Medical Students Raising Concerns.

ABSTRACT: After a number of high-profile incidents and national reports, it has become clear that all health professionals and all medical students must be able to raise concerns about a colleague's behavior if this behavior puts patients, colleagues, or themselves at risk.Detailed evidence from medical students about their confidence to raise concerns is limited, together with examples of barriers, which impair their ability to do so. We describe a questionnaire survey of medical students in a single-center, examining self-reported confidence about raising concerns in a number of possible scenarios. Thematic analysis was applied to comments about barriers identified.Although 80% of respondents felt confident to report a patient safety issue, students were less confident around issues of probity, attitude, and conduct. This needs to be addressed to create clear mechanisms to raise concerns, as well as support for students during the process.

The impact of subclinical sleep problems on self-reported driving patterns and perceived driving abilities in a cohort of active older drivers.

The present study sought to investigate the influence of subclinical sleep disturbances on driving practices and driver perceptions in a large cohort of healthy older drivers. Participants from the Candrive II prospective cohort study were investigated. Self-reported measures of sleep problems were used to determine the influence of sleep disturbance on self-reported driving practices and perceived driving abilities, as measured by the Situational Driving Frequency, Situational Driving Avoidance, and Perceived Driving Abilities scales. Hierarchical regression analyses were used to estimate whether mild self-reported sleep problems were predictive of driving restrictions and perceived abilities, while controlling for a variety of health-related factors and demographic variables known to mediate sleep problems or to impact driving. Cross-sectional analysis of baseline data from the Candrive II study suggests that subclinical sleep problems do not significantly influence self-reported driving patterns or perceived driving abilities in older drivers once control variables are considered. The relationship between sleep problems, driving frequency, avoidance and perceived abilities is better explained by mediating demographic, health, and cognitive factors. Further research examining sleep disturbances and driving should include objective measures of driving practices (exposure, patterns) and outcomes (crashes, violations) and should take in consideration the severity of sleep problems.

The antidepressant phenelzine enhances memory in the double Y-maze and increases GABA levels in the hippocampus and frontal cortex of rats.

Subchronic treatment with a non-competitive glutamate NMDA-receptor antagonist (e.g., MK-801, phencyclidine) or social isolation (SI) from weaning (age 21 days) to adulthood (age 56 days) produces deficits similar to some positive and negative symptoms of schizophrenia. Down-regulation of GABA-ergic neurons has been demonstrated in people with schizophrenia and treatment with GABA-ergic compounds (including benzodiazepines, valproate) has shown some favorable outcomes. We hypothesized that subchronic MK-801 (0.5 mg/kg 2 times daily for 7 days), post-weaning SI or the two in combination will alter activity in a novel environment and memory in the double Y-maze (a test with a spatial discrimination and spatial alternation component) and that treatment with phenelzine (PLZ), a monoamine oxidase (MAO)-inhibiting antidepressant that also produces a rapid increase in brain levels of GABA, will improve memory. SI rats (n=18) showed increased locomotor activity when exposed to a novel environment but no deficits in the double Y-maze and the combination of SI plus subchronic MK-801 did not alter these effects. Delays did not affect performance in the spatial discrimination component of the Y-maze and decreased performance in the alternation component for saline rats but not MK-801 rats. Treatment with PLZ improved performance in both components of the Y-maze in a dose-dependent manner. Neurochemical analyses confirmed that PLZ increased GABA levels in the brain and changes in levels of dopamine, serotonin and their metabolites were consistent with inhibition of MAO. It was concluded that PLZ does not specifically augment memory in SI or subchronic MK-801-treated rats.

Post-weaning social isolation and subchronic NMDA glutamate receptor blockade: effects on locomotor activity and GABA signaling in the rat suggest independent mechanisms.

Animal models of schizophrenia symptoms include administration of noncompetitive N-methyl-d-aspartate (NMDA) glutamate receptor antagonists, such as MK-801, and post-weaning social isolation (SI). We tested the hypothesis that a "double-hit" model, in which MK-801 administration during adulthood [post-natal day (P) 56-62] and SI are combined, produces greater behavioral and neurochemical effects than either insult alone. Rats obtained at weaning (P21) were either SI (n=21) or group housed (n=16) for the duration of the experiment. Subgroups received subchronic treatment with MK-801 (0.5 mg/kg i.p., 2 times daily for 7 days) or saline injections from P56-62. At P70, all groups were tested for locomotor activity and subsequently sacrificed to assess GAT-1 activity and GABA(A) receptor expression in the frontal cortex and hippocampus. SI resulted in increased locomotor activity, GAT-1 activity in frontal cortex and hippocampus and GABA(A) receptor expression in the frontal cortex; MK-801 increased GABA(A) receptor expression in the hippocampus. Activity changes were correlated with changes in hippocampal GAT-1 and frontocortical GABA(A) receptor number. There was no evidence that the double-hit produced a greater effect. Increased GAT-1 activity may be associated with suppression of GABA-mediated inhibitory synaptic transmission and increased GABA(A) receptor expression may be a compensatory response to decreased availability of GABA. Results suggest that SI and subchronic MK-801 may act through independent mechanisms.