Effectiveness of blended learning in radiological anatomy for first year undergraduate medical students.

PURPOSE: The aim of the study was to assess the effectiveness of blended learning modules for radiological anatomy among first-year medical students by estimating knowledge gain and evaluating student perceptions. METHODS: A single-group, pre- and post-test study design was utilized. Five radiological anatomy modules consisting of online presentations and self-assessment quizzes were developed for the upper limb, lower limb, head and neck, thorax, and abdomen and pelvis. The content of the modules was uploaded on to a learning management system called TYRO. Each module focused on the normal anatomical features observed on plain and contrast radiographs. Other relevant imaging modalities and clinical contexts were also introduced. During the classroom session, the students were instructed to peruse the modules and answer the self-assessment quiz. The teacher in the classroom acted as a facilitator and was available to the students for any clarifications. A pre- and post-test was administered to the students before and after exposure to the modules, respectively. A paired t test was used to estimate differences in the pre- and post-test scores. Students' perceptions were assessed using a questionnaire. RESULTS: One-hundred students attended both the tests. The mean and standard deviation of pre- and post-test scores were 17 ± 5.5 and 26 ± 7.6, respectively, and this difference was significant. Students' perceptions about the intervention were on the whole positive. CONCLUSION: A significant improvement in the knowledge of radiological anatomy was noted after exposure to five blended learning modules of radiological anatomy. The modules were well received by the students.

Factors that predict cognitive decline in patients with subjective cognitive impairment.

BACKGROUND: Current evidence supports the concept of a preclinical phase of Alzheimer's disease (AD) where pathological and imaging changes are present in asymptomatic individuals. Subjective cognitive impairment (SCI) may represent the earliest point on the continuum of AD. A better understanding of the baseline characteristics of this group of patients that later decline in cognition will enhance our knowledge of the very early disease processes, facilitate preventive strategies, early diagnosis, timely follow-up and treatment. METHODS: An observational exploratory study which followed up 62 consecutive patients with SCI presenting to a memory clinic and compared baseline characteristics of SCI patients who declined cognitively with those who did not. Cognitive decline was defined as a progression to a diagnosis of amnestic mild cognitive impairment (aMCI) or dementia at follow-up. RESULTS: Patients were followed up for a mean of 44 months (range 12-112 months). At the time of follow up, 24% of patients had declined. Patients that declined were significantly older at onset of symptoms and first presentation to memory clinic, and took significantly more medications for physical illnesses. Patients that declined also performed significantly worse on Trail Making Test (TMT) B and Cambridge Cognitive Examination - Revised (CAMCOG-R) at baseline. Survival analysis identified key variables that predicted decline (later age of onset and later age at first assessment). CONCLUSIONS: Patients who present with subjective memory complaints and are over the age of 61 years are at high risk of cognitive decline and warrant an in-depth assessment and follow-up.

Changes in smoking status, mental state and plasma clozapine concentration: retrospective cohort evaluation.

AIMS AND METHOD: To investigate the percentage of patients who commenced smoking after transferring out of a non-smoking forensic psychiatric unit, the corresponding clozapine dose adjustments, the effects on plasma clozapine/norclozapine concentrations and observed changes in mental state. We reviewed the notes and plasma clozapine/norclozapine concentrations of 46 patients transferred to medium secure units between July 2008 and December 2013. RESULTS: Thirty-five patients commenced smoking. Their median clozapine dose was increased by 50 mg/d. In the non-smokers, the median clozapine dose remained unchanged. Plasma clozapine/norclozapine concentrations were significantly reduced in smokers despite dosage adjustment. Eighteen patients experienced deterioration in mental state after transfer; almost all these patients were smokers. CLINICAL IMPLICATIONS: Approximately three-quarters of patients who were non-smokers by virtue of being in a secure non-smoking environment commenced smoking after transfer. Monitoring of clozapine serum levels and assessment of mental state in the immediate period after a change in smoking status is indicated.

Sensitization to silk allergen among workers of silk filatures in India: a comparative study.

BACKGROUND: Sericulture plays an eminent role in development of rural economy in India. Silk filature is a unit where silk is unwound from the cocoons and the strands are collected into skeins. During the process workers are exposed to the high molecular weight proteins like Sericin and Fibroin which are potent allergens leading to sensitization over a period of time and subsequently occupational related health disorders. OBJECTIVE: To identify and compare the magnitude of silk allergen sensitization in workers of silk filatures. METHODS: A community based comparative descriptive study was conducted for a period of 1 year at Ramanagara in south India. One hundred twenty subjects working in the silk filatures formed the study group. For comparison, 2 types of controls were selected viz.120 subjects who were not working in the silk filatures but resided in the same geographical area (control A) and 360 subjects who were not working in silk filatures as well not residing in the same geographical area (control B). Skin prick test was used to identify the silk allergen sensitization. RESULTS: Mean age was 34.14 ± 2.84 years in the study group. Mean age was 40.59 ± 14.40 years and 38.54 ± 12.20 years in control A and control B, respectively. There were 35 males (29.16%) and 85 females (70.84%) in the study group. There were 58 (48.34%) males and 62 (51.66%) females and 152 (42.2%) males and 208 females (57.8%) in control A and control B, respectively. Sensitization to silk allergen was 35.83% in the study group and 20.83% in the control group A and 11.11% in control group B. There was difference in the allergen sensitivity between the study group and control groups and it was statistically significant (chi-square = 38.08; p < 0.001). CONCLUSION: There is high burden of silk allergen sensitization among silk filature workers.

A study on occupational asthma among workers of silk filatures in South India.

BACKGROUND: The production of silk is a multidimensional and multistep process involving exposure of workers to allergens at work place. The silk allergen has been implicated in the development of bronchial asthma. OBJECTIVES: To identify the prevalence of occupational asthma (OA) and to identify sensitization to silk allergen and among workers in silk filature units. MATERIALS AND METHODS: A community-based cross-sectional study was conducted in silk filature units of Ramanagara (Silk City) in Karnataka, South India, for a period of 6 months. One hundred and twenty workers of silk filature units who met the inclusion and exclusion criteria were recruited into the study group. For comparison, a control group comprising of 120 individuals not working in silk filature units was constituted. All the subjects were interviewed using the standardized International Union against Tuberculosis and Lung Diseases (IUATLD) Questionnaire and subjected to the skin prick test, which used the extracts of silk allergen. RESULTS: The study group comprised of 35 males and 85 females, whereas the control group comprised of 58 males and 62 females. The prevalence of occupational asthma among workers in silk filatures was 20.83%. It was observed that 35.83% of those in the study group and 20.83% of those in the control group were found to be sensitive to silk allergen. This difference was statistically significant (χ(2)= 6.64; P < 0.05). CONCLUSION: There is a high burden of sensitization to silk allergen and occupational asthma among silk filature workers in South India.