Learning retinoscopy: A journey through problem space.

PURPOSE: Retinoscopy is a skill that requires the integration of procedural skill and declarative knowledge. Whilst the actual technique is simple, retinoscopy is a complex skill to acquire and is one that students often find challenging. This study compared the strategies that novices, third-year students and experts use when performing retinoscopy, with the aim of identifying the key stages of learning that may enlighten teaching practice. METHOD: This study employed a protocol-based approach in which the verbal protocols and cognitive strategies of novices, students and experts were recorded and then subjected to 'problem space' analysis. RESULTS: Clear differences existed when the retinoscopy of novices, students and experts was directly compared using a standardised simulated task. Experts were more accurate in performance and used defined strategies to reach the goal. The presence of these strategies significantly predicted the accuracy of the retinoscopy result. CONCLUSION: This study highlights the importance of meta-cognitive strategies and the need for an adequate theoretical foundation in skill acquisition. The underpinning knowledge provides a pedagogic tool that specifies activities which are beneficial to learning a clinical skill.

How common are ALS plateaus and reversals?

OBJECTIVE: To determine the frequency of amyotrophic lateral sclerosis (ALS) plateaus and reversals in the Pooled Resource Open-Access ALS Clinical Trials (PRO-ACT) database. METHODS: We analyzed Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS) and ALSFRS-revised (ALSFRS-R) data from PRO-ACT participants. The frequencies of participants experiencing plateaus (periods where scores did not change) were calculated over 6-, 12-, and 18-month epochs. The percentage of participants ever experiencing reversals (periods where scores improved) of different lengths were also calculated and plotted. RESULTS: Over 6 months, 25% of 3,132 participants did not decline. Over 12 months, 16% of 2,105 participants did not decline. Over 18 months, 7% of 1,218 participants did not decline. Small ALS reversals were also common, especially over shorter follow-up intervals; 14% of 1,343 participants had a 180-day interval where their ALSFRS-R slope was greater than zero. Fewer than 1% of participants ever experienced improvements of 4 or more ALSFRS-R points lasting at least 12 months. CONCLUSION: ALS plateaus and small reversals are common, especially over brief intervals. In light of these data, stable disease, especially for a short period of time, should not be interpreted as an ALS treatment effect. Large sustained ALS reversals, on the other hand, are rare, potentially important, and warrant further study.

Straight talk with...Jamie Heywood.

Last month, Genentech launched an unusual five-year research pact. The San Francisco subsidiary of the drug giant Roche partnered with Cambridge, Massachusetts-based PatientsLikeMe to mine the online patient network's database of real-world experiences. In exchange for an undisclosed fee, Genentech now has access to nearly all of the information collected by PatientsLikeMe, which currently includes more than 250,000 members with 2,000 different conditions. The hope is that studying the network will help Genentech learn how to stratify patient populations more precisely and measure drug effectiveness better, among other things.At the helm of PatientsLikeMe is Jamie Heywood, a mechanical engineer by training who devised the idea for the platform ten years ago when he noticed some striking similarities between the information asked of online dating websites and clinical trial portals. With his brother Benjamin and friend Jeff Cole, Heywood founded PatientsLikeMe later that same year. Nicholette Zeliadt spoke to Heywood about where the crowdsourcing site stands a decade on from its inception and what this new partnership with Genentech will mean for open-participation research.