Self-study and online interactive case-based discussion to improve knowledge of medical students in the COVID-19 era.

BACKGROUND: We aimed to determine whether a new online interactive learning method for fifth-year medical students could improve their knowledge of pre- and postoperative care during the COVID-19 era. METHODS: A retrospective cohort study was conducted from June 2020 to May 2022 during the pre- and postoperative care course for fifth-year medical students in a university hospital in southern Thailand. Students in the 2020 cohort received only a 60-minute lecture on spinal anesthesia via Zoom while a 3-step online interactive learning method was used for the 2021 cohort. Step 1: students performed self-study comprised of video lectures and case-based discussion one week before the online class with a pre-test submitted via Google forms. Step 2: an online interactive case-based discussion class was performed via Zoom by two experienced anesthesia staff and a post-test was submitted by the students via Google forms. Step 3: a small group discussion of course evaluation between 13 representatives of students and anesthesia staff was performed via Zoom. A comparison of the post-test and pre-test scores containing 20 multiple choice questions as well as the final exam scores before (2020) and after (2021) the new interactive learning was performed using a t-test. RESULTS: There were 136 and 117 students in the 2020 and 2021 academic years, respectively. The final mean (SD) exam scores for the 2020 and 2021 academic years were 70.3 (8.4) and 72.5 (9.0), respectively with a mean (95% confidence interval (CI)) difference of 2.2 (4.3, -0.02). In 2021, the mean (95% CI) difference between the post-test and pre-test scores was 5.8 (5.1, 6.5). The student representatives were satisfied with the new learning method and gave insightful comments, which were subsequently implemented in the 2022 academic year course. CONCLUSION: The new interactive learning method improved the knowledge of fifth-year medical students attending pre- and postoperative care course during the COVID-19 era. The final exam scores may not be suitable to represent the overall outcomes of the new interactive learning method. Using an online two-way communication method can improve the overall satisfaction and course adaptation during the COVID-19 era.

A comparison of ondansetron and lidocaine in reducing injection pain of propofol: a randomized controlled study.

BACKGROUND: Direct stimulation of the afferent nerve endings in the venous endothelium is one explanation of propofol injection pain. Previous studies found that ondansetron can also block sodium channels. This effect is similar to that of lidocaine. OBJECTIVE: The primary outcome was the efficacy of ondansetron compared to lidocaine and placebo for the reduction of propofol injection pain. METHOD: This trial was conducted in 240 patients, American Society of Anesthesiologists classification I-III and aged between 18-65 years old, undergoing elective surgery, and having a 20-gauge intravenous catheter at the hand dorsum. Each group of 80 patients received 8 mg. of ondansetron in the O Group, 40 mg. of lidocaine in the L Group and normal saline in the C Group. The study medications were blindly administered to the patients through a 20-gauge intravenous catheter placed on the hand dorsum, and then 1 min later, the small dose of propofol (50 mg.) was infused via the syringe pump at a rate of 600 ml/hr. for 30 s. Following that, the syringe pump of propofol was temporarily stopped, and the patients were asked to rate their pain at the injection site. RESULT: The incidence of pain was lowest in the L group (66.2%) compared with the O (82.5%) and the C groups (85.0%) (P < 0.01). The median pain score in the L, O, and C groups were 2 (0-4), 4 (2-5), and 4.5 (2-6), respectively (P < 0.01). The incidences of no pain, mild, moderate, and severe pain were also significantly different in the L group (33.8%, 37.5%, 21.2%, and 7.5%, respectively) compared with those in the O group (17.5%, 31.2%, 31.2%, and 20.0%, respectively) and the C groups (15.0%, 22.5%, 40.0%, and 22.5%, respectively) (P < 0.01). CONCLUSION: Pretreatment with intravenous lidocaine, rather than ondansetron, can reduce the incidence and intensity of propofol-induced pain.

The light-responsive promoter of cyanobacterial ORF76 gene overlaps with the htpG terminator.

A Synechococcus PCC7942 gene, encoding 76 amino acids of an unknown protein (designated ORF76), is located at the same orientation and downstream of the htpG gene. The processed site of ORF76 transcripts is located at position +39 with respect to the true transcription initiation site. The non-E. colisigma70-like basal promoter of ORF76 (-51 to -9) is controlled by three cis-acting elements: positively acting element (-160 to -86), negative regulatory element (-86 to -51) and light-responsive element (-51 to +63) that, together, respond to high light induction at transcriptional level. The ORF76 gene is expressed as monocistronic transcript. The promoter elements of ORF76 gene overlap with the coding sequence and 3' end formation signal of htpG gene.