Transforming medical education to strengthen the health professional training in Viet Nam: A case study.

The competency-based undergraduate curriculum reform at the University of Medicine and Pharmacy at Ho Chi Minh City, Faculty of Medicine (UMP-FM) is detailed and reviewed in reference to the instructional and institutional reforms, and enabling actions recommended by the Lancet 2010 Commission for Health Professional Education. Key objectives are to: revise the overall 6-year curriculum to be more integrated and competency-based; reinforce students' knowledge application, problem-solving, clinical competence, self-directed learning and soft skills; develop a comprehensive and performance-based student assessment programme; and establish a comprehensive quality monitoring programme to facilitate changes and improvements. New features include early introduction to the practice of medicine, family- and community-based medicine, professionalism, interprofessional education, electives experiences, and a scholarly project. Institutional reform introduces a faculty development programme, joint planning mechanism, a "culture of critical inquiry", and a transparent faculty reward system. Lessons learnt from the curriculum reform at UMP-FM could be helpful to medical schools from low- and middle-income countries considering transitioning from a traditional to a competency-based curriculum. Funding: This work receives no external funding.

Drivers of iPad use by undergraduate medical students: the Technology Acceptance Model perspective.

BACKGROUND: Medical students need to acquire a continuously growing body of knowledge during their training and throughout their practice. Medical training programs should aim to provide students with the skills to manage this knowledge. Mobile technology, for example, could be a strategy used through training and practice. The objective of this study was to identify drivers of using mobile technology (an iPad) in a UGME preclinical settings and to study the evolution of those drivers over time. METHODS: We solicited all students from two cohorts of a preclinical component of a Canadian UGME program. They were asked to answer two online surveys: one on their first year of study and another on the second year. Surveys were built based on the Technology Acceptance Model (TAM) to which other factors were also added. Data from the two cohorts were combined and analysed with partial least squares structural equation modelling (PLS-SEM) to test two measurement models, one for each year. RESULTS: We tested fifteen hypotheses on both data sets (first year and second year). Factors that explained the use of an iPad the first year were knowledge, preferences, perceived usefulness and anticipation. In the second year, perceived usefulness, knowledge and satisfaction explained the use of an iPad. Other factors have also significantly, but indirectly influenced the use of the iPad. CONCLUSIONS: We identified factors that influenced the use of an iPad in a preclinical medical program. These factors differed from the first year to the second year in the program. Our results suggest that interventions should be tailored for different point in time to foster the use of an iPad. Further study should investigate how interventions based on these factors may influence implementation of mobile technology to help students acquire ability to navigate efficiently through medical knowledge.

Profiling prefrontal cortex protein expression in rats exhibiting an incubation of cocaine craving following short-access self-administration procedures.

Introduction: Incubation of drug-craving refers to a time-dependent increase in drug cue-elicited craving that occurs during protracted withdrawal. Historically, rat models of incubated cocaine craving employed extended-access (typically 6 h/day) intravenous drug self-administration (IV-SA) procedures, although incubated cocaine craving is reported to occur following shorter-access IV-SA paradigms. The notoriously low-throughput of extended-access IV-SA prompted us to determine whether two different short-access IV-SA procedures akin to those in the literature result in qualitatively similar changes in glutamate receptor expression and the activation of downstream signaling molecules within prefrontal cortex (PFC) subregions as those reported previously by our group under 6h-access conditions. Methods: For this, adult, male Sprague-Dawley rats were trained to intravenously self-administer cocaine for 2 h/day for 10 consecutive days (2-h model) or for 6 h on day 1 and 2 h/day for the remaining 9 days of training (Mixed model). A sham control group was also included that did not self-administer cocaine. Results: On withdrawal day 3 or 30, rats were subjected to a 2-h test of cue-reinforced responding in the absence of cocaine and a time-dependent increase in drug-seeking was observed under both IV-SA procedures. Immunoblotting of brain tissue collected immediately following the cue test session indicated elevated phospho-Akt1, phospho-CaMKII and Homer2a/b expression within the prelimbic subregion of the PFC of cocaine-incubated rats. However, we failed to detect incubation-related changes in Group 1 metabotropic glutamate receptor or ionotropic glutamate receptor subunit expression in either subregion. Discussion: These results highlight further a role for Akt1-related signaling within the prelimbic cortex in driving incubated cocaine craving, and provide novel evidence supporting a potential role also for CaMKII-dependent signaling through glutamate receptors in this behavioral phenomenon.

The feasibility, reliability, and incremental value of two-dimensional speckle-tracking for the detection of significant coronary stenosis after treadmill stress echocardiography.

BACKGROUND: Two-dimensional speckle-tracking echocardiography (STE) may help detect coronary artery disease (CAD) when combined with dobutamine stress echocardiography. However, few studies have explored STE with exercise stress echocardiography (ESE). We aimed to evaluate the feasibility, reliability, and incremental value of STE combined with treadmill ESE compared to treadmill ESE alone to detect CAD. METHODS: We conducted a case-control study of all consecutive patients with abnormal ESE in 2018-2020 who subsequently underwent coronary angiography within a six-month interval. We 1:1 propensity score-matched these patients to those with a normal ESE. Two blinded operators generated a 17-segment bull's-eye map of longitudinal strain (LS). We utilized the mean differences between stress and baseline LS values in segments 13-17, segment 17, and segments 15-16 to create receiver operator curves for the overall examination, the left anterior descending artery (LAD), and the non-LAD territories, respectively. RESULTS: We excluded 61 STEs from 201 (30.3%) eligible ESEs; 47 (23.4%) because of suboptimal image quality and 14 (7.0%) because of excessive heart rate variability precluding the calculation of a bull's-eye map. After matching, a total of 102 patients were included (51 patients in each group). In the group with abnormal ESE patients (mean age 66.4 years, 39.2% female), 64.7% had significant CAD (> 70% stenosis) at coronary angiogram. In the group with normal ESE patients (mean age 65.1 years, 35.3% female), 3.9% were diagnosed with a new significant coronary stenosis within one year. The intra-class correlation for global LS was 0.87 at rest and 0.92 at stress, and 0.84 at rest, and 0.89 at stress for the apical segments. The diagnostic accuracy of combining ESE and STE was superior to visual assessment alone for the overall examination (area under the curve (AUC) = 0.89 vs. 0.84, p = 0.025), the non-LAD territory (AUC = 0.83 vs. 0.70, p = 0.006), but not the LAD territory (AUC = 0.79 vs. 0.73, p = 0.11). CONCLUSIONS: Two-dimensional speckle-tracking combined with treadmill ESE is relatively feasible, reliable, and may provide incremental diagnostic value for the detection and localization of significant CAD.

Optimizing lime pretreatment of rice straw for biolipid production using oleaginous microorganisms.

This work focuses on the lime pretreatment of rice straw, agricultural waste in northeast Vietnam, for microbial lipid (bio-lipid) production. A response surface methodology approach was performed to optimize parameters for the pretreatment process. These parameters are the concentration of Ca(OH)2, hydrolysis temperature, and maintained time; the effect is considered bio-lipid production yield. The lipid yield was estimated through consolidated bioprocessing of the pretreated rice straw as a substrate and using the fungus strain (Aspergillus oryzae 32) and the yeast strain (Lipomyces starkeyi 22). As a result, the optimal pretreatment conditions for maximum lipid yield were obtained at Ca(OH)2 concentration of 12 g/L and hydrolysis temperature of 110 °C within 60 min. The accumulated lipid in fermentation using these oleaginous microorganisms was 8.5g/100g oven-dry weight of rice straw (10.9g/100g for pretreated rice straw). The biolipid consisted of 42.6% saturated, 21.1% monounsaturated (MUFA), and 35.1% polyunsaturated (PUFA) fatty acids.

Prevalence, Species Distribution, and Related Factors of Fish-Borne Trematode Infection in Ninh Binh Province, Vietnam.

Background. Clonorchis sinensis/Opisthorchis viverrini and minute intestinal flukes (MIF) such as Haplorchis pumilio and H. taichui are fish-borne trematodes (FBT) that may coexist in regions where local people have a habit of eating raw fish like Vietnam. Responses to FBT should be verified according to the data on the distribution of these flukes. This study aims to explore the prevalence of different species of FBT and related factors among local people in a northern province of Vietnam. Methods. A cross-sectional study was conducted in Kim Son and Yen Khanh districts, Ninh Binh province, between March 2016 and March 2017. Four hundred people aged 15 years or older were interviewed and gave stool samples. The FBT eggs in faecal samples were enumerated by modified formalin-ether technique and identified by sequencing of the second internal transcribed spacer (ITS2) region. Result. Among the 400 persons, 19.5% were infected with FBT. On univariate analysis, eating raw fish was the main risk factor (odds ratios (OR)) of 6.769 (95% confidence interval (CI) of 2.655-17.259) followed by being of male gender (3.994 (CI95% 2.117-7.536)) and drinking alcohol (2.680 (CI95% 1.440-4.986)), respectively. There was no risk of increased infection among those living at home without hygienic latrines, those living close to rivers or having ponds, or those raising cats or dogs. By multivariate analysis, FBT infection was only related to the consumption of raw fish and gender. Seventy stool samples with a sufficient amount of faecal matter were subjected to DNA extraction, 42.85% of them yielded DNA production, and all were of Clonorchis sinensis. Conclusion. Results of the study showed the high prevalence of infection of fish-borne trematode, mostly C. sinensis among humans in Ninh Binh province. The prevention of FBT should be strengthened with programs detailed according to the distribution of FBT in different endemic areas.

Case report of an unusual and catastrophic presentation of coral reef aorta.

BACKGROUND: Coral reef aorta (CRA) is a rare condition characterized by atherosclerosis and overt calcification of the aorta leading to severe luminal stenosis of the vessel. Most patients present with hypertension and intermittent claudication at the time of diagnosis. Risk factors associated with this condition are essentially the same as those associated with atherosclerosis. However, no unique condition seems to predispose an individual to develop CRA. CASE SUMMARY: We describe the case of a patient known for rheumatoid arthritis (RA) treated with long-term systemic corticosteroids who presented with a shock of unknown aetiology and left ventricular ejection fraction of 10%. Conventional and computed tomography angiography showed a CRA with subtotal lesion of the aortic arch that led to cardiogenic shock. DISCUSSION: Even though the exact aetiology of her condition will remain uncertain, RA and extended use of corticosteroids likely played a role in the development of this severe form of CRA.

Right ventricular end-diastolic wall stress: does it impact on right atrial size, and does it differ in right ventricular pressure vs volume loading conditions?

BACKGROUND: Right ventricular (RV) diastolic dysfunction precedes RV systolic dysfunction. Improvement in noninvasive assessment of RV diastolic function may enable earlier detection of RV dysfunction, especially important in the assessment of patients with congenital heart disease. We investigated a new parameter we call RV end-diastolic wall stress (RVEDWS) in an effort to better characterize RV diastolic function. METHODS: We retrospectively studied consecutive adults with right-sided congenital heart disease between January 2005 and November 2006. RVEDWS was calculated with the Laplace law: r × p/λ, where r = basal RV dimension at end-diastole, p = RV end-diastolic pressure obtained from catheterization of the right side of the heart, and λ = thickness of RV free wall at end-diastole in the subcostal view. Calculated RVEDWS was correlated to echocardiographically derived right atrial (RA) measurements by means of the Pearson correlation. RESULTS: Twenty-four patients, aged 41 ± 15 years, were included in the study. Mean RVEDWS was 20 ± 11 g/cm(2) (range, 3-46 g/cm(2)). RVEDWS correlated significantly with RA area and volume (r = 0.71, P < 0.0001; r = 0.69, P < 0.001, respectively). An RVEDWS > 17 g/cm(2) had a sensitivity of 91% and specificity of 85% in predicting significant RA enlargement. RVEDWS was significantly higher in patients with RV volume overload compared with those with pressure or normal loading conditions (28 g/cm(2) vs 17 g/cm(2), P = 0.01). CONCLUSIONS: RVEDWS correlates significantly with RA size and differs considerably between RV volume and pressure overload states. Further work is needed to determine whether this RV diastolic parameter can be predictive of clinical outcomes in patients with RV loading lesions.

Reduction of delays in primary percutaneous coronary intervention.

BACKGROUND: Acute myocardial infarction is a major health issue. Primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction was proved to be superior to fibrinolytic therapy in many randomized trials when done in a timely manner. However, PPCI is associated with delays. Studies have shown that greater delay is associated with increased mortality rate. We applied simple interventions to reduce door-to-balloon time. Our study goal was to evaluate the reduction of delays after our interventions and to monitor 30-day mortality. METHODS: A prospective registry was created to evaluate delays and mortality associated with PPCI. Measures such as annual feedback with suggestions were taken to minimize the delays. Door-to-balloon delays before and after the interventions were compared. RESULTS: A total of 1361 primary PCIs were performed from 2005 to 2008. Of these cases, 1071 patients were transferred from community hospitals. The median door-to-balloon time for transferred patients was 142 minutes for 2005, 138 minutes for 2006, 125 minutes for 2007, and 121 minutes for 2008 (P < 0.001 for 2005 vs. 2008). Door-to-balloon time for patients admitted directly to our centre was 87 minutes in 2005, 74.5 minutes in 2006, 73.5 minutes in 2007, and 74.0 minutes in 2008 (P < 0.001 for 2005 vs. 2008). Thirty-day mortality of these consecutive patients is low (5.2% for 2005 and 3.8% for 2008; P = not significant). CONCLUSIONS: Inexpensive and simple interventions may significantly reduce primary PCI-related delays for transferred cases and patients admitted directly to a centre with PPCI facilities. We also observed a low mortality rate for those consecutive patients.

Right atrial size relates to right ventricular end-diastolic pressure in an adult population with congenital heart disease.

AIM: Noninvasive markers of right ventricular (RV) diastolic dysfunction are limited by their lack of reproducibility and accuracy. We tested the hypothesis that right atrial (RA) size measured by echocardiography was correlated to invasive parameters of RV diastolic filling. METHODS AND RESULTS: We studied 31 consecutive adult patients with congenital heart disease. From 2D echocardiography images, we measured maximal RA long-axis and short-axis lengths, area and volume. We compared each of these measures to right ventricular end-diastolic pressure (RVEDP) and mean right atrial pressure (mRAP) measured by right heart catheterization. RA long-axis, short-axis, area, and volume correlated significantly with RVEDP (r = 0.78, P < 0.001; r = 0.61, P < 0.001; r = 0.79, P < 0.001; and r = 0.75, P < 0.001, respectively) and mRAP (r = 0.66, P < 0.001; r = 0.56, P = 0.002; r = 0.70, P < 0.001; r = 0.68, P < 0.001, respectively). Single cut points for each echocardiographic parameter demonstrated reasonable accuracy to rule-in and rule-out RVEDP ≥ 7 mm Hg (sensitivity = 74%, specificity = 82%, positive LR = 4.1, negative LR = 0.32 for RA long-axis of 49 mm; sensitivity = 89%, specificity = 82%, positive LR = 4.9, negative LR = 0.12 for RA area of 14 cm²; sensitivity = 89%, specificity = 82%, positive LR = 4.9, negative LR = 0.13 for RA volume of 37 mL). CONCLUSION: RA size measured by echocardiography is strongly correlated to invasive parameters of RV diastolic filling and predicts high RV end-diastolic pressure.

Same-day transfer of patients with unstable angina and non-ST segment elevation myocardial infarction back to their referring hospital after angioplasty.

BACKGROUND: Recent evidence has shown the advantages of an early invasive strategy for patients with high-risk unstable angina (UA) and non-ST segment elevation myocardial infarction (NSTEMI). However, the number of beds available for postangioplasty monitoring limits the use of this approach at the Centre hospitalier universitaire de Sherbrooke (Fleurimont, Quebec). OBJECTIVES: To study the safety of a protocol allowing the same-day return of patients with UA or NSTEMI to their referring hospital after angioplasty at the Centre hospitalier universitaire de Sherbrooke. METHODS: From June 2001 to June 2003, of the 532 patients with UA and NSTEMI who underwent percutaneous coronary intervention with planned same-day transfer back to their referring hospital, 419 consecutive patients who were eligible to return the same day were prospectively followed for 24 h. RESULTS: Stents were used in 94.7% of patients and platelet glycoprotein IIb/IIIa receptor antagonists were used in 34.8% of patients. For 85% of patients, the femoral artery was used as the access route for percutaneous coronary intervention. The mean time that patients stayed in the hospital after angioplasty before returning to their referring centres was 4.4 h. No deaths, life-threatening arrhythmias or urgent revascularizations were reported during the 24 h postangioplasty follow-up period, but one patient had a major bleeding complication. During the study period, the mean angioplasty waiting time decreased from 5.7 days to 2.1 days. CONCLUSIONS: The protocol evaluated in the present article is safe. It frees more beds, thus reducing the waiting list and allowing patients with high-risk acute coronary syndromes without ST segment elevation from community hospitals to benefit from the advantages of an early invasive strategy.