The development of an evaluation tool to assess professional behavior and clinical competencies from the graduates' perspective.

PURPOSE: This study was designed to develop an evaluation tool for assessing professional behavior and clinical competencies from the graduates' perspective. METHODS: This study employed mixed method in a sequential exploratory design. The semi-structured interviews were conducted with three graduates from different cohorts. The qualitative analysis of the interviews found six emerging themes for professional behavior and clinical competencies development. These themes were then developed into a 55-item questionnaire. The questionnaire was then distributed to 84 medical graduates for exploratory factor analysis (EFA) from February to April 2019. The quantitative data were analyzed using IBM SPSS ver. 21.0 (IBM Corp., Armonk, USA) for principal axis factoring. After conducting EFA, we proceeded with confirmatory factor analysis (CFA) with another 120 graduates to validate the tool. RESULTS: Eighty-four graduates completed the questionnaire for EFA. Upon completion of EFA, 35 out of 55 items of the questionnaire were found to be valid and reliable. The most appropriate fit was seven factors, which explained 58.18% of variance between them after 15 iterations with Cronbach's α of 0.916. The personal satisfaction factor was noted to be weak. It was therefore added to patient management factor due to its similar intention. The final EFA factor after the modification was six. The CFA found that 34 out of 35 items was valid and reliable that representation of the latent variables. CONCLUSION: The questionnaire has achieved the desired construct validity score and can be used as an evaluation tool to assess professional behavior and clinical competencies from the graduates' perspective.

Development of an Instrument for Preceptor Evaluation of Medical Graduates' Performance: the Psychometric Properties.

BACKGROUND: A preceptor has a key role in evaluating medical graduate's performance in the clinical setting. This study is conducted to develop an instrument for preceptor evaluation of medical graduates' performance in the clinical setting. METHOD: A mixed-method study design, sequential exploratory approach was chosen to develop the instrument. Initial semi-structured interviews were conducted with 4 preceptors at the teaching hospitals. Five main themes emerged from the interviews. The themes were developed into a 23-item questionnaire. Nineteen Head or Assistant Head of clinical departments were asked to review the relevance of the content. The questionnaire was later sent out to 34 preceptors and 35 paramedic staffs to participate in the construct validity study by conducting exploratory factor analysis (EFA). SPSS version 21 software was used to analyze the data and Varimax rotation method was performed to simplify and describe the data structure. RESULT: Review of the factor structures suggested that the most appropriate fit was 5 factors. Most of the questionnaire items were relevant to assess performance (4.65 + 0.15), except in item 4 of the clinical skill factor. The 23 items of the evaluation instruments showed that five factors were extracted which explained 73.9% of the variance between them. Construct validity was achieved after the instrument was run for an iteration of eight times, with Cronbach's alpha of 0.951. DISCUSSION: The instrument has achieved the desired content and construct validity score. It can be used by other institutions to assess their medical graduates' performance in the clinical setting.

Proteomic analysis reveals that treatment with tocotrienols reverses the effect of H2O2 exposure on peroxiredoxin expression in human lymphocytes from young and old individuals.

Vitamin E has been suggested to modulate age-associated changes by altering the redox balance resulting in altered gene and/or protein expression. Here we have utilized proteomics to determine whether such regulation in protein expression occurs in human lymphocytes from two different age groups stressed with H2O2 and then treated with vitamin E in the form of tocotrienol-rich fraction (TRF). In this study, lymphocytes obtained from young (30-49 years old) and old (>50 years old) volunteers were first challenged with 1 mM H2O2. They were then treated by exposure to 50, 100 and 200 µg/ml TRF. Two-dimensional gel electrophoresis followed by MALDI-TOF/TOF (matrix-assisted laser desorption/ionization time-of-flight/time-of-flight) tandem mass spectrometry was then performed on whole-cell protein extracts to identify proteins that have changed in expression. A total of 24 proteins were found to be affected by H2O2 and/or TRF treatment. These included proteins that were related to metabolism, antioxidants, structural proteins, protein degradation and signal transduction. Of particular interest was the regulation of a number of proteins involved in stress response--peroxiredoxin-2, peroxiredoxin-3 and peroxiredoxin-6-all of which were shown to be down-regulated with H2O2 exposure. The effect was reversed following TRF treatment. The expression of peroxiredoxin-2 and peroxiredoxin-6 was confirmed by quantitative reverse transcriptase polymerase chain reaction. These results suggested that TRF directly influenced the expression dynamics of the peroxiredoxin-2, thus improving the cells ability to resist damage caused by oxidative stress.

Reduction of DNA damage in older healthy adults by Tri E Tocotrienol supplementation.

OBJECTIVE: The free radical theory of aging (FRTA) suggests that free radicals are the leading cause of deteriorating physiologic function during senescence. Free radicals attack cellular structures or molecules such as DNA resulting in various modifications to the DNA structures. Accumulation of unrepaired DNA contributes to a variety of disorders associated with the aging process. METHODS: A randomized, double-blinded placebo-controlled study was undertaken to evaluate the effect of Tri E Tocotrienol on DNA damage. Sixty four subjects 37-78 y old completed the study. A daily dose of 160 mg of Tri E Tocotrienol was given for 6 months. Blood samples were analyzed for DNA damage using comet assay, frequency of sister chromatid exchange (SCE), and chromosome 4 aberrations. RESULTS: Results showed a significant reduction in DNA damage as measured by comet assay after 3 mo (P < 0.01) and remained low at 6 mo (P < 0.01). The frequency of SCE was also reduced after 6 mo of supplementation (P < 0.05), albeit more markedly in the >50 y-old group (P < 0.01) whereas urinary 8-hydroxy-2'-deoxyguanosine (8-OHdG) levels were significantly reduced (P < 0.05). A strong positive correlation was observed between SCE with age, whereas weak positive correlations were observed in DNA damage and 8-OHdG, which were reduced with supplementation. However, no translocation or a stable insertion was observed in chromosome 4. CONCLUSION: Tri E Tocotrienol supplementation may be beneficial by reducing DNA damage as indicated by a reduction in DNA damage, SCE frequency, and urinary 8-OHdG.

Ginger extract (Zingiber officinale) has anti-cancer and anti-inflammatory effects on ethionine-induced hepatoma rats

OBJECTIVE: To evaluate the effect of ginger extract on the expression of NFêB and TNF-á in liver cancer-induced rats. METHODS: Male Wistar rats were randomly divided into 5 groups based on diet: i) control (given normal rat chow), ii) olive oil, iii) ginger extract (100mg/kg body weight), iv) choline-deficient diet + 0.1 percent ethionine to induce liver cancer and v) choline-deficient diet + ginger extract (100mg/kg body weight). Tissue samples obtained at eight weeks were fixed with formalin and embedded in paraffin wax, followed by immunohistochemistry staining for NFêB and TNF-á. RESULTS: The expression of NFêB was detected in the choline-deficient diet group, with 88.3 ± 1.83 percent of samples showing positive staining, while in the choline-deficient diet supplemented with ginger group, the expression of NFêB was significantly reduced, to 32.35 ± 1.34 percent (p<0.05). In the choline-deficient diet group, 83.3 ± 4.52 percent of samples showed positive staining of TNF-á, which was significantly reduced to 7.94 ± 1.32 percent (p<0.05) when treated with ginger. There was a significant correlation demonstrated between NFêB and TNF-á in the choline-deficient diet group but not in the choline-deficient diet treated with ginger extract group. CONCLUSION: In conclusion, ginger extract significantly reduced the elevated expression of NFêB and TNF-á in rats with liver cancer. Ginger may act as an anti-cancer and anti-inflammatory agent by inactivating NFêB through the suppression of the pro-inflammatory TNF-á.