The effects of 'ecstasy' (MDMA) on visuospatial memory performance: findings from a systematic review with meta-analyses.

To review, with meta-analyses where appropriate, performance differences between ecstasy (3,4-methylenedioxymethamphetamine) users and non-users on a wider range of visuospatial tasks than previously reviewed. Such tasks have been shown to draw upon working memory executive resources. Abstract databases were searched using the United Kingdom National Health Service Evidence Health Information Resource. Inclusion criteria were publication in English language peer-reviewed journals and the reporting of new findings regarding human ecstasy-users' performance on visuospatial tasks. Data extracted included specific task requirements to provide a basis for meta-analyses for categories of tasks with similar requirements. Fifty-two studies were identified for review, although not all were suitable for meta-analysis. Significant weighted mean effect sizes indicating poorer performance by ecstasy users compared with matched controls were found for tasks requiring recall of spatial stimulus elements, recognition of figures and production/reproduction of figures. There was no evidence of a linear relationship between estimated ecstasy consumption and effect sizes. Given the networked nature of processing for spatial and non-spatial visual information, future scanning and imaging studies should focus on brain activation differences between ecstasy users and non-users in the context of specific tasks to facilitate identification of loci of potentially compromised activity in users.

The effects of heavy social drinking on executive function: a systematic review and meta-analytic study of existing literature and new empirical findings.

BACKGROUND: Previous investigations of executive function in alcohol dependent and in social drinkers have not always produced consistent results and have not utilised key indicators of recent theoretical models of Executive Function (EF). The present paper reports the results of two studies that seek to address these limitations. METHOD: Study 1 took the form of a systematic review and meta-analysis of studies examining EF in social drinkers. In Study 2, 41 participants completed an alcohol use inventory and were assigned to either light or heavy alcohol use via median split of average weekly dose. Participants completed measures of the fractionated executive processes of updating, shifting, inhibition and access to semantic memory. RESULTS: Study 1 only identified seven studies of EF in social drinkers, and the mean effect size was non-significant. In study 2, the heavy alcohol use group performed worse on all measures of executive functioning except memory updating. CONCLUSIONS: To our knowledge, this is the first systematic investigation of executive functioning in social drinkers. Given that the participants were non-treatment seeking social drinking students, the EF deficit in the heavy user group is particularly worrying and could increase the likelihood of developing an alcohol use disorder.

An evaluation of an online numeracy assessment tool.

AIM: To evaluate users' perceptions of an online numeracy assessment tool in terms of improving their numeracy and confidence in mathematical calculation. METHOD: A quantitative and qualitative survey evaluation was performed. An online questionnaire was sent to 695 users of the tool. A response rate of 46% was achieved. Questions posed related to three broad areas: the respondents' mathematical qualifications and perceived level of competence, perceptions of the practice exercises and assessment, and the usability and design of the numeracy assessment tool. FINDINGS: After accessing the online numeracy tool, 23% of users undertook additional study to enhance their numeracy; 88% passed the practice assessment first time; 66% reported that the practice calculations reduced their anxiety about the final non-medical prescribing assessment; and 96% found the tool easy to use. CONCLUSION: Competence in numeracy is an important skill for all healthcare professionals, including prescribers. The numeracy assessment tool enables poor numeracy skills to be identified and support provided to improve the calculation skills of clinical staff.

Using questionnaires to determine whether medical graduates' career choice is determined by undergraduate or postgraduate experiences.

BACKGROUND: There has been increased interest in the factors influencing the career choice of doctors. Feminization of the medical workforce, changing health care needs, reform of training has ensured that this is an important issue for workforce planners and educationists. AIMS AND METHODS: Questionnaires were distributed to graduates from the University of Liverpool 5 years post graduation requesting the most important influences on career choice. RESULTS AND CONCLUSIONS: The majority of graduates felt their career choice was primarily dictated by their postgraduate experience. Graduates chose their career pathway for a number of reasons including specialties that would secure home-work balance, disenchantment with training programmes, and work experiences post graduation rather than their undergraduate clinical attachments.

Views of National Health Service (NHS) Ethics Committee members on how education research should be reviewed.

BACKGROUND: A Local Research Ethics Committee (LREC) may not be appropriate for reviewing research projects involving trainees as participants. AIMS: This study aimed to obtain views of LREC members regarding education research being reviewed by LRECS. METHODS: A questionnaire describing six medical education research projects was sent to an opportunistic sample of LRECs. Respondents were asked to indicate the type of ethics review and consent that would be required for each project. Free text comments were also invited. RESULTS: The majority of the 68 respondents felt that committee review (LREC or institutional) was required for contacting trainees to obtain taped or written interviews. Most felt that some form of consent was appropriate for all the studies. Themes arising from the free text responses were that: there were concerns about this study itself; the requirements for ethical approval for education research should be no different from those of clinical research; there are problems defining 'research', 'audit' and 'course evaluation'; ethical approval should be acquired for education research but not through LRECs; the COREC system is over-complex; and, high standards of research have to be maintained. CONCLUSION: The majority of ethics committee members feel that most education research needs independent review but not necessarily by LRECs.

The role of Abrams percutaneous pleural biopsy in the investigation of exudative pleural effusions.

INTRODUCTION: Blind percutaneous pleural biopsy has traditionally been performed to investigate the etiology of exudative pleural effusion in which the initial thoracentesis has been nondiagnostic. In view of the increasing use of image-guided and thoracoscopic pleural biopsies, this study examines the role of blind Abrams pleural biopsy in the investigation of pleural effusion in a large urban hospital. METHOD: Patients undergoing blind Abrams needle biopsy between January 1997 and 2003 were identified from the hospital pathology database. The case notes and pathology records of these patients were analyzed retrospectively. All patients had presented to respiratory teams with an exudative pleural effusion and had initial nondiagnostic thoracentesis. RESULTS: Seventy-five patients undergoing blind biopsy were identified. Pleural tissue was obtained in 59 biopsies (79%), with no statistically significant difference in pleural yield between respiratory specialist registrars (equivalent to pulmonary fellows in training) and senior house officers/preregistration house officers (equivalent to junior residents and interns, respectively) performing the biopsy (chi(2) test, p = 0.43). When up to three samples were obtained per episode, sufficient pleural tissue was obtained in 18 of 25 patients (72%) compared to 80% (32 of 40 patients) in whom four to six samples were taken (chi(2) test, p = 0.55 [not significant]). For all diagnoses, blind biopsy had a sensitivity of 38%, which rose to 43% when reviewing patients in whom sufficient pleural tissue was obtained (for malignant diagnosis alone, sensitivity values were 43% and 51%, respectively; specificity, 100%; negative and positive predictive values, 51%). No fatalities were reported, and pneumothorax was seen in eight patients (11%), with only two patients requiring specific intervention. CONCLUSIONS: Blind Abrams needle biopsy obtaining pleural tissue was diagnostic in approximately 50% of patients presenting with malignant effusion in the sample, and can be performed safely by all grades of medical staff with due attention to technique and supervision. The data support the continued use of the Abrams needle in the investigation of malignant pleural disease.

Comparison of aspects of preregistration house officer training from traditional and new medical curricula.

As medical graduates from the new (problem-based learning) curriculum at University of Liverpool undertook their first post in the postgraduate clinical setting, this study investigated whether their views of preregistration training in the Mersey Deanery differed from the last cohort of preregistration house officers who had graduated from the traditional lecture-based medical curriculum at University of Liverpool.

Preregistration house officer skill and competency assessment through questionnaires.

In 1996 the University of Liverpool reformed its medical course from a very traditional lecture-based curriculum to an integrated problem-based learning curriculum. This article summarizes the results of questionnaires sent to both traditional and reformed curricula Liverpool graduates asking them to assess their competencies.