Medical Student and General Practitioner Perceptions of Challenges in General Practice in Ireland.

In Ireland, there is a critical shortage in the supply of general practitioners that is projected to worsen. One possible response is to attempt to increase medical student interest in pursuing a career in general practice. Our study aimed to describe the challenges that medical students and general practitioners perceive in the field of general practice. A cross-sectional online survey of 96 medical students (10.5% response rate) enrolled at the National University of Ireland, Galway and 35 general practitioners (24.6% response rate) who attended the Vasco da Gama Movement (VdGM) Forum in February 2015. VdGM is the WONCA Europe Network for new and future general practitioner. The most commonly perceived challenges included remuneration, stress, access to imaging, respect from fellow medical professionals, treating the ageing population, and complexity of patients. These challenges were also generally rated as of high priority. There was large congruence between students and practitioners as to the challenges and what priority they represented. Of medical student participants, 18% indicated that general practice was their career of choice. Medical students and general practitioner have identified several challenges in the Irish general practice setting. Addressing these concerns is crucial to attract and retain future general practitioners.

Paediatric learning in a clinical attachment: undergraduate medical students' perspectives.

BACKGROUND: The clinical environment in paediatrics presents many unique challenges for medical students to achieve clinical proficiency. AIMS: Our study aimed to explore how different elements of the paediatric rotation aid medical students in achieving learning outcomes at the undergraduate stage. METHODS: Using a small-scale exploratory case study, three focus group interviews were conducted with 19 participants by an independent facilitator. Students' self-reported levels of achievement of module learning outcomes were also analysed. Qualitative data were recorded, transcribed and thematically analysed. Open coding was initially employed; codes were then refined into categories and grouped. Themes were identified, reviewed and defined. RESULTS: Students highlighted several key themes including trainee factors, teacher factors and environmental factors that were associated with positive learning environments. These included the opportunity to contribute to the patient care, feeling like part of the team. CONCLUSIONS: A clinical learning environment that allows medical students to become actively involved in patient care and to contribute as members to the clinical team can enhance their learning experience.

Intermittent social defeat stress enhances mesocorticolimbic ΔFosB/BDNF co-expression and persistently activates corticotegmental neurons: implication for vulnerability to psychostimulants.

Intermittent social defeat stress exposure augments behavioral response to psychostimulants in a process termed cross-sensitization. Brain-derived neurotrophic factor (BDNF) mediates synaptic plasticity and cellular responses to stress and drugs of abuse. We previously showed that repeated social defeat stress persistently alters BDNF and activates ΔFosB expression in mesocorticolimbic regions. Here, we hypothesized that social defeat stress would increase ΔFosB expression in BDNF-containing mesocorticolimbic neurons at a time when cross-sensitization is evident. Because the ventral tegmental area (VTA) is critical for cross-sensitization, we similarly hypothesized that repeated social defeat stress would induce ΔFosB in neurons of mesocorticolimbic terminal regions that innervate the VTA. We induced social defeat stress in rats by short confrontations with an aggressive resident rat every third day for 10 days. Control rats were handled according to the same schedule. Defeated rats exhibited sensitized locomotor response to amphetamine (1.0mg/kg, i.p.) 10 days after termination of stress exposure. Separate rats, which underwent stress procedures without amphetamine challenge, were used for histological assessments. Rats received intra-VTA infusion of the retrograde tracer, Fluorogold (FG), and brain tissue was collected 10 days after stress or handling for immunohistochemistry. Stress exposure increased BDNF immunoreactivity in anterior cingulate, prelimbic and infralimbic regions of the prefrontal cortex (PFC), medial amygdala (AMY), nucleus accumbens (NAc) and VTA; ΔFosB labeling in anterior cingulate cortex (ACG) and nucleus accumbens; and ΔFosB/BDNF co-expression in prelimbic cortex (PL), nucleus accumbens and medial amygdala. Infralimbic ΔFosB-labeling was enhanced by stress in neurons innervating the VTA. Increased ΔFosB/BDNF co-expression and persistent functional activation of corticolimbic neurons after stress may contribute to mechanisms underlying cross-sensitization to psychostimulants.

Short- and long-term effects of intermittent social defeat stress on brain-derived neurotrophic factor expression in mesocorticolimbic brain regions.

Social defeat stress is an ethologically salient stressor which activates dopaminergic areas and, when experienced repeatedly, has long-term effects on dopaminergic function and related behavior. The mechanism for these long-lasting consequences remains unclear. A potential candidate for mediating these effects is brain-derived neurotrophic factor (BDNF), a neurotrophin involved in synaptic plasticity and displaying alterations in dopaminergic regions in response to various types of stress. In this study, we sought to determine whether repeated social defeat stress altered BDNF mRNA and protein expression in dopaminergic brain regions either immediately after the last stress exposure or 4 weeks later. Male Sprague-Dawley rats were subjected to social defeat stress consisting of brief confrontation with an aggressive male rat every third day for 10 days; control rats were handled according to the same schedule. Animals were euthanized either 2 h or 28 days after the last stress or handling episode. Our results show that 2 h after stress, BDNF protein and mRNA expression increased in the medial prefrontal cortex. At this time-point, BDNF mRNA increased in the amygdala and protein expression increased in the substantia nigra. Twenty-eight days after stress, BDNF protein and mRNA expression were elevated in the medial amygdala and ventral tegmental area. Given the role of BDNF in neural plasticity, BDNF alterations that are long-lasting may be significant for neural adaptations to social stress. The dynamic nature of BDNF expression in dopaminergic brain regions in response to repeated social stress may therefore have implications for lasting neurochemical and behavioral changes related to dopaminergic function.

Choroidal and retinal detachment following argon laser iridotomy.

This case report examines another of the many complications resulting from argon laser iridotomy. The authors believe that choroidal and retinal detachment subsequent to argon laser iridotomy are a product of the exceptionally high cumulative energy used in the procedure and might result from changes induced in the chamber angle. Although the authors could not prospectively find any choroidal or retinal detachment in the patient, they think that it might occur subclinically and must be suspected in a pale iris if the energy used is high and/or if vision is transiently lowered during the postoperative period.

Combined trabeculectomy and cataract extraction: modified technique.

Two groups of patients with chronic open-angle glaucoma and cataract underwent combined surgery. Compared with the 11 who underwent the classic technique, the 11 who underwent a modified technique in which the cataractous lens was extracted through an incision in clear cornea obtained better control of their intraocular pressure and were less likely to have postoperative hyphema; however, their residual astigmatism was greater. The modified technique took a mean of 30 minutes less operating time and consistently produced a high-quality filtration bleb.

Ciliary block glaucoma: malignant glaucoma in the absence of a history of surgery and of miotic therapy.

A 45-year-old woman had malignant glaucoma but no history of glaucoma surgery or of treatment with miotics. The attack responded promptly and dramatically to cycloplegic therapy, the anterior chamber deepening and the intraocular pressure dropping. This is only the second such case reported in the literature.