Promoting excellence in teaching and learning in clinical education

Clinical learning is the essence of medical education. Many factors have been demonstrated to influence students' development of clinical competence. These factors include students' exposure to a large volume and variety of clinical experiences, learning in authentic clinical settings, self-directed learning, and the provision of a supportive environment. Clinical teachers have an extremely important role in the effectiveness of clinical education in supporting learners, encouraging reflection, and providing constructive and regular feedback. Early and frequent clinical experiences should be planned and integrated in curricula. The provision of such opportunities is associated with the development of appropriate attitudes and the acquisition of commendation and diagnostic skills among undergraduate medical students. The experiences of undergraduate medical students at clinical venues should be documented to enable monitoring of the quality of their exposure and planning for appropriate interventions. The combination of teaching in family practice centers and hospitals will probably provide the most effective approach and will combine the recognized advantages from different sites. The recent challenges facing the health care system necessitate the need for innovative teaching strategies, such as simulation, to meet the inadequacy of clinical cases at the teaching sites. The quality of clinical teaching should be maintained through regular evaluations of clinical teachers and all teaching activities. This article addresses the possible factors that could affect the process of student learning and suggests measures to promote the quality of clinical teaching and learning

guide to developing a competency based curriculum for a residency training program - Orthopaedic prospective

Residency training programs have emerged as an essential and important element in the lifelong learning path for any physician. In the Kingdom of Saudi Arabia [KSA], residency programs in different specialties have been implemented for more than 25 years. Although a number of changes have taken place regarding the format and conduct of these different training programs, the majority of residency programs have been developed based on the expertise of the prominent academics in the field and on feedback from physicians that underwent previous training programs in the region. However, in many centres, the true needs of physicians are not met and the teaching strategies used do not result in the intended outcome. In recent years, many new models for the development of residency program curricula have been developed worldwide. Many of these models are based on specific needs or are goal-driven. This article describes several of the essential and fundamental concepts for developing a competency-based curriculum for a residency training program in the field of orthopaedics. The concept of backward planning is explained, and the possible teaching methods based on the identified competencies and desired learning outcomes of physicians are illustrated

Initial experience of surgical microwave f issue precoagulation in liver resection for hepatocellular carcinoma in cirrhotic liver

Surgical hepatic resection has been considered as the first-line treatment which is most effective and radical treatment for HCC, however, HCC is usually associated with poor liver function owing to chronic hepatitis or liver cirrhosis. Techniques that can eradicate the tumor and also preserve liver function are needed. Moreover, hepatic resection, in the presence of cirrhosis, raises special problem of high risk as hemorrhage and liver failure, thus, good clinical results can only be achieved by minimizing operative blood loss, time of the intervention as well as the hepatic reserve. The tremendous progress in microwave technology has recently attracted considerable attention. This study evaluated the feasibility of this new liver transection technique demonstrating the high performance of this procedure, the accuracy in terms of squeeze effect on veins and portal branch and in terms of reducing the intra operative blood loss, and minimizing the operative time for safe hepatectomy.Twenty-six consecutive patients a first-time diagnosis of hepatocellular carcinoma [HCC] on top of liver cirrhosis were recruited for the study, from August 2011 to January 2013.A11 patients were subjected to full clinical examination, laboratory investigations, abdomen ultrasound [U/S], triphasic computed tomographic liver scan [CT] and dynamic magnetic resonance imaging [MRI] in some doubtful cases. Inclusion requirements were presence of resec-table disease without vascular invasion or extrahepatic spread at imaging, Child-Pugh class A and B [Score 7] liver cirrhosis, [INR]< 1.6or platelet count >60 000/mm3 with no previous treatment. Patients were treated by applying pre-coagulation of the liver transection lines using microwave probe positioned in parallel to the line of resection by open approach after intra-operative U/S assessment for localization of the tumor and line of resection.The procedures were performed under general anesthesia. Mobilization of the liver was not necessary to be done in all cases. Intra-operative ultrasound [Aloka, Tokyo, Japan] was used to exclude lesions not detected pre-operatively [operative surprise], to define the location, number and size of the tumor and to identify large intra-hepatic large vascular and biliary structures, and guide insertion of the microwave applicator. Intraoperative ultrasound was used again, to assess that the line of resection was done. Primary endpoints documented were total operative time, time for liver parenchyma transection, intraoperative blood loss and blood transfusion requirements. Secondary endpoints included postoperative complications, mortality and intensive care unit [ICU] together with hospital stay

[Screening of health care workers in NICU, labour and delivery theater for MRSA and MSSA colonization and their antimicrobial susceptibility pattern]

Staphylococcus aureus plays a major role in nosocomial infections. The development of resistance to methicillin among Staph. aureus is recognized as one of the main challenges in hospital infection control. The aim of the study was to assess the nasal carriage rate of MSSA [methicillin-sensitive Staphylococcus aureus], MRSA [methicillin-resistant Staphylococcus aureus] and their antimicrobial pattern among health care workers [Nurses and Physicians] of Neonatal Intensive Care Unit [NICU], labour and delivery theatre. Prospective descriptive study. This study was conducted over an eight month in NICU, labour room and delivery theaters of the Women's hospital, Hamad Medical Corporation from September 2005 through May 2006. Of the 466 health care workers, the study screened 340 staff members [73% of physicians and nurses], who are in close contact with patients in NICU, labour and delivery theatres, for MSSA and MRSA. Antimicrobial susceptibility testing was performed on all samples, which showed Staph. aureus colonization using the disk diffusion method. Seventy samples [20.6%] showed Staph. aureus colonization, 68 [97.1%] of them were MSSA and 2 samples [2.9%] were MRSA. Out of the 340 samples, 70 [20.6%] grew S. aureus. 20% of the House Care Workers [HCW] were MSSA carriers and only 0.6% were MRSA carriers. 17.7% of the total physicians and 21.2% of total nurses grew S. aureus; among them, only one physician and one nurse working in NICU were MRSA carriers. All the MSSA isolates were resistant to pencillin, whereas they were sensitive to vancomycin, teicoplanin, gentamicin and oxacillin. Similarly, all MRSA strains were resistant to penicillin, oxacillin and cefoxtin, while they were sensitive to erythromycin, clindamicin, vancomycin and teicoplanin. The prevalence rate of MRSA and MSSA among HCWs in Qatar is comparable to the rates found in other gulf countries. More nurses were carriers of MSSA than physicians. The whole issue deserves continuous surveillance

Clipping versus coiling for ruptured intracranial aneurysms after the international subarachnoid aneurysm trial. United Kingdom experience

The International Subarachnoid Aneurysm Trial [ISAT] was designed as the first multi-central international prospective randomized trial aiming to compare the safety and efficacy of the 2 available treatments for ruptured intracranial aneurysms; endovascular coiling and surgical clipping. The initial results were published in the Lancet [2002], and it showed clearly a superiority of coiling over clipping in the treatment of ruptured intracranial aneurysms; 22.7% of coiled patients were dependent or dead compared with 30.6% in the surgical group with absolute risk reduction of 6.9%. The results of the ISAT drew huge attention from both scientific authorities and lay media. Despite criticisms, the study has made a significant impact on the treatment of aneurysmal subarachnoid hemorrhage, especially in the United Kingdom and Europe. Since their initial results, the ISAT group has published further papers and updates covering more interesting results regarding the risks of rebleeding, repeat procedures, epilepsy, and the cost effectiveness of both treatments

Predictors of the intestinal parasitic infection among pre-school children in rural lower, Egypt

The study was conducted to investigate the prevalence and identify the predictors of the intestinal parasitic infection [IPI] among pre-school children living in the rural areas. A cross sectional survey was carried out from October to February, 2007, in a rural village, at Shebin El-Kom, Menoufiya, Egypt. A total of 300 children aged 2-5 years were studied. The data were collected using a structured interview questionnaire and laboratory analysis of fecal specimens. The results showed that 27% of children had intestinal parasitic infection. The most common parasites identified were Ascaris Lumbricoid [11.7%], Giardia Lamblia [7.7%], Entamebia Histolytica [4.0%], whereas 21.3% of children had multiple parasites; 5.7% of children had single parasite. By multivariate analysis, six main factors were identified as the most predictors of parasitic infections. Household respondents used to feed their children with unwashed hand [P=0.001, OR=38.5], poor handling of drinking water [P=0.001, OR 12.7], lack of the mothers' knowledge regarding to IPI risk reduction [P=0.0 14, 0R 9.4], children with dirty nails [P=0.007, OR=4.7], presence of animals inside home [P=0.020, 0R 3.9], and un-boiling child underwear [P=r 0.045, OR=3.1]. This study concluded that hygienic behaviors, environmental sanitations, lack of mothers' knowledge about parasitic infection among preschool children in the rural area. The study recommended continuous health education campaign that fight against intestinal parasitic infections to increase mothers' awareness about practicing proper sanitation and hygienic behavior at home and in the environment

Tfg-Mi, a root-knot nematode resistance gene from fenugreek [Trigonella foenum-graecum] confers nematode resistance in tomato

Several root-knot nematode [Meloidogyne spp.] resistance genes have been discovered in different plants. For the first time, the Mi gene from fenugreek [Trigonella foenum-graecum] was detected in this study. A candidate root-knot nematode resistance gene [designated as Tfg-Mi] was isolated from the resistant fenugreek line Giza 3 by degenerate PCR amplification combined with the RACE technique. Also, another two candidate root-knot nematode resistance genes [designated as To-Mi11 and To-Mi12] were isolated from the resistant tomato [Lycopersicon esculentum] line Nemagard. Expression profiling analysis revealed that both genes were highly expressed in roots, leaves and flowers and expressed at a lower level in stems, but are not detectable in fruits. To verify the function of Tfg-Mi, a sense vector containing the genomic DNA spanning the full coding region of Tfg-Mi was constructed and transferred into root-knot nematode susceptible tomato plants. Sixteen transgenic plants carrying one to five copies of T-DNA inserts were generated from two nematode susceptible tomato cultivars. RT-PCR analysis revealed that the expression levels of Tfg- Mi gene varied in different transgenic plants. PCR assays showed that the resistance to root-knot nematodes was significantly improved in some transgenic lines compared to untransformed susceptible plants, and that the resistance was heritable

In vitro regeneration of sugarbeet propagules and molecular analysis of the regenerants

An applicable regeneration protocol through in vitro direct and indirect organogenesis of sugarbeet was developed. Leaf and shoot base explants taken from in vitro grown seedlings were subjected to a medium containing different combinations of cytokinins [BA and Kin] and auxins [NAA and 2, 4-D]. The highest percentages of direct organogenesis were noticed with shoot base explants; however, leaf explant was more readily for indirect differentiation. Concerning growth regulators added to culture media, cytokinins [BA and kin] in combinations with NAA were more effective on direct regeneration since the best results of shoot emergence directly from shoot base explants [93%] were registered with a medium contained 0.5 mg/l BA + 0.5 mg/l NAA. However, the highest frequency of indirect regeneration [80%] was obtained when leaf explants were cultured on a medium containing 0.5 mg/l kin + 0.5 mg/l 2, 4-D. For multiplication of sugarbeet propagules, the medium contained 1 mg/l BA+50 mg/l adenine sulfate gave the highest number of shoots and leaves. However, the best results of shoot length were observed when 1 mg/l kin was combined with 50 mg/l adenine sulfate. Among different types of auxins used for in vitro root formation, IBA in concentration of 2 mg/l was more effective than IAA and NAA. SDS-PAGE protein patterns did not give variation between the direct and indirect proliferated cultures of sugarbeet. RAPD analysis was used to identify the differences among regenerants from tissue cultures. The results of PCR products showed slight differences between cultures and demonstrated that direct organogenesis is the most effective way to produce true-type regenerants in sugarbeet. A successful acclimatization to the free conditions was obtained by transferring of plantlets into pots contained a mixture of peatmoss and vermiculite [1:1] under high relative humidity conditions. High percentages of survival and plants of normal appearance were obtained after five weeks of transplanting

Micropropagation of some Egyptian date palm dry cultivars 1-maturation of somatic embryos

This study aimed to investigate the effect of adding different combinations of thiamine [5, 10, and 20 mg/l] and biotein [0, 1 and 2 mg/l] to culture medium on maturation of somatic embryos. Furthermore, the effect of MS-salt strength [[1/4], [1/2], [3/4] and full strength] on maturation of embryos was investigated. Embryonic calli were obtained from shoot tips and primordial leaves of three dry date palm cultivars [Bartamoda, Sakkoty and Malkaby]. Among the different treatments, a high frequency of mature embryos was proliferate from embryonic calli when cultured on [3/4] MS + 10 mg/l 2, 4-D + 3 mg/l 2iP + 10 mg/l thiamine HCL + 1mg/l biotein. This treatment gave 85.7%, 92.5% and 95.7% embryos with embryonic callus derived from shoot tip of Bartamoda, Malkaby and Sakkoty cultivars, respectively. However it was 58.7, 67.3 and 74.6 with those derived from primordial leaf explants of the three cultivars, respectively. Then, the obtained embryos of the three cultivars were successfully developed to shoots when recultured onto hormone free of [3/4] MS- salt medium

Could imatinib replace surgery in esophageal gastrointestinal stromal tumor

Gastrointestinal stromal tumors GISTs are cellular spindle, or epithelioid tumors that occur in the stomach, intestine, and rarely in the esophagus. A 61-year-old man was complaining of resistant dry cough with dysphagia for one month duration. Upper gastrointestinal tract endoscopic examination showed a polypoid mass 30 cm from the incisors obstructing 50% of the lumen, where multiple biopsies were taken. Magnetic resonance imaging MRI showed a mass in the wall of the esophagus extending into the thoracic cavity. Histologically, the stained sections with the routine hematoxylin and eosin as well as the immunohistochemical stains for CD117, CD34, S100, vimentin, and smooth muscle actin confirmed the diagnosis of esophageal GIST. The patient was treated with imatinib, 400 mg/day. There was a dramatic reduction in the size of the tumor with successful improvement of his symptoms after 2 months of treatment, which was confirmed by repeated upper GIT endoscopy, and MRI

effects of different storage media on the regeneration of pdl in experimentally avulsed teeth [histological and immuno-histochemical study]

The choice of storage medium for preserving the traumatically avulsed teeth is important for the success of future replantation. The objectives of this study were to evaluate the effectiveness of pre-replantation storage media on periodontal ligament healing. Extracted, fully-developed rat maxillary incisors were stored in milk, saline or tap water for 15 minutes. Teeth that had been stored in either cold milk or saline showed regeneration of typical PDL, while those stored in tap water showed signs of degeneration. The present study has showed that cold milk and saline may thus be rec-'ommended as storage medium for ex-articulated teeth prior to replantation in case when immediate replantation is not possible

Scanning electron microscopic observations of the root surface in both permanent and deciduous teeth

This study describes the histological features of human cementum along different locations of the root in both deciduous and permanent teeth. 20 freshly extracted teeth with minimal periodontal involvement were collected. They include deciduous [anterior and posterior] teeth and permanent [anterior and posterior] teeth. Scanning electron microscopic observations revealed presence of minute resorping lacunae in both deciduous and permanent teeth with great variability in the number and depth. A striking observation revealed the presence of cracks on the root surface of permanent teeth and their absence in deciduous one. The recorded differences may be related to the differences in the fate as well as the function of the roots in both dentitions. Where in deciduous teeth, roots were re-sorped during shedding whereas in permanent teeth, cementum provides media for the attachment of periodontal ligament through out the life span of the tooth

Salt tolerance in tissue culture of onion [Allium cepa L.]

The response of onion tissue cultures to salinity stress was investigated. Callus initiated from aseptic seedlings was exposed to different levles of salt mixture. Fresh weight and growth value of callus inoculms were decreased as salt mixture increased in culture medium. However, dry weight and dry matter increased as salt level increased up to 4000 ppm and then decreased. Total proteins of callus enhanced as salt mixture increased in culture medium. For selection under salt stress, regenerated shoot buds derived from tolerant callus cultures were exposed to the different levels of salts mixture. The number of proliferated shoot buds and their fresh weight and growth value were depressed upon increasing of salts in medium. The best results of salt tolerance ratio were reached at 2000 ppm salts. Although protein content took similar trend of callus, it was relatively higher than in callus cultures at the same salt levels. Esterase patterns showed new band with the tolersnce lines. This band had different mobility and more intensity with the shoot bud lines exposed to 2000 ppm of salt mixture. The tolerant shoot buds were in vitro rooted and successfully adapted to free-living conditions

Histological, histochemical and immunohistochemical demonstration of the effect of certain commonly used diuretics on rat tongue epithelium

The purpose of this study aimed to investigate the effect of certain commonly used diuretics as furosemide, amiloride and acetazolamide on the rat tongue epithelium. The study was conducted on 20 adult male rats, divided equally into 4 groups. Control group; group I: received furosemide in a daily oral dose of 40 mg/Kg; group II: received amiloride in a daily oral dose of 4mg/Kg; and group III: received acetazolamide in a daily oral dose of 8mg/Kg. Histological, histochemical and immunohistochemical study were carried out revealing that the three experimental groups demonstrated significant epithelial hyperplasia and alterations in the tongue epithelium structures. The degree of changes proved to be more severe in group I followed by group II.and then group III. These deteriorative changes may suggest increased enzymatic activity and general disturbance in the cell metabolism and homeostasis

Physico-chemical studies on hydrothermal characteristics of calcite-rich clays

Marl-clay deposits containing 30% CaCO3 from Sinai, Egypt, were calcined at different temperatures between 800C to 950C for 30 min. The processed briquettes from these powders were hydrothermally treated at 202C [16 atm] for 4 hours. The evaluation and assessment of the treated specimens were achieved through the determination of their physical properties and the phases developed by XRD, IR- spectroscopy, SEM and chemical analysis. The thermochemistry of these phases were followed using DSC and TG technique. A correlation between the determined properties and the developed phases were also discussed. The results encountered in this investigation indicated that the physical properties of the hydrothermally treated bodies are improved with increasing the precalcination temperature. Also, the data encourage the utilization of this technique [autoclaving] in production of building units from lime-rich clays as is followed in sand lime bricks industry without any additives