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Recent years have seen a steady decline in the number of new physician-investigation (Association of American Medical Colleges, 2000). To encourage medical students to select research careers, the Queen's University Faculty of Health Sciences curriculum includes a mandatory Critical Enquiry elective in the 2nd year. An anonymous written survey was administered to medical students before and after the elective to determine their perceptions of the value of the elective and its impact on their decision to pursue a career in medical research. There was a significant increase in the number of students expressing an interest in pursuing a research career following the elective (35-42%, p = 0.029). Students recognized other benefits including the development of critical appraisal, information literacy, and critical thinking skills; and the opportunity to select an area of and form contacts for postgraduate training. Even students who choose not to pursue careers in medical research perceive benefits to a mandatory undergraduate research elective. [ABSTRACT FROM AUTHOR]

• Significant variability between PTH assays exists. • Manufacturer supplied reference ranges do not reflect this variability. • Discordance exists between manufacturers as to whether PTH values exceed their ULN. • The ULN is an important cut-point for CKD-BMD assessment and management. • Discordance is reduced but not eliminated using empirically derived ULN. Parathyroid hormone (PTH) is measured routinely as part of Chronic Kidney Disease Bone and Mineral Disorders (CKD-MBD) assessment. Multiple PTH assays exist with known differences resulting in CKD-MBD guidelines recommending treatment based on assay-specific thresholds. The study objectives are to assess between manufacturer and within manufacturer variability of PTH assays and the impact of assay variability on the assessment of CKD-BMD using both vendor defined and empirically derived thresholds. Data were collected from Ontario, Canada's Proficiency Testing Program (24 challenge vials, 115–133 laboratories all using secondary generation PTH assays. Mean PTH and precision by the coefficient of analytical variation (CV a) were calculated. For each vial, whether the manufacturer's mean value exceeded the vendor-defined and empirically-derived upper limit of normal (ULN) was recorded and the concordance between assays was determined. Across all laboratories, the mean PTH range was 12.0 ± 3.9 pmol/L and the mean CV a was 30%. The percent of vials with a mean PTH exceeding manufacturer's specific ULN varied substantially between manufacturers. Only 58% of vials had complete concordance as to whether mean PTH was above assay-specific ULNs. This increased to 83% using the empirically derived ULN. CKD-BMD assessment and management will depend on the PTH assay. The between-assay variability is reduced but not eliminated when empirically derived reference intervals are used. Improvements in PTH measurement are required in order to ensure consistent patient care. [ABSTRACT FROM AUTHOR]

Objectives: Measurement of the serum B-type natriuretic peptide (BNP) level and more recently its precursor, N-terminal proBNP (NT-proBNP), has been advocated to facilitate the diagnosis of heart failure in the emergency department (ED). We sought to determine the potential impact of adding NT-proBNP testing to the routine evaluation of emergency patients with acute dyspnea., Methods: This prospective cohort study enrolled a convenience sample of acutely dyspneic patients at a tertiary care ED. We excluded trauma patients and those under 30 years of age. Patients underwent standard evaluation, including radiography when indicated. At the point of final diagnosis and blinded to the NT-proBNP result, physicians documented the likelihood that heart failure accounted for the patient's acute dyspnea on a 7-point Likert scale, the data from which was subsequently collapsed to 3 categories for analysis purposes. The primary outcome was the agreement between clinical impression and the NT-proBNP assay classified using manufacturer-recommended, age-specific cut-offs. Newly proposed cut-offs from a recent study were also evaluated., Results: One hundred and twenty-nine patients making 139 ED visits were enrolled (median age 76 years; 59% admitted). The serum NT-proBNP assay was positive in 119 (86%, 95% confidence interval [CI] 80%-91%) cases, including 75% (43/57, 95% CI 62%-86%) of the cases that the treating physician felt were not caused by heart failure, and 86% (25/29, 95% CI 68%-96%) where the treating physician was unsure. The median NT-proBNP concentration was higher in patients clinically believed to have heart failure rather than pneumonia or chronic obstructive pulmonary disease; however, the ranges of these values overlapped extensively (median 4361 pg/mL; interquartile range [IQR] 2386-10877 v. 1651 pg/mL; IQR 370-4745, respectively)., Conclusions: There is high discordance between the clinical impression of treating physicians and NT-proBNP concentrations, notably in patients who are believed not to have heart failure. Although the reference standard of ED diagnosis is imperfect, the broad overlap in NT-proBNP concentrations suggests poor specificity in this target patient population. The introduction of routine ED NT-proBNP testing using the current cut-offs would be expected to result in substantial indirect costs from further diagnostic testing. It remains unclear whether the introduction of this diagnostic test would have a positive impact on clinically relevant patient outcomes.