Identification of Health Systems Science in a Problem-Based Learning Clinical Reasoning Exercise.

The creation of developmentally appropriate and meaningfully complex clinical reasoning exercises in the pre-clerkship curriculum is a common challenge for many medical schools. We provide an overview of one component of the pre-clerkship clinical reasoning curriculum at Case Western Reserve University School of Medicine, and present evidence that inclusion of Health Systems Science in this exercise facilitates integrated thinking in a Problem-Based Learning curriculum.

High prevalence of syphilis in women, minors and precarious patients: a cross-sectional study in a Reunion Island sexually transmitted infection clinic, 2017-2020.

BACKGROUND: Syphilis is a sexually transmitted infection (STI) with a global prevalence estimated at 0.5% in 2012. Syphilis has been on the rise among men who have sex with men (MSM) in high-income countries and remains at endemic levels in low- and middle-income countries. This trend, however, has not been observed in Reunion Island. OBJECTIVES: To determine the prevalence, clinical characteristics and risk factors of syphilis in at-risk patients visiting the South Reunion STI clinic in Reunion Island. METHODS: This monocentric cross-sectional study included all patients who visited our STI clinic between 2017 and 2020. Syphilis serology was performed on all included patients, and data were collected using a standardized self-administered questionnaire. RESULTS: Over the 3-year study period, 2593 patients were enrolled. The prevalence of syphilis was 7.52% (n = 195, 95% CI, 6.50-8.65%) in the overall study population, 11.76% (n = 18, 95% CI, 6.97-18.59%) in minors (aged under 18 years) and 36.36% (n = 16, 95% CI, 21-59%) in pregnant women. The risk factors identified in multivariate analysis were being female [adjusted Prevalence Ratio (aPR) 1.85, 95% CI, 1.10-3.11], being MSM (aPR 2.87, 95% CI, 1.71-4.80), being aged under 18 years (aPR 3.54, 95% CI, 1.90-6.57), living in precarious conditions [aPR 3.12, 95% CI, 2.11-4.62] and being born in Reunion Island (aPR 2.43, 95% CI, 1.42-4.13). The clinical presentation was heterogeneous (plaques and papules, chancre, atypical ulcerations, multiple ulcerations, condyloma lata, etc.). CONCLUSIONS: These findings suggest a high prevalence of syphilis in at-risk patients visiting our STI clinic. Unlike the situation in other high-income countries, the people most at risk of syphilis in Reunion Island are local-born residents, minors, women and precarious patients. This is a source of concern, especially given the risk of resurgence of congenital syphilis on the island.

Students perceive skills learned in pre-clerkship PBL valuable in core clinical rotations.

Purpose: Problem-based learning (PBL) is an instructional method widely used by medical educators that promotes an environment in which students effectively learn the foundational knowledge and skills that are prerequisites for graduation. This study evaluated medical students' perceptions of the helpfulness of skills acquired in PBL to core clerkship rotations.Methods: A 25-item survey was designed to assess students' perceptions of skills learned in PBL that were helpful on core clerkships and transferable to the clinical setting. A random sample of students with at least 8 months of clerkship experience were invited to complete the survey.Results: Of 68 students, 35 (52%) returned questionnaires. Results suggest a clustering of themes based on their perceived value. Skills learned in PBL that students rated most highly as helpful or very helpful during core clinical rotations include: comfort discussing concepts, identifying key information, presentation skills, interpersonal skills, diagnostic thinking, finding information, self-awareness, and organizing information. Other items rated highly included: forming questions, time management, primary literature (engaging with published original research articles), and leadership. The skills acquired in PBL were associated with multiple competency domains.Conclusions: Although conditions of the pre-clerkship curriculum are substantially different from the learning environment of clerkship rotations, skills learned in PBL are perceived as applicable to authentic clinical training.

Scholarship in Teaching: An Approach to Enhancing the Value and Academic Standing of Teaching.

BACKGROUND: In our effort to increase the value and academic standing of teaching, we implemented an initiative focused on scholarship in teaching. Our program was narrowly focused, project-based, peer-reviewed, resource-neutral, and open to all faculty. Faculty members are invited annually to submit a description of their educational projects in keeping with Glassick's criteria. Our purpose was to assess the effects of this award program. METHOD: We reviewed the distribution of applications over a 3-year period and determined the academic departments, academic rank of applicants, and focus of projects. A questionnaire assessed applicants' perceptions of the value of participation, its contribution to promotion and advancement, and its role in subsequent dissemination activities. RESULTS: Slightly fewer than half (60 of 124, 48%) of the applications submitted during 2016 through 2018 were judged by peer review to meet Glassick's criteria for scholarship and received the award. Most applicants were junior faculty, and most applications were from the department of medicine though all departments who taught students in core clinical rotations were represented during the years studied. The projects that were awarded were more likely to be disseminated when compared with those who were not awarded. LESSONS LEARNED: Our scholarship in teaching program seemingly advanced educational scholarship among teaching faculty and provided a way of recognizing projects that advanced educational initiatives. Further efforts are required to promote support from departmental leadership, to enhance faculty participation, and to encourage success through mentoring and assistance in project preparation.

[How I treat ... out-of-hospital cardiac arrest. The role of the emergency medical dispatcher]. / Comment je traite ... l'arrêt cardio-respiratoire extrahospitalier: la fenêtre du centraliste 112.

Sudden cardiac arrest is an event associated with a very low survival rate. The latter is inversely proportional to the duration of the cardiovascular arrest. The chain of survival concept is a sequence of 4 events to be carried out as fast as possible with a view to ensure the patient's survival. This sequence consists of early access to and activation of the emergency medical system, early initiation of basic cardiopulmonary resuscitation, early defibrillation and early specialized care. The number of potential witnesses trained in Basic Life Support (BLS) does not guarantee an adequate basic resuscitation before the arrival of medical aid. In order to optimize the management of victims and callers, the concept of dispatching-assisted cardiopulmonary resuscitation based on a structured protocol has been implemented. The implementation of this plan to improve the quality of call handling required training and assessment of impacts on beneficiaries. The research datashow a reduction of the duration of cardiac arrest, an increase in resuscitation initiated by a witness, an improved survival rate, and a decreased stress and unanimous approval of dispatchers. Currently, the process is being improved and sustained.

[The alert algorithm: why, for whom, how, and when?]. / L'algorithme ALERT. Pourquoi, qui, comment, quand ?

Phone cardiopulmonary resuscitation (CPR) assists any cardiac arrest witness, previously trained or not, through standardized instructions given by phone. These instructions are intended to guide the bystander in checking for responsiveness, opening the airway and checking for adequate breathing, and to initiate chest compressions in case of apparent death. The "Algorithme Liégeois d'Encadrement à la Réanimation par Té1éphone" (ALERT) is an original phone CPR protocol helping the dispatchers to guide callers during the dispatcher's time window, between the beginning of the call and the Emergency Medical Services (EMS) arrival on scene. Its use has been demonstrated to increase the frequency and performance of bystanders' initial CPR efforts. Such improvement might increase the survival chances of out-of-hospital cardiac arrest victims (OOHCA).

RhoGDI-binding-defective mutant of Cdc42Hs targets to membranes and activates filopodia formation but does not cycle with the cytosol of mammalian cells.

We have identified a mutant of the human G-protein Cdc42Hs, R66E, that fails to form a detectable complex with the GDP-dissociation inhibitor RhoGDI in cell-free systems or in intact cells. This point mutant is prenylated, binds guanine nucleotide and interacts with GTPase-activating protein in a manner indistinguishable from wild-type Cdc42Hs. Immunofluorescence localization studies revealed that this RhoGDI-binding-defective mutant is found predominantly in the Golgi apparatus, with a staining pattern similar to that of the wild-type protein. However, unlike wild-type Cdc42Hs, which is distributed in both the microsomal membrane and cytosolic fractions, studies using differential centrifugation show that prenylated R66E Cdc42Hs is found exclusively in association with lipid bilayers. Additionally, whereas the overexpression of RhoGDI results in an apparent translocation of wild-type Cdc42Hs from the Golgi apparatus into the cytosol, identical RhoGDI-overexpression conditions do not alter the Golgi localization of the R66E mutant. Furthermore, overexpression of this RhoGDI-binding-defective mutant of Cdc42Hs seems to activate redistribution of the actin cytoskeleton and filopodia formation in fibroblasts in a manner indistinguishable from the wild-type protein. Taken together, these results suggest that the interaction of Cdc42Hs with RhoGDI is not essential for proper membrane targeting of nascent prenylated Cdc42Hs in mammalian cells; neither is this interaction an essential part of the mechanism by which Cdc42Hs activates filopodia formation. However, it does seem that redistribution of Cdc42Hs to the cytosolic compartment is absolutely dependent on RhoGDI interaction.

[Perspectives of atmospheric pollution]. / Perspectives de la pollution atmosphérique.

We describe briefly a new method for the analysis and forecast of energy consumption and apply this method to estimate the future emissions of the atmospheric pollutants SO2 and NOx. Our results show that the level of SO2 emissions will quickly go down to 1960 levels, but that the NOx emissions remain disturbingly high for the foreseeable future.