Hospital Medical School Research Articles

Jinx or Not?: There Is Nothing Like a "Black Cloud" Syndrome.

The aim of this study was to ascertain the validity of the widespread belief in the existence of jinxed physicians during night duty in emergency department (ED). We conducted a retrospective study involving 13 pediatricians with more than 12 spells of night duty (8 PM to 8.30 AM) in the ED at the "La Timone" Medical School Hospital in Marseilles, France, during the inclusion period (from November 1, 2010, to October 31, 2011) and 8 night nurses in the same ED. The 13 pediatricians rated themselves as jinxed and were rated as such by their peers and the night nurses. The number of ED visits (total, medical, and after midnight) and the number of hospitalizations were compared according to the jinx rating of the 13 pediatricians. The secondary outcome was a comparison of the self-assessed jinxed pediatrician group with the other group. Four pediatricians rated themselves as jinxes. Despite a nonperfect match, self-assessed jinxed pediatricians were also more often rated as being jinxed by their peers or the nurses. There was no difference (for the 13 pediatricians) regarding total ED visits (31.6 [14-57], P = 0.98), ED visits after midnight (10.37 [1-26], P = 0.876), and the number of hospitalizations (4.5 [0-12], P = 0.179). The number of ED visits (total, medical, after midnight) did not differ from the jinxed physicians (all P >0.20) to the other pediatricians, but the mean number of hospitalizations was higher when the pediatrician was rated as a jinx (4.9 vs 4.3, P = 0.034). We found no evidence of a jinx effect on workload in a pediatric ED.

Parkinson's disease and the quest for preclinical diagnosis: an interview with Professor Werner Poewe.

Werner Poewe speaks to Laura Dormer, Editorial Director: Professor Werner Poewe is Professor of Neurology and Director of the Department of Neurology at Innsbruck Medical University in Innsbruck, Austria. He held a Residency in Clinical Neurology and Psychiatry at the University of Innsbruck, Austria, from 1977 to 1984. From 1984 to 1985 he teamed up with Gerald Stern and Andrew Lees as a British Council Research Fellow at University College and Middlesex Hospital's Medical School in London to perform clinical studies into levodopa-induced dystonia and pharmacokinetics of levodopa in naive versus L-Dopa treated Parkinson's disease. Following his return to Austria, he held a position as Senior Lecturer in the Department of Neurology at the University of Innsbruck (1986-1989) after which he took over as Professor of Neurology and Acting Director of the Department of Neurology at Virchow Hospital of the Free University of Berlin (1990-1994). Professor Poewe's main research interests in the field of movement disorders are focused on differential and early diagnosis of Parkinson's disease, its natural history and pharmacological treatment. He has been involved in the steering committees of numerous drug trials in different stages of Parkinson's disease for the past 20years and has authored and coauthored more than 500 original articles and reviews in the field of movement disorders. Professor Poewe served as President of the Austrian Society of Neurology from 2002 to 2004 as well as President of the Austrian Parkinson's Disease Society from 1996 to 2009. He has been awarded honorary membership of the German Society of Neurology as well as the Japanese Society of Neurology. His awards include the Walther-Birkmayer-Prize of the Austrian PD Society, the Dingebauer-Prize of the German Neurological Society as well as the Research Excellence Award of Innsbruck Medical University. Professor Poewe served as President of the International Movement Disorder Society (MDS) from 2000 to 2002, during which period he initiated the creation of important MDS task forces related to the critique and development of rating scales and of evidence-based treatment reviews. In his presidency, fell the negotiations between the European Section of MDS and the European Federation of Neurological Societies that resulted in formal agreements about joint European congresses. This model served as an important underpinning of the success of the MDS European Section in the past 15years. Professor Poewe took over as chair of the MDS European Section from 2011 to 2013 and has recently been made an honorary member of the MDS. He is currently active as member of the Managing Board of the Movement Disorder Scientific Panel of the European Academy of Neurology.

The Difference in Clinical Features Between Acute Esophageal Mucosal Lesions and Severe Reflux Esophagitis

Introduction: The term “acute esophageal mucosal lesion” includes black esophagitis, also known as acute esophageal necrosis, and non-black esophagitis, which is characterized by diffuse circumferential erosions without black-appearing mucosa. Black esophagitis is easily diagnosed by its typical endoscopic findings, whereas non-black esophagitis is often misdiagnosed as severe reflux esophagitis. In this retrospective study, we investigated differences in clinical characteristics of patients with acute esophageal mucosal lesions and those with severe reflux esophagitis. Methods: Thirty-nine patients with severe reflux esophagitis and 32 with acute esophageal mucosal lesions were diagnosed on the basis of endoscopic findings at Saga Medical School Hospital from 2009 to 2016. Characteristics assessed included age, sex, presence of hiatal hernia, gastric atrophy, use of nonsteroidal anti-inflammatory drugs and antacids, comorbidities, and blood chemistry findings. Results: In contrast with severe reflux esophagitis, male sex, need for emergency endoscopy (P<0.001), presence of duodenal lesions (P=0.013), hypertension, and renal dysfunction were positively associated with acute esophageal mucosal lesions whereas hiatal hernia (P=0.003) was inversely associated with them. Analysis of associations between laboratory data and acute esophageal mucosal lesions showed that high white blood cell count (P<0.001), blood urea nitrogen (P<0.001), and blood glucose (P=0.018) were significantly associated with an increase odds ratio for acute esophageal mucosal lesions compared with severe reflux esophagitis. Conclusion: Thus, we found that acute esophageal mucosal lesions differed from severe reflux esophagitis regarding both endoscopic findings and clinicopathological features. We propose that AEML is a distinct inflammatory disease of the esophagus consisting of both black and non-black esophagitis.

Angela Hartley Brodie, 1934-2017: Assailant of Aromatase.

Angela Hartley Brodie, 1934-2017: Assailant of Aromatase.

Asthma drugs may reduce Parkinson’s risk

During an asthma attack, drugs such as salbutamol can help a person breathe easy by turning on a protein receptor that triggers the opening of the lung’s airways. According to a new study, drugs targeting this receptor might have another, unrelated benefit: reducing the risk of Parkinson’s disease (Science 2017, DOI: 10.1126/science.aaf3934). “It’s an exciting clue” that could point the way toward new treatments for the neurodegenerative disease, says Clemens Scherzer of Brigham & Women’s Hospital and Harvard Medical School, who led the research team. The findings connect the receptor targeted by asthma drugs to the expression of the gene that encodes the protein α-synuclein. In the brains of people with Parkinson’s, this protein aggregates and forms characteristic clumps. Scientists are working on therapies to clear toxic forms of the protein from the brain. But, Scherzer says, scientists still debate which form of α-synuclein is the toxic one. He and

Editorial introductions

Current Opinion in Anesthesiology was launched in 1988. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of anesthesiology is divided into 15 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Section Editors for this issue. SECTION EDITORS Jürgen SchüttlerJürgen SchüttlerProf. Jürgen Schüttler has been Dean of the Faculty of Medicine at Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany, since 2008 and Professor of Anesthesiology and Head of the Department of Anesthesiology, University Hospital Erlangen, Germany, since 1995. He studied medicine at the University of Bonn, Germany, from 1974 to 1980 and earned his MD degree (s.c.l.) in 1982 on the pharmacokinetics/-dynamics (PK/PD) of fentanyl with special emphasis on a respiratory rebound phenomenon. He was trained in anesthesiology and clinical pharmacology at the University of Bonn, University Hospital, and Stanford University Medical School from 1981–1985. He finalized his Habilitation in 1986 with several clinical studies on PK/PD of intravenous anesthetics like Propofol, Ketamine, and Etomidate. He pioneered together with Prof. Helmut Schwilden the concept of computer controlled application of intravenous anesthetics, nowadays in clinical use worldwide as TCI (Target Controlled Infusion) for intravenous anesthesia as well as EEG controlled closed loop anesthesia. Dr Schüttler's research focus today is in pain research: determinants and modulators of postoperative pain, and in medical technology of diagnostic and therapeutic procedures. Dr Schüttler is a member of the German Academy of Natural Sciences Leopoldina. He was awarded several prizes, among those the Karl-Thomas-Prize and the Sertürner-Prize as well as the Paul-Martini-Prize. Dr Schüttler was President of the German Society for Anesthesiology and Intensive Care Medicine (DGAI) from 2009 to 2010. Natalie F. HoltNatalie F. HoltNatalie F. Holt is an Assistant Professor in the Department of Anesthesiology at Yale School of Medicine in New Haven, CT, USA. She is also a staff anesthesiologist and Medical Director of the Ambulatory Procedures Unit and Anesthesia Prescreen Clinic at the Veterans Affairs Medical Center in West Haven, CT. She is on the editorial staff of Clinical Anesthesia (Barash et al.) and an anesthesiology section editor for UpToDate, an internet-based, clinical decision support tool for physicians. In addition, Dr Holt is a writer and editor of continuing medical education content published by the American Society of Anesthesiologists. Dr Holt completed her medical degree at Yale School of Medicine, USA in 2001 and an anesthesiology residency at Yale-New Haven Hospital in 2007. She also holds a Masters degree in Public Health from Johns Hopkins Bloomberg School of Public Health in Baltimore, MD, USA. She is dual-board certified in Anesthesiology and General Preventive Medicine. Her interests include preoperative risk assessment, operating room management, medical education, and medical writing.

Angus Osborn Robson

Angus Osborn Robson was proud to have been a general physician specialising in chest medicine during what he viewed as the heyday of the NHS. He was one of a...

Meet the First Authors.

HomeCirculation ResearchVol. 121, No. 3Meet the First Authors Free AccessIn BriefPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessIn BriefPDF/EPUBMeet the First Authors Originally published21 Jul 2017https://doi.org/10.1161/RES.0000000000000167Circulation Research. 2017;121:198Pathways from Telomeres to Heart Disease (p 214)Download figureDownload PowerPointYiqiang Zhan is a PhD student in the Molecular Aging Epidemiology group under the supervision of Dr Sara Hägg at Karolinska Institute, Sweden. He earned his MD in Preventive Medicine from Shandong University and MS in Epidemiology from Fudan University. He is interested in the intersection of telomere, cardiovascular disease, and aging. His current work is focused on telomere length shortening and its role in cardiovascular diseases and neurodegenerative disorders. Yiqiang intends to pursue further training and research in aging epidemiology, particularly from molecular and clinical perspectives. He enjoys reading and running (physical activity is beneficial for both telomere and cardiovascular diseases).DRP1 Regulates Cardiovascular Calcification (p 220)Download figureDownload PowerPointDr Maximillian (Max) Rogers, a Brigham and Women’s Hospital and Harvard Medical School Research Fellow, works in Dr Elena Aikawa’s lab at the Center for Interdisciplinary Cardiovascular Sciences at Harvard Medical School. Max earned his BS and BA degrees at the University of Washington, and his PhD in Biochemistry and Molecular Biology at Dartmouth. His research focuses on cardiovascular calcification, atherosclerosis, mitochondria, inflammation, and lipids. The Aikawa lab motto is, “Think outside the box,” which encouraged Max to look at cardiovascular calcification and DRP1, a mitochondrial dynamics protein also associated with neurological disorders. In his limited free time, Max enjoys traveling, reading, and watching Red Sox games.PVM and Aβ-Induced Neurovascular Dysfunction (p 258)Download figureDownload PowerPointDr Laibaik Park is an Assistant Professor in the Feil Family Brain and Mind Research Institute at Weill Cornell Medicine, New York, NY. He earned his BS in Biology at Chosun University in South Korea and his PhD in neurophysiology at the University of Saskatchewan (Canada). He completed his postdoctoral training at Weill Cornell. His research is focused on the neurovascular mechanisms underlying Alzheimer disease and vascular dementia, with the ultimate goal of developing new therapeutic strategies to ease the burden of dementia. When not in the lab, he loves spending time with his wife and two kids and exploring New York City.T Cell-Dependent Antibodies Limit Atherosclerosis (p 270)Download figureDownload PowerPointDr Andrew Sage earned his BS in Biochemistry at the University of Manchester and stayed to do his PhD on vascular calcification with Professor Ann Canfield. He continued this work at UCLA in the lab of Dr Linda Demer before returning to the UK to join the newly established lab of Dr Ziad Mallat at the University of Cambridge, working on adaptive immune responses in atherosclerosis. He quickly became focused on B-cell biology and is now pursuing this fulltime after obtaining independent funding from the British Heart Foundation. In his free time, he loves to travel and is slowly moving up his squash league. Previous Back to top Next FiguresReferencesRelatedDetails July 21, 2017Vol 121, Issue 3 Advertisement Article InformationMetrics © 2017 American Heart Association, Inc.https://doi.org/10.1161/RES.0000000000000167PMID: 28729446 Originally publishedJuly 21, 2017 PDF download Advertisement

High Cost of Hospitalization for Colonic Diverticular Bleeding Depended on Repeated Bleeding and Blood Transfusion: Analysis with Diagnosis Procedure Combination Data in Japan

Background: Bleeding from a colonic diverticulum is serious in aged patients. The aim of this study was to determine the risk factors for high-cost hospitalization of colonic diverticular bleeding using the diagnosis procedure combination (DPC) data. Methods: From January 2009 to December 2015, 78 patients with colonic diverticular bleeding were identified by DPC data in Saga Medical School Hospital. All patients underwent colonic endoscopy within 3 days. The patients were divided into 2 groups: the low-cost group (DPC cost of <500,000 yen) and the high-cost group (DPC cost of >500,000 yen). Results: Univariate analysis revealed that aging, hypertension, rebleeding, a low hemoglobin concentration at admission, and blood transfusion were risk factors for high hospitalization cost. Multivariate analysis revealed that rebleeding (OR 5.3; 95% CI 1.3-21.3; p = 0.017) and blood transfusion (OR 3.8; 95% CI 1.01-14.2; p = 0.048) were definite risk factors for high hospitalization cost. Conclusion: Rebleeding and blood transfusion were related to high hospitalization cost for colonic diverticular bleeding.

23 Dementia: thirty years back and forth

Professor Rossor graduated from Jesus College, Cambridge and Kings College Hospital Medical School London. He trained in Neurology at the National Hospital, Queen Square and undertook research into the neurochemistry of degenerative disease at the MRC neurochemical pharmacology unit in Cambridge. He is the NIHR National Director for Dementia Research, Director of the NIHR Queen Square Dementia Biomedical Research Unit and a NIHR Senior Investigator. He is honorary consultant neurologist at the National Hospital for Neurology and Neurosurgery where he established the specialist cognitive disorders clinic which acts as a tertiary referral service for young onset and rare dementias. Clinical research interests are in neurodegenerative disease and particularly in familial disease. In 1987 dementia was still a Cinderella subject, although a regular topic at BNPA meetings. Three years earlier the McKhann criteria for Alzheimer’s disease had been published and, whilst a major advance in standardising clinical diagnosis, created two issues that remain challenging. The first was the requirement for sufficient cognitive impairment to impair everyday function and the second was the focus on episodic memory. Revised criteria have partially addressed these issues but the problems of when to diagnose Alzheimer’s disease and the significance of imaging evidence of amyloid deposition remain. The range of cognitive deficits, apart from episodic memory, in the different dementias, including Alzheimer’s disease, is now well recognised by neuropsychiatrists but not by other clinicians. In 2047 the salience of these issues will be dictated in part by the availability of drug interventions. However, an ageing population characterised by comorbidities will test the concepts of stratified and precision medicine.

Elevated serotonin linked to infant death syndrome

It’s new parents’ worst nightmare: Their child dies suddenly in his or her sleep, and doctors can’t pinpoint a cause. According to the Centers for Disease Control & Prevention, approximately 1,600 children in the U.S. died in 2015 from this so-called sudden infant death syndrome (SIDS), which doctors believe is a range of disorders. Now a team led by Robin L. Haynes and Hannah C. Kinney of Boston Children’s Hospital and Harvard Medical School reports that nearly one-third of SIDS cases they studied had elevated levels of serotonin in their blood serum (Proc. Natl. Acad. Sci. USA 2017, DOI: 10.1073/pnas.1617374114). Previous studies by some of the same researchers found reduced levels of the neurotransmitter in the brain stems of about 40% of SIDS cases. “If these abnormalities coexist in the same infants, then we would identify these infants as having a global problem in serotonin production or serotonin-related function,” Haynes

Risk factors and clinical characteristics of non-promyelocytic acute myeloid leukemia of intracerebral hemorrhage: A single center study in China

BackgroundAlthough high mortality in patients with acute leukemia (AL) is associated with intracranial hemorrhage (ICH), the clinical features and pathogenesis of AL patients with cerebral hemorrhage are not well known. MethodsWe diagnosed 90 patients with ICH from a total of 1467 patients with non-promyelocytic AL who had been hospitalized in the First Affiliated Hospital of Medical School of Zhejiang University from January 2010 to October 2015. Moreover, the risk factors of ICH death were evaluated. ResultMedian age at ICH was 51years old, in which men accounted for 52.2%. They also accounted for 85.6% of acute myeloid leukemia. The relative incidence of ICH was the highest in M2 and M5 (60.1%). ICH presented with higher peripheral blood white blood cell count (WBC) (P<0.001), lower peripheral platelet counts (P<0.001), lower albumin (P<0.001), lower fibrous protein (P<0.001) and prolongation of prothrombin time (P<0.001) compared to those observed in the patients of NICH group; multivariate analysis, independent risk factors for death in patients with ICH include: WBC≥30.00×109/l and prothrombin time≥12.91 s. ConclusionsLeukocytosis and coagulation dysfunctions might be the main pathogenesis of acute leukemia complicated with cerebral hemorrhage.

The Effect of Adding Comorbidities to Current Centers for Disease Control and Prevention Central-Line–Associated Bloodstream Infection Risk-Adjustment Methodology

BACKGROUND Risk adjustment is needed to fairly compare central-line-associated bloodstream infection (CLABSI) rates between hospitals. Until 2017, the Centers for Disease Control and Prevention (CDC) methodology adjusted CLABSI rates only by type of intensive care unit (ICU). The 2017 CDC models also adjust for hospital size and medical school affiliation. We hypothesized that risk adjustment would be improved by including patient demographics and comorbidities from electronically available hospital discharge codes. METHODS Using a cohort design across 22 hospitals, we analyzed data from ICU patients admitted between January 2012 and December 2013. Demographics and International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) discharge codes were obtained for each patient, and CLABSIs were identified by trained infection preventionists. Models adjusting only for ICU type and for ICU type plus patient case mix were built and compared using discrimination and standardized infection ratio (SIR). Hospitals were ranked by SIR for each model to examine and compare the changes in rank. RESULTS Overall, 85,849 ICU patients were analyzed and 162 (0.2%) developed CLABSI. The significant variables added to the ICU model were coagulopathy, paralysis, renal failure, malnutrition, and age. The C statistics were 0.55 (95% CI, 0.51-0.59) for the ICU-type model and 0.64 (95% CI, 0.60-0.69) for the ICU-type plus patient case-mix model. When the hospitals were ranked by adjusted SIRs, 10 hospitals (45%) changed rank when comorbidity was added to the ICU-type model. CONCLUSIONS Our risk-adjustment model for CLABSI using electronically available comorbidities demonstrated better discrimination than did the CDC model. The CDC should strongly consider comorbidity-based risk adjustment to more accurately compare CLABSI rates across hospitals. Infect Control Hosp Epidemiol 2017;38:1019-1024.

Disorders of Growth and Stature.

1. Laurie R. Braun, MD*,† 2. Rose Marino, MD* 1. *Pediatric Endocrine Unit and 2. †Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA * Abbreviations: ACTH: : adrenocorticotropic hormone CDC: : Centers for Disease Control and Prevention CDGP: : constitutional delay of growth and puberty CNS: : central nervous system FSS: : familial short stature GH: : growth hormone GnRH: : gonadotropin-releasing hormone IGF-BP3: : IGF-1 binding protein 3 IGF-1: : insulin-like growth factor 1 ISS: : idiopathic short stature NPR2 : : natriuretic peptide receptor B rhGH: : recombinant human GH SGA: : small for gestational age SHOX : : short stature homeobox TSH: : thyroid-stimulating hormone T4: : thyroxine It is often challenging to identify children with abnormal growth patterns and distinguish normal growth variants from pathologic variants. After completing this article, readers should be able to: 1. Perform growth measurements and interpret growth charts to be able to identify children with short or tall stature. 2. Differentiate among the common origins of short and tall stature and plan an appropriate diagnostic evaluation for a slowly or rapidly growing child. 3. Describe when treatment is indicated for children with short and tall stature. Growth parameters are routinely measured in general pediatrics, with the goal of identifying children with abnormalities in growth and stature. Short stature is defined as a height less than 2 standard deviations (SDs) below the mean of the “normal” population, while tall stature is defined as a height greater than 2 SDs above the mean of the normal population. Both single growth measurements and the pattern of growth over time (growth velocity) are useful in identifying children with abnormal stature. The growth velocity changes over time, with relatively rapid growth in infancy and early childhood, followed by slower growth (approximately 5 cm per year) in later childhood and then rapid growth again during puberty. There is a range of pubertal peak growth velocities of around 7 to 12 cm per year and 6 to 10.5 cm per year in boys and girls, respectively, representing approximately the 3rd to 97th percentiles. The timing of peak growth velocity varies with the age of puberty onset and frequently reflects familial pubertal and growth patterns. Overall, it is thought that …

Urinary levels of prostaglandin E2 are positively correlated with intratumoral infiltration of Foxp3+ regulatory T cells in non-small cell lung cancer.

The immune microenvironment of primary tumors has been reported to be one of the factors influencing the prognosis of patients with cancer. The tumor-infiltrating regulatory T cell (Treg) count has previously been revealed to be positively correlated with intratumoral cyclooxygenase-2 (Cox-2) expression, and was also associated with poor survival among patients with non-small cell lung cancer (NSCLC). In addition, the urinary levels of a prostaglandin E2 (PGE2) metabolite (PGE-M) were used as a biomarker in clinical trials of the Cox-2 inhibitor celecoxib. In the current prospective study, the association of urinary PGE2 and PGE-M levels with intratumoral Cox-2 expression and Treg count was examined in patients with NSCLC. A total of 21 patients with NSCLC who underwent complete resection of the tumor at Kawasaki Medical School Hospital (Kurashiki, Japan) were enrolled. Urine specimens were obtained prior to surgery in order to examine urinary PGE2 and PGE-M levels. A significant positive association was observed between urinary PGE2 levels and the intratumoral Treg count (P=0.023), but not the intratumoral Cox-2 expression levels. No significant associations were identified between urinary PGE2 levels and any of the other clinicopathological characteristics examined, including age, sex, smoking history, histology, tumor size, nodal status and disease stage. However, no significant association was observed between urinary PGE-M levels and the intratumoral Treg count (P=0.069) or Cox-2 expression. In conclusion, urinary PGE2 levels were positively correlated with intratumoral Treg counts in patients with NSCLC in the current study. This indicates that urinary PGE2 may be an improved biomarker, compared with PGE-M, for the prediction of intratumoral Treg numbers.

Richard Paul Hyde Dunnill

Richard Dunnill was born in Bexhill, Sussex, where his father was a general practitioner-anaesthetist. He was the youngest of three siblings. He was educated at Charterhouse, Guildford, and then moved...

Medical student perceptions of clinical neurosurgery teaching in an undergraduate medical school curriculum

Aim: The aim of this study was to evaluate undergraduate medical student perceptions as to the value of different types of neurosurgical teaching to their general neuroscience education, delivered in the penultimate year of a U.K medical school.Methods: We surveyed penultimate-year medical students at St George’s Hospital Medical School, University of London (SGUL), who were undertaking their clinical neuroscience attachment from August 2014 to July 2015. A questionnaire comprising closed Likert scale questions and an open question inviting participants to comment freely was used to assess student perception about the value of Neurosurgical sessions within their overall neuroscience education.Results: Of the 316 students in the year we surveyed 247 (78.2%), of whom 201 responded (response rate 81.4%). On average, 82.8% of students either agreed or strongly agreed that neurosurgical teaching sessions made a valuable contribution to their learning. In particular, lectures by neurosurgeons, clinical teaching on the Glasgow Coma Scale in neuro-ITU, bedside teaching and neurosurgical clinics were considered the most beneficial. The majority of students felt the sessions improved their understanding of neurological examination, signs, and ‘red-flags’. The sessions were also beneficial for learning neuro-imaging and understanding of neurosurgical emergencies. Over two thirds felt that theatre sessions were beneficial, significantly more so amongst students invited to ‘scrub-in’.Conclusions: Students rated neurosurgical sessions highly and valued the contribution they made not only to their learning of neurosurgical conditions and emergencies, but also to their learning of general neurology and clinical neurosciences overall. Student perceived learning from theatre sessions was significantly correlated with whether or not the student had been invited to ‘scrub-in’. Expert neurosurgical teaching can make a valuable, and arguably essential contribution to the undergraduate medical curriculum.

Building Workforce Capacity Abroad While Strengthening Global Health Programs at Home: Participation of Seven Harvard-Affiliated Institutions in a Health Professional Training Initiative in Rwanda.

A consortium of 22 U.S. academic institutions is currently participating in the Rwanda Human Resources for Health Program (HRH Program). Led by the Rwandan Ministry of Health and funded by both the U.S. Government and the Global Fund to Fight AIDS, Tuberculosis and Malaria, the primary goal of this seven-year initiative is to help Rwanda train the number of health professionals necessary to reach the country's health workforce targets. Since 2012, the participating U.S. academic institutions have deployed faculty from a variety of health-related disciplines and clinical specialties to Rwanda. In this Article, the authors describe how U.S. academic institutions (focusing on the seven Harvard-affiliated institutions participating in the HRH Program-Harvard Medical School, Brigham and Women's Hospital, Harvard School of Dental Medicine, Boston Children's Hospital, Beth Israel Deaconess Medical Center, Massachusetts General Hospital, and Massachusetts Eye and Ear Infirmary) have also benefited: (1) by providing opportunities to their faculty and trainees to engage in global health activities; (2) by establishing long-term, academic partnerships and collaborations with Rwandan academic institutions; and (3) by building the administrative and mentorship capacity to support global health initiatives beyond the HRH Program. In doing this, the authors describe the seven Harvard-affiliated institutions' contributions to the HRH Program, summarize the benefits accrued by these institutions as a result of their participation in the program, describe the challenges they encountered in implementing the program, and outline potential solutions to these challenges that may inform similar future health professional training initiatives.

Revised 'Common Rule' Shapes Protections For Research Participants.

Investigators and institutions have begun to prepare for new federal protections of study participants set to take effect in 2018.

The Future of Pharmaceutical Education Based on Our Experience of Medical Education.

We have experienced a series of big revolutions in medical education in Japan. In undergraduate courses, common guidelines had been established for medical education (the model core-curriculum of medical education). Then, from 2005, a standard achievement testing system [objective structured clinical examination (OSCE) and computer based testing (CBT)] was begun, and clinical clerkships were accordingly promoted. In post-graduate courses, a new clinical resident training system was initiated in 2004, and there are currently approximately 40000 clinical instructors nationwide. Accreditation of Japanese medical schools based on global standards for quality improvement has just begun. Almost the same process has taken effect in the field of pharmaceutical education (PE), such as the preparation of guidelines for PE and clinical training, a shift to a six-year course, and the establishment of an accreditation organization. The educational guidelines were revised in 2013 to provide better clinical training. Both of these educational revolutions aim at providing the proper education to train healthcare professionals committed to practicing "patient-centered medicine" and to becoming lifelong learners. To educate such professionals naturally includes improving their communicative competency, and cultivating their professionalism along with their acquisition of scientific and medical knowledge, based on both quantitative and qualitative study. The Society for Medical Education has begun a new "Medical education specialist (MES) training system" responding to the need of MES in every medical school and training hospital. A new PE specialist educational system can be expected soon, as well.