Searching for a written patient feedback instrument for patient-medical student consultations.

OBJECTIVE: The Patient Teaching Associate (PTA) program at Eastern Health Clinical School uses volunteer patients with chronic illnesses in consultation-based medical student education. The PTA program aims to develop students' patient-centeredness and associated skills. Our study aims, 1) to identify key desirable characteristics of written patient feedback to doctors and/or students that focuses on patient-centeredness in consultations, and 2) to critically evaluate existing instruments to identify any suitable instrument for use for medical student teaching. METHODS: We reviewed our experience with the PTA program and explored the literature on patient-centeredness and patient feedback to identify desirable characteristics of written feedback for our program. A systematic search was conducted to identify existing patient feedback instruments. These were then evaluated in light of criteria based on desirable characteristics. RESULTS: Eight instruments met the inclusion criteria. While all were designed for patient use, none were ideal for the PTA program. The Doctors' Interpersonal Skills Questionnaire (DISQ), while not used with medical students, is the closest fit to criteria. CONCLUSION: The lack of instruments specifically designed for written patient feedback to medical students highlights a gap in the current literature. PRACTICE IMPLICATIONS: The DISQ provides a good basis for developing a new feedback instrument focused on patient-centeredness in medical students.

Measuring workplace trauma response in Australian paramedics: an investigation into the psychometric properties of the Impact of Event Scale.

INTRODUCTION: Investigation into the psychological effects of violence toward health care workers and its associated trauma is increasing. The Impact of Event Scale (IES) provides a measure of current, subjective, emotional distress symptomatic of a specific traumatic event. However, its validity among paramedics is largely unknown. PROBLEM: The purpose of this study was to investigate the psychometric properties and factor structure of the IES with a sample of Australian paramedics. METHODS: The study aimed to investigate the psychometric properties and factor structure of the 15-item IES with a sample of Australian paramedics using Exploratory Factor Analysis with model fit statistics as found in confirmatory analysis. RESULTS: Maximum Likelihood Factor Analysis with Varimax rotation supported the hypothesis that a two-factor solution would provide the best fit of the data. Procrustes rotation provided further support for this hypothesis indicating that the factors, labeled "Intrusion" and "Avoidance", as well as the individual items of the 12-item final model, were a good fit to an ideal solution. CONCLUSION: The revision of the scale has improved its validity for use in the general population of paramedics, improving the potential for its use in trauma-related research.

A novel TRH analog, Glp-Asn-Pro-D-Tyr-D-TrpNH2, binds to [3H][3-Me-His2]TRH-labelled sites in rat hippocampus and cortex but not pituitary or heterologous cells expressing TRHR1 or TRHR2.

Glp-Asn-Pro-D-Tyr-D-TrpNH(2) is a novel synthetic peptide that mimics and amplifies central actions of thyrotropin-releasing hormone (TRH) in rat without releasing TSH. The aim of this study was to compare the binding properties of this pentapeptide and its all-L counterpart (Glp-Asn-Pro-Tyr-TrpNH(2)) to TRH receptors in native rat brain tissue and cells expressing the two TRH receptor subtypes identified in rat to date, namely TRHR1 and TRHR2. Radioligand binding studies were carried out using [(3)H][3-Me-His(2)]TRH to label receptors in hippocampal, cortical and pituitary tissue, GH4 pituitary cells, as well as CHO cells expressing TRHR1 and/or TRHR2. In situ hybridization studies suggest that cortex expresses primarily TRHR2 mRNA, hippocampus primarily TRHR1 mRNA and pituitary exclusively TRHR1 mRNA. Competition experiments showed [3-Me-His(2)]TRH potently displaced [(3)H][3-Me-His(2)]TRH binding from all tissues/cells investigated. Glp-Asn-Pro-D-Tyr-D-TrpNH(2) in concentrations up to 10(-5)M did not displace [(3)H][3-Me-His(2)]TRH binding to membranes derived from GH4 cells or CHO-TRHR1 cells, consistent with its lack of binding to pituitary membranes and TSH-releasing activity. Similar results were obtained for the corresponding all-L peptide. In contrast, both pentapeptides displaced binding from rat hippocampal membranes (pIC(50) Glp-Asn-Pro-D-Tyr-D-TrpNH(2): 7.7+/-0.2; pIC(50) Glp-Asn-Pro-Tyr-TrpNH(2): 6.6+/-0.2), analogous to cortical membranes (pIC(50) Glp-Asn-Pro-D-Tyr-D-TrpNH(2): 7.8+/-0.2; pIC(50) Glp-Asn-Pro-Tyr-TrpNH(2): 6.6+/-0.2). Neither peptide, however, displaced [(3)H][3-Me-His(2)]TRH binding to CHO-TRHR2. Thus, this study reveals for the first time significant differences in the binding properties of native and heterologously expressed TRH receptors. Also, the results raise the possibility that Glp-Asn-Pro-D-Tyr-D-TrpNH(2) is not displacing [(3)H][3-Me-His(2)]TRH from a known TRH receptor in rat cortex, but rather a hitherto unidentified TRH receptor.

Discovery of a dual action first-in-class peptide that mimics and enhances CNS-mediated actions of thyrotropin-releasing hormone.

Thyrotropin-releasing hormone (TRH) displays multiple CNS-mediated actions that have long been recognized to have therapeutic potential in treating a wide range of neurological disorders. Investigations of CNS functions and clinical use of TRH are hindered, however, due to its rapid degradation by TRH-degrading ectoenzyme (TRH-DE). We now report the discovery of a set of first-in-class compounds that display unique ability to both potently inhibit TRH-DE and bind to central TRH receptors with unparalleled affinity. This dual pharmacological activity within one molecular entity was found through selective manipulation of peptide stereochemistry. Notably, the lead compound of this set, L-pyroglutamyl-L-asparaginyl-L-prolyl-D-tyrosyl-D-tryptophan amide (Glp-Asn-Pro-D-Tyr-D-TrpNH(2)), is effective in vivo at producing and potentiating central actions of TRH without evoking release of thyroid-stimulating hormone (TSH). Specifically, this peptide displayed high plasma stability and combined potent inhibition of TRH-DE (K(i) 151 nM) with high affinity binding to central TRH receptors (K(i) 6.8 nM). Moreover, intraperitoneal injection of this peptide mimicked and augmented the effects of TRH on behavioural activity in rat. Analogous to TRH, it also antagonized pentobarbital-induced narcosis when administered intravenously. This discovery provides new opportunities for probing the role of TRH actions in the CNS and a basis for development of novel TRH-based neurotherapeutics.