Boosting clinical performance: The impact of enhanced final year placements.

BACKGROUND: This study follows on from a study that investigated how to develop effective final year medical student assistantship placements, using multidisciplinary clinical teams in planning and delivery. AIMS: This study assessed the effects on objective structured clinical examination (OSCE) performance of the in-course enhanced "super-assistantship" placement introduced to a randomly selected sample of 2013-14 final year medical students at Leeds medical school. METHODS: Quantitative data analysis was used to compare the global grades of OSCE stations between students who undertook this placement against those who did not. RESULTS: There was a small overall improvement in the "super-assistantship" student scores across the whole assessment (effect size = 0.085). "Pre-op Capacity", "Admissions Prescribing" and "Hip Pain" stations had small-medium effect sizes (0.226, 0.215, and 0.214) in favor of the intervention group. Other stations had small effect sizes (0.107-0.191), mostly in favor of the intervention group. CONCLUSIONS: The "super-assistantship" experience characterized by increasing student responsibility on placement can help to improve competence and confidence in clinical decision-making "in a simulated environment". The clinical environment and multidisciplinary team must be ready and supported to provide these opportunities effectively. Further in-course opportunities for increasing final year student responsibility should be developed.

Circular Permutation of the Trp-cage: Fold Rescue upon Addition of a Hydrophobic Staple.

The Trp-cage, at 20 residues in length, is generally acknowledged as the smallest fully protein-like folding motif. Linking the termini by a two-residue unit and excising one residue affords circularly permuted sequences that adopt the same structure. This represents the first successful circular permutation of any fold of less than 50-residue length. As was observed for the original topology, a hydrophobic staple near the chain termini is required for enhanced fold stability.

The Alabama Eye Bank: 25 years of giving sight.

Modern Eye Banking had its start in the mid-1940's. However, it was not until the 1960's that eye banking grew to become a movement or even a necessary part of the health care delivery system in the state of Alabama. The Alabama Eye Bank has grown rapidly to become one of the largest corneal processing networks in the United States. Corneal transplant surgery remains highly successful in restoring sight. The contraindications for donor tissue should be clarified to all physicians and other health care professionals. The public should be make aware of the vision care available to them in the state of Alabama. The general public should be aware of how to become a pre-pledged eye donor, of research, teaching and transplantable tissue and also how they can be assured that their wishes are carried out at the time of their demise. Even with scheduled transplant surgery for all Alabamians, the need for the general public and medical professionals to be oriented and educated towards multi-organ and tissue donations is important.

Increased muscle efficiency and sustained benefits in an outpatient community hospital-based pulmonary rehabilitation program.

Previous reports of pulmonary rehabilitation programs have demonstrated improvement in exercise capacity in subjects with disabling pulmonary disease. However, the cost-effectiveness, benefits to outpatients in a community setting, durability of these improvements, and mechanism of improved exercise capacity remain unclear. Forty-four patients with an average FEV1 of 33 +/- 4 percent of predicted completed a six-week long period of supervised treadmill exercise, as well as a continuing home program. Twenty percent had previously unsuspected cardiac disease discovered through the program, while 36 percent had previously unsuspected exercise desaturation. Cardiopulmonary stress testing before and after the program revealed a 73 +/- 16 percent improvement in aerobic capacity (METs peak [power]) and a 250 +/- 78 percent improvement in endurance (MET-min [work]). No significant change was seen in VE max, HR max, FEV1, or the degree of exercise desaturation. Only a small improvement was noted in VO2 max (15 +/- 8 percent) and O2 pulse (16 +/- 8 percent), suggesting that most of the improvement was due to improved muscle efficiency. Follow-up testing at 12 +/- 3 months in 24 subjects revealed that 89 +/- 7 percent of the peak exercise performance was maintained. The cost of the basic program was +800. The results demonstrated that an outpatient community hospital pulmonary rehabilitation program can accomplish substantial exercise capacity improvement with sustained benefits in a cost-effective manner.