Novel Spaced Repetition Flashcard System for the In-training Examination for Obstetrics and Gynecology.

INTRODUCTION: Electronic flashcards allow repeated information exposure over time along with active recall. It is increasingly used for self-study by medical students but remains poorly implemented for graduate medical education. The primary goal of this study was to determine whether a flashcard system enhances preparation for the in-training examination in obstetrics and gynecology (ob-gyn) conducted by the Council on Resident Education in Obstetrics and Gynecology (CREOG). METHODS: Ob-gyn residents at Duke University were included in this study. A total of 883 electronic flashcards were created and distributed. CREOG scores and flashcard usage statistics, generated internally by interacting with the electronic flashcard system, were collected after the 2019 exam. The primary outcome was study aid usage and satisfaction. The secondary outcome was the impact of flashcard usage on CREOG exam scores. RESULTS: Of the 32 residents, 31 (97%) participated in this study. Eighteen (58%) residents used the study's flashcards with a median of 276 flashcards studied over a median of 3.7 h. All of the flashcard users found the study aid helpful, and all would recommend them to another ob-gyn resident. Using the flashcards to study for the 2019 CREOG exam appeared to correlate with improvement in scores from 2018 to 2019, but did not achieve statistical significance after adjusting for post-graduate year (beta coefficient = 10.5; 95% confidence interval = - 0.60,21.7; p = 0.06). DISCUSSION: This flashcard resource was well received by ob-gyn residents for in-training examination preparation, though it was not significantly correlated with improvement in CREOG scores after adjusting for post-graduate year.

Correction to: Novel Spaced Repetition Flashcard System for the In-training Examination for Obstetrics and Gynecology.

[This corrects the article DOI: 10.1007/s40670-021-01320-z.].

Opioid-induced Somatic Activation: Prevalence in a Population of Patients With Chronic Pain.

Context and objective Opioids have heterogeneous side effects including a well-known effect of sedation; however, the opposing effect of stimulation, or somatic activation, has been largely ignored or overlooked. The objective of this study is to determine the prevalence of opioid-induced somatic activation (OISA). Methods We conducted a retrospective chart review of 189 patients seen by a single clinical psychiatrist/pain specialist. During the initial encounter, the clinician took a standardized history of every opioid currently or previously taken by the patients, and enquired if the patients had experienced a somatically activating or sedating effect per opioid. Results Patients recalled an average exposure to 5.1 opioids (SD: 1.9). Ninety-one patients (48.1%; mean: 1.6) reported somatic activation, while 118 (62.4%; mean: 1.7) reported sedation from at least one opioid. Fifty-eight patients (30.7%) identified at least one opioid as activating, and another as sedating. The distribution of OISA did not significantly differ by gender, race, primary pain diagnosis, or depression. The distribution of OISA by oxycodone significantly differed compared to morphine sulfate (27.3% vs 8.9%; p: 0.005), while sedation did not (29.0% vs 24.3%; p: 0.46). Conclusions In this study, we quantified the previously unstudied phenomenon of OISA. This phenomenon appears dependent on opioid type with some opioids, such as oxycodone, appearing more likely to have this effect. Given current concerns about the risks of opioids in high-risk populations, future studies are needed to study this phenomenon to arrive at an accurate determination of the potential risks and benefits of OISA.

Determination of mitochondrial nitric oxide synthase activity.

The main biological targets of nitric oxide (NO) are hemoproteins, thiols, and superoxide anion (O2-). Mitochondria possess several hemoproteins, thiol-containing molecules, and they are one of the prime cellular producers of O2-. Thus, these organelles remain one of the main biological targets for NO. Reports on the existence of a Ca2+-sensitive mitochondrial NO synthase (mtNOS) have opened a new window in the field of NO and mitochondria research (Ghafourifar and Richter, 1997). mtNOS-derived NO reversibly decreases the activity of the mitochondrial hemoprotein, cytochrome c oxidase. This function of mtNOS regulates mitochondrial respiration and transmembrane potential (Deltapsi). The NO generated by mtNOS reacts with mitochondrial thiol-containing proteins including caspase-3. Because the S-nitrosated caspase-3 remains apoptotically silent as long as it is located within the mitochondria, this function of mtNOS portrays an anti-apoptotic property for mtNOS. mtNOS-derived NO also reacts with O2- to generate peroxynitrite. mtNOS-derived peroxynitrite induces oxidative stress and releases cytochrome c from the mitochondria, which represents a pro-apoptotic role for mtNOS. How mitochondria harmonize the reversible functions of mtNOS for mitochondrial respiration, its anti-apoptotic actions via S-nitrosation of caspase-3, versus the pro-apoptotic properties of peroxynitrite remains to be fully understood. However, intramitochondrial ionized Ca2+ concentration ([Ca2+]m) and the status of mitochondrial reducing defense barriers seem to play crucial roles in orchestrating the functions of mtNOS for mitochondria and cells (Ghafourifar and Cadenas, 2005).