What do university students know about cervical cancer and HPV vaccine?

OBJECTIVE: Cervical cancer is one of the most common cancers in women. Infection with high-risk human papillomavirus (HPV) genotypes is responsible for most cervical cancer cases. This study aimed to assess the knowledge of undergraduate medical and non-medical students about cervical cancer and HPV vaccines. MATERIALS AND METHODS: A cross-sectional questionnaire-based survey was distributed to 172 students in the final 2 years of an undergraduate program at the College of Medicine and the College of Business and Art at the King Saud University. RESULTS: Thirty-one and 83 students (36% and 96.5%, respectively) in the non-medical and medical cohorts, respectively, answered that cervical cancer is preventable (p < 0.001). Further, there was a significant difference in the two cohorts regarding their responses to the etiology of cervical cancer (p < 0.001). Forty-five of the medical students answered correctly that the vaccine should be administered to boys and girls alike (52.3%), whereas only 19 (22.1%) non-medical students gave this answer. Moreover, 52 of the medical students (60.5%) expressed willingness to take the vaccine, whereas only 23 (26.7%) of the non-medical students were willing to receive the vaccination. The most common primary source of knowledge of the medical students was medical courses (96.5%), whereas for non-medical students was social media (66.28%). Vaccine availability was the commonest obstacle preventing medical students from receiving the vaccine, whereas that of non-medical students was inadequate information. CONCLUSIONS: Medical students' knowledge about cervical cancer and vaccination was more accurate than that of non-medical students. We expect that the public will have an even lower level of knowledge. We recommend including necessary information about the vaccine in schools, colleges, and community education programs.

Convalescent plasma as a potential management option in COVID-19: a critical review of randomized controlled registered trials.

Currently, there is no approved antiviral agent to treat COVID-19. The management is based on reducing the virus spread in communities, providing supportive treatment to patients, and recently receiving immunization. In this critical review, we focus on randomized and controlled clinical trials. ClinicalTrials.gov, Chinese Clinical Trial Registry (ChiCTR), Japan Primary Registries Network (JPRN), the Australian New Zealand Clinical Trials Registry (ANZCTR), and six other Clinical Trials Registers were searched. Only randomized controlled trials covering treatment or prevention with convalescent plasma in COVID-19 patients were included. Data were extracted into summary tables. The matrix developed was used to identify common themes and compare primary and secondary outcomes of each trial against other parameters/characteristics of the trial. Microsoft Excel was used to create grids of numbers, texts and analysis using various formulae. A total of 3109 trial registry entries were identified, and 44 fulfilled the inclusion and exclusion criteria of the study. The majority of trials (n= 42, 95%) explored the therapeutic potential; only two examined prevention use. The trial's outcome measures varied and were 59 primary (median:1, IQR, 0) and 267 secondary measure outcomes (median: 6, IQR, 8). While 17 studies were recruiting for Phase 1 or 2, the remaining 16 studies were in Phase 2, and 3 and 11 studies had no phases. The total number of participants in these studies was 9432, including control groups (median: 120, IQR, 211). This review provides an overall analysis of clinical trials currently available from seventeen countries and highlights critical issues that we can learn from these trials based on available information.

COVID-19: pathophysiology, diagnosis, complications and investigational therapeutics.

The novel coronavirus disease 2019 (COVID-19) outbreak started in early December 2019 in the capital city of Wuhan, Hubei province, People's Republic of China, and caused a global pandemic. The number of patients confirmed to have this disease has exceeded 9 million in more than 215 countries, and more than 480 600 have died as of 25 June 2020. Coronaviruses were identified in the 1960s and have recently been identified as the cause of a Middle East respiratory syndrome (MERS-CoV) outbreak in 2012 and a severe acute respiratory syndrome (SARS) outbreak in 2003. The current SARS coronavirus 2 (SARS-CoV-2) is the most recently identified. Patients with COVID-19 may be asymptomatic. Typical symptoms include fever, dry cough and shortness of breath. Gastrointestinal symptoms such as nausea, vomiting, abdominal pain and diarrhoea have been reported; neurologically related symptoms, particularly anosmia, hyposmia and dysgeusia, have also been reported. Physical examination may find fever in over 44% of patients (and could be documented in over 88% of patients after admission), increased respiratory rate, acute respiratory disease and maybe decreased consciousness, agitation and confusion. This article aims at presenting an up-to-date review on the pathogenesis, diagnosis and complications of COVID-19 infection. Currently no therapeutics have been found to be effective. Investigational therapeutics are briefly discussed.

Impact factor of medical education journals and recently developed indices: Can any of them support academic promotion criteria?

Journal Impact Factor (JIF) has been used in assessing scientific journals. Other indices, h- and g-indices and Article Influence Score (AIS), have been developed to overcome some limitations of JIF. The aims of this study were, first, to critically assess the use of JIF and other parameters related to medical education research, and second, to discuss the capacity of these indices in assessing research productivity as well as their utility in academic promotion. The JIF of 16 medical education journals from 2000 to 2011 was examined together with the research evidence about JIF in assessing research outcomes of medical educators. The findings were discussed in light of the nonnumerical criteria often used in academic promotion. In conclusion, JIF was not designed for assessing individual or group research performance, and it seems unsuitable for such purposes. Although the g- and h-indices have demonstrated promising outcomes, further developments are needed for their use as academic promotion criteria. For top academic positions, additional criteria could include leadership, evidence of international impact, and contributions to the advancement of knowledge with regard to medical education.

Group interaction in problem-based learning tutorials: a systematic review.

INTRODUCTION: This review aimed at identifying studies on group interaction in problem-based learning (PBL) and elucidate methods used, factors affecting group interaction and the relationship between interaction and student's learning. MATERIALS AND METHODS: PubMed, EMBASE, PsycINFO and HighWire were searched (January 1999 to June 2013) using a combination of pre-specified search terms. The search words were also used in searching nine journals in dental and medical education. Also edited research books on PBL were searched. Both qualitative and descriptive studies of group interaction were selected and critically appraised. RESULTS: Finally, 42 of 10,606 papers were included (35 journal articles and seven from research books). The materials used in assessing group interaction varied depending on the methodology design. Forty-three percent of the studies used video recording to evaluate group interaction. Other studies used indirect approaches such as focus groups, interviews and questionnaires. Factors affecting group interactions were students' and tutors' perceptions, tutor's subject-matter expertise, training students, tutor's group dynamics. There was no conclusive evidence about the impact of interaction in PBL on learning. Most studies were from medicine (64%), and 35 papers were published in the last 10 years. The majority of studies were conducted in Europe, North America and Asia. CONCLUSIONS: Although there is a progressive increase in publications on PBL group interaction during the last 10 years, there are knowledge gaps and deficiencies in this area and most studies are lacking solid theoretical basis and are descriptive. There is a deficiency in the literature in this area from dentistry and other allied health disciplines.

Writing for publication in medical education in high impact journals.

BACKGROUND: One of the key priorities of a scholarly teacher is to demonstrate the ability to contribute to the advancement of knowledge, and transformation of new knowledge into applications that can be of value to the profession and the teaching/learning community. However, successful contribution to a scholarly activity such as publication is challenging particularly when academics lack confidence in their writing skills. AIM: The aim of this article is to highlight keys for successful publication in medical education. METHODS: We reviewed the current literature, recent medical education proceedings, and Association of Medical Education in Europe (AMEE) Guides and explored the basic principles for creating a scholarly publication. We have also reflected on our collective long experience as reviewers to educational, scientific, and clinical journals as well as our roles on editorial boards of medical education and scientific journals. RESULTS: Using the methods described, we have developed the following twelve tips: (1) Start with the end of mind, (2) Sharpen your idea, (3) Select the right journal, (4) Discuss authorship, (5) Adhere to ethical principles, (6) Prepare the manuscript, (7) Avoid common mistakes, (8) See it from the reviewer's eyes, (9) Prepare a cover letter, (10) Respond to the editor's and reviewers' reports, (11) Don't be discouraged by rejection, and (12) Reflect on your experience. CONCLUSIONS: Writing for publication in medical education, particularly in journals with high impact ratings, is a challenging task. However, becoming passionate about your contention, and working on transforming your idea into a published work necessitates self-regulation, resilience, visualization of outcomes, and implementing scholarly approaches. Overcoming challenges and focusing on your goal can be reached if these tips are applied.

Understanding pharmacokinetics: are YouTube videos a useful learning resource?

OBJECTIVES: To investigate whether YouTube videos on pharmacokinetics can be a useful learning resource for medical students. METHODS: YouTube was searched from 01 November to 15 November 2013 for search terms "Pharmacokinetics", "Drug absorption", "Drug distribution", Drug metabolism", "Drug elimination", "Biliary excretion of drugs", and "Renal excretion of drugs".  Only videos in the English and those matching the inclusion criteria were included. For each video, the following characteristic data were collected: title, URL, duration, number of viewers, date uploaded, and viewership per day, like, dislike, number of comments, number of video sharing, and the uploader /creator. Using standardized criteria comprising technical, content, authority and pedagogy parameters, three evaluators independently assessed the videos for educational usefulness. Data were analyzed using SPSS software and the agreement between the evaluators was calculated using Cohen's kappa analysis. RESULTS: The search identified 1460 videos. Of these, only 48 fulfilled the inclusion criteria. Only 30 were classified as educationally useful videos (62.5%) scoring 13.83±0.45 (mean±SD) while the remaining 18 videos were not educationally useful (37.5%) scoring 6.48±1.64 (mean±SD), p = 0.000. The educationally useful videos were created by pharmacologists/educators 83.3% (25/30), professors from two universities 13.3% (04/30) and private tutoring body 3.3% (01/30). The useful videos were viewed by 12096 (65.4%) and had a total of 433332 days on YouTube, while the non-educationally useful videos were viewed by 6378 (34.6%) viewers and had 20684 days on YouTube. No correlation was found between video total score and number of like (R2 0.258), dislike (R2 0.103), viewers (R2 0.186), viewership/day (R2 0.256), comments (R2 0.250), or share (R2 0.174). The agreement between the three evaluators had an overall Cohen's kappa score in the range of 0.582-0.949. CONCLUSIONS: YouTube videos on pharmacokinetics and drug elimination showed a range of variability in regard to the contents of their educational usefulness.  Medical educators should be aware of the potential influence of YouTube videos may have on student's understanding of pharmacokinetics and drug elimination. Users who rely on the comments made by viewers or the approval expressed in terms of the number of like given by viewers should become aware that these indicators are not accurate and do not correlate with the scores given to videos.

Rural training and the state of rural health services: effect of rural background on the perception and attitude of first-year medical students at the university of melbourne.

The aim of this project is to investigate the relationship between medical students' background and their perception of the state of rural health services; willingness to undertake internship training or work as a doctor in a rural hospital; expected benefits and disadvantages of training or working as a doctor in a rural hospital; and factors interfering with acceptance of a job as a doctor in rural areas. A questionnaire-based survey was distributed to 100 first-year medical students attending the Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne at the end of semester 1. The response rate was 97%, including 44 males and 53 females. A strong relationship was found between rural background and an intention to undertake internship training in a rural hospital (86% of students from a rural background expressed this desire vs 30% of students from an urban background). Furthermore, all students from a rural background expressed a desire to work as a doctor in a rural hospital after completing postgraduate training. Compared to urban students, students from a rural background showed a more positive attitude towards health services in rural areas including public hospitals ( P = 0.02), private general practice ( P = 0.004), ambulance service ( P = 0.0002) and baby health centres ( P = 0.005). Citizenship or gender was not significantly related to the perception of any of these services. The ranking of factors interfering with acceptance of a job as a doctor in rural areas were different for rural and urban students. Students from rural backgrounds reported spouse/partner needs (76% vs 49%, P = 0.038) and school availability for children (59% vs 30%, P = 0.023) as barriers more frequently than urban students, respectively). On the other hand, urban students rated the following factors higher: personal factors (76% vs 53%, respectively), education opportunities (56% vs 24%), social/cultural facilities (50% vs 41%) and the need for frequent travel (29% vs 12%). None of these interfering factors were significantly different. Urban students were more likely than rural students to report that their views were a result of adverse media reports. In conclusion, students from a rural background were more willing to be trained or to work as doctors in rural areas. This was associated with a greater adverse influence by the media upon students.

Problem-based learning. A critical review of its educational objectives and the rationale for its use.

Over the past 30 years there has been an increasing interest in curriculum innovation in medical schools in North America, the United Kingdom, Netherlands, and Australia. Since the introduction of problem-based learning at McMaster University in Canada in 1969, several medical schools throughout the world have adopted problem-based learning as the educational and philosophical basis of their curricula. Several studies have shown that problem-based learning is an important educational strategy for integrating the curriculum, motivating the students and helping them to identify their learning issues and set their own learning goals. However, there is a great deal of concern regarding what problem-based learning means and the advantages of problem-based learning over traditional curriculum have not been clearly addressed. In this review, a broad range of the definitions of problem-based learning have been addressed and the rationale for problem-based learning and its educational objectives are discussed.

Problem-based learning. Challenges, barriers and outcome issues.

Although many recent studies have discussed specific issues related to problem-based learning in medical education, a comprehensive review of the literature on the consequences of its use and the outcomes of curriculum based on problem-based learning have not been accurately looked at. Furthermore, there is no available review that critically evaluates challenges and barriers to the implementation of problem-based learning curriculum in medical schools. The purpose of this part is to highlight the major challenges and barriers reported during curriculum preparation and implementation and to critically evaluate the consequences of problem-based learning introduction and its educational outcomes.

Problem-based learning. A critical review of its educational objectives and the rationale for its use.

Over the past 30 years there has been an increasing interest in curriculum innovation in medical schools in North America, the United Kingdom, Netherlands, and Australia. Since the introduction of problem-based learning at McMaster University in Canada in 1969, several medical schools throughout the world have adopted problem-based learning as the educational and philosophical basis of their curricula. Several studies have shown that problem-based learning is an important educational strategy for integrating the curriculum, motivating the students and helping them to identify their learning issues and set their own learning goals. However, there is a great deal of concern regarding what problem-based learning means and the advantages of problem-based learning over traditional curriculum have not been clearly addressed. In this review, a broad range of the definitions of problem-based learning have been addressed and the rationale for problem-based learning and its educational objectives are discussed.

Biochemical assay of serum bile acids: methods and applications.

Immunoassays and bioluminescence assays of bile acids in serum have provided relatively simple and sensitive methods for assessing the concentration of selected sub-groups of bile acids. However, these assays do not provide full data for each of the individual bile acids. The recent development of sensitive techniques such as high-performance liquid chromatography (HPLC) and gas-liquid chromatography-mass spectrometry (GLC-MS) have made possible the separation and quantification of free and conjugated bile acids in biological samples. Several studies have demonstrated the value of individual serum bile acid levels and bile acid ratios when assessing the hepatic function of experimental animals treated with various hepatoxic agents, and in humans with various hepatic disorders. Current data show that individual serum bile acids are more sensitive and specific as early predictors of hepatic injury, and are an accurate independent prognostic indicator. These studies have provided further insight into the various determinants of serum bile acid levels in physiological and pathological conditions affecting the liver. Future studies using these techniques and perhaps monoclonal antibodies, fast atom bombardment-mass spectrometry (FAB-MS) and nuclear magnetic resonance (NMR) for bile acid assays may provide both researcher and clinician with a reliable, sensitive and specific indicator of hepatic injury.

Current concepts of hepatic uptake, intracellular transport and biliary secretion of bile acids: physiological basis and pathophysiological changes in cholestatic liver dysfunction.

Hepatic sinusoidal uptake of bile acids is mediated by defined carrier proteins against unfavourable concentration and electrical gradients. Putative carrier proteins have been identified using bile acid photoaffinity labels and more recently using immunological probes, such as monoclonal antibodies. At the sinusoidal domain, proteins with molecular weights of 49 and 54 kDa have been shown to be carriers for bile acid transport. The 49 kDa protein has been associated with the Na(+)-dependent uptake of conjugated bile acids, while the 54 kDa carrier has been involved in the Na(+)-independent bile acid uptake process. Within the hepatocyte, cytosolic proteins, such as the glutathione S-transferase (also designated the Y protein), the Y binders and the fatty acid binding proteins, are able to bind bile acids and possibly facilitate their movement to the canalicular domain. At the canalicular domain a 100 kDa carrier protein has been isolated and it has been shown by several laboratories that this particular protein is concerned with canalicular bile acid transport. The system is ATP-dependent and follows Michaelis-Menten kinetics. Interference with bile acid transport has been demonstrated by several chemicals. The mechanisms by which these chemicals inhibit bile acid transport may explain the apparent cholestatic properties observed in patients and experimental animals treated with these agents. Several studies have shown that Na+/K(+)-ATPase activity is markedly decreased in cholestasis induced by ethinyloestradiol, taurolithocholate and chlorpromazine. However, other types of interference have been described and the cholestatic effects may be the result of several mechanisms. Cholestasis is associated with several adaptive changes that may be responsible for the accumulation of bile acids and other cholephilic compounds in the blood of these patients. It may be speculated that the nature of these changes is to protect liver parenchymal cells from an accumulation of bile acids to toxic levels. However, more detailed quantitative experiments are necessary to answer questions with regard to the significance of these changes and the effect of various hepatobiliary disorders in modifying these mechanisms. It is expected that the mechanisms by which bile acid transport is regulated and efforts to understand the molecular basis for these processes will be among the areas of future research.

Sequential changes in serum levels of individual bile acids in patients with chronic cholestatic liver disease.

In order to determine the value of serum bile acids in predicting the course of chronic cholestatic liver diseases, we measured individual serum bile acids serially, using high-performance liquid chromatography, over a 4 year observation period in 12 patients with primary biliary cirrhosis and six patients with primary sclerosing cholangitis. The changes in individual serum bile acids and the ratios thereof, conventional liver tests and Child-Turcotte and Mayo scores were compared between survivors (n = 10) and patients who underwent liver transplantation for (n = 3) or died of the liver disease (n = 5). Patients with a serum total chenodeoxycholic acid concentration at study entry that exceded 15 mumol/L were 10 times more likely to die or need a liver transplant in the following 4 years than those with chenodeoxycholic acid levels < 15 mumol/L (P < 0.05). None of the other biochemical parameters or clinicopathological scores could similarly discriminate between the two groups at entry. Time-dependent analyses for the cholic acid/chenodeoxycholic acid ratio, serum total bilirubin and albumin concentrations and Child-Turcotte and Mayo scores were able to differentiate between primary sclerosing cholangitis patients who died or were transplanted and those who were not, whereas age of the patients and other parameters did not. The taurocholic acid/taurochenodeoxycholic acid ratio fell during progression of primary biliary cirrhosis but rose in temporal relationship with primary sclerosing cholangitis. This differential pattern of change was unique compared with other clinical and laboratory indices. In conclusion, serum chenodeoxycholic acid levels and the cholic acid/chenodeoxycholic acid ratio in both diseases were independent indices that allowed for the prediction of survival or the need for liver transplantation. These indices are worthy of further examination in a larger group of patients as prognostic criteria for chronic cholestatic liver disease and in the assessment of the efficacy of therapeutic interventions, including liver transplantations.