Teaching asthma management: an evidence-based educational approach.

BACKGROUND: Asthma management plans and asthma education have been incorporated into recent guidelines, and implementation of these reduces asthma morbidity. Junior doctors are frequently involved in asthma management, but teaching about asthma in medical school is seldom assessed. We studied asthma knowledge, confidence in practical asthma management, and the effectiveness of an interactive asthma education workshop in final year medical students. Thirty-five students attended the workshop, with 26 returning questionnaires on both of the two sessions. METHODS: Students attended a two hour asthma workshop comprising interactive teaching sessions on management of acute and stable asthma, and a practical session using asthma devices. Theoretical knowledge was assessed by a 20 item questionnaire, completed immediately prior to the workshop and after two weeks, at a feedback session. Practical knowledge was assessed by confidence scores in use of asthma devices on a five point scale (not at all confident to very confident), before, immediately after the workshop, and after two weeks. RESULTS: Students scored poorly in questions on: predictors of asthma mortality, nebuliser and Turbuhaler use, asthma management plans, and physical signs in acute asthma. Mean (SE) knowledge score increased significantly from 64.4% (6.1) to 74.2% (5.6) (p<0.05; paired t-test) at two weeks. Confidence scores rose significantly for all practical aspects of asthma management (p<0.01; Wilcoxon matched pairs test), and declined at two weeks, but still remained significantly higher than at baseline (p<0.05). CONCLUSIONS: Medical students had poor knowledge about several important features of asthma care. The asthma workshop was effective in increasing knowledge and confidence in management of asthma in the short term, and could be useful in optimising implementation of asthma guidelines in clinical practice and potentially later in training of junior medical officers.

The cognitive and neuroanatomical correlates of multitasking.

Patients who show the "strategy application disorder" can show deficits restricted to situations requiring multitasking, but the precise neuroanatomical and cognitive correlates of this problem have been rarely investigated. In this study, 60 people with circumscribed cerebral lesions and 60 age- and IQ-matched controls were given a multitasking procedure which allowed consideration of the relative contributions of task learning and remembering, planning, plan-following and remembering one's actions to multitasking performance. Lesions to the left posterior cingulate and forceps major regions gave deficits on all measures except planning. Remembering task contingencies after a delay was also affected by lesions in the region of the left anterior cingulate, and rule-breaking and failures of task switching were additionally found in people with lesions affecting the medial and more polar aspects of Brodmann's areas 8, 9 and especially 10. Planning deficits were associated with lesions to the right dorsolateral prefrontal cortex (RDLPFC). A theory of the relationships between the cognitive constructs underpinning multitasking was tested using structural equation modelling. The results suggest that there are three primary constructs that support multitasking: retrospective memory, prospective memory, and planning, with the second two drawing upon the products of the first. It is tentatively suggested that the left anterior and posterior cingulates together play some part in the retrospective memory demands, while the prospective memory and planning components make demands on processes supported by the left areas 8, 9 and 10 and the RDLPFC respectively.

Pharyngeal arch patterning in the absence of neural crest.

Pharyngeal arches are a prominent and critical feature of the developing vertebrate head. They constitute a series of bulges within which musculature and skeletal elements form; importantly, these tissues derive from different embryonic cell types [1]. Numerous studies have emphasised the role of the cranial neural crest, from which the skeletal components derive, in patterning the pharyngeal arches [2-4]. It has never been clear, however, whether all arch patterning is completely dependent on this cell type. Here, we show that pharyngeal arch formation is not coupled to the process of crest migration and, furthermore, that pharyngeal arches form, are regionalized and have a sense of identity even in the absence of the neural crest. Thus, vertebrate head morphogenesis can now be seen to be a more complex process than was previously believed and must result from an integration of both neural-crest-dependent and -independent patterning mechanisms. Our results also reflect the fact that the evolutionary origin of pharyngeal segmentation predates that of the neural crest, which is an exclusively vertebrate characteristic.

The epidemiology of serious adverse drug reactions among the elderly.

Although the incidence and prevalence of serious adverse drug reactions (ADRs) in the elderly cannot be accurately stated, published estimates appear to be unchanged since the earliest reports in the 1960s. Whereas heightened awareness of the problem may weigh in favour of a reduction in ADR frequency, the dramatic increase in the number and availability of therapeutic agents has undoubtedly contributed to the observed high proportion of drug-induced morbidity among acute geriatric hospital admissions. No single drug or drug class is of particular concern since none appears to cause serious morbidity out of proportion with its use. Although numerous studies have sought to identify risk factors for ADRs, the only truly independent predictor is the absolute number of concurrently used medications. However, other studies indicate that there is poor doctor-patient agreement regarding a patient's drug regimen, and interventions that aim to reduce the incidence of ADRs have failed to demonstrate a positive effect. Thus at present the most rational approach would appear to be to establish an accurate knowledge of the patients drug regimens: once this is known one can attempt to rationally minimise the number of medications without compromising therapeutic goals.