Near-Peer-Teaching Revision Series During the COVID-19 Recovery Phase: An Experience From a UK Medical School.

Background The COVID-19 pandemic led to a significant disruption in clinical attachments for final-year medical students which can result in gaps in clinical knowledge and lower confidence levels. We developed a targeted near-peer-teaching (NPT) revision series to bridge this gap. Method A one-week virtual revision series was developed by the postgraduate doctors (PD and AT) and supervised by the final year written paper lead (NS) as per curriculum requirements. The series focused on eight key common clinical presentations. It was delivered via Leicester Medical School's virtual platform by PD and AT a week before the finals. Multiple-choice surveys were sent out prior to the commencement of the series to gauge participation and baseline confidence. Surveys were also sent out before and after each session evaluating teaching, confidence levels, and improvement points. Results This NPT experience was the first comprehensive revision series during the COVID-19 recovery phase. Between 30 and 120 students attended each session. From the pre-series survey (n=63), almost all students indicated that their clinical attachments had been affected by the pandemic and that they (100%) would be interested in participating in the NPT series. From the post-session surveys, 93% of students reported that the session enhanced their confidence in recognizing and managing the clinical presentation, and 100% considered the quality of teaching to be good to excellent. From the post-series survey, a significant improvement was seen in confidence based on the Likert scale (from a combined 35% to 83%, pre, and post-series, respectively). Conclusion The series evaluation demonstrates that students found it a valuable experience and benefited from the social and cognitive congruence afforded by near-peer teachers. Furthermore, the results support the continued use and development of a virtual pre-exam revision series within the medical school curriculum as an adjunct to normal teaching.

Acute stroke hypertension: current and future management.

The management of hypertension in acute stroke remains a hotly debated issue. Clinical practice varies widely between physicians, and both European and US guidelines reflect the uncertainty surrounding this question. Although there is a large amount of data that, on the whole, tends to support a connection between poststroke hypertension and hypotension and worse outcome, there have been few randomized controlled trials to clarify whether pharmacologic intervention is safe or beneficial. Data from secondary prevention trials convincingly demonstrate the benefits of controlling hypertension after a stroke but do not guide us as to how early to implement therapy. There is even less information from trials regarding the use of pressor agents in hypotensive stroke patients. This review discusses the dilemmas in the management of acute stroke hypertension and summarizes the available evidence from studies involving a variety of both depressor and pressor agents. The authors detail the ongoing studies that will help to answer some of the outstanding questions and summarizes the existing guidelines regarding indications for acute stroke blood pressure manipulation currently available to physicians.

Abnormalities in cardiac baroreceptor sensitivity in acute ischaemic stroke patients are related to aortic stiffness.

Cardiac BRS (baroreceptor reflex sensitivity) is impaired following ischaemic stroke and predicts the risk of subsequent long-term death and disability. Impaired cardiac BRS may be due to impaired central processing of baroreceptor information following stroke or reduced baroreceptor activity due to increased large artery stiffness. We evaluated the relationship between large (aortic) artery stiffness and cardiac BRS during the acute phase of ischaemic stroke and in comparison with a group of stroke-free control subjects. Thirty-one ischaemic stroke patients were studied within 48 h of onset and again on day 14, along with 26 control subjects free of cerebrovascular disease. Cardiac BRS (determined by spectral analyses) and arterial stiffness estimated by PWVcf (carotid-femoral pulse wave velocity) using applanation tonometry were obtained. At baseline, cardiac BRS was lower in the stroke compared with the control group (4.3+/-2.3 compared with 6.5+/-4.2 ms/mmHg; P < 0.05). Cardiac BRS values were correlated with PWVcf at < 48 h (r = -0.51, P < 0.01) and on day 14 (r = -0.54, P < 0.01), but not in the control group (r = -0.27, P = not significant). In quantile regression models, taking into account the effect of all cardiovascular variables, cardiac BRS was independently related to PWVcf at baseline and on day 14 in the stroke patients, but stroke was not related to cardiac BRS level when other cardiovascular variables were considered. Wall stiffness of the arterial vessels involved in the baroreflex arc may account for, at least in part, the reduced cardiac BRS observed in acute stroke patients.