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Purpose: Clinical skills are often taught in preclinical courses such as "Introduction to Clinical Medicine" (ICM). We sought to define current national course objectives, roles of standardized and real patients, and methods of assessment in ICM courses, and to readdress the need and desire for establishing consensus.Methods: In April 2005, the Clerkship Directors in Internal Medicine (CDIM) organization conducted its annual, voluntary, and confidential survey. The survey contained a section (24 questions) on preclinical education teaching methods and evaluations.Results: Wide variations exist in the teaching and assessment methods used by ICM courses in 4-year medical schools. Respondents indicated a desire for a consensus statement concerning ICM course objectives in addition to guidance on case development, use of standardized patients, and student assessments.Conclusion: Our findings suggest that consensus remains elusive for preclinical education teaching objectives, but would be embraced by ICM course directors. [ABSTRACT FROM AUTHOR]

Polymyalgia rheumatica and giant cell arteritis are common, closely related vasculitic conditions that almost exclusively occur in patients older than 50 years. They may be manifestations of the same underlying disease and often coexist. Patients with polymyalgia rheumatica usually present with acute onset of stiffness and pain in the shoulder and pelvic musculature, which may be accompanied by fever, malaise, and weight loss. If untreated, polymyalgia rheumatica may result in significant disability. Giant cell arteritis may manifest as visual loss or diplopia, abnormalities of the temporal artery such as tenderness or decreased pulsation, jaw claudication, and new-onset headaches. Erythrocyte sedimentation rate and temporal artery biopsy help make the diagnosis. Giant cell arteritis requires urgent diagnosis because without treatment it may lead to irreversible blindness. Patients with either condition also may have nonspecific symptoms. Corticosteroids are the mainstay of therapy for both conditions, with higher doses required for treatment of giant cell arteritis. Duration of corticosteroid therapy can be five years or longer before complete clinical remission is achieved. Monitoring for corticosteroid-associated side effects such as osteoporosis and diabetes, as well as for relapses and flare-ups, is key to chronic management. The prognosis for either condition, if treated, is good. [ABSTRACT FROM AUTHOR]

Background: Medical education programs need outcome measurements to promote curriculum improvement and to help meet accreditation standards.Purpose: Determine the added value of qualitative comments written by program directors (PDs) in response to a survey concerning first postgraduate year (PGY-1) graduates. We hypothesized that these comments would serve as an additional outcome measurement for our graduates, adding information not readily captured in numeric data.Methods: PD evaluation form surveys from 1993-2002. All qualitative comments offered in response to free text questions were coded and compared with numeric ratings.Results: A total of 1,247 surveys were included (80% response rate). Comments about specific graduates were coded as positive, negative, or neutral and were categorized into themes. Inter-rater reliability was high (kappa= 0.82). Compared with 4% of graduates who received one or more numeric ratings of less than satisfactory, 7% had one or more qualitative phrases classified as negative.Conclusions: Qualitative comments can serve as a useful outcome measurement. [ABSTRACT FROM AUTHOR]

The size of subcellular structures must be tightly controlled to maintain normal cell function. Despite its importance, few studies have determined how the size of organelles or other structures is maintained during development, when cells are growing, dividing and rearranging. The developing Drosophila egg chamber is a powerful model in which to study the relative growth rates of subcellular structures. The egg chamber contains a cluster of 16 germline cells, which are connected through intercellular bridges called ring canals. As the egg chamber grows, the germline cells and the ring canals that connect them increase in size. Here, we demonstrate that ring canal size scaling is related to lineage; the largest, 'first-born' ring canals increase in size at a relatively slower rate than ring canals derived from subsequent mitotic divisions. This lineage-based scaling relationship is maintained even if directed transport is reduced, ring canal size is altered, or in egg chambers with twice as many germline cells. Analysis of lines that produce larger or smaller mature eggs reveals that different strategies could be used to alter final egg size., Competing Interests: Competing interests The authors declare no competing or financial interests., (© 2024. Published by The Company of Biologists Ltd.)

Aim: To characterize nurses' engagement in Centers for Disease Control and Prevention promoted personal protective behaviors (PPBs) outside the work setting during the COVID-19 pandemic and factors that inform engagement in these behaviors., Background: Nurses' health is of vital importance to the functioning of the healthcare system. Little is known as to what informs nurses' use of PPBs outside the work setting., Design: Cross-sectional survey study., Settings: A large healthcare system in the southeastern region of the United States., Participants: Nine hundred fifty eight registered nurses., Methods: Participants surveyed during the week of September 14th. Survey contained questions regarding factors that may be linked to nurses' compliance with PPBs., Results: The most frequently reported behavior practiced outside work was "cover mouth with cough or sneeze." Concern for COVID-19 infection and confidence in masks to control the spread of COVID-19 were positively related to both frequency and number of protective behaviors engaged in (p < .01), while fatigue was inversely related to engagement with PPBs (p = .01). There was some evidence that viewing self as role model may predict behavior., Conclusions: Personal factors drive engagement with protective behaviors outside the work setting. Implications for nursing management and education are explored., (© 2021 Wiley Periodicals LLC.)

To improve health care, the USA needs to create a longitudinal medical education system that will develop physicians able to lead the transformation of health care toward a focus on the promotion of healthy behaviors aimed at preventing disease. The development of patient-centered care has been an important step in promoting healthy behaviors. However, to truly develop a meaningful relationship with a patient, a physician must first see them as a person, not as a list of diseases. Medical education should develop physicians able to provide person-centered care - moving beyond patient-centered care to focus more broadly on the entirety of the person, for whom being a patient is merely one aspect of their personhood. Restructuring medical education begins with the admission process itself, followed by longitudinal changes at the undergraduate, graduate, and continuing professional development levels that will reinforce the attributes critical for future physicians. The authors view this longitudinal approach through the theoretical framework of situated cognition, exploring personal, environmental, and social factors leading to success; outline several key stages of medical education from matriculation through continuing professional development; and identify potential areas that merit longitudinal efforts to develop future physicians able to promote positive health behaviors.

Preparation for a Liaison Committee of Medical Education (LCME) accreditation site visit is a daunting task for any medical school, particularly for medical schools that have adopted integrated curricula. The LCME accreditation is the standard that all US and Canadian allopathic medical schools must meet in order for the school to award the degree of medical doctor. The Uniformed Services University of the Health Sciences (USU) recently underwent a full-scale LCME accreditation visit that was conducted under the newly revised LCME standards and elements. The site visit occurred just 5 years after our school began implementing a totally revised, organ system-based curriculum. Preparing for a critical, high-stakes site visit shortly after transitioning to a totally revised, integrated module-based preclerkship curriculum presented an array of new challenges that required a major modification to the type of preparation, communication, and collaboration that traditionally occurs between course directors and departmental chairs. These included the need to ensure accurate, timely communication of curricular details to different levels of the academic administration, particularly as it related to the execution of self-directed learning (SDL). Preparation for our site visit, did, however, provide a novel opportunity to highlight the unique educational experiences associated with the study of pathology, as pathology traverses both clinical and basic sciences. Sharing these experiences may be useful to other programs that are either undergoing or who are preparing to undergo an accreditation visit and may also aid in a broader communication of the highlights or initiatives of educational activities., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

This study presents a literature review of interventions for improving daily living skills of individuals with ASD. This review investigated the quality of the design and evidence of the literature base and determined the state of the evidence base related to interventions for improving daily living skills of individuals with ASD. Included studies were evaluated to determine the overall quality of the evidence for each design within each article, based on the What Works Clearinghouse standards for single-case experimental design (Kratochwill et al. 2010), adapted by Maggin et al. (Remedial Spec Educ 34(1):44-58, 2013. doi: 10.1177/0741932511435176 ). As a result, video modeling was found to be an evidence-based practice. Limitations and implications for future research and for practitioners are discussed.

Objective: The purpose of this brief report was to determine the effect on receptive identification of photos of a tablet computer-based augmentative and alternative communication (AAC) system with voice output., Methods: A multiple baseline single-case experimental design across vocabulary words was implemented. One participant, a preschool-aged boy with autism and little intelligible verbal language, was included in the study., Results: Although a functional relation between the intervention and the dependent variable was not established, the intervention did appear to result in mild improvement for two of the three vocabulary words selected., Conclusion: The authors recommend further investigations of the collateral impacts of AAC on skills other than expressive language.

Objective: To compare the diagnostic accuracy and agreement of commonly available assays for anti-citrullinated protein antibodies in patients with established rheumatoid arthritis (RA) and subjects at increased risk of RA., Methods: Tests for anti-cyclic citrullinated peptide (anti-CCP) antibodies were performed using CCP2 IgG and CCP3.1 IgA/IgG enzyme-linked immunosorbent assays in the following groups: probands with established RA (n = 340) from the Studies of the Etiology of Rheumatoid Arthritis (SERA) cohort and their first-degree relatives (FDRs) without inflammatory arthritis (n = 681), Department of Defense Serum Repository (DoDSR) RA cases with pre-RA diagnosis samples (n = 83; 47 cases also had post-RA diagnosis samples), and blood donor and DoDSR control subjects (n = 283)., Results: In patients with established RA, the CCP2 assay was more specific (99.2% versus 93.1%; P < 0.01) but less sensitive (58.7% versus 67.4%; P = 0.01) than the CCP3.1 assay; the specificity of the CCP3.1 assay increased to 97.2% when cutoff levels ≥3-fold the standard level were considered. In all subjects, CCP3.1 assay positivity (using standard cutoff levels) was more prevalent. Among DoDSR cases, the CCP2 assay was more specific than the CCP3.1 for predicting a future diagnosis of RA, and higher CCP levels trended toward increasing specificity for the development of RA within 2 years. At standard cutoff levels, assay agreement was good in patients with established RA (κ = 0.76) but poor in FDRs without inflammatory arthritis (κ = 0.25)., Conclusion: Anti-CCP assays differ to an extent that may be meaningful for diagnosing RA in patients with inflammatory arthritis and evaluating the natural history of RA development in subjects at risk of RA. The mechanisms underlying these differences in test performance need further investigation., (Copyright © 2013 by the American College of Rheumatology.)

Little is known about the clinical manifestations and correlates of osseous sarcoidosis and few data exist to guide pulmonologists in their evaluation of patients for possible osseous involvement. To determine the relationship between pulmonary and osseous sarcoidosis, and to develop an algorithm for use by pulmonologists in assessing patients with suspected osseous sarcoidosis, we conducted a retrospective, case control study of patients with pulmonary sarcoidosis and musculoskeletal complaints who were evaluated for osseous disease. All patients underwent a standard evaluation to include physical examination, chest radiograph (CXR), spirometry (PFTs), bone scintigraphy and plain radiographs of the hands and feet. Patients completed a health assessment questionnaire and serum angiotenisin converting enzyme, erythrocyte sedimentation rate, and C-reactive protein were measured. Patients eventually diagnosed with osseous sarcoidosis were compared to those lacking osseous involvement. Osseous involvement in patients with pulmonary sarcoidosis and musculoskeletal symptoms was common and seen in 38.9% of subjects. Patients with osseous sarcoidosis were more likely to concomitantly suffer from cutaneous sarcoidosis and to have elevated ACE levels and ESRs. No measure of pulmonary involvement (CXR stage, PFTs or symptoms) differentiated patients with osseous sarcoidosis from those without this condition. In cases of osseous sarcoidosis, bone scintigraphy identified a mean of four sites of osseous involvement, some of which would have been missed with the use of plain radiographs limited to the hands and feet. We conclude that in patients with pulmonary sarcoidosis who have significant musculoskeletal complaints, osseous involvement is frequent. Pulmonary features of sarcoidosis do not differ between patients with and without osseous disease. Bone scintigraphy aids in the evaluation of these patients.

We describe a 53-year-old woman with a 4-month history of palpable purpuric papules on the upper and lower extremities. Biopsy of the skin lesions revealed leukocytoclastic vasculitis. Although she denied any systemic symptoms, urinalysis demonstrated hematuria and proteinuria. Although the patient's skin lesions responded to prednisone, her urinalysis did not improve. A 10-cm complex mass involving the left ovary and adnexa was incidentally discovered on renal ultrasound. Serum CA-125, an ovarian cancer marker, was elevated. Laparotomy revealed ovarian carcinoma confined to the left ovary. After the cancer was resected, the patient's urinalysis slowly improved. Leukocytoclastic vasculitis (LCV) is infrequently associated with underlying malignancy and only rarely with solid tumors. We postulate that the patient's vasculitis represented a paraneoplastic phenomenon that allowed a diagnosis of asymptomatic ovarian carcinoma. To our knowledge, this is the first report of LCV occurring as the presenting sign of ovarian cancer.

The Mendocino fracture zone may continue through or below North America near 40 degrees N latitude. This is suggested by instances of left-lateral movement, location of basin deeps, sedimentation patterns, interruption of a major magnetic anomaly, and inflection of major structural trends. A major segmentation of middle North America results.