According to MITI scores, standardised patient role-plays are similar in effectiveness to student role-plays when teaching basic motivational interviewing skills for smoking cessation to Year 3 medical students.
Background: One of the US government health goals outlined in the Healthy People 2010 document (2000) is to increase the number of physicians who counsel their patients regarding unhealthy behaviors. Studies have shown a low rate of physicians provide smoking cessation counseling. We introduced a motivational interviewing curriculum into our medical school for first and third year students and then evaluated the effect of this curriculum on third year students counseling skills. Methods: The motivational interviewing curriculum was comprised of a lecture series and small group teaching with practice in role plays. The effectiveness of the curriculum was evaluated by student performance in a videotaped interview with a standardized patient who portrayed a smoker. The interview was rated using the Motivational Interviewing Treatment Integrity scoring tool (MITI). The MITI assesses 6 criteria: empathy, MI spirit (autonomy, evocation and collaboration), MI adherence (asking permission, affirmation, emphasis of control and support), MI non adherence (advise, confront and direct), the types of questions (open or closed) and the number of reflections. Secondary outcomes included a knowledge exam related to motivational interviewing and students' evaluations of the effectiveness of the motivational interviewing curriculum. Results: Analysis of the MITI scores showed that students reached a proficiency level on the rate of reflections, were just below proficiency in assessment of empathy and motivational interviewing spirit and substantially below proficiency in the percent of open ended questions. These proficiency scores were for professional counselors but nevertheless provided us with information on the effectiveness of the new curriculum and where the focus of our teaching should be. On the optional evaluation of the first-year MI curriculum by 112 students, 83% felt that the MI curriculum had helped them be more comfortable in discussing behavior change with patients and 98% felt it was an important skill for physicians to have.
The uptake kinetics of a 14C-labelled trypanocidal compound isometamidium chloride (Samorin, RMB Animal Health Ltd, UK) was measured in drug-resistant and drug-sensitive Trypanosoma congolense. It was established that drug uptake was significantly more rapid and quantitatively greater in drug-sensitive parasites. There was clear evidence that drug uptake in both the resistant and sensitive trypanosomes was by a specific, receptor-mediated process. This specific drug transport was energy-dependent, being sensitive to metabolic inhibition with SHAM/glycerol. Significant differences in drug transport were observed which could be correlated with resistance to isometamidium. The optimal pH for drug accumulation was lowered in the resistant trypanosomes; this finding, along with an observed change in specificity for the related compound homidium bromide, suggested that the specific receptor for isometamidium is altered in the resistant trypanosomes, possibly resulting in a reduction in drug uptake. In addition to these alterations in drug uptake, efflux of isometamidium also appears to occur in the resistant trypanosomes. Both a reduction in incubation temperature and metabolic inhibition increased the level of trypanosome-associated isometamidium in the resistant parasites. This was in contrast to observations using drug-sensitive parasites. Furthermore, the addition of calcium flux-modulating agents to the incubation medium also resulted in an increase in accumulation by the resistant parasites.
Strongyloides is endemic in parts of the United States. Most often it is asymptomatic but it has a wide range of clinical presentations. Because of the unusual capacity of strongyloides for autoinfection, it can cause hyperinfection, when it effects the pulmonary and gastrointestinal systems, or disseminated infection, when other organs are involved. Both hyperinfection and disseminated strongyloides usually occur in immunosuppressed patients. We report a case of hyperinfection with strongyloides in a man presenting with fever of unknown origin who was not immunosuppressed. ( A 36-year-old Hispanic man presented with 4 weeks of fever up to 38.8°C, a nonproductive cough, generalized abdominal pain, and a 12-lb weight loss. He had no history of tick exposure, contact with sickness, or recent travel. He had been treated previously with antiviral medication for influenza and with ciprofloxacin for presumptive prostatitis with no improvement in his symptoms. He had no significant medical history and was not taking any chronic medications. He worked as a brick layer and lived with his wife and children in rural North Carolina; he denied alcohol use. Review of systems was negative for diarrhea, vomiting, rash, night sweats, and dysuria. It was positive for headache, malaise, myalgias, arthralgias, and decreased appetite.Physical examination revealed a well-nourished, well-developed man who appeared flushed but was otherwise in no acute distress. He had a temperature of 38.6°C, pulse of 95 beats per minute, respiratory rate of 22 breaths per minute, and blood pressure of 146/83 mm Hg. Physical examination was otherwise normal. Laboratory examination revealed a white blood cell count of 11.2 ϫ 10
Background: Computer-based learning (CBL) is an effective form of medical education. Educators have developed recommendations for instructional design but there is only minimal research that evaluates these recommendations. Aim: To evaluate the effect of case-based questions contained in computer modules on learning efficacy. Methods: The authors conducted a randomized controlled trial in 124 medical students of two CBL PowerPoint modules-based on Medicare. The modules were identical except one contained 11 case-based scenarios followed by multiple choice questions. The primary outcome measurement was a previously validated, 11-item knowledge test taken at the end of the module and at the end of the academic year to test retention. Results: The students who studied the module with case-based questions answered one more item correctly in the first test (8.9 vs. 10.00 correct answers, p ¼ 0.001). This difference had disappeared by the time of the second test (4.2 vs. 4.7, p ¼ 0.095).Conclusions: This study shows that computer modules with case-based questions enhance learning in the short-term but at the expense of increased time and so decreased learning efficiency. This learning benefit was not maintained.
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