Pathophysiology Course Research Articles

Haemolytic uraemic syndrome

Haemolytic uraemic syndrome (HUS) is the most common cause of acute kidney injury (AKI) in children. It is categorized by a triad of clinical features, haemolytic anaemia, thrombocytopaenia and AKI. HUS is subdivided into two broad categories, diarrhoea positive HUS (more than 90% of cases) most commonly caused by Shiga toxin (Stx)-producing Escherichia coli (also called verotoxin) and the less common diarrhoea negative HUS. HUS is initiated by intestinal colonization with Stx-producing bacteria. HUS results in widespread thrombotic microangiopathy (TMA) in renal glomeruli, the gastrointestinal tract, the brain, and the pancreas. The aim of this review is to summarise the latest developments in our understanding of this condition, focussing on epidemiology, pathophysiology and disease course.

Authentic Engagement in High-Enrollment Graduate Courses: Pathophysiology Consumers Become Content Creators.

The challenge to educate increasing numbers of nursing students at all levels in both online and in-class environments calls for innovative instructional strategies that may include technology-based assignments to help students apply knowledge to clinical situations. This article describes a case study assignment created for a graduate-level pathophysiology course that required students to create digitally enhanced patient stories. Nursing students enrolled in the online and in-class sections of the course worked together using commonly available learning technology tools to create content that bridged pathophysiology concepts and clinical practice.

Immunology education within a Postgraduate Nursing Science program in New Zealand

Abstract Immunology is key to understanding the cellular basis for certain diseases. Postgraduate Nursing Science students with a limited undergraduate background in Biomedical Science may find Immunological course components challenging. The goal was to successfully incorporate and establish a substantial Immunological component within the postgraduate Pathophysiology course for Nursing Science and Health students at Victoria University of Wellington in New Zealand. In-class teaching sessions were conducted that covered the fundamental concepts of Immunology and included Innate, Adaptive Immunity, Inflammation and Immunopathophysiology lessons. A variety of teaching and learning approaches and strategies were employed to facilitate in-class learning for students and support understanding, and improve participation and student engagement with in-class activities. These included the use of Youtube video clips, animations depicting key cellular and mechanistic interactions, one-on-one peer discussions and traditional lecture sessions interspersed with brief question and answer interactions designed to gauge understanding and also consolidate learning. Cumulative data showed favourable student outcomes were achieved for Immunological assessment components. Student satisfaction and teaching scores based on formal student evaluation processes also showed positive responses regarding the Immunology course elements. This work highlights the successful incorporation of essential Immunological components into a teaching curriculum for Postgraduate Nursing Science education in New Zealand.

Blended Learning Versus Traditional Lecture in Introductory Nursing Pathophysiology Courses.

Currently, many undergraduate nursing courses use blended-learning course formats with success; however, little evidence exists that supports the use of blended formats in introductory pathophysiology courses. The purpose of this study was to compare the scores on pre- and posttests and course satisfaction between traditional and blended course formats in an introductory nursing pathophysiology course. This study used a quantitative, quasi-experimental, nonrandomized control group, pretest-posttest design. Analysis of covariance compared pre- and posttest scores, and a t test for independent samples compared students' reported course satisfaction of the traditional and blended course formats. Results indicated that the differences in posttest scores were not statistically significant between groups. Students in the traditional group reported statistically significantly higher satisfaction ratings than students in the blended group. The results of this study support the need for further research of using blended learning in introductory pathophysiology courses in undergraduate baccalaureate nursing programs. Further investigation into how satisfaction is affected by course formats is needed.

Hypertrophic Cardiomyopathy from A to Z: Genetics, Pathophysiology, Imaging, and Management.

Hypertrophic cardiomyopathy (HCM) is a heterogeneous group of diseases related to sarcomere gene mutations exhibiting heterogeneous phenotypes with an autosomal dominant mendelian pattern of inheritance. The disorder is characterized by diverse phenotypic expressions and variable natural progression, which may range from dyspnea and/or syncope to sudden cardiac death. It is found across all racial groups and is associated with left ventricular hypertrophy in the absence of another systemic or cardiac disease. The management of HCM is based on a thorough understanding of the underlying morphology, pathophysiology, and clinical course. Imaging findings of HCM mirror the variable expressivity and penetrance heterogeneity, with the added advantage of diagnosis even in cases where a specific mutation may not yet be found. The diagnostic information obtained from imaging varies depending on the specific stage of HCM-phenotype manifestation, including the prehypertrophic, hypertrophic, and later stages of adverse remodeling into the burned-out phase of overt heart failure. However, subtle or obvious, these imaging findings become critical components in diagnosis, management, and follow-up of HCM patients. Although diagnosis of HCM traditionally relies on clinical assessment and transthoracic echocardiography, recent studies have demonstrated increased utility of multidetector computed tomography (CT) and particularly cardiac magnetic resonance (MR) imaging in diagnosis, phenotype differentiation, therapeutic planning, and prognostication. In this article, we provide an overview of the genetics, pathophysiology, and clinical manifestations of HCM, with the spectrum of imaging findings at MR imaging and CT and their contribution in diagnosis, risk stratification, and therapy.

Impact of a concept map teaching approach on nursing students’ critical thinking skills

Nurses confront complex problems and decisions that require critical thinking in order to identify patient needs and implement best practices. An active strategy for teaching students the skills to think critically is the concept map. This study explores the development of critical thinking among nursing students in a required pathophysiology and pharmacology course during the first year of a Bachelor of Science in Nursing in response to concept mapping as an interventional strategy, using the Health Education Systems, Incorporated critical thinking test. A two-group experimental study with a pretest and posttest design was used. Participants were randomly divided into a control group (n = 42) taught by traditional didactic lecturing alone, and an intervention group (n = 41), taught by traditional didactic lecturing with concept mapping. Students in the concept mapping group performed much better on the Health Education Systems, Incorporated than students in the control group. It is recommended that deans, program directors, and nursing faculties evaluate their curricula to integrate concept map teaching strategies in courses in order to develop critical thinking abilities in their students.

Use of Visual Narrative Illustrations to Teach Pathophysiology Concepts to Nursing Students

The care of patients with acute and chronic illnesses requires nurses to fully understand the underlying pathophysiology associated with disease processes. Although mastering a pathophysiology course is a strong predictor of student success in nursing programs, it is a course with which students and new nurses most often struggle. The authors describe a teaching innovation--visual narrative illustration (VNI)--and demonstrate how VNIs are used to teach complex pathophysiology concepts to nursing students. The consistent positive feedback regarding the VNIs that have already been implemented in the pathophysiology course prompted the authors to systematically and formally study the impact of this innovative approach on student learning and knowledge retention. Use of VNI is an innovative teaching strategy that has the potential to augment other course materials and bridge some of the knowledge gaps that challenge nursing students from fully understanding pathophysiologic concepts.

Impact of lithium alone or in combination with haloperidol on selected oxidative stress parameters in human plasma in vitro

Objectives: Lithium may inhibit lipid peroxidation (LP) and protein oxidation, stimulate cell proliferation, increase neurogenesis, and delay cell death. Oxidative stress (OxS) is a state of imbalance between oxidative processes and antioxidant defenses, which may play an important role in the pathophysiology and disease course of bipolar disorder (BD). The aim of this study was to estimate the influence of lithium, administered alone or in combination with haloperidol, on selected OxS parameters in human plasma in vitro.Methods: The OxS parameters evaluated were thiobarbituric acid reactive substances (TBARS) and total antioxidant capacity (TAC). Plasma samples from healthy volunteers were incubated with drug concentrations used in psychiatry.Results: Incubation of plasma with lithium or haloperidol alone did not produce statistically significant changes of TBARS levels in comparison with control samples. However, significantly higher TBARS levels were observed in samples incubated with haloperidol plus lithium compared to control, haloperidol, or lithium samples. The TAC value did not differ between samples.Conclusions: Lithium does not influence OxS parameters in human plasma in vitro during short-term observation when applied at concentrations used in psychiatry. However, lithium increased the TBARS level in the samples when given in combination with haloperidol, which may be one of the mechanisms behind the neurotoxicity associated with combined lithium and haloperidol administration.

Pulmonary Vascular Disease in Bronchopulmonary Dysplasia

Pulmonary vascular disease and pulmonary hypertension (PH) contributes significantly to the pathogenesis, pathophysiology, and clinical course of infants with bronchopulmonary dysplasia (BPD). This article briefly reviews the impact of premature birth on the developing lung circulation, mechanisms that contribute to the development of PH in premature newborns, and the diagnostic evaluation and management of severe PH in infants with BPD.

Defining pathways for development of disease-modifying therapies in children with type 1 diabetes: a consensus report.

Emerging data suggest that type 1 diabetes is a more aggressive disease in children than in adults, with important differences in pathophysiology and clinical course. Therefore, the efficacy of disease-modifying therapies may be different in the two populations. Understanding the developmental and regulatory pathways for type 1 diabetes–modifying therapies in children will enable industry, academia, funders, advocacy groups, and regulators to translate new science to clinical care. This consensus report characterizes the fundamental differences in type 1 diabetes between children and adults and proposes a thoughtful approach to better understand the development and regulatory pathways for type 1 diabetes therapies.

Complex regional pain syndrome (CRPS)

Complex regional pain syndrome (CRPS), once known as reflex sympathetic dystrophy, Sudeck's dystrophy and causalgia, is a pain syndrome with indistinctive pathophysiology and unpredictable clinical course. CRPS can develop after a limb fracture, injury or damage to the peripheral or central nervous system. The diagnosis of CRPS is based on the signs and symptoms obtained from the medical history and physical examination. The disease is often resistant to treatment, and its course is not always favorable. A brief overview of this clinical entity is presented, and most relevant and up-to-date information is discussed.

Development of Clinical Pathophysiology Lectures for Physician Assistant (PA) Students

Physiology is an essential foundation of medicine, yet it is often taught with a strong emphasis on biophysics and minimal clinical references. Pathophysiology breeches this gap, but it is often neglected placing the burden primarily on the students to make the connections between basic function and clinical application. PA programs present a unique challenge, where similar breadth and depth of material is covered in half the time of medical programs providing much less opportunity for integration of knowledge. We developed lectures with the primary objective of integration of pathophysiology and clinical medicine. We chose five emergency medicine relevant topics: heart failure, respiratory failure, acute kidney injury, hypertensive urgencies/emergencies and circulatory shock; and, in close collaboration between clinician (MPS) and basic scientist (FKJ), developed comprehensive pathophysiology and medicine lecture pairs for each. All materials have been previously covered in the respective physiology and clinical medicine courses from an organ system point‐of‐view. Lecture pairs were delivered “back‐to‐back” in the pathophysiology course and were tested on the same exam using higher order pathophysiology and clinical scenario based questions. From student performance on the exam, as well as anonymous student feedback we found this approach to be highly successful. Students were not only able to solve clinical problems, but also demonstrated a strong understanding of pathophysiology, and perceived improved command of the clinical material. We feel this is an important initial step towards reforming the approach to medical physiology education.

Teaching Pathophysiology to BSN Nursing Students: Useful Strategies

Pathophysiology is essential for nursing practice and is offered either as a prerequisite or core course for most baccalaureate nursing programs. Learning pathophysiological concepts can be challenging for students, due to variety of factors: family obligations; inadequate study habits; lack of prerequisite knowledge of the biological sciences. However, studies have shown that using a variety of engaging teaching strategies, improve student outcomes (Igbo, Landson, & Straker, 2014; Salamonson, Andrew, & Everett, 2009; and Van Horn, Hyde, Tesh & Kautz, 2014).Consistently, students who were strong in the pathophysiology course were successful on the exit exam used to assess student preparation for the NCLEX. This presentation will discuss active learning strategies: case studies, group presentations, use of immediate response module and online discussions. These strategies increased comprehension and application of the course material as evidenced by improved performance in an exit exam.Igbo, N., Landson, M. and Straker, K. (2014). Nursing Student Retention Strategy: An Integrated Study Skills Elective. Caputi, L. (Ed.). Innovations in Nursing Education: Building the Future of Nursing, Volume 2. Washington, DC: NLN.Salamonson, Y., Andrew, S. and Everett, B. (2009). Academic engagement and disengagement as predictors of performance in pathophysiology among nursing students. Contemporary Nurse: A Journal for the Australian Nursing Profession 32(1‐2): 123‐132.Van Horn, E.R., Hyde, Y.M., Tesh, A.S. and Kautz, D.D. (2014). Teaching pathophysiology: strategies to enliven the traditional lecture. Nurse Educ. 39(1): 34‐7.

Characterizing the Effective Modern Medical School Lecture

Recent guidelines from the Liaison Committee on Medical Education (LCME) based on adult learning principles recommend promotion of active learning, which has led to the evaluation of audience response systems and optimization of multimedia use to enhance audience engagement. We assessed the use of these and similar new techniques in delivering medical school lectures in conjunction with traditional techniques, to develop updated “best practice” lecture guidelines and identify lecture characteristics that correlate best with student satisfaction. We evaluated 39 recorded lectures given by 13 current or prior course directors of second-year pathophysiology courses at Icahn School of Medicine at Mount Sinai. Based on student ratings, the lectures were divided into those given by “above average” or “below average” lecturers. We scored each lecture on 47 distinct characteristics. Using the student t test to compare the “above average” and “below average” lectures for each characteristic, we found four characteristics that differed significantly between the two groups—oral summarization of key points, presence of summary slide in the presentation, asking questions that require a show of hands from the class, and rank of full professor as compared to associate or assistant. The characteristics that distinguish the “above-average” from “below-average” lecturers share a theme of summarizing information and engaging the audience through questioning involving the entire class. Our study did not identify improved student satisfaction with recently developed techniques such as using electronic clickers or asking students to discuss questions among themselves. Future work includes assessing the effect of subjective qualities of lecturers on ratings and evaluating a broader range of lecturers, including those who are not course directors.

Pathologic patterns of interleukin 10 expression--a review.

Interleukin 10 (IL-10) is important pleiotropic immunoregulatory cytokine which gene is located on chromosome 1 at 1q31-32. There are many genetic variants of IL-10 gene. However, the most studied are two dinucleotide repeats (microsatellites), IL10.G and IL10.R, located 1.2 kb and 4 kb upstream of the transcription start site and three single nucleotide polymorphisms (SNPs) -1082(G/A), -819(C/T) and -592(C/A). A large number of studies have shown that IL-10 gene polymorphisms are associated with different diseases and play an important role in pathophysiology and clinical course of these diseases. This review summarizes published literature knowledge about the association of IL-10 polymorphisms and expression patterns with asthma, systemic lupus erythematosus, psoriasis, inflammatory bowel disease, rheumatoid arthritis, tuberculosis and some neoplasms.

Cirrhosis and portal hypertension: The importance of risk stratification, the role of hepatic venous pressure gradient measurement.

Portal hypertension is the main prognostic factor in cirrhosis. The recent emergence of potent antiviral drugs and new algorithm of treatment for the management of complications due to portal hypertension have sensibly changed our perception of cirrhosis that can be now considered as a multistage liver disease whose mortality risk can be reduced by a tailored approach for any stage of risk. Experts recommend to move toward a pathophysiological classification of cirrhosis that considers both structural and functional changes. The hepatic venous pressure gradient HVPG, is the reference gold standard to estimate the severity of portal hypertension in cirrhosis. It correlates with both structural and functional changes that occur in cirrhosis and carries valuable prognostic information to stratify the mortality risk. This article provides a general overview of the pathophysiology and natural course of cirrhosis and portal hypertension. We propose a simplified classification of cirrhosis based on low, intermediate and high mortality stage. The prognostic information provided by HVPG is presented according to each stage. A comparison with prognostic models based on clinical and endoscopic variables is discussed in order to evidence the additional contribute given by HVPG on top of other clinical and instrumental variables widely used in clinical practice.

Stromal SLIT2 impacts on pancreatic cancer-associated neural remodeling.

Pancreatic ductal adenocarcinoma (PDA) is a critical health issue in the field of cancer, with few therapeutic options. Evidence supports an implication of the intratumoral microenvironment (stroma) on PDA progression. However, its contribution to the role of neuroplastic changes within the pathophysiology and clinical course of PDA, through tumor recurrence and neuropathic pain, remains unknown, neglecting a putative, therapeutic window. Here, we report that the intratumoral microenvironment is a mediator of PDA-associated neural remodeling (PANR), and we highlight factors such as ‘SLIT2' (an axon guidance molecule), which is expressed by cancer-associated fibroblasts (CAFs), that impact on neuroplastic changes in human PDA. We showed that ‘CAF-secreted SLIT2' increases neurite outgrowth from dorsal root ganglia neurons as well as from Schwann cell migration/proliferation by modulating N-cadherin/β-catenin signaling. Importantly, SLIT2/ROBO signaling inhibition disrupts this stromal/neural connection. Finally, we revealed that SLIT2 expression and CAFs are correlated with neural remodeling within human and mouse PDA. All together, our data demonstrate the implication of CAFs, through the secretion of axon guidance molecule, in PANR. Furthermore, it provides rationale to investigate the disruption of the stromal/neural compartment connection with SLIT2/ROBO inhibitors for the treatment of pancreatic cancer recurrence and pain.

A Subgroup Analysis of the Impact of Self-testing Frequency on Examination Scores in a Pathophysiology Course

To determine if the frequency of self-testing of course material prior to actual examination improves examination scores, regardless of the actual scores on the self-testing. Practice quizzes were randomly generated from a total of 1342 multiple-choice questions in pathophysiology and made available online for student self-testing. Intercorrelations, 2-way repeated measures ANOVA with post hoc tests, and 2-group comparisons following rank ordering, were conducted. During each of 4 testing blocks, more than 85% of students took advantage of the self-testing process for a total of 7042 attempts. A consistent significant correlation (p≤0.05) existed between the number of practice quiz attempts and the subsequent examination scores. No difference in the number of quiz attempts was demonstrated compared to the first testing block. Exam scores for the first and second testing blocks were both higher than those for third and fourth blocks. Although self-testing strategies increase retrieval and retention, they are uncommon in pharmacy education. The results suggested that the number of self-testing attempts alone improved subsequent examination scores, regardless of the score for self-tests.

The Robyn Barst Memorial Lecture: Differences between the fetal, newborn, and adult pulmonary circulations: relevance for age-specific therapies (2013 Grover Conference series).

Pulmonary arterial hypertension (PAH) contributes to poor outcomes in diverse diseases in newborns, infants, and children. Many aspects of pediatric PAH parallel the pathophysiology and disease courses observed in adult patients; however, critical maturational differences exist that contribute to distinct outcomes and therapeutic responses in children. In comparison with adult PAH, disruption of lung vascular growth and development, or angiogenesis, plays an especially prominent role in the pathobiology of pediatric PAH. In children, abnormalities of lung vascular development have consequences well beyond the adverse hemodynamic effects of PAH alone. The developing endothelium also plays critical roles in development of the distal airspace, establishing lung surface area for gas exchange and maintenance of lung structure throughout postnatal life through angiocrine signaling. Impaired functional and structural adaptations of the pulmonary circulation during the transition from fetal to postnatal life contribute significantly to poor outcomes in such disorders as persistent pulmonary hypertension of the newborn, congenital diaphragmatic hernia, bronchopulmonary dysplasia, Down syndrome, and forms of congenital heart disease. In addition, several studies support the hypothesis that early perinatal events that alter lung vascular growth or function may set the stage for increased susceptibility to PAH in adult patients ("fetal programming"). Thus, insights into basic mechanisms underlying unique features of the developing pulmonary circulation, especially as related to preservation of endothelial survival and function, may provide unique therapeutic windows and distinct strategies to improve short- and long-term outcomes of children with PAH.

Advanced Screencasting With Embedded Assessments in Pathophysiology and Therapeutics Course Modules

To implement and assess the effectiveness of a hybrid learning model using advanced screencasting with embedded assessments in pathophysiology and therapeutics modules. Two pathophysiology and therapeutics course modules on viral hepatitis and the clinical pharmacokinetics of aminoglycosides were chosen for study. The preclass portion of the hybrid model involved student completion of interactive e-lectures that were created with the use of advanced screencasting and included embedded assessments. Students viewed the e-lectures and completed the assessment questions prior to in-class lecture. Preimplementation and postimplementation test scores were compared and student survey data were analyzed. Test scores improved significantly and students' perceptions of the learning method were favorable. Test scores improved most significantly on higher-level Bloom's taxonomy questions. A hybrid model that used advanced screencasting with embedded assessments offered a novel method to afford students active-learning opportunities to progress to higher cognitive domains of learning.