Dissociable Roles of the Dorsolateral and Ventromedial Prefrontal Cortex in Human Categorization.

Models of human categorization predict the prefrontal cortex (PFC) serves a central role in category learning. The dorsolateral prefrontal cortex (dlPFC) and ventromedial prefrontal cortex (vmPFC) have been implicated in categorization; however, it is unclear whether both are critical for categorization and whether they support unique functions. We administered three categorization tasks to patients with PFC lesions (mean age, 69.6 years; 5 men, 5 women) to examine how the prefrontal subregions contribute to categorization. These included a rule-based (RB) task that was solved via a unidimensional rule, an information integration (II) task that was solved by combining information from two stimulus dimensions, and a deterministic/probabilistic (DP) task with stimulus features that had varying amounts of category-predictive information. Compared with healthy comparison participants, both patient groups had impaired performance. Impairments in the dlPFC patients were largest during the RB task, whereas impairments in the vmPFC patients were largest during the DP task. A hierarchical model was fit to the participants' data to assess learning deficits in the patient groups. PFC damage was correlated with a regularization term that limited updates to attention after each trial. Our results suggest that the PFC, as a whole, is important for learning to orient attention to relevant stimulus information. The dlPFC may be especially important for rule-based learning, whereas the vmPFC may be important for focusing attention on deterministic (highly diagnostic) features and ignoring less predictive features. These results support overarching functions of the dlPFC in executive functioning and the vmPFC in value-based decision-making.

Incidence and factors influencing sleep disorders in patients with chronic hepatitis B infection: A case-control study.

Chronic hepatitis B (HBV) infection is a disease that imposes a considerable financial burden on patients and can lead to sleep disorders (SDs), resulting in a serious deterioration to patient quality of life. This study aimed to determine the prevalence of SDs in patients with HBV and the correlated sociodemographic and clinical characteristics. A total of 747 patients with chronic HBV infection were recruited. All patients completed the Pittsburgh Sleep Quality Index (PSQI), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 scale, Social Support Rating Scale, Short Form 36 Health Survey (SF-36), and Visual Analogue Scale (VAS). The total PSQI score of patients with each type of chronic HBV infection was significantly higher compared to healthy Chinese adults (p < .05). The incidence of SDs in HBV carriers and patients with mild HBV, moderate HBV, severe HBV, liver failure, compensated cirrhosis, and decompensated liver cirrhosis was 25%, 26%, 32%, 47%, 56%, 31%, and 49%, respectively. The incidence of SDs in all patients with chronic HBV infection was 30%. Binary logistic regression analysis revealed that the course of disease, aspartate aminotransferase levels, PHQ-9 scores, and VAS scores were independent risk factors for SDs, while the total SF-36 score was a protective factor for SDs (all p < .05). In conclusion, the prevalence of SDs was significantly higher in patients with chronic hepatitis B compared to healthy subjects. The independent risk factors for SDs included disease duration, aspartate aminotransferase levels, depression, and fatigue. Clinicians should pay more attention to SDs in patients with chronic HBV infection.

Urinary lipid profile of atopic dermatitis in murine model and human patients.

Atopic dermatitis (AD) is the most common inflammatory skin disease in children. The serum level of thymus and activation-regulated chemokine (TARC) is a useful AD index to reflect disease severity; however, it requires blood collection from young children. In comparison, urine samples are easier to collect in a pediatric clinical setting. Here, we analyzed the lipids excreted in urine to identify a diagnostic biomarker for AD. We generated a murine dermatitis model by repeated topical application of 2,4-dinitrofluorobenzene (DNFB) or tape-stripping the dorsal skin. Lipid metabolites excreted in the urine were comprehensively analyzed using liquid chromatography-tandem mass spectrometry. To corroborate our findings, we also analyzed urine samples from patients with AD. DNFB application induced AD-like skin lesions, including epidermal thickening, infiltration of eosinophils and T cells, and an increase in Th2 cytokine levels. Assessment of lipids excreted in urine showed a dominance of prostaglandins (PGs), namely, a PGF2α metabolite (13,14-dihydro-15-keto-tetranor-PGF1α ), a PGE2 metabolite (13,14-dihydro-15-keto-tetranor-PGE2 ), and a PGD2 metabolite (13,14-dihydro-15-keto PGJ2 ). mRNA and protein expression of PGF2α , PGE2 , and PGD2 synthase was upregulated in DNFB-treated skin. The tape-stripping model also caused dermatitis but without Th2 inflammation; urine PGF2α and PGD2 metabolite levels remained unaffected. Finally, we confirmed that the urinary levels of the aforementioned PG metabolites, as well as PGI2 metabolite, 6,15-diketo-13,14-dihydro-PGF1α and arachidonic acid metabolite, 17-hydroxyeicosatetraenoic acid (17-HETE) increased in patients with AD. Our data highlights the unique urinary lipid profile in patients with AD, which may provide insight into novel urinary biomarkers for AD diagnosis.

High-flow nasal cannula therapy reduced the respiratory rate and respiratory distress in a standard model simulator and in patients with hypoxemic respiratory failure.

High-flow nasal cannula (HFNC) therapy has been increasingly applied to treat patients with severe hypoxemic respiratory failure. We investigated whether vital signs reflect the reduction of work of breathing in a simulator study and a clinical study. In the simulator study, a standard model high-fidelity human patient simulator (HPS) directly received 35 L/minute of 100% O2 via the HFNC. In the clinical study, the medical records of patients with hypoxemic respiratory failure who received HFNC therapy between January 2013 and May 2015 were retrospectively reviewed. Statistical analysis was performed using a one-way repeated analysis of variance followed by Bonferroni post-hoc testing. In the HPS, HFNC therapy significantly reduced the partial pressure of alveolar CO2, respiratory rate, and tidal volume (p < 0.001), and all values returned to baseline following HFNC therapy termination (p < 0.001). In the clinical study including 48 patients, the respiratory rate was significantly reduced from 27 ± 9 (baseline) to 24 ± 8 (3 hours), 24 ± 8 (5 hours), and 24 ± 8.0 (6 hours) (p < 0.05). The heart rate also decreased significantly (p < 0.05). Our results suggested that HFNC therapy reduced work of breathing and assessing vital signs can be important.

Pulse contour analysis of arterial waveform in a high fidelity human patient simulator.

The measurement of cardiac output (CO) may be useful to improve the assessment of hemodynamics during simulated scenarios. The purpose of this study was to evaluate the feasibility of introducing an uncalibrated pulse contour device (MostCare, Vytech, Vygon, Padova, Italy) into the simulation environment. MostCare device was plugged to a clinical monitor and connected to the METI human patient simulator (HPS) to obtain a continuous arterial waveform analysis and CO calculation. In six different simulated clinical scenarios (baseline, ventricular failure, vasoplegic shock, hypertensive crisis, hypovolemic shock and aortic stenosis), the HPS-CO and the MostCare-CO were simultaneously recorded. The level of concordance between the two methods was assessed by the Bland and Altman analysis. 150-paired CO values were obtained. The HPS-CO values ranged from 2.3 to 6.6 L min-1 and the MostCare-CO values from 2.8 to 6.4 L min-1. The mean difference between HPS-CO and MostCare-CO was - 0.3 L min-1 and the limits of agreement were - 1.5 and 0.9 L min-1. The percentage of error was 23%. A good correlation between HPS-CO and MostCare-CO was observed in each scenario of the study (r = 0.88). Although MostCare-CO tended to underestimate the CO over the study period, good agreements were found between the two methods. Therefore, a pulse contour device can be integrated into the simulation environment, offering the opportunity to create new simulated clinical settings.

Case report: Helicobacter suis infection in a pig veterinarian.

This study describes a non-Helicobacter (H.) pylori Helicobacter (NHPH) infection in a pig veterinarian. The patient suffered from reflux esophagitis and general dyspeptic symptoms and was referred to the hospital for upper gastrointestinal endoscopy. Histologic examination of corpus and antrum biopsies revealed a chronic gastritis. Large spiral-shaped non-H. pylori helicobacters could be visualized and were identified as H. suis by PCR. The patient was treated with a triple therapy, consisting of amoxicillin, clarithromycin, and pantoprazole for 10 days. Successful eradication was confirmed after a follow-up gastrointestinal endoscopy and PCR 10 weeks after treatment. A mild chronic gastritis was, however, still observed at this point in time. This case report associates porcine H. suis strains with gastric disease in humans, thus emphasizing the zoonotic importance of H. suis bacteria from pigs.

Systematic Review of Tissue-Engineered Vascular Grafts.

Pathologies related to the cardiovascular system are the leading causes of death worldwide. One of the main treatments is conventional surgery with autologous transplants. Although donor grafts are often unavailable, tissue-engineered vascular grafts (TEVGs) show promise for clinical treatments. A systematic review of the recent scientific literature was performed using PubMed (Medline) and Web of Science databases to provide an overview of the state-of-the-art in TEVG development. The use of TEVG in human patients remains quite restricted owing to the presence of vascular stenosis, existence of thrombi, and poor graft patency. A total of 92 original articles involving human patients and animal models were analyzed. A meta-analysis of the influence of the vascular graft diameter on the occurrence of thrombosis and graft patency was performed for the different models analyzed. Although there is no ideal animal model for TEVG research, the murine model is the most extensively used. Hybrid grafting, electrospinning, and cell seeding are currently the most promising technologies. The results showed that there is a tendency for thrombosis and non-patency in small-diameter grafts. TEVGs are under constant development, and research is oriented towards the search for safe devices.

Epitope imprinting of alpha-synuclein for sensing in Parkinson's brain organoid culture medium.

Parkinson's disease (PD) is a progressive nervous system disorder that affects movement, whose early signs may be mild and unnoticed. α-Synuclein has been identified as the major component of Lewy bodies and Lewy neurites, which are the characteristic proteinaceous deposits that are the hallmarks of PD. In this work, three alpha-synuclein peptides were synthesized as templates for the molecular imprinting of conductive polymers to enable recognition of alpha-synuclein via ultrasensitive electrochemical measurements. The peptide sequences encompassed specific residues where mutations are known to accelerate PD (though the target sequences, in this study, were wild-type.) The different peptide targets were all successfully imprinted, but with differing imprinting effectiveness, probably owing to differences in target carboxylic acids (which can bind to the aniline (AN) m-aminobenzenesulfonic acid (MSAN) MIP polymers.) Composition of the imprinted polymer, (the mole proportions of AN and MSAN), and the concentrations and sequences of imprinted peptide templates were optimized by measuring the electrochemical responses to target peptides. The imprinted electrode can detect alpha-synuclein at fg/mL levels, and was therefore used to measure alpha-synuclein in the culture medium of human brain organoids generated from normal and idiopathic PD patients.

Cavin3 Suppresses Breast Cancer Metastasis via Inhibiting AKT Pathway.

OBJECTIVE: Cavin3 is a putative tumor suppressor protein. However, its molecular action on tumor regulation is largely unknown. The aim of the current study is to explore the implication of cavin3 alteration, its clinical significance, and any potential molecular mechanisms in the regulation of breast cancer (BC). METHODS: TCGA (The Cancer Genome Atlas) and GTEx (Genotype-Tissue Expression) data bases, and 17 freshly paired BC and adjacent normal tissues were analyzed for mRNA levels of Cavin3. Furthermore, cavin3 protein expression from 407 primary BC samples were assessed by immunohistochemistry (IHC) and measured by H-score. The clinical significance of cavin3 expression was explored by Kaplan-Meier analysis and the Cox regression method. In vitro biological assays were performed to elucidate the function and underlying mechanisms of cavin 3 in BC cell lines. RESULTS: Cavin3 mRNA was dramatically down-regulated in BC compared with the negative control. The median H-score of cavin3 protein by IHC was 50 (range 0-270). There were 232 (57%) and 175 (43%) cases scored as low (H-score≤50) and high (H-score >50) levels of cavin3, respectively. Low cavin3 was correlated with a higher T and N stage, and worse distant metastasis-free survival (DMFS) and overall survival (OS). Multivariate survival analysis revealed low cavin3 was an independent fact for worse DMFS. In BC cells, an overexpression of cavin3 could inhibit cell migration and invasion, and significantly decreased the level of p-Akt. Knockout of cavin3, meanwhile, promoted cell invasion ability and increased the level of p-AKT. CONCLUSION: Cavin3 expression is significantly lower in BC and is correlated with distant metastasis and worse survival. Cavin3 functions as a metastasis suppressor via inhibiting the AKT pathway, suggesting cavin3 as a potential prognostic biomarker and a target for BC treatment.

Mutations associated with human neural tube defects display disrupted planar cell polarity in Drosophila.

Planar cell polarity (PCP) and neural tube defects (NTDs) are linked, with a subset of NTD patients found to harbor mutations in PCP genes, but there is limited data on whether these mutations disrupt PCP signaling in vivo. The core PCP gene Van Gogh (Vang), Vangl1/2 in mammals, is the most specific for PCP. We thus addressed potential causality of NTD-associated Vangl1/2 mutations, from either mouse or human patients, in Drosophila allowing intricate analysis of the PCP pathway. Introducing the respective mammalian mutations into Drosophila Vang revealed defective phenotypic and functional behaviors, with changes to Vang localization, post-translational modification, and mechanistic function, such as its ability to interact with PCP effectors. Our findings provide mechanistic insight into how different mammalian mutations contribute to developmental disorders and strengthen the link between PCP and NTD. Importantly, analyses of the human mutations revealed that each is a causative factor for the associated NTD.

As an embryo develops, its cells must work together to build mature tissues and organs. During the formation of the nervous system, for example, a sheet of cells destined to become the brain and spinal cord folds up into a tube spanning the length of the embryo. Normally, this tube ­ known as the 'neural tube' ­ zips up, and the cells that will eventually become skin and other surrounding tissues close in over it. If the neural tube does not close completely, different parts of the spinal cord or brain can remain unprotected. This can cause diseases called neural tube defects, such as spina bifida, which is characterized by holes in the backbone exposing the spinal cord and surrounding membranes. Patients with neural tube defects can have similar genetic mutations, for example, in the genes controlling a process called "planar cell polarity", or PCP for short. Cells arranged in flat sheets use the PCP process to sense direction, and it is this process that allows structures, such as the scales on a fish or the hairs on a mouse, to all point in the same direction. PCP is also important in embryonic development: sheets of cells that can sense direction correctly can therefore move collectively to complete complex tasks (such as closing the neural tube). However, no-one knew whether the specific PCP gene mutations implicated in neural tube defects in humans actually affected the cells' ability to sense direction, or indeed whether they were even involved in causing the diseases. Humphries et al. set out to find out more about these mutations using fruit flies as a model system. The fruit fly is widely used to study the genes and signals involved in direction sensing, especially PCP. Problems with PCP produce easily measurable changes in the wing and eye, showing what went wrong and how badly. Humphries et al. genetically engineered fruit flies to have the same mutations as human patients and revealed that these mutations did indeed alter cells' ability to sense direction. These experiments also showed that each mutation did so in a different way, and with varying severity. This explained why the same mutations caused different levels of neural defects in mice (which are commonly used to study human diseases) and suggests that they might contribute to neural tube disorders in humans. These results show potential connections between neural tube defects and direction sensing in cells. In the future, this study and follow-up work could help researchers to understand what types of mutation have the most impact, which may eventually allow doctors to better predict who is most at risk of being affected by these conditions.

Simulation 2.0: Integrating Basic Scientists and Clinicians in a Simulation Environment.

An increasing number of medical schools are implementing curricular changes that better integrate clinical and basic sciences throughout all four years of medical school. One of the most frequently cited reasons is to improve medical student clinical reasoning skills while simultaneously aiming to decrease the attrition of basic science knowledge. Multiple pedagogical strategies have been explored to achieve this goal. We have found that simulation is a viable medium to integrate basic science within standardized patient encounters for early medical students.

Analysis of the Type II-A CRISPR-Cas System in Streptococcus canis Isolated from Diseased Companion Animals and One Human Patient in Japan.

We determined the whole-genome sequence (WGS) of Streptococcus canis strain TA4 harboring the M-like protein gene (scm); the strain was isolated from a human patient presenting with bacteremia. The potential of type II-A clustered regularly interspaced short palindromic repeats (CRISPR) array-based typing was evaluated, and the genetic relation was elucidated between spacer genogroups and scm prevalence and/or polymorphisms among the isolates from 19 diseased companion animals and the human patient. CRISPRFinder and CRISPRCasFinder detected the type II-A locus with the same repeat sequences in strain TA4 and another WGS of S. canis strain, isolated from a cow with mastitis. An optimized PCR-based amplification method was used to sequence the region covering the locus around the leader and terminal repeat sequences. Among the 20 isolates sequenced, 16 strains (including TA4) were identified with the CRISPR array. We conducted comparative analysis of the homologous spacer sequences and performed grouping based on the successive common ancestral spacer types. These 16 isolates were assigned to five genogroups (A to E) with scm being absent in genogroup A. We found a relationship between genogroups C and E and allele type 1 of the deduced M-like protein. These preliminary findings suggest the feasibility of CRISPR array-based typing and a genetic relation between the spacer genogroups and scm prevalence and/or polymorphisms in the isolates.

Promoting experiential learning through the use of high-fidelity human patient simulators in midwifery: A qualitative study.

BACKGROUND:  The need to use innovative teaching and learning strategies in the nursing pedagogy is important in the 21st century. The challenges of clinical sites and opportunities for nursing students to gain clinical experience are a growing concern for many nurse educators. High-fidelity human patient simulators (HFHPS) are computerised mannequins that replicate a real-life patient, and when integrated into classroom teaching they allow students to become fully immersed into an almost real-life scenario. OBJECTIVES:  The aim of this study was to describe how HFHPS can promote experiential learning following the management of postpartum haemorrhage as a midwifery clinical emergency. METHOD:  A descriptive qualitative research approach was carried out in this study. The research setting was a local university in KwaZulu-Natal. The total population included all (N = 43) fourth-year baccalaureate of nursing undergraduate student midwives who participated as observers and/or role-players of a scenario role-play. An all-inclusive sampling was performed. There were 43 student midwives involved in the simulation teaching session with 6 of these students actively participating in each role-play at a time, while the remaining 37 observed. This occurred in two separate sessions and all the student midwives were involved in a debriefing session. These student midwives were then followed up and asked to participate in a focus group. The data in this article came from two separate focus groups which comprised 20 student midwives in total. Data were analysed using content analysis. RESULTS:  Four categories emerged from the data, namely HFHPS offers a unique opportunity for student midwives to manage complex real-life emergencies; promotes reflection by allowing student midwives to reflect or review their roles, decisions and skills; allows student midwives to learn from their own experiences and encourages student midwives to try out what they learnt in a real-life situation. CONCLUSION:  High-fidelity human patient simulators can be used in a complex case scenario to promote experiential learning of a clinical emergency.

Measuring health care students' attitudes toward interprofessional learning, perceptions of effectiveness as an interprofessional team member, and competence in managing adult cardiac arrest.

BACKGROUND AND PURPOSE: Interprofessional education can be used to prepare healthcare graduates for teamwork. Simulations, when used with interprofessional education, create realistic clinical situations that promote teamwork. Faculty assessed changes in pharmacy and nursing students' competence in treating adult cardiac arrest and perceived readiness for interprofessional learning and teamwork. EDUCATIONAL ACTIVITY AND SETTING: Eighty-three pharmacy students and 57 nursing students participated in a high fidelity simulation focused on adult cardiac arrest as an expectation of their respective courses. This study took place at a single campus College of Health Professions located at a public land grant institution. FINDINGS: The Readiness for Health Care Students for Interprofessional Learning Scale (RIPLS) and Team Skills Scale (TSS) were used to develop a survey administered prepost simulation. A paired t-test indicated statistically significant increases of mean values prepost (p < 0.001) for: teamwork and collaboration, professional identity, team skills, and competence. An independent sample t-test found no differences by gender or degree. DISCUSSION: This research supports using simulation in interprofessional education to increase competence and promote changes in attitudes toward interprofessional learning and teamwork. SUMMARY: An interprofessional simulation increased student's perceived competence and positively increased perceptions of learning and working with other health profession students.

Bridging burn care education with modern technology, an integration with high fidelity human patient simulation.

OBJECTIVE: The Advanced Burn Life Support (ABLS) program is a burn-education curriculum nearly 30 years in the making, focusing on the unique challenges of the first 24h of care after burn injury. Our team applied high fidelity human patient simulation (HFHPS) to the established ABLS curriculum. Our hypothesis was that HFHPS would be a feasible, easily replicable, and valuable adjunct to the current curriculum that would enhance learner experience. METHODS: This prospective, evidenced-based practice project was conducted in a single simulation center employing the American Burn Association's ABLS curriculum using HFHPS. Participants managed 7 separate simulated polytrauma and burn scenarios with resultant clinical complications. After training, participants completed written and practical examinations as well as satisfaction surveys. RESULTS: From 2012 to 2013, 71 students participated in this training. Simulation (ABLS-Sim) participants demonstrated a 2.5% increase in written post-test scores compared to traditional ABLS Provider Course (ABLS Live) (p=0.0016). There was no difference in the practical examination when comparing ABLS-Sim versus ABLS Live. Subjectively, 60 (85%) participants completed surveys. The Educational Practice Questionnaire showed best practices rating of 4.5±0.7; with importance of learning rated at 4.4±0.8. The Simulation Design Scale rating for design was 4.6±0.6 with an importance rating of 4.4±0.8. Overall Satisfaction and Self-Confidence with Learning were 4.4±0.7 and 4.5±0.7, respectfully. CONCLUSIONS: Integrating HFHPS with the current ABLS curriculum led to higher written exam scores, high levels of confidence, satisfaction, and active learning, and presented an evidenced-based model for education that is easily employable for other facilities nationwide.

Simulation to Manage the Septic Patient in the Intensive Care Unit.

Sepsis and septic shock are complex, clinical conditions associated with high morbidity and mortality rates. There are evidence-based guidelines outlining priority care areas for sepsis, including early screening outside the intensive care unit. Nurses are directly involved with patient care and must be able to provide safe, competent care after graduation. High-fidelity human patient simulation is an educational tool that provides access to a safe learning environment where the care of a septic patient can be experienced. Nurses can gain confidence and knowledge surrounding the care of the septic patient while improving patient care outcomes.

Bridging medical simulation with computer science and engineering: A growing field of study.

BACKGROUND: Medical simulation has become an essential educational tool in the curricula of healthcare professionals. A literature review revealed a knowledge gap in healthcare simulation education with respect to the technological expertise required to operate highly sophisticated simulation equipment. With this motivation, a case study was designed to determine if implementing on-site technological expertise allows for the facile navigation of high fidelity manikins. Next, a research study was conducted to evaluate engineering students understanding of simulation, and their interest to attend a program in medical simulation. OBJECTIVES: To determine if on-site technological expertise lifts barriers associated with manikin use and to assess levels of understanding and interest among engineering students following exposure to the technology used in healthcare simulation. DESIGN: A prospective, descriptive study with pre-post surveys. SETTINGS: The Nursing Skills and Simulation Center at a New England University campus. PARTICIPANTS: Engineering students attending 6 different engineering programs (Computer Science, Computer Engineering, Mechanical Engineering, Biomedical Engineering, Electrical Engineering and Technology Management) and having different educational levels (undergraduate and graduate). METHODS: Two assessments were applied to engineering students attending a class on technology used in healthcare simulation. A pre-test measured the understanding and interest of students in the engineering/computer science courses before attending a simulation class. A post-test assessment measured their improvement in understanding and interest to learn more about simulation technologies. RESULTS: Statistical analysis and comparisons of pre-and post-test assessments show a 23% gain in understanding of this field following exposure to the healthcare simulation class. Furthermore, post test results show greater than 67% of those surveyed have an interest in attending a program in healthcare simulation. CONCLUSIONS: The results indicate the collaboration of nursing and engineering has lifted known barriers to simulation education, and reveal engineering students have an interest in the field of medical simulation.

Evaluation of pharmacist satisfaction with simulation-based learning in Singapore.

BACKGROUND AND PURPOSE: High fidelity human patient simulation (HPS) has been incorporated in various United States doctor of pharmacy programs with favorable learning experiences, knowledge retention, and problem-solving skills reported. In Singapore, HPS is a novel learning technique as it has not been utilized in the Bachelor of Science (Pharmacy) curriculum or for continuing professional education (CPE). It is necessary to evaluate acceptance of HPS compared to asynchronous online learning (AOL). EDUCATIONAL ACTIVITY AND SETTING: Nineteen participants from two institutions completed the study in Singapore. This was an experimental study design with participants randomized into groups A and B. Group A completed AOL followed by HPS, whereas group B completed them in reverse order. Acceptance of teaching modalities was evaluated with a Likert scale survey and analyzed with Fisher's exact test. Educational content was congestive heart failure and was evaluated externally for equivalency. FINDINGS: All participants enjoyed the HPS activity compared to 13 (68.4%; p = 0.02) for AOL. Eighteen (94.7%) and 15 (78.9%; p = 0.34) participants felt that HPS activity and AOL improved their critical and decision-making skills respectively. Sixteen (84.2%) and 17 (89.5%) agreed that AOL and HPS activity improved their confidence (p = 1.00). DISCUSSION: Participants enjoyed HPS activity significantly more than AOL. HPS activity could be used to achieve improved critical and decision-making skills of learners as there was a trend of more learners perceiving improvement compare to AOL. SUMMARY: High fidelity HPS learning was well received by participants in Singapore and can be implemented in CPE.

Does teaching non-technical skills to medical students improve those skills and simulated patient outcome?

Objectives: The purpose of this study is to evaluate the effects of a tailor-made, non-technical skills seminar on medical student's behaviour, attitudes, and performance during simulated patient treatment. Methods: Seventy-seven students were randomized to either a non-technical skills seminar (NTS group, n=43) or a medical seminar (control group, n=34). The human patient simulation was used as an evaluation tool. Before the seminars, all students performed the same simulated emergency scenario to provide baseline measurements. After the seminars, all students were exposed to a second scenario, and behavioural markers for evaluating their non-technical skills were rated. Furthermore, teamwork-relevant attitudes were measured before and after the scenarios, and perceived stress was measured following each simulation. All simulations were also evaluated for various medical endpoints. Results: Non-technical skills concerning situation awareness (p<.01, r=0.5) and teamwork (p<.01, r=0.45) improved from simulation I to II in the NTS group. Decision making improved in both groups (NTS: p<.01, r=0.39; control: p<.01, r=0.46). The attitude 'handling errors' improved significantly in the NTS group (p<.05, r=0.34). Perceived stress decreased from simulation I to II in both groups. Medical endpoints and patients´ outcome did not differ significantly between the groups in simulation II. Conclusions: This study highlights the effectiveness of a single brief seminar on non-technical skills to improve student's non-technical skills. In a next step, to improve student's handling of emergencies and patient outcomes, non-technical skills seminars should be accompanied by exercises and more broadly embedded in the medical school curriculum.