Information-Seeking Behaviors of Medical Students: A Cross-Sectional Web-Based Survey.

BACKGROUND: Medical students face an information-rich environment in which retrieval and appraisal strategies are increasingly important. OBJECTIVE: To describe medical students' current pattern of health information resource use and characterize their experience of instruction on information search and appraisal. METHODS: We conducted a cross-sectional web-based survey of students registered in the four-year MD Program at Dalhousie University (Halifax, Nova Scotia, and Saint John, New Brunswick, sites), Canada. We collected self-reported data on information-seeking behavior, instruction, and evaluation of resources in the context of their medical education. Data were analyzed using descriptive statistics. RESULTS: Surveys were returned by 213 of 462 eligible students (46.1%). Most respondents (165/204, 80.9%) recalled receiving formal instruction regarding information searches, but this seldom included nontraditional tools such as Google (23/107, 11.1%), Wikipedia, or social media. In their daily practice, however, they reported heavy use of these tools, as well as EBM summaries. Accessibility, understandability, and overall usefulness were common features of highly used resources. Students identified challenges managing information and/or resource overload and source accessibility. CONCLUSIONS: Medical students receive instruction primarily on searching and assessing primary medical literature. In their daily practice, however, they rely heavily on nontraditional tools as well as EBM summaries. Attention to appropriate use and appraisal of nontraditional sources might enhance the current EBM curriculum.

Alice in wonderland and other migraine associated phenomena-evolution over 30 years after headache diagnosis.

BACKGROUND: The International Classification of Headache Disorders-III beta includes a number of episodic syndromes associated with migraine. Those who treat pediatric headaches are aware of a number of other phenomena (such as the Alice in Wonderland syndrome) which are thought to occur as precursors of migraine. There is no available data on the course of these phenomena over the decades following childhood headache diagnosis. METHODS: Patients who were observed by one of the authors in 1983 were contacted by telephone in 1993, 2003, and 2013. Details were gathered regarding the presence and characteristics of ongoing headaches and about the presence of sleepwalking, motion sickness, and distortions of either time or space perceptions. RESULTS: Twenty-eight patients were monitored in 1993, 2003, and 2013. Ongoing headaches were reported by 71%. Sleepwalking was only present in one patient in 2013. More than a third still complained of motion sickness, and more than one quarter still experienced distortions of time. Distortions of space were still reported by nearly 20%. Reporting any of these phenomena was not consistent over time, with some patients reporting distortions for the first time in adulthood. There was no clear correlation with migraine, and patients with tension-type headaches also reported the phenomena. CONCLUSIONS: Motion sickness and distortions of both space and time persist into the fifth decade for many patients initially observed with headaches in childhood. The correlation with migraine is less clear than previously thought.

Comparison of the MK-801-induced appetitive extinction deficit with pressing for reward and associated pERK1/2 staining in prefrontal cortex and nucleus accumbens.

Administration of the noncompetitive N-methyl-d-aspartate (NMDA)-receptor antagonist (+)-5-methyl-10,11-dihydro-5H-dibenzo[a,d]cyclohepten-5,10-imine maleate (MK-801) has been shown to produce extinction deficits on appetitive operant tasks. The present study sought to further explore this by comparing extinction pressing to pressing for the primary reward and examining associated neural correlates to determine if the MK-801 extinction profile resembled the behavioral and neural profile associated with pressing for primary reward. Immunohistochemical labeling of phosphorylated extracellular signal-regulated kinase-1 and -2(pERK1/2) in the prelimbic (PrL) and infralimbic (IL) cortices and nucleus accumbens shell (AcbSh) and core (AcbC) was examined after rewarded or extinction lever pressing conditions. A dose-response curve revealed a within-day extinction deficit following administration of 0.05 mg/kg MK-801. All doses of MK-801 were associated with reduced IL pERK1/2 staining but only the 0.05 mg/kg dose was associated with elevated AcbSh pERK1/2 labeling. Extinction pressing under the influence of MK-801 was elevated compared to that seen during rewarded pressing-whether on MK-801 or saline. Rewarded pressing following saline or MK-801 was associated with elevated pERK1/2 in the PrL with no similar patterns in the MK-801/extinction group. There was more pERK1/2 labeling in the AcbSh of the MK-801 extinction group than any other condition. These data suggest that the MK-801-induced extinction deficit may be due to the combination of an underactive cortical behavioral inhibition system and an overactive AcbSh reward system.