Effectiveness of alternative approaches to integrating SDOH into medical education: a scoping review

BACKGROUND

There is increasing recognition of including social determinants of health (SDOH) in teaching for future doctors. However, the educational methods and the extent of integration into the curriculum vary considerably-this scoping review is aimed at how SDOH has been introduced into medical schools' curricula.

METHODS

A systematic search was performed of six electronic databases, including PubMed, Education Source, Scopus, OVID (Medline), APA Psych Info, and ERIC. Articles were excluded if they did not cover the SDOH curriculum for medical students; were based on service-learning rather than didactic content; were pilot courses, or were not in English, leaving eight articles in the final study.

RESULTS

The initial search yielded 654 articles after removing duplicates. In the first screening step, 588 articles were excluded after applying inclusion and exclusion criteria and quality assessment; we examined 66 articles, a total of eight included in the study. There was considerable heterogeneity in the content, structure and duration of SDOH curricula. Of the eight included studies, six were in the United States(U.S.), one in the United Kingdom (U.K.) and one in Israel. Four main conceptual frameworks were invoked: the U.S. Healthy People 2020, two World Health Organisation frameworks (The Life Course and the Michael Marmot's Social Determinants of Health), and the National Academic of Science, Engineering, and Medicine's (Framework For educating Health Professionals to Address the Social Determinants of Health). In general, programs that lasted longer appeared to perform better than shorter-duration programmes. Students favoured interactive, experiential-learning teaching methods over the traditional classroom-based teaching methods.

CONCLUSION

The incorporation of well-structured SDOH curricula capturing both local specification and a global framework, combined with a combination of traditional and interactive teaching methods over extended periods, may be helpful in steps for creating lifelong learners and socially accountable medical school education.

The removal of caesium ions using supported clinoptilolite

In this paper, the sorptive kinetic and diffusional characteristics of caesium ion removal from aqueous solution by carbon-supported clinoptilolite composites are presented. Natural clinoptilolite was supported on carbonaceous scaffolds prepared from date stones. Thermal treatment was applied to produce voids in the carbon which was conditioned using polydiallyldimethylammonium chloride to facilitate the clinoptilolite attachment. This method allowed the formation of a consistent zeolite layer on the carbon surface. The composite was applied in the removal of non-radioactive caesium ions showing an enhanced uptake from 55 mg g(-1) to 120.9 mg g(-1) when compared to clinoptilolite. Kinetic studies using Pseudo First Order model revealed an enhanced rate constant for carbon-clinoptilolite (0.0252 min(-1)) in comparison with clinoptilolite (0.0189 min(-1)). The Pseudo-First Order model described the process for carbon-clinoptilolite, meanwhile Pseudo Second Order model adjusted better for pure clinoptilolite. Diffusivity results suggested that mass transfer resistances involved in the Cs(+) sorption are film and intraparticle diffusion for natural clinoptilolite and intraparticle diffusion as the mechanism that controls the process for carbon-clinoptilolite composite. The most significant aspect being that the vitrified volume waste can be reduced by over 60% for encapsulation of the same quantity of caesium due to the enhanced uptake of zeolite.

Puesta de huevos y composición de la glándula del albumen de archachatina marginata durante las fases de crecimiento

Se analizó el modelo de puesta y la composición de las glándulas del albumen de Archachatina marginata en tres fases de crecimiento: cría, juvenil y adulto. La puesta fue mayor en la etapa juvenil (9,3) seguida de la adulta (4,7), no hubo puesta de huevos en las crías. Los huevos de la etapa adulta fueron más pesados (p

An analysis of listening skills of healthcare students in Nigeria

BACKGROUND

Listening is a primary communication skill essential for human learning and reported to be positively correlated with school achievement. It enables the healthcare professional to explore fully the ideas and concerns of the patient during a healthcare encounter. It is especially needed by healthcare students and professionals in light of the study showing that the typical physician will interrupt a patient after about 18-23 seconds.

OBJECTIVE

The objective of this study was to measure the listening skills of the undergraduate health sciences students in a Nigerian setting and to attempt to explain different levels of individual listening skills.

METHODS

Selected undergraduate students in medicine, dentistry, nursing and physiotherapy who volunteered to complete a self-administered questionnaire were studied. The questionnaire contained seventeen items, ranked on a 5-point Likert scale on the various habits people adopt when listening to others and the students' three most recent academic test scores.

RESULTS

The mean (SD) score for the seventeen items was 2.72 (1.14) out of 5. Seven items had mean scores greater than 3.00, eight items had mean scores between 2.00 and 3.00, and two items had mean less than 2.00. The students had a minimum score of 27 and a maximum score of 67 compared with a possible 17 and 85. The mean (SD) score for the listening scale by the students was 46.87 (7.33). Eighty percent of the respondents had good listening skills. There were no statistically significant associations between the listening skills scores of the students and several possible explanatory variables - age, gender, course being studied and test scores.

CONCLUSION

The findings indicate that neither males nor females are the better listeners. It showed impressively high levels of listening skills among the respondents. There was the absence of explanatory variables which were significant in explaining differences between individual listening skill scores.

Supporting grid-based clinical trials in Scotland

A computational infrastructure to underpin complex clinical trials and medical population studies is highly desirable. This should allow access to a range of distributed clinical data sets; support the efficient processing and analysis of the data obtained; have security at its heart; and ensure that authorized individuals are able to see privileged data and no more. Each clinical trial has its own requirements on data sets and how they are used; hence a reusable and flexible framework offers many advantages. The MRC funded Virtual Organisations for Trials and Epidemiological Studies (VOTES) is a collaborative project involving several UK universities specifically to explore this space. This article presents the experiences of developing the Scottish component of this nationwide infrastructure, by the National e-Science Centre (NeSC) based at the University of Glasgow, and the issues inherent in accessing and using the clinical data sets in a flexible, dynamic and secure manner.

Towards a virtual anonymisation grid for unified access to remote clinical data

Grid technologies provide an infrastructure through which, amongst other things, data access and integration is facilitated across highly distributed and heterogeneous resources. Different domains have their own requirements on the nature of this data access and integration. The clinical domain offers arguably the greatest challenges facing the roll-out and adoption of Grid technologies to meet the changing face of post-genomic clinical research, especially with regard to information governance, ethics and hence security solutions. This paper outlines a novel system design for secure anonymous data access and linkage that meets the needs of key stakeholders in this space including end user researchers, data providers and owners and ethical oversight bodies amongst others. We identify how existing solutions developed within the Medical Research Council funded Virtual Organisations for Trials and Epidemiological Studies (VOTES) project are being re-factored to meet the needs of these players and to address information governance criteria.

Small bowel obstruction caused by intraluminal migration of retained percutaneous endoscopic gastrostomy internal bumper

INTRODUCTION

Early complications associated with percutaneous endoscopic gastrostomy are well documented. Late complications associated with retained gastrostomy flange are rare. It is unclear why some patients with retained gastrostomy flange (internal bumper) develop mechanical obstruction and others do not. We report a case of mechanical obstruction with perforation occurring 6 months after the tube was cut.

PATIENT AND METHODS

A 76-year-old hemiplegic patient with no swallowing reflex and who previously was on long-term percutaneous gastrostomy feeding tube underwent removal of the feeding tube but the internal bumper was left in situ due to encrustation.

RESULTS

Due to migration of the retained flange, the patient developed small bowel obstruction.

CONCLUSIONS

Retained internal bumper is potentially dangerous and we recommend endoscopic retrieval of such flange.

Essential oil composition of Piper guineense and its antimicrobial activity. Another chemotype from Nigeria

The analysis of the essential oil of Piper guineense from Nigeria presents a new chemotype of constituents different from earlier reports with the absence of the usual myristicin. Ishwarane, a common constituent of Aristolochia indica and Bixa orellana, was also isolated from the essential oil of the fruit. The essential oil inhibited the growth of Pseudomonas aeruginosa UCH 655 strain at 5 mg/mL on which standard antibiotic drugs were ineffective.

Ontogeny of stool passage in low birth weight infants < or = 1500 grams

The onset of stool passage, timing of transition to yellow stools and the pattern of stooling frequency over the first 4 weeks were studied in infants < 1500 g at birth. The time of passage of the first stool (median, 19) correlated with birth weight and gestational age but not with presence or severity of respiratory distress; fourteen percent passed stool after 1st 48 hours. Transition to yellow occurred at 17.6 +/- 6.4 days and was related to the onset of feeding and birth weight. Stooling frequency was similar in Wk 2 as Wk 1, increased in Wk 3 and plateaued on Wk 4. Volume of feeding/day increased each week over that of preceding week but stooling frequency was not related to the increased volume or any of the other variables.

Evidence that circulating lymphocytes act as vehicles or viraemia in measles

Previously described giant multinucleated cells were observed in phytohaemagglutinin (PHA) cultures of leucocytes from blood samples of 17 (36%) out of 47 children with measles or undiagnosed fever in Ibadan. The giant cells were more readily seen in PHA cultures of purified lymphocyte preparations than in total leucocyte suspensions. It was concluded that the observation indicates in vivo infection of some blood lymphocytes of patients with measles and related infections by syncitium producing virus to manifest the giant cells seen in culture. The practical application of lymphocyte cultures to the laboratory diagnosis of measles is stressed and the concept of circulating lymphocytes contributing to the systemic spread of measles infection is highlighted.

Maternal and cord serum glycosylated protein in neonatal macrosomia and correlation with birth weight

Maternal glycosylated hemoglobin and glycosylated protein and cord glycosylated protein were measured at delivery in 20 normal mothers of 20 macrosomic neonates over 4000 g (group I) and compared with values in two groups of mother/infant pairs: 20 normal/20 appropriate for gestational age (group II) and nine diabetic mothers/ten neonates (group III). Infants in group I, by design, weighed more (mean +/- SD 4403 +/- 337 g) than those in group II (2902 +/- 278 g) or group III (3365 +/- 898 g) (P less than .001). There was no significant difference in weight between group II and group III infants. Birth weight ratio was greater (P less than .001) in group I than in group II or group III (1.39 +/- 0.1, 0.9 +/- 0.08, and 1.08 +/- 0.25, respectively); group III infants had a higher birth weight ratio (P less than .05) than those in group II. Hematocrit (%) was higher (P less than .05) in group III (62 +/- 3) than in group I (59 +/- 5) or group II (57 +/- 6) infants. Glycosylated hemoglobin values were similar in all three groups. Mean serum glycosylated protein was higher (P less than .001) in group III (13.8 +/- 2%) than in group I (10 +/- 2%) or group II (9.8 +/- 2.5%) mothers. Cord glycosylated protein was also higher (P less than .001) in group III (12.3 +/- 1.9%) than in group I (9 +/- 1.3%) or group II (8.6 +/- 1.7%) neonates.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood lymphocytes and measles viraemia

Previously described giant multinucleated cells were observed in phytohaemagglutinin (PHA) cultures of washed leucocytes from blood samples of seventeen (36%) out of forty-seven children with measles or undiagnosed fever in Ibadan. The giant cells were more readily seen in PHA cultures of purified lymphocyte preparations than in total leucocyte suspensions. It was concluded that the giant cells seen in cultures indicate in-vivo infection of some blood lymphocytes of patients with measles and related infections by syncytium-producing virus. The practical application of lymphocyte cultures to the laboratory diagnosis of measles is stressed, and the concept of circulating lymphocytes acting as vehicles for the systemic spread of measles infection is highlighted.

Genetic variants of human erythrocyte glucose 6-phosphate dehydrogenase: new variants in West Africa characterized by column chromatography

Five electrophoretically slow-moving genetic variants of glucose 6-phosphate dehydrogenase are described: four are from Nigeria and one is from Togo. All variants have normal or moderately reduced activity, and they are not associated with adverse clinical or haematological manifestations. Three variants have been fully characterized and are different from all previously described ones. Two variants have been partially characterized and at least one of them is also probably new. The overall population incidence of sporadic variants of G6PD in the Nigerian population is 0-3%. In the course of this study a previously described ion-exchange chromatographic technique for the characterization of G6PD variants has been extensively evaluated. Data are given on ten different variants to demonstrate the high resolving power of this technique.