessibility and network capabilities of the WWW. The use of an Internet web-browser interface provides platform-independent access and the opportunity to share and discuss case information from different remote locations. We believe that those applications can support POL groups in establishing intensive communication and can supplement their traditional POL learning approach by using the internet-support. Cases can be exchanged more easily, including complex multimedia case-related data. Facilitated information exchange on an inter-university level offers an opportunity to discuss with students coming from different backgrounds.
PMCID: PMC1761714
Problem-based Learning; Internet; Medical Education; Digital Camera; Palm Pilot; Kasus
7.  A Brief Educational Intervention in Personal Finance for Medical Residents 
Although medical educational debt continues to escalate, residents receive little guidance in financial planning.
To educate interns about long-term investment strategies.
University-based medicine internship program.
Program Description
An unselected cohort of interns (n = 52; 84% of all interns) underwent a 90-minute interactive seminar on personal finance, focusing on retirement savings. Participants completed a preseminar investor literacy test to assess baseline financial knowledge. Afterward, interns rated the seminar and expressed their intention to make changes to their long-term retirement accounts. After 37 interns had attended the seminar, a survey was administered to all interns to compare actual changes to these accounts between seminar attendees and nonattendees.
Measurements and Main Results
Interns’ average score on the investor literacy test was 40%, equal to the general population. Interns strongly agreed that the seminar was valuable (average 5.0 on 5-point Likert scale). Of the 46 respondents to the account allocation survey, interns who had already attended the seminar (n = 25) were more likely than interns who had not yet attended (n = 21) to have switched their investments from low to high-yield accounts at the university hospital (64 vs 19%, P = 0.003) and to enroll in the county hospital retirement plan (64 vs 33%, P = 0.07).
One 90-minute seminar on personal finances leads to significant changes in allocation of tax-deferred retirement savings. We calculate that these changes can lead to substantial long-term financial benefits and suggest that programs consider automatically enrolling trainees into higher yield retirement plans.
PMCID: PMC1824762  PMID: 17356971
curriculum program/evaluation; financial management; medical student and residency education
8.  A Brief Educational Intervention in Personal Finance for Medical Residents 
Although medical educational debt continues to escalate, residents receive little guidance in financial planning.
To educate interns about long-term investment strategies.
University-based medicine internship program.
Program Description
An unselected cohort of interns (n = 52; 84% of all interns) underwent a 90-minute interactive seminar on personal finance, focusing on retirement savings. Participants completed a preseminar investor literacy test to assess baseline financial knowledge. Afterward, interns rated the seminar and expressed their intention to make changes to their long-term retirement accounts. After 37 interns had attended the seminar, a survey was administered to all interns to compare actual changes to these accounts between seminar attendees and nonattendees.
Measurements and Main Results
Interns’ average score on the investor literacy test was 40%, equal to the general population. Interns strongly agreed that the seminar was valuable (average 5.0 on 5-point Likert scale). Of the 46 respondents to the account allocation survey, interns who had already attended the seminar (n = 25) were more likely than interns who had not yet attended (n = 21) to have switched their investments from low to high-yield accounts at the university hospital (64 vs 19%, P = 0.003) and to enroll in the county hospital retirement plan (64 vs 33%, P = 0.07).
One 90-minute seminar on personal finances leads to significant changes in allocation of tax-deferred retirement savings. We calculate that these changes can lead to substantial long-term financial benefits and suggest that programs consider automatically enrolling trainees into higher yield retirement plans.
PMCID: PMC1824762  PMID: 17356971
curriculum program/evaluation; financial management; medical student and residency education
9.  A case study of haemoglobinopathy screening in the Netherlands: witnessing the past, lessons for the future 
Ethnicity & Health  2011;17(3):217-239.
Objectives. In 2007 neonatal screening (NNS) was expanded to include screening for sickle cell disease (SCD) and beta-thalassaemia. Up until that year no formal recommendations for haemoglobinopathy (carrier) screening existed in the Netherlands. Although it has been subject to debate in the past, preconceptional and prenatal haemoglobinopathy carrier screening are not part of routine healthcare in the Netherlands. This study aimed to explore the decision-making process of the past: why was the introduction of a screening programme for haemoglobinopathy considered to be untimely, and did ethnicity play a role given the history in other countries surrounding the introduction of haemoglobinopathy screening?
Design. A witness seminar was organised, inviting key figures to discuss the decision-making process concerning haemoglobinopathy screening in the Netherlands, thereby adding new perspectives on past events. The transcript was content-analysed.
Results. The subject of haemoglobinopathy screening first appeared in the 1970s. As opposed to a long history of neglect of African-American health in the United States, the heritage of the Second World War influenced the decision-making process in the Netherlands. As a consequence, registration of ethnicity surfaced as an impeding factor. However, overall, official Dutch screening policy was restrained regarding reproductive issues caused by fear of eugenics. In the 1990s haemoglobinopathy screening was found to be ‘not opportune’ due to low prevalence, lack of knowledge and fear of stigmatisation. Currently the registration of ethnicity remains on the political agenda, but still proves to be a sensitive subject.
Discussion. Carrier screening in general never appeared high on the policy agenda. Registration of ethnicity remains sensitive caused by the current political climate. Complexities related to carrier screening are a challenge in Dutch healthcare. Whether carrier screening will be considered a valuable complementary strategy in the Netherlands, depends partly on participation of representatives of high-risk groups in policy making.
PMCID: PMC3396381  PMID: 21819310
screening; haemoglobinopathy; sickle cell; ethnicity; reproductive choice; eugenics
10.  The emergence of community health worker programmes in the late apartheid era in South Africa: An historical analysis 
Social Science & Medicine (1982)  2010;71(6-3):1110-1118.
There is re-emerging interest in community health workers (CHWs) as part of wider policies regarding task-shifting within human resources for health. This paper examines the history of CHW programmes established in South Africa in the later apartheid years (1970s–1994) – a time of innovative initiatives. After 1994, the new democratic government embraced primary healthcare (PHC), however CHW initiatives were not included in their health plan and most of these programmes subsequently collapsed. Since then a wide array of disease-focused CHW projects have emerged, particularly within HIV care.
Thirteen oral history interviews and eight witness seminars were conducted in South Africa in April 2008 with founders and CHWs from these earlier programmes. These data were triangulated with written primary sources and analysed using thematic content analysis. The study suggests that 1970s–1990s CHW programmes were seen as innovative, responsive, comprehensive and empowering for staff and communities, a focus which respondents felt was lost within current programmes. The growth of these earlier projects was underpinned by the struggle against apartheid. Respondents felt that the more technical focus of current CHW programmes under-utilise a valuable human resource which previously had a much wider social and health impact. These prior experiences and lessons learned could usefully inform policy-making frameworks for CHWs in South Africa today.
PMCID: PMC2941026  PMID: 20638169
Community health workers; Community health worker (CHW) policy; South Africa; Oral history; Apartheid; Task-shifting; Community participation
11.  Peer review and journal impact factor: the two pillars of contemporary medical publishing 
Hippokratia  2010;14(Suppl 1):5-12.
The appraisal of scientific quality is a particularly difficult problem. Editorial boards resort to secondary criteria including crude publication counts, journal prestige, the reputation of authors and institutions, and estimated importance and relevance of the research field, making peer review a controversial rather than a rigorous process. On this background different methods for evaluating research may become required, including citation rates and journal impact factors (IF), which are thought to be more quantitative and objective indicators, directly related to published science. The aim of this review is to go into the two pillars of contemporary medical publishing, that is the peer review process and the IF. Qualified experts' reviewing the publications appears to be the only way for the evaluation of medical publication quality. To improve and standardise the principles, procedures and criteria used in peer review evaluation is of great importance. Standardizing and improving training techniques for peer reviewers, would allow for the magnification of a journal's impact factor. This may be a very important reason that impact factor and peer review need to be analyzed simultaneously. Improving a journal's IF would be difficult without improving peer-review efficiency. Peer-reviewers need to understand the fundamental principles of contemporary medical publishing, that is peer-review and impact factors. The current supplement of the Hippokratia for supporting its seminar for reviewers will help to fulfil some of these scopes.
PMCID: PMC3049421  PMID: 21487485
impact factor; peer-review; citation; editor; medical; quality
12.  The Relationship between Media Consumption and Health-Related Anxieties after the Fukushima Daiichi Nuclear Disaster 
PLoS ONE  2013;8(8):e65331.
The Fukushima Daiichi nuclear disaster caused a global panic by a release of harmful radionuclides. In a disaster setting, misusage of contemporary media sources available today can lead to disseminated incorrect information and panic. The study aims to build a scale which examines associations between media and individual anxieties, and to propose effective media usages for future disaster management.
The University of Tokyo collaborated with the Fukushima local government to conduct a radiation-health-seminar for a total of 1560 residents, at 12 different locations in Fukushima. A 13 item questionnaire collected once before and after a radiation-seminar was used on factor analysis to develop sub-scales for multiple regression models, to determine relationships between the sub-scales and media type consumed. A paired t–test was used to examine any changes in sub-scale of pre- and post-seminar scores.
Three sub-scales were revealed and were associated with different media types: was with rumors, while concern for the future was positively associated with regional-newspapers and negatively with national-newspapers. Anxiety about social-disruption was associated with radio. The seminar had a significant effect on anxiety reduction for all the three sub-scales.
Different media types were associated with various heightened concerns, and that a radiation seminar was helpful to reduce anxieties in the post-disaster setting. By tailoring post-disaster messages via specific media types, i.e., radio, it may be possible to effectively convey important information, as well as to calm fears about particular elements of post-disaster recovery and to combat rumors.
PMCID: PMC3743804  PMID: 23967046
13.  Evidence-based Health Care Continuing Education Seminars Improve Academic Staff Knowledge and Attitudes in Saudi Arabia 
Objective: To assess the influence of a monthly evidence-based health care (EBHC) seminar series on academic staff knowledge, attitudes, and barriers regarding EBHC practice.
Methodology: All academic staff in the College of Applied Medical Sciences (CAMS), King Saud University, Saudi Arabia, were sent a validated web-based survey. The survey contained 35 items regarding 3 domains: knowledge (14 items), attitudes (11 items), and barrier factors (10 items). A 5-point Likert scale was used and descriptive statistics were generated for demographic data and participants’ responses to each item.
Results: Among academic staff at CAMS, 79 of 198 (40%) completed the survey. Among the survey respondents, 58% had attended at least one EBHC seminar. Those who had attended at least one seminar had better knowledge of 8 items compared with those who did not attend any seminars (P<.05). Academic staff members who attended at least one seminar were more likely to have a positive attitude regarding EBHC. Insufficient time was the only factor that significantly differed between the 2 groups, serving as a barrier to EBHC practice.
Conclusions: Our findings suggest that EBHC seminars may improve the abilities and skills of academic staff for using EBHC.
PMCID: PMC3809279  PMID: 24353612
Evidence-based health care; Health profession education; Academic staff
14.  A model for offering an International Medicine Seminar Course for US medical students: the 13-year experience of the New Jersey Medical School. 
An International Medicine Elective Seminar Course at the New Jersey Medical School (NJMS) was designed in 1985 to present a description of medical education, medical care systems, major global health problems, and intervention programs in other countries. Seminars are scheduled for nine weeks in the fall semester. At the end of each course, the medical students complete evaluations. Almost all (97%) students in 1997-1998 evaluated the course as either good (55%) or excellent (45%). Enrollment in the International Medicine Seminar Course increased from 12 medical students in 1985-1986 to 62 students in 1997-1998. An increasing number of students have applied for a fourth-year overseas International Medicine Elective. This and students' evaluations indicated that they have been motivated toward international medicine. The atmosphere of informal seminars and faculty interaction with students has characterized the course. It has made this model of teaching an ideal forum for medical students' professional growth. This course offers students the opportunity and insight to explore facets of their professional role not explicitly covered in the formal medical curriculum. The International Medicine Seminar Course is a self-supported model and can be adopted readily by other medical schools.
PMCID: PMC2608518  PMID: 10599189
15.  Witnessing Violence Toward Siblings: An Understudied but Potent Form of Early Adversity 
PLoS ONE  2011;6(12):e28852.
Research on the consequences of witnessing domestic violence has focused on inter-adult violence and most specifically on violence toward mothers. The potential consequences of witnessing violence to siblings have been almost entirely overlooked. Based on clinical experience we sought to test the hypothesis that witnessing violence toward siblings would be as consequential as witnessing violence toward mothers. The community sample consisted of unmedicated, right-handed, young adults who had siblings (n = 1,412; 62.7% female; 21.8±2.1 years of age). History of witnessing threats or assaults to mothers, fathers and siblings, exposure to parental and sibling verbal abuse and physical abuse, sexual abuse and sociodemographic factors were assessed by self-report. Symptoms of depression, anxiety, somatization, anger-hostility, dissociation and ‘limbic irritability’ were assessed by rating scales. Data were analyzed by multiple regression, with techniques to gauge relative importance; logistic regression to assess adjusted odds ratios for clinically-significant ratings; and random forest regression using conditional trees. Subjects reported witnessing violence to siblings slightly more often than witnessing violence to mothers (22% vs 21%), which overlapped by 51–54%. Witnessing violence toward siblings was associated with significant effects on all ratings. Witnessing violence toward mother was not associated with significant effects on any scale in these models. Measures of the relative importance of witnessing violence to siblings were many fold greater than measures of importance for witnessing violence towards mothers or fathers. Mediation and structural equation models showed that effects of witnessing violence toward mothers or fathers were predominantly indirect and mediated by changes in maternal behavior. The effects of witnessing violence toward siblings were more direct. These findings suggest that greater attention be given to the effects of witnessing aggression toward siblings in studies of domestic violence, abuse and early adversity.
PMCID: PMC3244412  PMID: 22216127
16.  The views of doctors in their first year of medical practice on the lasting impact of a preparation for house officer course they undertook as final year medical students 
BMC Medical Education  2010;10:48.
The UK General Medical Council recommends that medical students have the opportunity of shadowing the outgoing new doctor whose post they will soon undertake. At the University of Nottingham the two-week shadowing period was preceded by two weeks of lectures/seminars wherein students followed sessions on topics such as common medical/surgical emergencies, contracts, time management, surviving the first two years of clinical practice, careers advice and so on.
The present study aimed to gain a better knowledge and understanding of the lasting impact of a four-week preparation course for new Foundation Year 1 doctors [F1 s - interns]. The objectives chosen to achieve this aim were:
1/ to determine the extent to which the lecture/seminar course and shadowing period achieved their stated aim of smoothing the transition from life as a medical student to work as a new doctor;
2/ to evaluate perceptions of the importance of various forms of knowledge in easing the transition between medical student and new doctor
In the spring of 2007, 90 graduates from Nottingham were randomly selected and then emailed a link to a short, online survey of quantitative and qualitative questions. Of these 76 responded. Analysis of quantitative data was carried out using SPSS 16.0 and employed McNemar's test. Analysis of the qualitative data was carried out using the constant comparative method.
Only 31% of respondents strongly agreed or agreed that the lecture/seminar part of the course prepared them well for their first FY1 post; 14% agreed that during their first job they drew on the knowledge gained during the lecture/seminar course; 94% strongly agreed or agreed that the shadowing part of the course was more useful than the lecture/seminar part.
Experiential knowledge gained in the shadowing was the most highly valued, followed by procedural knowledge with propositional knowledge coming far behind.
Our study shows that new doctors retrospectively value most the knowledge they are able to transfer to the workplace and value least material which seems to repeat what they had learned for their final exams.
PMCID: PMC2909973  PMID: 20573253
17.  Characteristics of inmates witnessing overdose events in prison: implications for prevention in the correctional setting 
Although prevention of opiate overdose has been gaining attention as a harm reduction measure with community drug users, there is scarce information about drug overdose in prison. In correctional institutions without a drug free environment, awareness of overdose events is an important public health concern. This study explores the frequency with which inmates in a state penitentiary system report having witnessed drug overdose events in prison. It also explores whether participants who have witnessed an overdose in prison and know someone who died from an overdose in prison significantly differ from those that do not in selected sociodemographic variables and drug use history to identify a target population for prevention interventions.
Data comes from a cross-sectional survey of sentenced inmates in the state prisons of Puerto Rico. A complex probabilistic, multistage sampling design was used. A total of 1,179 individuals participated for an 89% response rate.
Factors associated with witnessing an overdose event in prison include: male sex, age 25 or older, drug use during current incarceration, and drug injection in prison. Factors associated with knowing someone who died from an overdose in prison include: male sex, age between 25–35, previous incarcerations, and drug use during current incarceration.
Witnessing a drug overdose is a frequent occurrence within the prison system. The likelihood of witnessing an overdose is greater with being male, polydrug use and drug injection in prison. Findings signal an urgent public health challenge that requires prompt interventions to reduce this drug related harm within the correctional system, including adequate access to medication with opiate agonists.
PMCID: PMC2718878  PMID: 19589157
18.  Conducting correlation seminars in basic sciences at KIST Medical College, Nepal 
KIST Medical College is a new medical school in Lalitpur, Nepal. In Nepal, six basic science subjects are taught together in an integrated organ system-based manner with early clinical exposure and community medicine. Correlation seminars are conducted at the end of covering each organ system. The topics are decided by the core academic group (consisting of members from each basic science department, the Department of Community Medicine, the academic director, and the clinical and program coordinators) considering the public health importance of the condition and its ability to include learning objectives from a maximum number of subjects. The learning objectives are decided by individual departments and finalized after the meeting of the core group. There are two student coordinators for each seminar and an evaluation group evaluates each seminar and presenter. Correlation seminars help students revise the organ system covered and understand its clinical importance, promote teamwork and organization, and supports active learning. Correlation seminars should be considered as a learning modality by other medical schools.
PMCID: PMC3208187  PMID: 22066033
Educational measurement; Learning; Medical school; Nepal; Undergraduate medical education
19.  Evaluating an educational intervention to improve the accuracy of death certification among trainees from various specialties 
The inaccuracy of death certification can lead to the misallocation of resources in health care programs and research. We evaluated the rate of errors in the completion of death certificates among medical residents from various specialties, before and after an educational intervention which was designed to improve the accuracy in the certification of the cause of death.
A 90-min seminar was delivered to seven mixed groups of medical trainees (n = 166) from several health care institutions in Spain. Physicians were asked to read and anonymously complete a same case-scenario of death certification before and after the seminar. We compared the rates of errors and the impact of the educational intervention before and after the seminar.
A total of 332 death certificates (166 completed before and 166 completed after the intervention) were audited. Death certificates were completed with errors by 71.1% of the physicians before the educational intervention. Following the seminar, the proportion of death certificates with errors decreased to 9% (p < 0.0001). The most common error in the completion of death certificates was the listing of the mechanism of death instead of the cause of death. Before the seminar, 56.8% listed respiratory or cardiac arrest as the immediate cause of death. None of the participants listed any mechanism of death after the educational intervention (p < 0.0001).
Major errors in the completion of the correct cause of death on death certificates are common among medical residents. A simple educational intervention can dramatically improve the accuracy in the completion of death certificates by physicians.
PMCID: PMC2194687  PMID: 18005414
20.  Evaluating the Impact of Pain Management (PM) Education on Physician Practice Patterns—A Continuing Medical Education (CME) Outcomes Study 
California Assembly Bill AB487 mandates that all practicing physicians are required to obtain 12 h of Continuing Medical Education in Pain Management and End of Life Care before the year 2006 in order to renew their state license to practice medicine. In order to determine the effectiveness of this bill in influencing the practice of medicine, we conducted the first of five planned annual Pain Management seminars and utilized physician questionnaires to determine possible practice changes as a result of this seminar. Eighty-one physicians representing 17 multiple specialties of medicine enrolled in this seminar. The topics included: management of malignant and non-malignant pain, pharmacology and management of side effects of opiate and non-opiate analgesics, and adjunctive therapies including depression management and spirituality issues. Physicians were asked to respond to an immediate post-seminar questionnaire and were subsequently queried 4 months following the conference. Fifty-one out of 81 physician registrants responded to an immediate post-attendance questionnaire, and 31 responded to the 4-month follow-up questionnaire. Responses included:
EarlyLateI will change/have changed my practice3428I see no need to change my practice62I will await further information71No response regarding practice change4Responses of those who changed their practices included: Increased use of known modalities for pain control21 Earlier referrals to specialists14 More attention to psychosocial aspects14 Use of new drugs/modalities of care11
This audience represents the most motivated group of practitioners electing to receive Pain Management Education long before the mandated deadline. Sixty-seven percent expressed an interest in changing their practice following this intensive educational experience. Ninety percent responding to the follow-up evaluation indicated that their practices had changed, suggesting that this seminar series is effective in altering physician practice patterns (supported by Cancer Center Support Grant CA 33572 and Sarnat Foundation).
PMCID: PMC3751402  PMID: 20204577
California Assembly Bill AB487; Pain management; Practicing physicians
21.  Current Concepts in the Neurophysiologic Basis of Sleep; a Review 
Sleep is a very vital physiological mechanism, which involves complex interactions in the nervous system. These interactions are not well understood and have been a subject of controversy in contemporary medical practice.
To review of the neurophysiological factors in the subject of sleep, and recent research findings that forms the basis for the current knowledge on sleep.
Information sources consulted included, published works of past researchers, current articles on sleep in conference papers, recent editions of textbooks on neuroscience, articles in seminar papers, reports extracted from newspaper and magazine articles on sleep, reports accessed from the Internet using Google Search Engines and lecture notes.
It was noted that emphasis has now shifted from the concept that sleep was predominantly the product of activities in the neural systems in phylogenetically old reticular core of the brain through withdrawal of sensory input, to emphasis on the role of neurotransmitter systems, especially - Ach, serotonin and GABA. This review also noted that, among others, emphasis is further shifting to the PGO waves which is fast gaining prominence as the mechanism involved in the production of REM sleep and dreams in particular.
It became obvious from this review, that full knowledge of the neurophysiological processes involved in sleep production appear generally to still be more of speculative, and are yet far from full understanding.
PMCID: PMC3507109  PMID: 23209972
Current concepts; neurophysiological basis; sleep
22.  In vivo molecular targeted radiotherapy 
Unsealed radionuclides have been in clinical therapeutic use for well over half a century. Following the early inappropriate clinical administrations of radium salts in the early 20th century, the first real clinical benefits became evident with the use of 131I-sodium iodide for the treatment of hypothyroidism and differentiated thyroid carcinoma and 32P-sodium phosphate for the treatment of polycythaemia vera. In recent years the use of bone seeking agents 89Sr, 153Sm and 186Re for the palliation of bone pain have become widespread and considerable progress has been evident with the use of 131I-MIBG and 90Y-somatostatin receptor binding agents. Although the use of monoclonal antibody based therapeutic products has been slow to evolve, the start of the 21st century has witnessed the first licensed therapeutic antibody conjugates based on 90Y and 131I for the treatment of non-Hodgkin's lymphoma. The future clinical utility of this form of therapy will depend upon the development of radiopharmaceutical conjugates capable of selective binding to molecular targets. The availability of some therapeutic radionuclides such as 188Re produced from the tungsten generator system which can produce activity as required over many months, may make this type of therapy more widely available in some remote and developing countries.
Future products will involve cytotoxic radionuclides with appropriate potency, but with physical characteristics that will enable the administration of therapeutic doses with the minimal need for patient isolation. Further developments are likely to involve molecular constructs such as aptamers arising from new developments in biotechnology.
Patient trials are still underway and are now examining new methods of administration, dose fractionation and the clinical introduction of alpha emitting radiopharmaceutical conjugates. This review outlines the history, development and future potential of these forms of therapy.
PMCID: PMC3097596  PMID: 21625282
Radionuclide therapy; nuclear medicine therapy; targeted therapy
23.  A qualitative study of overdose responses among Chicago IDUs 
Opioid overdose is a leading cause of death among injection drug users. Over half of injection drug users report at least one nonfatal overdose during their lifetime. Death from opioid overdose rarely occurs instantaneously, but rather over the course of one to three hours, allowing ample time for providing life-saving measures. In response to the prevalence of overdoses in the U.S., there are a growing number of overdose prevention and naloxone distribution programs targeting the injection drug using community.
We explored injection drug users' experiences with opioid overdose response, examining differences between overdose responses in which naloxone was and was not used. The current study is based upon qualitative interviews (N = 31) with clients of the Chicago Recovery Alliance needle exchange program who had witnessed an overdose in the past six months. The interviews explored participants' drug use history, personal overdose experiences, and details concerning their last witnessed overdose. Verbatim transcripts were coded and analyzed thematically to address major study questions.
Participants were 81% were male, their median age was 38. They reported having injected a median of 10 years and having witnessed a median of six overdoses in their lifetime. All described overdoses were recognized and responded to quickly. None of the overdoses resulted in a fatality and naloxone was successfully administered in 58% of the last witnessed overdoses. Administering naloxone for the first time was characterized by trepidation, but this feeling dissipated as the naloxone quickly took effect. Emergency medical personnel were called in 10 of the 31 described overdoses, including four in which participants administered naloxone. The overwhelming majority of experiences with police and paramedics were positive
Overall, our small study found that the overdose prevention efforts build on extensive knowledge possessed by IDUs. Teaching IDUs how to use naloxone is an effective risk reduction strategy.
PMCID: PMC2245921  PMID: 18218071
24.  Spirituality and health in the curricula of medical schools in Brazil 
BMC Medical Education  2012;12:78.
According to recent surveys, 59% of British medical schools and 90% of US medical schools have courses or content on spirituality and health (S/H). There is little research, however, on the teaching of S/H in medical schools in other countries, such as those in Latin America, Asia, Australia and Africa. The present study seeks to investigate the current status of teaching on S/H in Brazilian medical schools.
All medical schools in Brazil (private and public) were selected for evaluation, were contacted by email and phone, and were administered a questionnaire. The questionnaire, sent by e-mail, asked medical school directors/deans about any S/H courses that were taught, details about those courses, S/H lectures or seminars, importance of teaching this subject for medical school directors, and medical schools characteristics.
A total of 86 out of 180 (47.7%) medical schools responded. Results indicated that 10.4% of Brazilian Medical Schools have a dedicated S/H courses and 40.5% have courses or content on spirituality and health. Only two medical schools have S/H courses that involve hands-on training and three schools have S/H courses that teach how to conduct a spiritual history. The majority of medical directors (54%) believe that S/H is important to teach in their schools.
Few Brazilian medical schools have courses dealing specifically with S/H and less than half provide some form of teaching on the subject. Unfortunately, there is no standard curriculum on S/H. Nevertheless, the majority of medical directors believe this issue is an important subject that should be taught.
PMCID: PMC3502099  PMID: 22900476
Spirituality; Religion; Medical education; Medical schools; Medical students
25.  Evaluation of a communication skills seminar for students in a Japanese medical school: a non-randomized controlled study 
Little data exist for the effectiveness of communication skills teaching for medical students in non-English speaking countries. We conducted a non-randomized controlled study to examine if a short intensive seminar for Japanese medical students had any impact on communication skills with patients.
Throughout the academic year 2001–2002, a total of 105 fifth-year students (18 groups of 5 to 7 students) participated, one group at a time, in a two-day, small group seminar on medical interviewing. Half way through the year, a five-station objective structured clinical examination (OSCE) was conducted for all fifth-year students. We videotaped all the students' interaction with a standardized patient in one OSCE station that was focused on communication skills. Two independent observers rated the videotapes of 50 students who had attended the seminar and 47 who had not. Sixteen core communication skills were measured. Disagreements between raters were resolved by a third observer's rating.
There was a statistically significant difference in proportions of students who were judged as 'acceptable' in one particular skill related to understanding patient's perspectives: asking how the illness or problems affected the patient's life, (53% in the experimental group and 30% in the control group, p = .02). No differences were observed in the other 15 core communication skills, although there was a trend for improvement in the skill for asking the patient's ideas about the illness or problems (60% vs. 40%, p = .054) and one of the relationship building skills; being attentive and empathic nonverbally (87% vs. 72%, p = .064).
The results of this study suggest that a short, intensive small group seminar for Japanese medical students may have had a short-term impact on specific communication skills, pertaining to understanding patient's perspectives.
PMCID: PMC534797  PMID: 15550166

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