Longitudinal Assessment of Empathy and Burnout Across a Single Pharmacy Class Cohort.

OBJECTIVE: This is a final analysis of longitudinal evaluation of burnout and empathy among a cohort of Doctor of Pharmacy students throughout their 4-year enrollment. METHODS: The class of 2021 received sequential Qualtrics (Qualtrics, Provo, UT) surveys containing 2 validated survey instruments, the Jefferson Scale of Empathy and the Maslach Burnout Inventory. Surveys were disseminated at the start of the program (PY1start) and the end of each academic year (PY1end, PY2, PY3, PY4). Linear mixed models accounting for repeated measures, Generalized Estimating Equation, and Cochran's Q statistic were used to evaluate longitudinal change in the Jefferson Scale of Empathy and Maslach Burnout Inventory survey scores, categorized subscales, and burnout. RESULTS: Matched survey responses were included for 91 students (85.8% response rate). Across all years, a decrease in empathy and professional efficacy and an increase in exhaustion and cynicism was seen. High categorical levels of exhaustion and cynicism indicated evidence of burnout throughout the program. Year-to-year analysis indicated statistically significant increases in exhaustion and cynicism between PY1start and all subsequent assessments, a decrease in professional efficacy from PY1start to PY1end and PY2, and a decrease in empathy for PY1start to PY1end. CONCLUSION: Students reported trends of decreasing empathy and professional efficacy, with a simultaneous increase in exhaustion and cynicism. Further evaluation of the impact of COVID-19 on these results, as well as additional methods to support overall student wellness, is needed.

Identifying Biopsychosocial Characteristics of Emergency Youth Shelter Residents With Psychiatric Diagnoses.

Background In the United States, homelessness is an issue that may affect a significant portion of the adolescent population. There is no consensus on the extent to which this population has been impacted by poor mental health and lack of resources. This study aimed to characterize trends among those who struggle with housing insecurity and mental illness to provide a clearer picture of mental health needs among this population. Methods Data from 641 adolescents who presented to a local adolescent homeless shelter between 2015 and 2021 were utilized to determine if there were significant associations between specific mental illness diagnoses and biopsychosocial characteristics. A chi-square test of independence was performed on demographic and psychosocial variables for categories with a frequency greater than five. For continuous variables, an unpaired t-test was utilized to assess significance (p<0.05). Results Among the study population, 61.3% (369) had at least one psychiatric diagnosis, which is higher than even the most conservative estimates of mental illness among the general public. Having one or more psychiatric diagnoses was significantly associated with suicide attempts, documented aggressive behavior, and tobacco use. Contrary to our initial hypothesis, there were no significant correlations between psychiatric diagnoses and demographic characteristics or drug use other than tobacco. Conclusions Our findings indicate that though the particular reasons for homelessness among adolescents may vary, the prevalence of mental illness among these young individuals was roughly uniformly distributed and vastly above normal levels. Future research must focus on developing interventions to mitigate the effects of mental illness among homeless adolescents, as they are at a vulnerable point in their formative years.

Do incoming residents vary in measures of emotional status even prior to residency training?

Objectives: To determine whether Empathy, Emotional Intelligence, and Burnout scores differ by specialty in incoming residents. Methods: This is a single-site, prospective, cross-sectional study. Three validated survey instruments, the Jefferson Scale of Physician Empathy, Maslach Burnout Inventory, and Emotional and Social Competency Inventory, were written into a survey platform as a single 125-question Qualtrics survey. Over three academic years, 2015-2017, 229 incoming residents across all specialties were emailed the survey link during orientation. Residents were grouped by incoming specialty with anonymity assured. A total of 229 responses were included, with 121 (52.8%) identifying as female. Statistical analysis was performed using the Analysis of Variance or Kruskal-Wallis test, Chi-Square or Fisher's Exact test, and Independent Samples t-test or Mann Whitney U test. A Bonferroni correction was applied for pairwise comparisons. Results: Family Medicine had a higher median Jefferson Scale of Physician Empathy score (127) compared to Emergency Medicine (115), (U=767.7, p=0.0330). Maslach Burnout Inventory depersonalization and personal accomplishment subcategory scores showed a significant difference between specialties when omnibus tests were performed, but pairwise comparisons with emergency medicine residents showed no differences. Differences were found in the Maslach Burnout Inventory categories of Depersonalization (χ2(8, N=229) =15.93, p=0.0434) and Personal Accomplishment level (χ2(8, N=229) =20.80, p=0.0077) between specialties. Conclusions: Differences in measures of well-being exist across specialties, even prior to the start of residency training. The implication for educators of residency training is that some incoming residents, regardless of specialty, already exhibit troublesome features of burnout, and resources to effectively deal with these residents should be developed and utilized.

Measures of Burnout and Empathy in United States Doctor of Pharmacy Students: Time for a Change?

PURPOSE: To review interim data regarding longitudinal burnout and empathy levels in a single Doctor of Pharmacy class cohort. METHODS: Students were emailed an electronic survey during their first semester and annually at the end of each academic year for a total of 3 years (2017-2020). Validated survey tools included the Jefferson Scale of Empathy (JSE) and the Maslach Burnout Inventory (MBI) student version. The JSE survey consists of 20 questions, with higher scores denoting more empathy. The MBI student version contains 3 subscales: exhaustion (higher scores are worse), cynicism (higher scores are worse) and professional efficacy (higher scores are better). RESULTS: The median JSE score at the end of the third academic year (PY3) was 110, with females scoring significantly higher (114.5 vs. 103.5; p<0.02). A majority of the 62 students reported burn out (82.3%), scoring in the highest category for either exhaustion (76%) or cynicism (55%). A majority (66%) also reported a low or moderate professional efficacy score, a negative finding. Measures of student burnout increased after the start of the program and remained at the higher level each subsequent year (p<0.0001). In the Spring of 2020, during the COVID-19 pandemic, nearly every student had moderate or high levels of emotional exhaustion (97%) and cynicism (78%) as measured by the MBI. CONCLUSION: This interim data suggests high degrees of pharmacy student burnout. Empathy levels remained stable throughout the duration of the study. Pharmacy schools may need to focus on reform regarding well-being and prevention of burnout.

Relationship Between Sexual Activity, Contraceptive Utilization and Biopsychosocial Characteristics Among Homeless Shelter Adolescents.

Objective: To determine whether biopsychosocial factors are associated with sexual activity and contraceptive utilization among homeless shelter adolescents. Methods: A retrospective study of 440 adolescents at a shelter in Pennsylvania between February 2015 and September 2019 was conducted. The cohort was evaluated to determine what relationship age, gender identity, substance use, and trauma history have with sexual activity and contraceptive utilization. Results: Sexual activity was significantly related to age (mean 15.8+1.4 years in sexually active vs. 14.7+1.6 years in abstinent youth, p<0.001); remote history of self-harm behavior (relative risk ratio (RR) 1.23 [95% CI 1.03-1.46]; p=0.02), history of aggressive behavior (RR 1.21 [95% CI 1.01-1.46]; p=0.04), history of trauma (RR 1.24 [95% CI 1.04-1.48]; p=0.03), and substance use (RR 2.27 [95%CI 1.86-2.77]; p<0.001). There were 55.7% sexually active females vs. 42.50% males reporting contraception use (p=0.01). After adjustment, older age and substance use remained significantly associated with sexual activity (adjusted odds ratio (AOR) 1.58 [95% CI 1.36-1.83]; p<0.001 and AOR 5.18 [95% CI 3.28-8.18]; p<0.001, respectively). Conclusions: Females self-reported sexual activity using contraception more than males. After adjustment, older age and substance use were associated with sexual activity. By better understanding the impact these factors can have on contraceptive utilization, informed policy and practice interventions can be developed and implemented to help increase safe sex practices in spaces where homeless adolescents access healthcare.

Developing Emotional Intelligence Through a Longitudinal Leadership Curriculum in UME: Combating the Decline in Medical Student Empathy.

We report on a novel curriculum (Scholarly Excellence, Leadership Experiences, Collaborative Training [SELECT]) in an allopathic medical school designed to prepare students to be physician leaders while remaining empathetic by combating burnout. SELECT students were surveyed annually. The survey contained the Jefferson Scale of Empathy (JSE) and Maslach Burnout Inventory (MBI). In this cohort, empathy did not decrease, as measured by the JSE, and SELECT students' MBI Depersonalization burnout scores decreased after year 3. In summary, in this allopathic US medical school utilizing a novel curriculum, there was no significant decline in empathy after the third year of medical school. The SELECT program appears to mitigate the decline in empathy and increased Depersonalization burnout levels often seen at the end of the third year of medical school.

Relationship Between Vaccination Status and Biopsychosocial Characteristics in Sheltered Adolescents.

Introduction Homeless youth are a vulnerable population. A volunteer clinic supported by medical students in northeastern Pennsylvania provides shelter and healthcare to adolescents seeking refuge. We set out to determine the immunization status of youth in the shelter and evaluate for associations of immunization deficiency with demographics or biopsychosocial factors. Methods After IRB approval, a retrospective cohort study was performed from existing clinical records at the shelter 2/2015-9/2019. Chart abstraction included variables such as demographics (including age, sex, and race/ethnicity), biopsychosocial factors (including childhood trauma/abuse history, substance abuse history, and sexual activity), and immunization history. Results A total of 440 charts were analyzed. When comparing demographics of patients that had complete vaccine regimens versus those who did not, the race was statistically significant (p=.006). The most prominent difference in race was seen for Black/African American patients; only 19.57% had a completed vaccine regimen documented. Regarding immunization history, vaccine schedules of hepatitis B, measles mumps rubella (MMR), inactivated polio vaccine (IPV), and varicella were most likely to be complete; pneumococcal conjugate vaccine (PCV) 13, rotavirus, influenza, and human papillomavirus vaccine (HPV) were least likely. There was no association found between a completed vaccine regimen and biopsychosocial variables. A larger portion of females (37.35%) completed the HPV vaccine compared to males (23.14%) (p=.009). Conclusions In this single-site study, this vulnerable, at-risk population of sheltered adolescents lacked the vaccinations recommended by the Centers for Disease Control and Prevention. Racial disparities further compounded this vulnerability for Black/African American teens. Additionally, a significantly greater number of female patients received the HPV vaccine compared to males.

STAT RAD: Prospective Dose Escalation Clinical Trial of Single Fraction Scan-Plan-QA-Treat Stereotactic Body Radiation Therapy for Painful Osseous Metastases.

PURPOSE: Radiation therapy is a well-established treatment for symptomatic bone metastases. Despite continued advances in both planning techniques and treatment delivery, the standard workflow has remained relatively unchanged, often requiring 1 to 3 weeks and resulting in patient inconvenience and delayed palliation. We developed an expedited method wherein computed tomography simulation, treatment planning, quality assurance, and treatment delivery are performed in 1 day. This prospective pilot clinical trial evaluates the safety, efficacy, and patient satisfaction of this rapid workflow. METHODS AND MATERIALS: Patients with 1 to 3 painful bone metastases were prospectively enrolled and treated with 1 fraction of stereotactic body radiation therapy, using a same-day Scan-Plan-QA-Treat workflow, termed STAT RAD, in a phase 1/2 dose escalation trial from 8 Gy to 15 Gy per fraction. Bone pain, opioid use, patient satisfaction, performance status, and quality of life were evaluated before and at 1, 4, 8, 12, 26, and 52 weeks after treatment. Outcomes and treatment-related toxicity were analyzed. RESULTS: A total of 49 patients were enrolled, and 46 patients with 60 bone metastases were treated per the protocol. Partial or greater pain response occurred in 50% of patients at 1 week, 75% of patients at 8 weeks, 68.7% of patients at 6 months, and 33.3% of patients at 12 months. There were 2 grade-3 toxicities, including 1 spinal fracture associated with disease progression and hyperbilirubinemia. Reirradiation was required in 16.7% of treated lesions at a median time to retreatment of 4.9 months. Most patient responses (78.6%) indicated that patients would choose this workflow again. CONCLUSIONS: The results demonstrate that treating bone metastases with palliative stereotactic body radiation therapy via a single-fraction, patient-centric workflow is feasible and safe with doses up to 15 Gy. However, pain response decreased at 12 months and was associated with a 16.7% retreatment rate, which suggests that further dose escalation is warranted.

Emergency Medicine Resident Self-assessment of Clinical Teaching Compared to Student Evaluation Using a Previously Validated Rubric.

PURPOSE: The quality of clinical teaching in the emergency department from the students' perspective has not been previously described in the literature. Our goals were to assess senior residents' teaching ability from the resident/teacher and student/learner viewpoints for any correlation, and to explore any gender association. The secondary goal was to evaluate the possible impact of gender on the resident/student dyad, an interaction that has previously been studied only in the faculty/student pairing. METHODS: After approval by an institutional review board, a 1-year, grant-funded, single-site, prospective study was implemented at a regional medical campus that sponsors a 4-year dually approved emergency medicine residency. The residency hosts both medical school students (MSs) and physician's assistant students (PAs). Each student and senior resident working concurrently completed a previously validated ER Scale, which measured residents' teaching performance in 4 categories: Didactic, Clinical, Approachable, and Helpful. Students evaluated residents' teaching, while residents self-assessed their performance. The participants' demographic characteristics gathered included prior knowledge of or exposure to clinical teaching models. Gender was self-reported by participants. The analysis accounted for multiple observations by comparing participants' mean scores. FINDINGS: Ninety-nine subjects were enrolled; none withdrew consent. Thirty-seven residents (11 women) and 62 students (39 women) from 25 MSs and 6 PA schools were enrolled, completing 517 teaching assessments. Students evaluated residents more favorably in all ER Scale categories than did residents on self-assessments (P < 0.0001). This difference was significant in all subgroup comparisons (types of school versus postgraduate years [PGYs]). Residents' evaluations by type of student (MS vs PA) did not show a significant difference. PGY 3 residents assessed themselves higher in all categories than did PGY 4 residents, with Approachability reaching significance (P = 0.0105). Male residents self-assessed their teaching consistently higher than did female residents, significantly so on Clinical (P = 0.0300). Students' evaluations of the residents' teaching skills by residents' gender did not reveal gender differences. IMPLICATIONS: MS and PA students evaluated teaching by EM senior residents statistically significantly higher than did EM residents on self-evaluation when using the ER Scale. Students did not evaluate residents' teaching with any difference by gender, although male residents routinely self-assessed their teaching abilities more positively than did female residents. These findings suggest that, if residency programs utilize resident self-evaluation for programmatic evaluation, the gender of the resident may impact self-scoring. This cohort may inform future study of resident teaching in the emergency department, such as the design of future resident-as-teacher curricula.

Safety evaluation of HOWARU® Restore (Lactobacillus acidophilus NCFM, Lactobacillus paracasei Lpc-37, Bifidobacterium animalis subsp. lactis Bl-04 and B. lactis Bi-07) for antibiotic resistance, genomic risk factors, and acute toxicity.

Although probiotic lactobacilli and bifidobacteria are generally considered safe by various regulatory agencies, safety properties, such as absence of transferable antibiotic resistance, must still be determined for each strain prior to market introduction as a probiotic. Safety requirements for probiotics vary regionally and evaluation methods are not standardized, therefore methodologies are often adopted from food ingredients or chemicals to assess microbial safety. Four individual probiotic strains, Lactobacillus acidophilus NCFM®, Lactobacillus paracasei Lpc-37®, Bifidobacterium animalis subsp. lactis strains Bl-04®, and Bi-07®, and their combination (HOWARU® Restore) were examined for antibiotic resistance by broth microdilution culture, toxin genes by PCR and genome mining, and acute oral toxicity in rats. Only B. lactis Bl-04 exhibited antibiotic resistance above a regulated threshold due to a tetW gene previously demonstrated to be non-transferable. Genomic mining did not reveal any bacterial toxin genes known to harm mammalian hosts in any of the strains. The rodent studies did not indicate any evidence of acute toxicity following a dose of 1.7-4.1 × 1012 CFU/kg body weight. Considering a 100-fold safety margin, this corresponds to 1.2-2.8 × 1012 CFU for a 70 kg human. Our findings demonstrate a comprehensive approach of in vitro, in silico, and in vivo safety testing for probiotics.

Safety evaluation of AB-LIFE(®) (Lactobacillus plantarum CECT 7527, 7528 and 7529): Antibiotic resistance and 90-day repeated-dose study in rats.

AB-LIFE(®) is a probiotic product consisting of equal parts of three strains of Lactobacillus plantarum (CECT 7527, 7528, and 7529) blended with inert excipients. Whole genome sequencing was performed on each of the three strains. Antibiotic resistance was evaluated by genomic mining for resistance genes, and assessment for transferability. No risk of transfer potential was identified for any antibiotic resistance genes in the three strains. AB-LIFE(®) was evaluated for potential subchronic oral toxicity in rats, with dosages of 300 and 1000 mg/kg BW/day (equivalent to 5.55 × 10(10) and 1.85 × 10(11) CFU/kg BW/day). Survival of the three test strains through the gastrointestinal tract was supported by fecal analysis. No adverse effects were identified with respect to in-life parameters, clinical or anatomic pathology, translocation, or fecal chemical analyses. The no-observed-adverse-effect level (NOAEL) for AB-LIFE(®) in male and female rats was 1000 mg/kg BW/day (1.85 × 10(11) CFU of AB-LIFE(®)/kg BW/day), the highest dose level evaluated. These results, in conjunction with a previous acute toxicity study in rats, support the conclusion that AB-LIFE(®) is safe for human consumption.

A Cross-Sectional Study of Medical Student Knowledge of Evidence-Based Medicine as Measured by the Fresno Test of Evidence-Based Medicine.

BACKGROUND: Evidence-based medicine (EBM) has been included in the Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Emergency Medicine (ABEM) milestones project as a required component during emergency medicine (EM) residency training. Milestone Level One states that graduating medical students must be able to "describe basic principles of EBM." OBJECTIVE: We sought to identify the EBM skills of third- and fourth-year medical students. METHODS: Our institution, a network with 17 different residencies, hosts U.S. osteopathic and allopathic medical students. As a part of orientation, students are required to complete an entry Fresno Test of EBM (FTEBM). Retrospectively, medical student FTEBM scores from 2011 were assessed using descriptive statistics. RESULTS: Four hundred seventeen FTEBM scores were analyzed. Participants represented 40 medical schools, including 17 allopathic (MD) and 23 osteopathic (DO) schools. Fifty percent of participants (n = 210) were female, and 51.6% (n = 215) were from a DO medical school. Overall mean performance for the FTEBM was 47.2%. Exploring the results by individual question were (individual EBM question topics are in parentheses): 1A (study question), 62.0%; 1B (study question), 64.4%: 2 (sources of evidence), 67.6%; 3 (study design), 57.1%; 4 (search strategies), 53.2%; 5 (relevance), 41.2%; 6 (internal validity), 43.6%; 7 (magnitude), 37.8%; 8 (two-by-two grids), 30.0%; 9 (number needed to treat), 16.9%; 10 (confidence intervals), 34.3%; 11 (diagnosis), 5.0%; and 12 (prognosis), 43.4%. CONCLUSIONS: As measured by the FTEBM, senior medical students demonstrate understanding of about half of EBM. EM residencies can anticipate the need to instruct their residents in EBM concepts in order to meet ACGME/ABEM milestone requirements.

Using Telemedicine Technology to Assess Physician Outpatient Teaching.

BACKGROUND AND OBJECTIVES: Video conferencing technology (telemedicine) can be applied to many settings within the medical community; we assessed the feasibility of its use in conducting observations of faculty at remote family medicine teaching sites. METHODS: We deployed seven telemedicine units to five family medicine residency sites and two observation stations within our division. Practice managers and physician faculty members received on-site training on the basic functionality of the technology, as well as "best practices" and minor troubleshooting techniques. Quick reference guides and other support documents were developed and provided for each site. During the remote faculty observation, two observers simultaneously viewed the resident being precepted, assessing the faculty member using a standardized tool. After the experience, all participants were asked to complete a survey on the usability of the technology. RESULTS: Nineteen observations were successfully conducted from November 2011 to December 2012. From a qualitative perspective, faculty accepted this as a viable means of faculty development. Minor technical hurdles were captured in the survey and improved upon as staff and faculty became more comfortable with the technology and as our technical capabilities allowed. Overall, the technology was rapidly accepted into the practices. CONCLUSIONS: Video teleconferencing represents a valuable tool that contributes to the development of faculty by making observation available to numerous sites, including remote areas that may have been previously challenging to reach due to logistics. Recent improvements in technology should make the process easier and allow more aspects of the encounters to be readily observed.

Determining the safety of microbial cultures for consumption by humans and animals.

Fermented foods and feeds have been consumed for millennia, and microorganisms isolated from traditional fermentations have been used as probiotics. There is interest in developing new microbial cultures for these uses, but to date safety evaluation procedures have only been discussed in general terms. We propose a comprehensive approach for determining the safety of microbial cultures that lack an established history of safe use for their intended new applications. Three scenarios are considered: (1) substantially increased exposure to a culture that has an established record of safety in a more limited application; (2) a new strain without a history of safe use that was isolated from a food or feed that has a history of safe use; and (3) a new strain isolated from a non-food or non-feed source. Our safety evaluation process is based on scientific procedures and is in the form of a decision tree composed of 13 questions. Our decision tree for determining the safety of microbial cultures for consumption by humans or animals is modeled on previous decision trees that are used worldwide to evaluate the safety of microbial enzymes for use in human food or animal feed.

Utilizing a novel tool for the comprehensive assessment of resident operative performance.

PURPOSE: A mechanism for more effective and comprehensive assessment of surgical residents' performance in the operating room (OR) is needed, especially in light of the new requirements issued by the American Board of Surgery. Furthermore, there is an increased awareness that assessments need to be more meaningful by including not only procedure-specific and general technical skills, but also nontechnical skills (NOTECHS), such as teamwork and communication skills. Our aims were to develop a methodology and create a tool that comprehensively assesses residents' operative performance. METHODS: A procedure-specific technical skill assessment for laparoscopic colon resections was created through use of task analysis. Components of previously validated tools were added to broaden the assessment to include general technical skills and NOTECHS. Our instrument was then piloted in the OR to measure face and content validity through an iterative process with faculty evaluators. Once the tool was finalized, postgraduate 3 (PG3) and PG5 residents on a 2-month long rotation were assessed by 1 of 4 colorectal surgeons immediately after completing a case together. Construct validity was measured by evaluating the difference in scores between PG3 and PG5 residents' performance as well as the change in scores over the course of the rotation. RESULTS: Sixty-three assessments were performed. All evaluations were completed within 48 hours of the operation. There was a statistically significant difference between the PG3 and PG5 scores on procedure-specific performance, general technical skills, NOTECHS, and overall performance. Over the course of the rotation, a statistically significant improvement was found in residents' scores on the procedure-specific portion of the assessment but not on the general surgical skills or NOTECHS. CONCLUSION: This is a feasible, valid, and reliable assessment tool for the comprehensive evaluation of resident performance in the OR. We plan to use this tool to assess resident operative skill development and to improve direct resident feedback.

Evaluation of an electricity-free, culture-based approach for detecting typhoidal Salmonella bacteremia during enteric fever in a high burden, resource-limited setting.

BACKGROUND: In many rural areas at risk for enteric fever, there are few data on Salmonella enterica serotypes Typhi (S. Typhi) and Paratyphi (S. Paratyphi) incidence, due to limited laboratory capacity for microbiologic culture. Here, we describe an approach that permits recovery of the causative agents of enteric fever in such settings. This approach involves the use of an electricity-free incubator based upon use of phase-change materials. We compared this against conventional blood culture for detection of typhoidal Salmonella. METHODOLOGY/PRINCIPAL FINDINGS: Three hundred and four patients with undifferentiated fever attending the outpatient and emergency departments of a public hospital in the Kathmandu Valley of Nepal were recruited. Conventional blood culture was compared against an electricity-free culture approach. Blood from 66 (21.7%) patients tested positive for a Gram-negative bacterium by at least one of the two methods. Sixty-five (21.4%) patients tested blood culture positive for S. Typhi (30; 9.9%) or S. Paratyphi A (35; 11.5%). From the 65 individuals with culture-confirmed enteric fever, 55 (84.6%) were identified by the conventional blood culture and 60 (92.3%) were identified by the experimental method. Median time-to-positivity was 2 days for both procedures. The experimental approach was falsely positive due to probable skin contaminants in 2 of 239 individuals (0.8%). The percentages of positive and negative agreement for diagnosis of enteric fever were 90.9% (95% CI: 80.0%-97.0%) and 96.0% (92.7%-98.1%), respectively. After initial incubation, Salmonella isolates could be readily recovered from blood culture bottles maintained at room temperature for six months. CONCLUSIONS/SIGNIFICANCE: A simple culture approach based upon a phase-change incubator can be used to isolate agents of enteric fever. This approach could be used as a surveillance tool to assess incidence and drug resistance of the etiologic agents of enteric fever in settings without reliable local access to electricity or local diagnostic microbiology laboratories.

Residents as teachers: residents' perceptions before and after receiving instruction in clinical teaching.

CONTEXT: Residents play an integral role in educating junior residents, medical students, and patients. OBJECTIVE: To determine how residents describe their training, proficiency, and comfort level in teaching before and after receiving instruction in clinical teaching. METHODS: Emergency medicine residents at a 980-bed suburban hospital system filled out a 12-question survey on their training as teachers and their self-perceptions of themselves as teachers. The residents then participated in a 2-hour education session on adult learning principles, methods of clinical teaching, and how to give effective feedback. After the session, participants completed a second, 11-question survey on the effectiveness of the session. RESULTS: Thirty-seven residents completed the presession survey and 33 completed the postsession survey. In the presession survey, 23 residents (62%) identified their proficiency as a teacher and ability to give feedback as that of a novice or beginner. Fourteen (38%) felt competent or proficient as teachers. Twenty-six (70%) reported never receiving instruction in clinical teaching during their residency, and 33 (89%) were interested in learning these skills. In the postsession survey, 28 (85%) described the teaching module as very helpful to their training, and 33 (100%) reported feeling more prepared to teach. Twenty-six (79%) stated they were very likely to teach students more often, and 33 (100%) reported a better understanding of how to give effective feedback. CONCLUSION: The majority of the residents surveyed expressed an interest in learning teaching skills and felt that completing the training was helpful to their education. After instruction, this cohort of residents felt more prepared and reported they were more likely to teach.

Comparison of molecular detection methods for Vibrio parahaemolyticus and Vibrio vulnificus.

Pathogenic vibrios are a global concern for seafood safety and many molecular methods have been developed for their detection. This study compares several molecular methods for detection of total and pathogenic Vibrio parahaemolyticus and Vibrio vulnificus, in MPN enrichments from oysters and fish intestine samples. This study employed the DuPont Qualicon BAX® System Real-Time PCR assay for detection of V. parahaemolyticus and V. vulnificus. Multiplex real-time PCR detection of total (tlh+), tdh+, and trh+V. parahaemolyticus was conducted on the Cepheid SmartCycler II. Total (rpoD) and tdh+V. parahaemolyticus were also detected using LAMP. V. vulnificus detection was performed using real-time PCR methods developed for the SmartCycler and the AB 7500 Fast. Recommended template preparations were compared to BAX® lysis samples for suitability. There was no significant difference in detection of V. parahaemolyticus and V. vulnificus using the BAX® or SmartCycler assays. The AB assay showed no difference from other methods in detection of V. vulnificus unless boiled templates were utilized. There was a significant difference in detection of tdh+V. parahaemolyticus between SmartCycler and LAMP assays unless the total (tlh+) V. parahaemolyticus gene target was omitted from the SmartCycler assay; a similar trend was observed for trh+V. parahaemolyticus.

Rapid detection of influenza A and B viruses in clinical specimens by Light Cycler real time RT-PCR.

BACKGROUND: the influenza viruses cause morbidity and mortality annually among children and elderly. Surveillance and rapid diagnosis is imperative in the reference laboratory, as clinical symptoms are insufficient for proper diagnosis. OBJECTIVES: this study involved the design of a rapid detection method for influenza A and B viruses using real time RT-PCR from clinical specimens. Methods were specifically designed for use on the Light Cycler. The sensitivity and specificity were also to be determined. STUDY DESIGN: the identification and discrimination of influenza A and B viruses employs two dual probe systems based on fluorescence resonance energy transfer (FRET) technology. Following submission by physicians participating in the Florida sentinel influenza network, 58 specimens were chosen for testing using both tissue culture and Light Cycler methods. RESULTS: of the 35 identified positive for influenza virus via tissue culture isolation, the Light Cycler results matched identification and typing with 100% agreement. However, the Light Cycler recognized 16 additional specimens that were positive for the presence of the virus. RT-PCR and nucleotide sequencing confirmed the presence of influenza A virus in these specimens. Using tenfold serial dilutions, the sensitivity of the Light Cycler method was determined to be 0.01 TCID50. The lower limit of RNA detection was determined as 1.6 x 10(-7) microg for influenza A virus, and 1.2 x 10(-7) microg for influenza B virus. Specificity of the Light Cycler method was determined by testing specimens containing adenovirus, parainfluenza virus and echovirus, all of which yielded negative results with no discernible background. CONCLUSIONS: overall, this newly developed method of simultaneous detection and typing of influenza types A and B using the Light Cycler proves to be more sensitive than tissue culture isolation, with corresponding specificity. This technique may be valuable for surveillance and rapid identification of influenza for early diagnosis.