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Students have to develop a wide variety of clinical skills, from cannulation to advanced life support, prior to entering clinical practice. An important challenge for health professions' educators is the implementation of strategies for effectively supporting students in their acquisition of different types of clinical skills and also to minimize skill decay over time. Cognitive science provides a unified approach that can inform how to maximize clinical skill acquisition and also minimize skill decay. The Guide discusses the nature of expertise and mastery development, the key insights from cognitive science for clinical skill development and skill retention, how these insights can be practically applied and integrated with current approaches used in clinical skills teaching.
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OBJECTIVE: Chronic hemolysis is a hallmark of sickle cell disease (SCD) and a driver of vasculopathy; however, the mechanisms contributing to hemolysis remain incompletely understood. Although XO (xanthine oxidase) activity has been shown to be elevated in SCD, its role remains unknown. XO binds endothelium and generates oxidants as a byproduct of hypoxanthine and xanthine catabolism. We hypothesized that XO inhibition decreases oxidant production leading to less hemolysis. Approach and Results: Wild-type mice were bone marrow transplanted with control (AA) or sickle (SS) Townes bone marrow. After 12 weeks, mice were treated with 10 mg/kg per day of febuxostat (Uloric), Food and Drug Administration-approved XO inhibitor, for 10 weeks. Hematologic analysis demonstrated increased hematocrit, cellular hemoglobin, and red blood cells, with no change in reticulocyte percentage. Significant decreases in cell-free hemoglobin and increases in haptoglobin suggest XO inhibition decreased hemolysis. Myographic studies demonstrated improved pulmonary vascular dilation and blunted constriction, indicating improved pulmonary vasoreactivity, whereas pulmonary pressure and cardiac function were unaffected. The role of hepatic XO in SCD was evaluated by bone marrow transplanting hepatocyte-specific XO knockout mice with SS Townes bone marrow. However, hepatocyte-specific XO knockout, which results in >50% diminution in circulating XO, did not affect hemolysis levels or vascular function, suggesting hepatocyte-derived elevation of circulating XO is not the driver of hemolysis in SCD. CONCLUSIONS: Ten weeks of febuxostat treatment significantly decreased hemolysis and improved pulmonary vasoreactivity in a mouse model of SCD. Although hepatic XO accounts for >50% of circulating XO, it is not the source of XO driving hemolysis in SCD.
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Anemia Falciforme/tratamento farmacológico , Inibidores Enzimáticos/farmacologia , Eritrócitos/efeitos dos fármacos , Febuxostat/farmacologia , Hemodinâmica/efeitos dos fármacos , Hemólise/efeitos dos fármacos , Artéria Pulmonar/efeitos dos fármacos , Xantina Oxidase/antagonistas & inibidores , Anemia Falciforme/sangue , Anemia Falciforme/enzimologia , Anemia Falciforme/fisiopatologia , Animais , Modelos Animais de Doenças , Eritrócitos/enzimologia , Fígado/enzimologia , Masculino , Camundongos Endogâmicos C57BL , Camundongos Knockout , Artéria Pulmonar/enzimologia , Artéria Pulmonar/fisiopatologia , Função Ventricular/efeitos dos fármacos , Xantina Oxidase/genética , Xantina Oxidase/metabolismoRESUMO
Learning in groups is commonly used in academic and clinical health professions education (HPE). There is growing recognition that regulation during learning is essential for both the individual learner and group learning. The authors in this article propose a practical approach for understanding, evaluating and providing feedback on regulation during group learning. The approach is informed by previous studies conducted in other areas of education. Three varieties of regulation during group learning are discussed: individual, co-regulation and shared regulation. Each variety of regulation has a focus on three essential activities during group learning: task, social and motivation. Illustrative scenarios are presented to describe how the approach can be practically used in HPE. The specific and additional focus on regulation can enhance current approaches for providing feedback on group learning and the authors discuss recommendations for practical implementation and future research.
Aprendizagem em grupo é muito utilizada no ensino dos profissionais de saúde tanto na parte acadêmica quanto na parte clínica. Há um crescente reconhecimento de que a regulação durante aprendizagem é essencial para o indivíduo e em grupo. Os autores deste artigo propõem um modelo prático para entender, avaliar e fornecer feedback em regulação durante a aprendizagem em grupo. Esse modelo é baseado por estudos publicados em outras áreas de educação, sendo composto por três variações de regulação durante aprendizagem em grupo, a saber, individual, corregulação e regulação compartilhada. Cada variação de regulação foca em três atividades essenciais durante a aprendizagem em grupo: tarefa, social e motivacional. Cenários ilustrativos são apresentados para descrever como esse modelo pode ser utilizado em ensino em saúde. O foco específico e adicional em regulação pode melhorar práticas de feedback em aprendizagem em grupos e os autores discutem recomendações para implementações práticas assim como pesquisas futuras.
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Aprendizagem , Educação , RetroalimentaçãoRESUMO
Purpose: Mouthwash is used by a large population. Short-term clinical trials have shown that antibacterial mouthwash deplete oral nitrate-reducing bacteria, and decrease systemic nitric oxide bioavailability. Our previous publication from the San Juan Overweight Adults Longitudinal Study (SOALS) was the first to show frequent over-the-counter mouthwash use was independently associated with increased risk of prediabetes/diabetes. This manuscript evaluates whether over-the-counter mouthwash was associated with increased risk of hypertension.Materials and methods: SOALS recruited 40-65 year old overweight/obese individuals; baseline evaluations started in 2011 and the 3-year follow-up exam was completed by 2016. From the 1028 participants (76%) who completed follow-up, we excluded people with reported physician diagnosis of hypertension or systolic or diastolic BP at or above the hypertension cut-offs (n = 481), missing smoking (n = 1), missing physical activity (n = 1) and missing alcohol intake (n = 5) at baseline; 540 participants were included. The primary exposure was mouthwash use twice daily or more. The primary outcome for this manuscript is self-reported physician-diagnosed hypertension over the follow-up. We used Poisson regression controlling for age, sex, smoking, physical activity, waist circumference, alcohol intake, systolic blood pressure, pre-diabetes/diabetes status and cardiac medication use. We additionally evaluated other mouthwash use categorizations.Results: Twelve percent (66/540) developed hypertension over follow-up. People who used mouthwash twice/day or more had higher incidence of hypertension compared to less frequent users (Incidence Rate Ratio = 1.85; 95% Confidence Interval: 1.17, 2.94), and compared to non-users (IRR = 2.17; 95% CI: 1.27, 3.71). Several additional potential confounders evaluated did not impact these associations. Associations persisted among never smokers. Additional outcomes including BP assessed at a single study visit did not show associations.Conclusion: In this study, frequent regular use of over-the-counter mouthwash was associated with increased risk of hypertension, independent of major risk factors for hypertension and several other potential confounders.
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Bactérias/efeitos dos fármacos , Pressão Sanguínea , Hipertensão/epidemiologia , Boca/microbiologia , Antissépticos Bucais/efeitos adversos , Óxido Nítrico/metabolismo , Adulto , Idoso , Bactérias/metabolismo , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Incidência , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Porto Rico , Medição de Risco , Fatores de Risco , Fatores de TempoRESUMO
The dilution rates of indicators Enterococcus faecalis and E. coli were studied from the St. John's River estuary in Grenada, West Indies. Health risk zones were established based on the levels of bacteriological pollution. In accordance with the World Health Organization (WHO) health risk guidelines, risks were in the range of <1% gastrointestinal (GI); <0.3% acute febrile respiratory illness (AFRI) to a 1%-5% GI; and 0.9%-1.9% AFRI within 100 m from the St. John's River outflow site in St. George's Bay. These values were the result of river water dilution, where the most probable number (MPN) levels for both indicator organisms from the river were equivalent to that of raw sewage with an AFRI health risk of >3.9% and a GI risk of >10%. The distance intervals farther than 100 m showed fluctuating values and corresponding health risks. E. faecalis and E. coli strains isolated were resistant to 35.7% and 42.9% of the antibiotics tested, respectively.