Objective: The purpose of this study was to evaluate the feasibility of a flipped classroom progamme, designed and implemented by medical students, in communicating nutrition education to fourth-grade school students aged 9–10 years and to characterise teachers’ assessments of the progamme, which was designed to minimise the burden placed on teachers. Design: Each student–participant served as control before and as case after exposure to the novel healthSLAM (hS) curriculum. The results on the pre-tests and post-tests were matched and compared. Teachers completed a one-time survey after observing the new curriculum. Setting: The study was conducted in 2013 in the fourth-grade classrooms of an elementary school in Derry Township, Pennsylvania, USA. Methods: The hS progamme included a web-based video that delivered nutrition education didactics and a classroom portion in which medical students guided exercises to reinforce nutrition concepts discussed in the video. A pre-test and post-test were given to students, and teachers completed a survey to determine the effects of the curriculum on nutrition knowledge, and teacher surveys were administered to assess the appropriateness and acceptability of the curriculum. In all, 166 students’ pre- and post-tests from nine different classrooms were analysed. Results: Significant improvements in nutrition knowledge in both median and mean test scores were found ( p < .001), and the raw pre-test and post-test score distributions were found to be homogeneous across the nine different classrooms studied. Teachers reported the new curriculum to be feasible and grade-appropriate. Conclusion: The hS programme, rooted in flipping pedagogy using a video didactic lecture and an activity-based classroom session to reinforce concepts, appeared to communicate nutrition information successfully and was seen as both feasible and acceptable by teachers.
Phyllodes tumor is an uncommon breast lesion with characteristic histologic appearance when examined by hematoxylin and eosin staining: leaf-like fronds projecting into cystic spaces on low-power microscopy, and biphasic (epithelial and stromal) components on high-power microscopy. We report a rare primary case of this tumor arising within the vulva. A 34-year old African American female presented with a 3 cm slow-growing vulvar mass initially thought to be an inclusion cyst. The lesion was excised and histologic examination demonstrated this lesion to be a rare case of benign phyllodes tumor with morphologic features similar to those arising from breast tissue. Patient received no further treatment and did not exhibit any recurrence or metastasis. Nearly two years after excision, the patient died due to an unrelated medical cause. This rare tumor should be considered in the differential diagnosis for women presenting with a slow-growing vulvar mass.
Our goal was to assess adherence to American College of Cardiology/American Heart Association guideline-based medical therapy in patients admitted with type I non-ST elevation myocardial infarction (NSTEMI) and to determine factors associated with medication administration delay. We performed a retrospective analysis using data from the Acute Coronary Treatment and Intervention Outcomes Network (ACTION) Registry. Baseline patient demographics, 12-lead electrocardiogram (ECG) findings, laboratory values, medications administered and the time they were administered, and in-hospital clinical outcomes were collected. Global Registry of Acute Coronary Events risk scores were calculated for all patients. We included 1002 patients admitted from the emergency department with a type I NSTEMI. A total of 802 (80%) patients received appropriate initial therapy consisting of therapeutic anticoagulation with heparin and dual antiplatelet therapy. Of the 200 (20%) patients who did not receive therapy, documentation in the chart regarding possible contraindications for administration of the medications was missing in up to half. Female sex, older age, a normal initial ECG, and prolonged time spent in the emergency department were predictors of significant delay in receiving guideline-based medications, while an elevated initial troponin was a predictor of faster medication administration. Global Registry of Acute Coronary Events risk scores had no association with the timing of medication administration. In conclusion, 20% of NSTEMI patients did not receive American College of Cardiology/American Heart Association guideline-based medical therapy. Delay in medication administration was significant for women, older individuals, and patients who did not have ischemic findings on the initial ECG.
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