RESUMEN

Introduction: There is limited information on medical students' perceptions of peer feedback in team-based learning (TBL), both in terms of its value and how it has affected them as they move forward in their careers. The primary goals of this study were to examine students' perceptions about their peer feedback experiences throughout medical school and into residency and to identify areas for improvement to develop a more valuable experience. Materials and Methods: This study utilized exploratory qualitative research. A total of six focus group sessions were conducted, in which each group consisted of medical students or residents. All participants were asked for their thoughts about peer feedback using semi-structured interviews. The sessions were transcribed and thematic analysis of student responses was completed by independent reviewers. Results: A total of 11 first-year, 12 second-year, 12 rising third-year, and 10 rising fourth-year medical students participated in the focus groups. In addition, three graduates participated in the study. Overall, four key themes were identified regarding the peer feedback experience. These included (1) preparation and training, (2) procedure and implementation, (3) evaluation of student feedback, and (4) student considerations. Discussion: The participants indicated that the idea of providing and receiving effective peer feedback throughout the medical school curriculum was a valuable experience. This analysis raised awareness about several potential areas of difficulty for students in regard to the peer feedback process used in TBL. Quality improvement initiatives may include educating students about the use of constructive feedback, adding self-reflection, or using oral instead of written feedback.

RESUMEN

Variation in the structure of host-associated microbial communities has been correlated with the occurrence and severity of disease in diverse host taxa, suggesting a key role of the microbiome in pathogen defense. However, whether these correlations are typically a cause or consequence of pathogen exposure remains an open question, and requires experimental approaches to disentangle. In amphibians, infection by the fungal pathogen Batrachochytrium dendrobatidis (Bd) alters the skin microbial community in some host species, whereas in other species, the skin microbial community appears to mediate infection dynamics. In this study, we completed experimental Bd exposures in three species of tropical frogs (Agalychnis callidryas, Dendropsophus ebraccatus,andCraugastor fitzingeri) that were sympatric with Bd at the time of the study. For all three species, we identified key taxa within the skin bacterial communities that were linked to Bd infection dynamics. We also measured higher Bd infection intensities in D. ebraccatus and C. fitzingeri that were associated with higher mortality in C. fitzingeri. Our findings indicate that microbially mediated pathogen resistance is a complex trait that can vary within and across host species, and suggest that symbiont communities that have experienced prior selection for defensive microbes may be less likely to be disturbed by pathogen exposure.

Asunto(s)

RESUMEN

This paper reports on a study of student peer mentorship in the context of nursing education in a higher education program in Canada. The study used an embodied hermeneutic phenomenological methodology to investigate student peer mentors' perceptions of teaching during peer mentorship. The data were collected over one calendar year (2019) and involved analysis of 10 participants' interview data and their 'body maps,' produced in response to guided questions. Through the data analysis a core theme of 'commitment to mentee growth' was identified, along with seven interrelated themes: sharing responsibility for learning, moderating stress, mediating power relations, navigating unknown processes, valuing creative approaches, offering generous acceptance, and facilitating confidence. Student peer mentorship has the potential to contribute to health professions education in a number of unique ways including through embodied attunement, trusting intersubjective relations, and dialogic education. This study is innovative in its purposeful design and aim to investigate both cognitive and embodied perceptions of student peer mentors. The findings point to the promise of student peer mentorship for advancing health sciences education. Implications for peer mentorship program development in health professions education are discussed.

Asunto(s)

RESUMEN

Threshold concepts are those ideas that learners often find difficult, but must understand in order to master a discipline. Nearly all research into threshold concepts has been from the perspective of teachers. We argue that the students' perspectives can also be helpful. In this commentary, we explore this issue and inform the debate by drawing on insights from a pilot study in which medical students articulated their own views on what constituted threshold concepts from recent learning experiences in physiology. Combining insights, from teachers and students, into candidate threshold concepts could be used to improve the medical curriculum.

RESUMEN

OBJECTIVE: High-grade gliomas (HGGs) continue to carry poor prognoses, and patient outcomes depend heavily on the extent of resection (EOR). The utility of conventional image-guided surgery is limited by intraoperative brain shift. More recent techniques to maximize EOR, including intraoperative imaging and the use of fluorescent dyes, combat these limitations. However, the relative efficacy of these two techniques has never been systematically compared. Thus, the authors performed an exhaustive systematic review in conjunction with quantitative network meta-analyses to evaluate the comparative effectiveness of 5-aminolevulinic acid (5-ALA) and intraoperative MRI (IMRI) in optimizing EOR in HGG. They secondarily analyzed associated progression-free and overall survival and performed subgroup analyses by level of evidence. METHODS: PubMed, Embase, Cochrane Central, and Web of Science were searched for studies evaluating conventional neuronavigation, IMRI, and 5-ALA in HGG resection. The primary study endpoint was the proportion of patients attaining gross-total resection (GTR), defined as 100% elimination of contrast-enhancing lesion on postoperative MRI. Secondary endpoints included overall and progression-free survival and subgroup analyses for level of evidence. Comparative efficacy analysis of IMRI and 5-ALA was performed using Bayesian network meta-analysis models. RESULTS: This analysis included 11 studies. In a classic meta-analysis, both IMRI (OR 4.99, 95% CI 2.65-9.39, p < 0.001) and 5-ALA (OR 2.866, 95% CI 2.127-3.863, p < 0.001) were superior to conventional navigation in achieving GTR. Bayesian network analysis was employed to indirectly compare IMRI to 5-ALA, and no significant difference in GTR was found between the two (OR 1.9 favoring IMRI, 95% CI 0.905-3.989, p = 0.090). A handful of studies additionally suggested that the use of either IMRI (2 and 4 studies, respectively) or 5-ALA (2 and 2 studies, respectively) improves progression-free and overall survival. CONCLUSIONS: IMRI and 5-ALA are individually superior to conventional neuronavigation for achieving GTR of HGG. Between IMRI and 5-ALA, neither method is clearly more effective. Future studies evaluating the comparative cost and surgical time associated with IMRI and 5-ALA will better inform any cost-benefit analysis.

RESUMEN

Throughout the often complex and challenging process of musculoskeletal rehabilitation, the words that we use can have a significant impact on the clinical outcome. Words contain both the ability to heal and harm. Gaining an improved understanding of the frequently hidden influence that language can have on musculoskeletal rehabilitation is of paramount importance. This Viewpoint article highlights the powerful consequences of the words that we use in clinical practice and discusses the practical considerations for adapting the current language of musculoskeletal rehabilitation. J Orthop Sports Phys Ther 2018;48(7):519-522. doi:10.2519/jospt.2018.0610.

Asunto(s)

RESUMEN

Vertebrates, including amphibians, host diverse symbiotic microbes that contribute to host disease resistance. Globally, and especially in montane tropical systems, many amphibian species are threatened by a chytrid fungus, Batrachochytrium dendrobatidis (Bd), that causes a lethal skin disease. Bd therefore may be a strong selective agent on the diversity and function of the microbial communities inhabiting amphibian skin. In Panamá, amphibian population declines and the spread of Bd have been tracked. In 2012, we completed a field survey in Panamá to examine frog skin microbiota in the context of Bd infection. We focused on three frog species and collected two skin swabs per frog from a total of 136 frogs across four sites that varied from west to east in the time since Bd arrival. One swab was used to assess bacterial community structure using 16S rRNA amplicon sequencing and to determine Bd infection status, and one was used to assess metabolite diversity, as the bacterial production of anti-fungal metabolites is an important disease resistance function. The skin microbiota of the three Panamanian frog species differed in OTU (operational taxonomic unit, ~bacterial species) community composition and metabolite profiles, although the pattern was less strong for the metabolites. Comparisons between frog skin bacterial communities from Panamá and the US suggest broad similarities at the phylum level, but key differences at lower taxonomic levels. In our field survey in Panamá, across all four sites, only 35 individuals (~26%) were Bd infected. There was no clustering of OTUs or metabolite profiles based on Bd infection status and no clear pattern of west-east changes in OTUs or metabolite profiles across the four sites. Overall, our field survey data suggest that different bacterial communities might be producing broadly similar sets of metabolites across frog hosts and sites. Community structure and function may not be as tightly coupled in these skin symbiont microbial systems as it is in many macro-systems.

RESUMEN

The vertebrate microbiome contributes to disease resistance, but few experiments have examined the link between microbiome community structure and disease resistance functions. Chytridiomycosis, a major cause of amphibian population declines, is a skin disease caused by the fungus, Batrachochytrium dendrobatidis (Bd). In a factorial experiment, bullfrog skin microbiota was reduced with antibiotics, augmented with an anti-Bd bacterial isolate (Janthinobacterium lividum), or unmanipulated, and individuals were then either exposed or not exposed to Bd. We found that the microbial community structure of individual frogs prior to Bd exposure influenced Bd infection intensity one week following exposure, which, in turn, was negatively correlated with proportional growth during the experiment. Microbial community structure and function differed among unmanipulated, antibiotic-treated, and augmented frogs only when frogs were exposed to Bd. Bd is a selective force on microbial community structure and function, and beneficial states of microbial community structure may serve to limit the impacts of infection.

Asunto(s)

RESUMEN

Host-microbe symbioses rely on the successful transmission or acquisition of symbionts in each new generation. Amphibians host a diverse cutaneous microbiota, and many of these symbionts appear to be mutualistic and may limit infection by the chytrid fungus, Batrachochytrium dendrobatidis, which has caused global amphibian population declines and extinctions in recent decades. Using bar-coded 454 pyrosequencing of the 16S rRNA gene, we addressed the question of symbiont transmission by examining variation in amphibian skin microbiota across species and sites and in direct relation to environmental microbes. Although acquisition of environmental microbes occurs in some host-symbiont systems, this has not been extensively examined in free-living vertebrate-microbe symbioses. Juvenile bullfrogs (Rana catesbeiana), adult red-spotted newts (Notophthalmus viridescens), pond water and pond substrate were sampled at a single pond to examine host-specificity and potential environmental transmission of microbiota. To assess population level variation in skin microbiota, adult newts from two additional sites were also sampled. Cohabiting bullfrogs and newts had distinct microbial communities, as did newts across the three sites. The microbial communities of amphibians and the environment were distinct; there was very little overlap in the amphibians' core microbes and the most abundant environmental microbes, and the relative abundances of OTUs that were shared by amphibians and the environment were inversely related. These results suggest that, in a host species-specific manner, amphibian skin may select for microbes that are generally in low abundance in the environment.

Asunto(s)

RESUMEN

CONTEXT: Clinical reasoning lies at the heart of medical practice and has been the subject of scholarly inquiry and research for some decades. However, despite this, it is still poorly understood. This is largely because current theoretical models are limited in their explanatory power because they are based on particular assumptions of what constitutes clinical reasoning. DISCUSSION: A variety of ways of articulating and conceptualising clinical reasoning can provide us with richer means of understanding what is involved in clinical encounters. A dialogical approach to clinical reasoning is proposed. Dialogism provides a vocabulary that encourages us to integrate insights from different frameworks in ways that combine the strengths of each. Dialogism also puts a focus on the complex ways in which we use language in clinical reasoning to generate meaning. The complexity of language includes narrative, rhetoric and metaphor. CONCLUSIONS: A dialogical approach does not require us to discard the findings of earlier theories about clinical reasoning, but provides us with a means of integrating what we know in ways that are more useful in the reality of clinical practice.

Asunto(s)

RESUMEN

A total of 34 dynamic matched frontal sled tests were performed, 17 low (2.5g, Δv=4.8kph) and 17 medium (5.0g, Δv=9.7kph), with five male human volunteers of approximately 50th percentile height and weight, a Hybrid III 50th percentile male ATD, and three male PMHS. Each volunteer was exposed to two impulses at each severity, one relaxed and one braced prior to the impulse. A total of four tests were performed at each severity with the ATD and one trial was performed at each severity with each PMHS. A Vicon motion analysis system, 12 MX-T20 2 megapixel cameras, was used to quantify subject 3D kinematics (±1mm) (1kHz). Excursions of select anatomical regions were normalized to their respective initial positions and compared by test condition and between subject types. The forward excursions of the select anatomical regions generally increased with increasing severity. The forward excursions of relaxed human volunteers were significantly larger than those of the ATD for nearly every region at both severities. The forward excursions of the upper body regions of the braced volunteers were generally significantly smaller than those of the ATD at both severities. Forward excursions of the relaxed human volunteers and PMHSs were fairly similar except the head CG response at both severities and the right knee and C7 at the medium severity. The forward excursions of the upper body of the PMHS were generally significantly larger than those of the braced volunteers at both severities. Forward excursions of the PMHSs exceeded those of the ATD for all regions at both severities with significant differences within the upper body regions. Overall human volunteers, ATD, and PMHSs do not have identical biomechanical responses in low-speed frontal sled tests but all contribute valuable data that can be used to refine and validate computational models and ATDs used to assess injury risk in automotive collisions.

Asunto(s)

RESUMEN

Most health professionals are unaware of the extent to which aspects of language, such as metaphor, influence their practice. Sensitivity to metaphor can deepen our understanding of healthcare and, arguably, improve its quality. This is because metaphors, and the linguisticality of which they are a part, shape medical practice in important ways. Examples are the metaphors used in pain management. By exploring the dialogical tension between such metaphors, we can better understand the ways in which they influence medical practice.

Asunto(s)

Asunto(s)