Teaching clinical reasoning to medical students.

Clinical reasoning is often not explicitly addressed in the early medical school curriculum. As a result, students observe the process while on clinical placements with little or no understanding of the complex processes underlying it. Clinical reasoning has significant implications for patient safety. Medical errors as a consequence of faulty reasoning contribute to patient morbidity and mortality. Educating medical students at an early stage about the processes of clinical reasoning and strategies to avoid associated errors can have positive impacts upon patient safety. The authors propose that clinical reasoning should be taught as early as the first year of medical school, using frameworks, anatomical knowledge and mnemonics. Using this approach with simulated cases during the pre-clinical years, students will be equipped with an understanding of the clinical reasoning process as it unfolds before them while on clinical placements, enhancing their overall learning experience.

The Impact of Physical Activity on Non-Motor Symptoms in Parkinson's Disease: A Systematic Review.

Parkinson's disease (PD) is a neurological disorder that is associated with both motor and non-motor symptoms (NMS). The management of PD is primarily via pharmaceutical treatment; however, non-pharmaceutical interventions have become increasingly recognized in the management of motor and NMS. In this review, the efficacy of physical activity, including physiotherapy and occupational therapy, as an intervention in NMS will be assessed. The papers were extracted between the 20th and 22nd of June 2016 from PubMed, Web of Science, Medline, Ovid, SportsDiscuss, and Scopus using the MeSH search terms "Parkinson's," "Parkinson," and "Parkinsonism" in conjunction with "exercise," "physical activity," "physiotherapy," "occupational therapy," "physical therapy," "rehabilitation," "dance," and "martial arts." Twenty studies matched inclusion criteria of having 10 or more participants with diagnosed idiopathic PD participating in the intervention as well as having to evaluate the effects of physical activity on NMS in PD as controlled, randomized intervention studies. The outcomes of interest were NMS, including depression, cognition, fatigue, apathy, anxiety, and sleep. Risk of bias in the studies was evaluated using the Cochrane Collaboration's tool for assessing risk of bias. Comparability of the various intervention methods, however, was challenging due to demographic variability and methodological differences. Nevertheless, physical activity can positively impact the global NMS burden including depression, apathy, fatigue, day time sleepiness, sleep, and cognition, thus supporting its therapeutic potential in neurodegenerative conditions such as PD. It is recommended that further adequately powered studies are conducted to assess the therapeutic role of physical activity on both motor and non-motor aspects of PD. These studies should be optimally designed to assess non-motor elements of disease using instruments validated in PD.