bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rethinking programme evaluation in health professions education: beyond ‘did it work?’
Authors: Haji Faizal , Morin Marie‐Paule , Parker Kathryn 
Published: March 2013

Context  For nearly 40 years, outcome‐based models have dominated programme evaluation in health professions education. However, there is increasing recognition that these models cannot address the complexities of the health professions context and studies employing alternative evaluation approaches that are appearing in the literature. A similar paradigm shift occurred over 50 years ago in the broader discipline of programme evaluation. Understanding the development of contemporary paradigms within this field provides important insights to support the evolution of programme evaluation in the health professions.Methods  In this discussion paper, we review the historical roots of programme evaluation as a discipline, demonstrating parallels with the dominant approach to evaluation in the health professions. In tracing the evolution of contemporary paradigms within this field, we demonstrate how their aim is not only to judge a programme’s merit or worth, but also to generate information for curriculum designers seeking to adapt programmes to evolving contexts, and researchers seeking to generate knowledge to inform the work of others.Discussion  From this evolution, we distil seven essential elements of educational programmes that should be evaluated to achieve the stated goals. Our formulation is not a prescriptive method for conducting programme evaluation; rather, we use these elements as a guide for the development of a holistic ‘programme of evaluation’ that involves multiple stakeholders, uses a combination of available models and methods, and occurs throughout the life of a programme. Thus, these elements provide a roadmap for the programme evaluation process, which allows evaluators to move beyond asking whether a programme worked, to establishing how it worked, why it worked and what else happened. By engaging in this process, evaluators will generate a sound understanding of the relationships among programmes, the contexts in which they operate, and the outcomes that result from them.
Longitudinal integrated rural placements: a social learning systems perspective
Authors: Daly Michele , Roberts Chris , Kumar Koshila , Perkins David 
Published: March 2013

Objectives  There is currently little theoretically informed exploration of how non‐traditional clinical placement programmes that are longitudinal, immersive, based on community‐engaged education principles and located in rural and remote settings may contribute to medical student learning. This paper aims to theoretically illustrate the pedagogical and socio‐cultural underpinnings of student learning within a longitudinal, integrated, community‐engaged rural placement.Methods  Data collected using semi‐structured interviews with medical students, their supervisors and other health clinicians participating in a longitudinal rural placement programme were analysed using framework analysis. Data interpretation was informed by the theory of social learning systems (SLSs).Results  In a longitudinal, rural clinical placement students participate in an SLS with distinct yet interrelated learning spaces that contain embedded communities of practice (CoPs). These spaces are characterised by varying degrees of formality, membership and interaction, and different learning opportunities and experiences. They are situated within and shaped by a unique geography of place comprising the physical and social features of the placement setting. Within these learning spaces, students acquire clinical knowledge, skills and competencies, professional attitudes, behaviours and professional values. The process of connectivity helps explain how students access and cross the boundaries between these learning spaces and develop a more complex sense of professional identity.Conclusions  Longitudinal, integrated clinical placement models can be understood as SLSs comprising synergistic and complementary learning spaces, in which students engage and participate in multiple CoPs. This occurs in a context shaped by unique influences of the geography of place. This engagement provides for a range of student learning experiences, which contribute to clinical learning and the development of a more sophisticated professional identity. A range of pedagogical and practical strategies can be embedded within this SLS to enhance student learning.
In the eye of the beholder: student perspectives on professional roles in practice
Authors: Bennett Deirdre , McCarthy Marian , O’Flynn Siun , Kelly Martina 
Published: March 2013

Context Learning about professional roles in clinical settings is confounded by the gap between espoused theory and the professional practice of the workplace. Workplace learning is grounded in that which is afforded to learners and individuals’ engagement with those affordances. The meaning students make of the real‐world performance of professional roles and how this relates to formal professionalism frameworks remain unclear. Construal of experience is individual. Professional roles are enacted in the eye of the beholder. In their reflections, student subjectivities, intentionalities and engagement with workplace affordances are revealed. Our research question was: How do students’ perspectives of professional roles in practice, revealed through written reflections, relate to the formal professionalism curriculum?Methods Year 3 students (n = 108) wrote reflections during hospital and community placements. Thematic content analysis was performed.A prioricategories based on the CanMEDS Physician Roles Framework were used to map content.Results A total of 107 students consented to the use of their reflections (n = 315). The CanMEDS roles of Communicator, Professional and Scholar predominated. Students were seen applying prior knowledge to new situations and reflecting on them. For some, the confirmation of previous learning was the outcome; for others, the mismatch between practice and the formal curriculum led to the questioning of both. The roles of Manager, Collaborator and Health Advocate were less frequently reflected upon. Differences between the affordances of hospital and community placements were seen. Means to address findings are discussed with reference to Billett’s duality of workplace learning.Conclusions Reflective narratives reveal how students construe professional roles in practice. Mapping the content of reflections to a competency framework confirmed the mismatch between the formal and enacted curricula. Billett’s duality of workplace learning provides a useful lens through which to identify means to address this, through the structural aspects of access and guidance, and through the promotion of individual engagement and reflection.
DNA methylation by CcrM activates the transcription of two genes required for the division of Caulobacter crescentus
Authors: Gonzalez Diego , Collier Justine 
Published: March 2013

SummaryDNA methylation regulates many processes, including gene expression, by superimposing secondary information on DNA sequences. The conserved CcrM enzyme, which methylates adenines in GANTC sequences, is essential to the viability of several Alphaproteobacteria. In this study, we find that Caulobacter crescentus cells lacking the CcrM enzyme accumulate low levels of the two conserved FtsZ and MipZ proteins, leading to a severe defect in cell division. This defect can be compensated by the expression of the ftsZ gene from an inducible promoter or by spontaneous suppressor mutations that promote FtsZ accumulation. We show that CcrM promotes the transcription of the ftsZ and mipZ genes and that the ftsZ and mipZ promoter regions contain a conserved CGACTC motif that is critical to their activities and to their regulation by CcrM. In addition, our results suggest that the ftsZ promoter has the lowest activity when the CGACTC motif is non‐methylated, an intermediate activity when it is hemi‐methylated and the highest activity when it is fully methylated. The regulation of ftsZ expression by DNA methylation may explain why CcrM is essential in a subset of Alphaproteobacteria.
Forgotten resources of older home care clients: Focus group study in Finland
Authors: Turjamaa Riitta , Hartikainen Sirpa , Pietilä Anna‐Maija 
Published: March 2013

AbstractIn this qualitative focus group study, the resources available to older home‐dwelling people, particularly incoming and existing home care clients, are described from the viewpoint of home care professionals (n = 32). The data were analyzed using inductive content analysis. There were three categories of older people requiring resources from the viewpoint of interviewers: home‐dwelling people, incoming home care clients, and existing home care clients. Based on the analysis, the resources of older home‐dwelling people were categorized in terms of support, meaningful life, everyday activities, and environment. Incoming home care client resources were support, out‐of‐home activities, in‐home activities, and environment. Existing client resources were described in terms of support, everyday activities, and environment. Home care professionals described the resources of the older home‐dwelling people in diverse ways, but those of the perspective of existing clients were reduced. The biggest difference was in everyday activities. Psychological and social resources, including meaningful life and social relationships, seemed to be forgotten. All available resources must be taken into account, especially in the everyday home care services for existing home care clients.
Association between physical activity and metabolic syndrome in older adults in Korea: Analysis of data from the Korean National Health and Nutrition Examination Survey IV
Authors: Choi Mona , Yeom Hye‐A , Jung Dukyoo 
Published: March 2013

AbstractThe prevalence of metabolic syndrome is consistently increasing among Korean adults and is reported to be particularly high among older adults in Korea. This paper reports the prevalence of metabolic syndrome and identifies the association between metabolic syndrome and physical activity in Korean older adults. Subjects of this study were 3653 older adults who participated in the fourth Korean National Health and Nutrition Examination Survey during the years 2007–2009. The prevalence of metabolic syndrome in the study population was 46.84%. The prevalences of abdominal obesity, elevated fasting glucose, elevated triglycerides, reduced high‐density lipoprotein cholesterol, and elevated blood pressure were 39.51, 45.53, 39.55, 48.24, and 69.14%, respectively, in the study population. Compared to subjects who reported low levels of physical activity, the odds ratios of metabolic syndrome for those who were moderately active and highly active were 0.93 and 0.63, respectively. Nurses should develop metabolic syndrome management programs that are tailored to the needs of the targeted group and that include individually adapted physical activity programs to promote health.
Pain and quality of life in Turkish cancer patients
Authors: Ovayolu Nimet , Ovayolu Özlem , Serçe Sibel , Tuna Döndü , Pirbudak Çöçelli Lütfiye , Sevinç Alper 
Published: March 2013

AbstractThis study was designed to examine the relationship between patients' pain severity and their self‐reported quality of life, to evaluate factors that may affect pain and quality of life, and to assess patients' opinions and practices on the use of analgesics. The study was conducted with 260 cancer patients. Data were collected using a Quality of Life Scale and Visual Analog Scale questionnaire. It was found that mean scores of pain, all subdomains of quality of life, and overall mean scores of patients were at a moderate level, the lowest score in the subdomains of quality of life was in the psychological subdomain and the highest was in the spiritual subdomain. It was also found that as severity of pain experienced by patients increased, their general activities, mood, activeness, sleep, and nutrition were negatively affected. As severity of pain experienced by patients increased, their quality of life worsened. Patients were observed to have insufficient knowledge and a poor understanding with respect to the use of analgesics. In conclusion, it is very important for nurses to assess factors that can complicate pain management and to establish an effective pain control.
The experiences of adult ventilator‐dependent patients: A meta‐synthesis review
Authors: Tsay Shwu‐Feng , Mu Pei‐Fan , Lin Shirling , Wang Kai‐Wei Katherine , Chen Yu‐Chih 
Published: March 2013

AbstractStudies exploring the perceptions of patients whose lives are maintained by mechanical ventilation highlight the stressful nature of this type of experience. The objective of this meta‐synthesis study was to describe the nature of the experience of adult ventilator‐dependent patients. A systematic literature search of English and Chinese databases was undertaken, covering the period between 1970 and 2012. Qualitative research findings were extracted and pooled using the Joanna Briggs Institute Qualitative Assessment and Review Instrument. A total of 1004 papers were identified from various database and hand searches. Nineteen papers were critically appraised and 16 met inclusion criteria. Five meta‐synthesis themes emerged from the analysis: (1) the feelings of fear due to being dependent on a ventilator and the loss of control of life; (2) disconnection with reality; (3) impaired embodiment; (4) construction of coping patterns; (5) trust and caring relationship. Suggested implications for practice include enhancing the trust relationship with health professionals, as well as nursing actions throughout the suction procedure relating to release of patient's psychological distress and empowering their resilience factors.
Electrical tissue impedance spectroscopy: a novel device to measure esophageal mucosal integrity changes during endoscopy
Authors: Weijenborg P. W. , Rohof W. O. A. , Akkermans L. M. A. , Verheij J. , Smout A. J. P. M. , Bredenoord A. J. 
Published: March 2013

AbstractBackgroundPatients with gastroesophageal reflux disease (GERD) have impaired esophageal mucosal integrity. Measurement of the mucosal integrity is complex and time‐consuming. Electrical tissue impedance spectroscopy (ETIS) is a device that measures impedance of tissue in vivo during endoscopy. In this study, we aimed to validate ETIS as a measure of esophageal mucosal integrity.MethodsElectrical tissue impedance spectroscopy measurements were performed during upper endoscopy in 12 GERD patients and 11 healthy controls after cessation of proton pump inhibition. During endoscopy biopsies of the distal esophagus were obtained for transmission electron microscopy to determine dilation of intercellular spaces (DIS) and for Ussing chamber experiments to determine transepithelial permeability and transepithelial electrical resistance.Key ResultsExtracellular impedance measured in vivo by ETIS was significantly lower in GERD patients compared to controls [mean (SD) 5621 (3299) Ω.m and 8834 (2542) Ω.m, respectively, P < 0.05]. We found a strong inverse relation between extracellular impedance determined by ETIS and DIS (r = −0.76, P < 0.05), and between extracellular resistance in vivo and transepithelial permeability of esophageal biopsies (r = −0.65, P < 0.01).Conclusions & InferencesElectrical tissue impedance spectroscopy is a new tool that can be used to evaluate esophageal mucosal integrity changes during endoscopy.
Ginger and its pungent constituents non‐competitively inhibit activation of human recombinant and native 5‐HT3 receptors of enteric neurons
Authors: Walstab J. , Krüger D. , Stark T. , Hofmann T. , Demir I. E. , Ceyhan G. O. , Feistel B. , Schemann M. , Niesler B. 
Published: March 2013

AbstractBackgroundBeneficial effects of ginger in the treatment of gastrointestinal (GI) problems and chemotherapy‐induced nausea and vomiting are well accepted. In rodents, the action of ginger seems to be mediated by the inhibition of 5‐HT3 receptors, which are established targets to combat emesis and irritable bowel syndrome.MethodsHeterologously expressed human 5‐HT3A or 5‐HT3AB receptors were characterized by means of Ca2+influx studies using HEK293 cells. Complementing Ca2+ measurements in Fluo‐4‐AM‐stained whole‐mount preparations of the human submucous plexus were carried out. Furthermore, [3H]GR65630 binding assays were performed to reveal the mode of action of ginger and its pungent compounds.Key ResultsWe show for the first time that ginger extracts and its pungent arylalkane constituents concentration‐dependently inhibit activation of human 5‐HT3 receptors. Ginger extracts inhibited both receptors with increasing content of pungent compounds, confirming that these are part of ginger's active principle. Inhibition potencies of the arylalkanes 6‐gingerol and 6‐shogaol on both receptors were in the low micromolar range. A lipophilic ginger extract and 6‐gingerol had no influence on 5‐HT potency, but reduced the 5‐HT maximum effect, indicating non‐competitive inhibition. The non‐competitive action was confirmed by [3H]GR65630 binding, showing that the ginger extract did not displace the radioligand from 5‐HT3A and 5‐HT3AB receptors. The potential relevance of the inhibitory action of ginger on native 5‐HT3 receptors in the gut was confirmed in whole‐mount preparations of the human submucous plexus. While a general neurotoxic effect of 6‐gingerol was ruled out, it inhibited the 2‐methyl‐5‐HT‐mediated activation of 5‐HT3 receptors residing on enteric neurons.Conclusions & InferencesOur findings may encourage the use of ginger extracts to alleviate nausea in cancer patients receiving chemotherapy and to treat functional GI disorders.
Arrhythmias in the gut
Authors: Lammers W. J. E. P. 
Published: March 2013

AbstractIn recent years, it has become possible to record, from a large number of extracellular electrodes, the electrical activities of smooth muscle organs. These recordings, after proper processing and analysis, may reveal origin and propagation of normal and abnormal electrical activities in these organs. Several publications have appeared in the past 5 years describing origin and propagation of slow waves in the stomach of experimental animals and in humans. Furthermore, publications are now starting to appear that describe pathophysiological patterns of propagation and these studies provide us with novel concepts regarding potential mechanisms of arrhythmias in the gut, crucial information if we are ever going to successfully treat patients suffering from such arrhythmias. In this issue of Neurogastroenterology & Motility, Angeli et al. have mapped the slow wave propagation in the porcine small intestine and discovered two types of reentry; functional reentry and circumferential reentry. Next to the descriptions of arrhythmias in the stomach, the fact that reentrant arrhythmias may also occur in the small intestine further extends this new emerging field of gastrointestinal (GI) arrhythmias. In this viewpoint, the relevance of these arrhythmias is further discussed and a few ideas for future research in this field, not necessarily constrained to the GI system, proposed.
Selective RAF inhibitor impairs ERK1/2 phosphorylation and growth in mutant NRAS, vemurafenib‐resistant melanoma cells
Authors: Le Kaitlyn , Blomain Erik S. , Rodeck Ulrich , Aplin Andrew E. 
Published: March 2013

SummaryThe RAF inhibitor vemurafenib achieves remarkable clinical responses in mutant BRAF melanoma patients. However, vemurafenib is burdened by acquired drug resistance and by the side effects associated with its paradoxical activation of the ERK1/2 pathway in wild‐type BRAF cells. This paradoxical effect has driven the development of a new class of RAF inhibitors. Here, we tested one of these selective, non‐paradox‐inducing RAF inhibitors termed paradox‐breaker‐04 (PB04) or PLX7904. Consistent with its design, PB04 is able to efficiently inhibit activation of ERK1/2 in mutant BRAF melanoma cells but does not hyperactivate ERK1/2 in mutant RAS‐expressing cells. Importantly, PB04 inhibited ERK1/2 phosphorylation in mutant BRAF melanoma cells with acquired resistance to vemurafenib/PLX4720 that is mediated by a secondary mutation in NRAS. Consistent with ERK1/2 reactivation driving the re‐acquisition of malignant properties, PB04 promoted apoptosis and inhibited entry into S phase and anchorage‐independent growth in mutant N‐RAS‐mediated vemurafenib‐resistant cells. These data indicate that paradox‐breaker RAF inhibitors may be clinically effective as a second‐line option in a cohort of acquired vemurafenib‐resistant patients.
Prognostic value of brain injury biomarkers in acute encephalitis/encephalopathy
Authors: Tsukahara Hirokazu , Fujii Yosuke , Matsubara Kousaku , Yamada Mutsuko , Nagaoka Yoshiharu , Saito Yukie , Yashiro Masato , Tsuge Mitsuru , Goto Shinichiro , Kitamura Tetsuro , Hata Atsuko , Ichiyama Takashi , Morishima Tsuneo 
Published: March 2013

AbstractBackgroundAcute encephalitis/encephalopathy (AEE) is a devastating cause of severe neurodevelopmental sequelae or death in children. Assessing ongoing brain injury and predicting outcomes using bedside point‐of‐care testing is expected to be extremely valuable.MethodsFor this study, three brain injury markers, S‐100B, glial fibrillary acidic protein (GFAP), and tau protein, were measured in early cerebrospinal fluid samples of children with AEE. Subjects comprised three groups: Group 1 (non‐AEE control, n = 27); Group 2 (AEE with normal resolution or mild sequelae, n = 13); and Group 3 (AEE with severe sequelae or death, i.e. “poor outcome,” n = 10).ResultsAll marker levels were significantly higher in Group 3 than in Group 1 or 2. In Group 3, only S‐100B was significantly higher in non‐survivors than in survivors. For scoring assessment (range: 0–3 points), the predictive accuracies of 3 points for poor outcomes in children with AEE (i.e. Group 2 and 3, n = 23) were 91% (21/23) for S‐100B, 74% (17/23) for GFAP, and 78% (18/23) for tau. When the scores were summed up for S‐100B, GFAP, and tau (range: 0–9 points), and for S‐100B and tau (range: 0–6 points), the patients with poor outcomes were identified more accurately using the respective thresholds of 6 points and 4 points (96% [22/23] and 100% [23/23], respectively).ConclusionOur findings suggest that combined measurement and scoring assessment of the markers, especially S‐100B and tau, show promise as predictors of clinical outcomes in children with AEE.
Time to diagnosis of brain tumors in children: A single‐centre experience
Authors: Molineus Anja , Boxberger Nicole , Redlich Antje , Vorwerk Peter 
Published: March 2013

AbstractBackgroundThe aim of the study was to analyze the pre‐diagnostic symptomatic interval (PSI) of children with brain tumors with regard to the parental and doctor's delay and the clinical symptoms.MethodsA retrospective review of all children with brain tumors diagnosed in a single centre over a period of 11 years was carried out.ResultsSeventy‐nine patients (35 boys, 44 girls), with a mean age of 9.2 years (0.2–23.5 years), were analyzed. PSI was 28 weeks with a parental delay of 11.1 weeks and a doctor's delay of 16.9 weeks. Main clinical symptoms were headache (66.7%), vomiting (57.7%), vision (46.2%) and gait (41.6) disorders and fatigue (41.0%) followed by other neurological signs.ConclusionsDiagnosis of pediatric brain tumors is often delayed in relation to the presenting symptoms. If parents report a combination of headache with other neurological abnormalities, a brain tumor should always be considered.