Bile acids modulate reinstatement of cocaine conditioned place preference and accumbal dopamine dynamics without compromising appetitive learning.

Psychostimulants target the dopamine transporter (DAT) to elicit their psychomotor actions. Bile acids (BAs) can also bind to DAT and reduce behavioral responses to cocaine, suggesting a potential therapeutic application of BAs in psychostimulant use disorder. Here, we investigate the potential of BAs to decrease drug-primed reinstatement when administered during an abstinence phase. To do this, after successful development of cocaine-associated contextual place preference (cocaine CPP), cocaine administration was terminated, and animals treated with vehicle or obeticholic acid (OCA). When preference for the cocaine-associated context was extinguished, mice were challenged with a single priming dose of cocaine, and reinstatement of cocaine-associated contextual preference was measured. Animals treated with OCA demonstrate a significantly lower reinstatement for cocaine CPP. OCA also impairs the ability of cocaine to reduce the clearance rate of electrically stimulated dopamine release and diminishes the area under the curve (AUC) observed with amperometry. Furthermore, the AUC of the amperometric signal positively correlates with the reinstatement index. Using operant feeding devices, we demonstrate that OCA has no effect on contextual learning or motivation for natural rewards. These data highlight OCA as a potential therapeutic for cocaine use disorder.

Public Humiliation in the Surgical Clerkship: Qualitative Analysis of Responses to the Association of American Medical Colleges Graduation Questionnaire.

BACKGROUND: Nearly 1 in 5 medical students reports at least 1 incident of mistreatment, with many occurring in the perioperative environment. We aimed to further define the types of mistreatment occurring perioperatively in a national data set by using a mixed-methods approach. STUDY DESIGN: A sample of 2,224 responses to the general public humiliation free-text question on the 2015 Association of American Medical College's Graduation Questionnaire were analyzed. Using grounded theory methodology, 4 raters independently created and refined the coding schema. Final coding was determined by majority rating. Descriptive statistics, interrater reliability, and chi-square analysis were performed where appropriate. RESULTS: Among responses, 2,411 events were identified. Interrater reliability was moderate (>0.41) on 94% of variables. Events occurring in a specific setting implicated the surgery clerkship and the operating room 53.2% and 21.8% of the time, respectively. Perioperative events accounted for nearly one-third of verbal abuse reports (30.5%, 324/1059), and almost half of events described yelling (47.0%, 178/379). Mistreatment involving physical contact was significantly more likely to occur in the operating room (59% vs 41%, p < 0.001). Events coded as possibly routine education (n = 379) were significantly less common perioperatively than nonsurgical settings (20.5% vs 79.4%, p = 0.007). CONCLUSIONS: A significant proportion of medical student mistreatment events occur in the context of surgery. Surgeons and trainees must play active roles in leading and instituting needed changes to improve the learning environment to support medical students and recruit a sufficient future surgical workforce.

Postpartum Blues.

An experience that occurred during an obstetrics 3rd year clerkship on the postpartum wards elaborates on and reflects upon the interaction between a student and patient. The stressful interaction and ultimate resolution underpin the sometimes critical moments in education that help define patient-physician relationships.

Contemporary practice of standardised bedside teaching rounds.

BACKGROUND: The purpose of this article is to review the extant literature on bedside teaching rounds within the context of ward rounds performed with the entire clinical team at the patient's bedside, and to assess the effects of standardisation of this process on patient and learner satisfaction, as well as other duty-hour restrictions and patient care metrics in the academic inpatient setting. Ultimately, the intent of this review is to inform faculty development sessions for educators on the benefits and challenges of standardised rounding protocols. METHODS: We performed a search of PubMed, Scopus and CINAHL databases (from 2003 to August 2019). Randomised, controlled trials, pre- and post-interventional studies and cohort studies, in English, were eligible for inclusion. Two reviewers independently searched, screened and analysed the studies, and a narrative synthesis was performed. Articles were evaluated methodologically using the Medical Education Research Quality Study Instrument (MERQSI). RESULTS: Five articles were included, with one randomised controlled trial, three cohort studies, and one pre- and post-interventional study. The collective MERSQI score for the studies was 12.3. Patient satisfaction increased uniformly across studies when standardised practices were used. Attempts to improve learner satisfaction, however, achieved mixed results. In addition, the time of bedside rounds was found to decrease with standardised interventions overall. CONCLUSION: In light of generally positive albeit limited evidence for standardised rounding practices, faculty development initiatives might use these data to inform and educate faculty members regarding the use of standardised protocols for bedside rounds.