Residents report that they received inadequate teaching in palliative care and low levels of comfort and skills when taking care of dying patients. This study describes the effects of a problem-based palliative care course on perceived competence and knowledge in a representative Dutch cohort of residents in internal medicine. Before and after the course, we carried out a questionnaire survey and knowledge test in 91 residents. The results show that many residents felt they had limited competence or were incompetent when taking care of patients in the palliative care phase. This was particularly true with respect to communication concerning euthanasia and physician-assisted suicide or hastened death (86% and 85% respectively reported limited competence or incompetence). Participants reported that they received inadequate training in palliative care and believed that specific education would make them feel more competent. The number of times that residents were engaged in palliative care situations and the years of clinical experience had a positive influence on perceived competence. Participating in the course improved perceived competence and knowledge in palliative care. No correlation was found between perceived competence and knowledge of palliative care.

We studied the effect of two diets, one rich in polyunsaturated and the other in saturated fatty acids, on the postprandial processing of exogenous and endogenous triglyceride-rich lipoproteins (chylomicrons, very-low-density lipoproteins, and their remnants). For this purpose, 12 normolipidaemic young volunteers were fed, in a cross-over design of 9 days on each diet, either a diet rich in saturated fat (21% of their daily energy intake from saturated fat, 12% from monounsaturated fat, and 3% from polyunsaturated fat) or a diet rich in polyunsaturated fat (10% saturated fat, 9% monounsaturated fat, and 18% polyunsaturated fat) (P/S ratios 0.14 and 1.8, respectively). On the last day of each dietary period blood samples were drawn six times over a 24-h period for determination, by densitometric scanning of SDS gels, of the diurnal pattern of apoprotein B-48 and B-100 in the d less than 1.019 g ml-1 fractions, as estimates for the processing of chylomicrons and very-low-density lipoproteins. In addition to the usual decrease in the fasting and diurnal concentrations of total serum cholesterol and of cholesterol in the low-density lipoprotein fractions (between 15 and 21%), the diet rich in polyunsaturated fat resulted in 43% lower daily concentrations of chylomicrons and their remnants. This was due to differences in the clearance rate of chylomicrons and their remnants, rather than to differences in the absorption rate of exogenous fat. In addition, the concentrations of very low density lipoproteins and their remnants during the day were 20% lower on the diet rich in polyunsaturated fat.(ABSTRACT TRUNCATED AT 250 WORDS)

Simvastatin appeared to be more potent than pravastatin in lowering total cholesterol, low-density lipoprotein cholesterol and apolipoprotein B, whereas both drugs had the same short-term safety profile.

Policy initiatives that aim to elevate the position of medical teaching to that of medical research could influence the satisfaction of three basic psychological needs related to motivation for medical teaching. To explore relations between the satisfaction of three basic psychological needs towards medical teaching and two policy initiatives for medical teaching: (Junior) Principal Lecturer positions [(J)PL positions] and Subsidized Innovation and Research Projects in Medical Education (SIRPMEs). An online questionnaire was used to collect data about medical teaching in the setting of a university hospital. We adapted the Work-related Basic Need Satisfaction scale (Van den Broeck et al. in J Occup Organ Psychol, 83(4):981-1002, 2010), in order to measure feelings of autonomy, competence, and relatedness in teaching. We examined the relations between (J)PL positions and SIRPMEs and the satisfaction of three basic psychological needs. A total of 767 medical teachers participated. The initiatives appear to be related to different beneficial outcomes in terms of feelings of autonomy, competence, and relatedness in medical teaching. Either a (J)PL position is obtained by teachers who feel competent and related towards medical teaching, or obtaining a (J)PL position makes teachers feel more competent and related towards teaching, or these relations could be interacting. Also, either a SIRPME is obtained by teachers who feel competent and autonomous towards medical teaching, or obtaining a SIRPME makes teachers feel more competent and autonomous towards teaching, or these relations could be interacting. Additional research needs to scrutinize the causal or interacting relations further and to determine optimal conditions for these policy initiatives more specifically. Implications for future research are discussed.

The fluctuations of serum lipid and lipoprotein concentrations within one cycle were studied both in women using and not using oral contraceptives. High-density lipoprotein cholesterol decreased significantly from 1 47 mmol/l (57 mg/100 ml) to 1 30 mmol/l (50 mg/100 ml) during one contraceptive cycle in eight women and rose again to the initial value during the pill-free days. The mean concentration of total cholesterol also fell significantly as a result of the decrease of high-density lipoprotein cholesterol and of a not significant decrease of low-density lipoprotein cholesterol. The mean serum triglyceride concentration did not change significantly. The fluctuations in the concentration of serum lipids and lipoproteins in 10 women not using oral contraceptives were smaller than in the women using oral contraceptives and no significant changes in the concentrations were found during one cycle.Thus, high-density lipoprotein cholesterol concentration decreases during each contraceptive cycle. Since these concentrations are related to the risk of coronary heart disease,5 precise knowledge of the effect of oral contraceptives is of the utmost importance.The effect of oral contraceptives on high-density lipoprotein cholesterol is a particularly controversial subject, probably because of the qualitative and quantitative differences between the many formulations of drug combinations in use.6 7 Moreover, in most of these studies blood samples were taken on random days of the contraceptive cycle. Furthermore, the concentrations of serum lipids and lipoproteins were assumed to be more or less constant during one cycle. This has, however, never been proved. We therefore studied possible changes in the concentrations of serum lipids and lipoproteins during one contraceptive cycle in women using oral contraceptives and also during one menstrual cycle in women not using them.