An anatomical appraisal of dynamic muscle transfer of the orbicularis oculi muscle.

Facial nerve palsy can cause significant distress for patients. We investigated the innervation of the orbicularis oculi muscle (OOM) and assessed the viability of unipedicle contralateral muscle transfer to restore symmetrical and spontaneous blinking. Cadaveric dissection and measurements were performed on lite fixed cadavers (n = 15). Medial innervation of the OOM was identified prior to raising and transposing a flap to the contralateral eyelid. Measurements were performed in-situ and following transposition. A medial ascending branch of the buccal nerve innervating the OOM was identified bilaterally in all cadavers. The average length of flap raised was 59.85 mm (± 4.69 mm) with no difference between the left and right. Flaps with pedicles not dissected off the bone covered 48% of the ciliary margin length (CM) and 62% of the palpebral length (PL). Flaps dissected off the bone covered 72% of the CM and 92% of the PL. The results demonstrate that a flap can theoretically transpose to >50% of the contralateral eyelid length. Increased coverage of the eyelid was achieved by releasing the pedicle from the underlying bone. Little attention was focused on buccal innervation of the eyelids, and this consistent medial pattern may allow an innervated flap transfer to restore symmetrical blinking, something that eludes modern paralysis surgery in a single-stage procedure.

Using ultrasound to teach anatomy in the undergraduate medical curriculum: an evaluation of the experiences of tutors and medical students.

This paper describes the experiences of staff and students at two UK medical schools, who introduced portable ultrasound (PU) as an imaging technology to deliver clinical anatomy teaching and to aid skill development in interpretation of cross-sectional anatomy (CSA). A sonographer contributed to curriculum design and teaching, but mostly anatomy tutors delivered the teaching. This case study method evaluates staff and student perspectives on the ultrasound-based anatomy teaching. Quantitative data and qualitative data were collected and analysed. Staff were positive about the experience. They described their expectations for students and solutions for practical issues regarding the teaching, but were concerned about their competency in scanning and wanted bespoke training for sonoanatomy teaching. Curriculum development was accelerated through engagement with a sonographer and an ultrasound champion. Students were extremely positive about their experience; they valued the expertise of a sonographer who taught more challenging sonoanatomy, but were equally positive regarding teaching sessions led by well-trained anatomy tutors who taught more simple sonoanatomy. Students affirmed most tutors' expectations that ultrasound could reinforce existing anatomical knowledge, added clinical contextualisation, but not that use of ultrasound (US) assisted in interpreting CSA. Students valued the introduction to the technology and found sonoimage interpretation challenging, but not insurmountable. Students wanted more instruction on ultrasound physics, an expansion of ultrasound curriculum, with smaller groups and opportunities to scan volunteers. These data support the case for the use of PU to deliver anatomy teaching and to prime medical students for later clinical encounters with PU.

The impact of wearing scrubs on contextual learning.

BACKGROUND: Godden and Baddeley ( 1975 ) suggested strong contextual influence on recall, suggesting learning in an educational context might not transfer well to practice. AIM: To explore the impact of an authentic context (wearing hospital scrubs) on learning and recall. METHODS: 82 first year medical students sat a pre-test on renal gross anatomy and imaging, to establish prior knowledge, wearing their own clothes. Students wore either scrubs or their own clothes for the first teaching session on renal gross anatomy. A mid-test on this topic was completed immediately after the teaching session. Students then changed into opposite clothing and attended a self-directed session on renal imaging. An imaging specific mid-test was completed. 5 weeks later students completed two post-tests (gross anatomy and imaging) in their own clothes. Tests were online. RESULTS: Data were analysed using paired t-tests. Results showed no significant difference between test performance immediately after the teaching session, but a significant improvement (p = 0.04) on recall between groups tested in the same clothing versus testing in different clothing. The effect size of the teaching intervention was 0.27, a 'moderate' effect in teaching terms. CONCLUSIONS: Students examined in the same context as they were taught recalled significantly more information.

A cross-cultural comparison of anatomy learning: learning styles and strategies.

Cultural influences on anatomy teaching and learning have been investigated by application of a questionnaire to medical students in British and Chinese Medical Schools. Results from the responses from students of the two countries were analyzed. Both groups found it easier to understand anatomy in a clinical context, and in both countries, student learning was driven by assessment. Curriculum design differences may have contributed to the British view wherein students were less likely to feel time pressure and enjoyed studying anatomy more than their Chinese counterparts. Different teaching approaches resulted in British students being more likely to recite definitions to learn, and the Chinese students found learning from cross-sectional images easy. Cultural differences may account for the observation that British students were more inclined to ask questions in class, and the preference of Chinese students to study in small groups. The findings give evidence to show how 'cultures of learning' influence students' approaches and indicate the importance of cultural influences as factors amongst international and home learner groups.

Virtual human dissector as a learning tool for studying cross-sectional anatomy.

BACKGROUND: Within diagnostic medicine there is a continuing and marked increase in the use of two-dimensional (2D) images of cross-sectional anatomy. Medical undergraduates should therefore develop skills to interpret such images early in their education. The Virtual Human Dissector (VHD) software facilitates such learning, permitting users to study actual images of 2D anatomical cross-sections and reconstructed three-dimensional (3D) views simultaneously. This study investigates the use of VHD in facilitating students' ability to interpret cross-sectional images and understand the relationships between anatomical structures. METHODS: First year medical students (n=89) were randomly divided into two groups. Using a crossover design, the investigation was undertaken as two 20 minute self-directed learning (SDL) activities using VHD in a computer suite and prosections and models in the dissecting room (DR), interspersed between 3 tests identifying anatomical structures in cross-sectional images (pre-, mid- and post-session). RESULTS: Statistical analysis of test performance revealed significant improvements in each group between the pre- and midsession tests, and again between mid- and post-session tests. There was no significant difference between the two groups at any stage. SDL using the VHD was as effective as SDL using prosections.

Characterization of the interaction between fenamates and hippocampal neuron GABA(A) receptors.

Fenamate NSAIDs have several central effects, including anti-epileptic and neuroprotective actions. The underlying mechanism(s) of these actions are not presently understood. In this study, the effects of five members of the fenamate NSAID group were investigated on native ligand-gated ion channels expressed in cultured rat hippocampal neurons. All fenamates tested (1-100 microM) dose-dependently potentiated GABA-evoked currents; mefenamic acid (MFA) was the most potent and efficacious and was found to shift the GABA dose-response curve to the left without effect on the maximum amplitude or the GABA Hill Slope. The modulation of GABA receptors by MFA was not reduced in the presence of the benzodiazepine antagonist, flumazenil (10 microM) and was moderately voltage-dependent. MFA at concentrations >or=10 microM evoked dose-dependent currents in the absence of GABA. These currents were potentiated by diazepam (1 microM) and blocked by bicuculline (10 microM). The MFA (50 microM) current-voltage relationship and reversal potential were similar to that evoked by GABA. MFA (1-100 microM) had no effects on sub-maximal glycine, glutamate or NMDA evoked currents. These data show that fenamate NSAIDs are a highly effective class of GABA(A) receptor modulator and activators.

Anatomy teaching: ghosts of the past, present and future.

INTRODUCTION: Anatomy teaching has perhaps the longest history of any component of formalised medical education. In this article we briefly consider the history of dissection, but also review the neglected topic of the history of the use of living anatomy. CURRENT DEBATES: The current debates about the advantages and disadvantages of cadavers, prosection versus dissection, and the use of living anatomy and radiology instead of cadavers are discussed. THE FUTURE: Future prospects are considered, along with some of the factors that might inhibit change.