A comparison of student performance on discipline-specific versus integrated exams in a medical school course.

Curricular reform is a widespread trend among medical schools. Assessing the impact that pedagogical changes have on students is a vital step in review process. This study examined how a shift from discipline-focused instruction and assessment to integrated instruction and assessment affected student performance in a second-year medical school pathology course. We investigated this by comparing pathology exam scores between students exposed to traditional discipline-specific instruction and exams (DSE) versus integrated instruction and exams (IE). Exam content was controlled, and individual questions were evaluated using a modified version of Bloom's taxonomy. Additionally, we compared United States Medical Licensing Examination (USMLE) step 1 scores between DSE and IE groups. Our findings indicate that DSE students performed better than IE students on complete pathology exams. However, when exam content was controlled, exam scores were equivalent between groups. We also discovered that the integrated exams were composed of a significantly greater proportion of questions classified on the higher levels of Bloom's taxonomy and that IE students performed better on these questions overall. USMLE step 1 exam scores were similar between groups. The finding of a significant difference in content complexity between discipline-specific and integrated exams adds to recent literature indicating that there are a number of potential biases related to curricular comparison studies that must be considered. Future investigation involving larger sample sizes and multiple disciplines should be performed to explore this matter further.

Optical versus virtual: teaching assistant perceptions of the use of virtual microscopy in an undergraduate human anatomy course.

Many studies that evaluate the introduction of technology in the classroom focus on student performance and student evaluations. This study focuses on instructor evaluation of the introduction of virtual microscopy into an undergraduate anatomy class. Semi-structured interviews were conducted with graduate teaching assistants (TA) and analyzed through qualitative methods. This analysis showed that the teaching assistants found the virtual microscope to be an advantageous change in the classroom. They cite the ease of use of the virtual microscope, access to histology outside of designated laboratory time, and increasing student collaboration in class as the primary advantages. The teaching assistants also discuss principal areas where the use of the virtual microscope can be improved from a pedagogical standpoint, including requiring students to spend more time working on histology in class.

Are the adverse effects of body position in patients with obstructive sleep apnea dependent on sleep stage?

PURPOSE: The purpose of the study was to determine if the adverse effect of body position on obstructive sleep apnea (OSA) is worsened during rapid eye movement (REM) sleep and if patients with OSA decrease the time spent supine during REM sleep. METHODS: Overnight polysomnography from 80 sequential patients referred to Buffalo VA Sleep Lab for suspected OSA were analyzed with 20 patients in each of the following groups: normal with apnea-hypopnea indices (AHI) <5/h, mild (AHI, 5-< 15/h), moderate (AHI, 15-<30/h), and severe (AHI, >30/h). We used extended Cox models with the Anderson-Gill modification for multiple events with two time varying covariates: sleep stage and body position. Generalized estimating equations with logit link were used to take into account correlated data within each patient for the relation between sleep stage and body position. RESULTS: The hazard ratios for events in REM vs non-REM sleep was significant for the normal, mild, and moderate groups only: 1.71 (95% CI 1.4-2.08), 1.45 (95% CI 1.22-1.73), 1.28 (95% CI 1.1-1.5), respectively. The hazard ratio for events in the supine vs non-supine position was significant for the mild and moderate groups only: 1.25 (95% CI 1.02-1.52) and 1.24 (95% CI 1.04-1.47), respectively. The addition of an interaction effect between sleep stage and body position was not statistically significant for any group. The odds ratios of sleeping in supine position for REM vs non-REM sleep were 0.47 (95% CI 0.27-0.82) for moderate OSA group and 0.54 (95% CI 0.3-0.95) for severe OSA. CONCLUSION: In summary, we found significant effects of both sleep stage and body position in mild and moderate but not severe OSA. Patients with moderate and severe OSA were less likely to spend time in the supine position during REM compared with non-rapid eye movement sleep.

Quantitative and qualitative changes in teaching histology by means of virtual microscopy in an introductory course in human anatomy.

This study compares overall laboratory averages and individual test scores along with a student survey to determine the effects of using virtual microscopy in place of optical microscopes in a large undergraduate human anatomy course. T-tests revealed that the first two laboratory examinations (of four) and the overall laboratory averages were significantly increased compared with the previous year. We hypothesize that this is due to students' ability to use and understand the technology quickly as opposed to learning how to maneuver an optical microscope. Students also responded positively in a survey about the virtual microscope, indicating that increased accessibility, ease of use, and the ability to understand the material were important components of the virtual microscope. In addition, an increase in student collaboration was noted because multiple students were able to view the image at a time. This level of acceptance of virtual microscopy has been reported in previous studies, though this level of increased examination scores is rare. We attribute this to differences between the medical students, with whom this technology has been researched in the past, and undergraduate introductory students.

Improved learning efficiency and increased student collaboration through use of virtual microscopy in the teaching of human pathology.

The implementation of virtual microscopy in the teaching of pathology at the Bloomington, Indiana extension of the Indiana University School of Medicine permitted the assessment of student attitudes, use and academic performance with respect to this new technology. A gradual and integrated approach allowed the parallel assessment with respect to both the virtual and optical microscopes. Student survey data indicated that the virtual imaging technology was enthusiastically received, and aggregate grade comparisons with the previous classes showed no decrease in content mastery. Survey questions assessing a variety of parameters reveal improved time and resource utilization, as well as increased student collaboration. Even so, 50% of the respondents indicated having both optical and virtual microscopes available was preferable.

Morphological changes of isolated rat pancreatic islets: a structural, ultrastructural and morphometric study.

Improved techniques for pancreatic islet extraction can yield a reasonable number of transplantable cells. However, the isolation and purification process may damage the islets and impair their physiological functions. The aim of this study was to determine the effect of the isolation procedure on the structure of isolated islets and to correlate this with their functionality. Islets were isolated from rat pancreata and purified by Eurocollins-Ficoll discontinuous density gradient processing, and then processed for light microscopy, and scanning and transmission electron microscopy. Morphometric analysis was also performed. Islet functionality was determined by reversal of streptozotocin-induced diabetes and the intraperitoneal glucose tolerance test in a syngeneic rat model of pancreatic islet transplantation. Fragments of variable size and shape comprised a relatively large proportion (26%) of the isolated endocrine tissue. Isolated islets showed slight alterations of cell ultrastructure. Major damage (including breakage of the plasma membrane) and loss of cells were observed in the peripheral cells of the isolated islets. An equal mass of islet equivalent (IEq, islets with an average diameter of 150 microm), but with a different islet equivalent/islet number ratio, was transplanted in diabetic animals. When larger and more complete islets were transplanted (higher ratio), better function of the graft was observed by reversal of hyperglycaemia and response to the glucose tolerance test as compared with the functionality and response of smaller (fragmented) islets transplanted (lower ratio). Digestion, trauma and hypoxia during isolation are responsible for qualitative and quantitative changes of isolated islets. Alterations in normal secretory function after the transplant were related to lower islet equivalent/islet number ratio. The incomplete integrity of the islets may explain the failure of the fine glycaemic metabolic regulation.

Functional MR microimaging of pancreatic beta-cell activation.

The increasing incidence of diabetes and the need to further understand its cellular basis has resulted in the development of new diagnostic and therapeutic techniques. Nonetheless, the quest to noninvasively ascertain beta-cell mass and function has not been achieved. Manganese (Mn)-enhanced MRI is presented here as a tool to image beta-cell functionality in cell culture and isolated islets. Similar to calcium, extracellular Mn was taken up by glucose-activated beta-cells resulting in 200% increase in MRI contrast enhancement, versus nonactivated cells. Similarly, glucose-activated islets showed an increase in MRI contrast up to 45%. Although glucose-stimulated Ca influx was depressed in the presence of 100 microM Mn, no significant effect was seen at lower Mn concentrations. Moreover, islets exposed to Mn showed normal glucose sensitivity and insulin secretion. These results demonstrate a link between image contrast enhancement and beta-cell activation in vitro, and provide the basis for future noninvasive in vivo imaging of islet functionality and beta-cell mass.

Effect of heated humidification on compliance and quality of life in patients with sleep apnea using nasal continuous positive airway pressure.

STUDY OBJECTIVE: To determine whether the addition of heated humidification at treatment initiation with nasal continuous positive airway pressure (CPAP) would lead to better CPAP compliance and improve quality of life and subjective sleepiness in patients with sleep apnea. DESIGN: Randomized controlled trial. SETTING: An academic sleep center located at a Veterans Affairs hospital. PATIENTS: Ninety-eight patients with obstructive sleep apnea who had not received nasal CPAP previously. MEASUREMENTS AND RESULTS: Patients received heated humidification at CPAP initiation in the treatment group. In the control group, patients could receive heated humidification only if they had upper airway symptoms that could not be treated successfully with simpler measures. Patients were followed up at 1 month, 3 months, and 12 months. Outcome measures were compliance with nasal CPAP (mean hours per night at effective pressure), quality of life as measured by the Calgary sleep apnea quality of life index, subjective sleepiness measured with the Epworth sleepiness scale, and CPAP side effects. There was no difference in CPAP compliance between groups. Quality of life and subjective sleepiness improved in both groups with nasal CPAP therapy, but there was no difference in the extent of improvement between groups. The overall CPAP side effect score was similar in both groups, but individual symptoms of dry nose and dry mouth and throat were significantly lower in the heated humidification group. CONCLUSIONS: The addition of heated humidification when nasal CPAP was instituted did not lead to better compliance, greater improvement in sleepiness, or improved quality of life, but was associated with fewer symptoms attributable to the upper airway.

[Utilization of the Canadian Occupational Performance Measure (COPM) among children and their parents: a Swiss experience]. / Utilisation de la MCRO auprès d'enfants et de leurs parents: une expérience suisse.

BACKGROUND: This descriptive and exploratory study examined the use of the Canadian Occupational Performance Measure (COPM) involving 33 children and their parents in French speaking Switzerland. The overall aim of the study was to determine the utility of the measure in order to objectivize the impact of the treatment. METHOD: The COPM was administered twice (initial assessment and reassessment) in order to measure the change in occupational performance and satisfaction over time. The interviews were conducted by 18 occupational therapists, either separately or with both the parents and children together. RESULTS: The analyses highlight the statistically significant changes that occured between the initial assessment and the reassessment, in both the occupational performance and satisfaction. It appears that occupational therapists plan to use the COPM more as a guide when interviewing the parents and the children, rather than as an evaluation tool. Only 17 % of the occupational therapists indicated that they intended to use the point rating scale, but the majority said that the COPM would be useful in establishing a better partnership between parents and professionals. PRACTICE IMPLICATIONS: The contribution of this study lies not only in the results of the research confirming the relevance of the COPM in measuring the impact of practice, but also in the influence of its use on occupational therapy practice, with a greater focus on the needs of the clients and on their independance in daily life.