Barriers to effective research supervision in clinical specialist training: Experience from a medical school in Malaysia

INTRODUCTION

A compulsory research component is becoming increasingly common for clinical residents. However, integrating research into a busy clinical training schedule can be challenging. This study aimed to explore barriers to research supervision in specialist training programmes from the perspectives of clinical supervisors and trainees at a Malaysian university hospital.

METHODS

Qualitative interviews and focus group discussions were conducted (December 2016 to July 2017) with clinical supervisors (n=11) and clinical trainees (n=26) utilising a topic guide exploring institutional guidelines, research culture and supervisor-student roles. Interviews were transcribed verbatim and analysed thematically to identify barriers to research supervision.

RESULTS

Supervisors and trainees from 11 out of 18 departments participated. Both clinical supervisors and trainees struggled to successfully integrate a compulsory research component into residency training. Among the reasons identified included a lack of supervisory access due to the nature of clinical rotations and placements, clashing training priorities (clinical vs research) that discouraged trainees and supervisors from engaging in research, poor research expertise and experience among clinical supervisors hampering high-quality supervision, and a frustrating lack of clear standards between the various parties involved in research guidance and examination.

CONCLUSION

Both clinical supervisors and trainees struggled to successfully integrate a compulsory research component into residency training. This was not only an issue of resource limitation since questions regarding clinical priorities and unclear research standards emerged. Thus, institutional coordinators need to set clear standards and provide adequate training to make research meaningful and achievable for busy clinical supervisors and trainees.

Improved spinal cord gray matter morphology induced by Spirulina platensis following spinal cord injury in rat models

Despite intense preclinical research focusing on developing potential strategies of mitigating spinal cord injury (SCI), SCI still results in permanent, debilitating symptoms for which there are currently no effective pharmacological interventions to improve the recovery of the fine ultrastructure of the spinal cord. Spirulina platensis is thought to have potential neuroprotective effects. We have previously demonstrated its protective potential on the lesioned corticospinal tracts and behavioral recovery. In this study, spirulina, known for its neuroprotective properties was used to further explore its protective effects on spinal cord gray matter ultrastructural. Twenty-four Sprague-Dawley rats were used and divided into sham group (laminectomy without SCI), control group (SCI without S. platensis), and S. platensis group (SCI + 180 mg/kg S. platensis). All animals were anesthetized via intramuscular injection. A partial crush injury was induced at the level of T12. The rats were humanely sacrificed for 28 days postinjury for ultrastructural study. There were significant mean differences with respect to pairwise comparisons between the ultrastructural grading score of neuronal perikarya of control and the S. platensis following injury at day 28, which correlates with the functional locomotor recovery at this timepoint in our previous study. The group supplemented with spirulina, thus, revealed a better improvement in the fine ultrastructure of the spinal cord gray matter when compared to the control group thereby suggesting neuroprotective potentials of spirulina in mitigating the effects of spinal cord injury and inducing functional recovery.

Neuroprotective potential of Spirulina platensis on lesioned spinal cord corticospinal tract under experimental conditions in rat models

Spinal cord injury (SCI) results from penetrating or compressive traumatic injury to the spine in humans or by the surgical compression of the spinal cord in experimental animals. In this study, the neuroprotective potential of Spirulina platensis was investigated on ultrastructural and functional recovery of the spinal cord following surgical-induced injury. Twenty-four Sprague-Dawley rats were divided into three groups; sham group, control (trauma) group, and experimental (S. platensis) group (180 mg/kg) of eight rats each. For each group, the rats were then subdivided into two groups to allow measurement at two different timepoints (day 14 and 28) for the microscopic analysis. Rats in the control and experimental S. platensis groups were subjected to partial crush injury at the level of T12 with Inox number 2 modified forceps by compressing on the spinal cord for 30 s. Pairwise comparisons of ultrastructural grading mean scores difference between the control and experimental S. platensis groups reveals that there were significant differences on the axonal ultrastructure, myelin sheath and BBB Score on Day 28; these correlate with the functional locomotor recovery at this timepoint. The results suggest that supplementation with S. platensis induces functional recovery and effective preservation of the spinal cord ultrastructure after SCI. These findings will open new potential avenue for further research into the mechanism of S. platensis-mediated spinal cord repair.

Experimental spinal cord trauma: a review of mechanically induced spinal cord injury in rat models

It has been shown that animal spinal cord compression (using methods such as clips, balloons, spinal cord strapping, or calibrated forceps) mimics the persistent spinal canal occlusion that is common in human spinal cord injury (SCI). These methods can be used to investigate the effects of compression or to know the optimal timing of decompression (as duration of compression can affect the outcome of pathology) in acute SCI. Compression models involve prolonged cord compression and are distinct from contusion models, which apply only transient force to inflict an acute injury to the spinal cord. While the use of forceps to compress the spinal cord is a common choice due to it being inexpensive, it has not been critically assessed against the other methods to determine whether it is the best method to use. To date, there is no available review specifically focused on the current compression methods of inducing SCI in rats; thus, we performed a systematic and comprehensive publication search to identify studies on experimental spinalization in rat models, and this review discusses the advantages and limitations of each method.

The effects of energy expenditure rate on work productivity performance at different levels of production standard time

[Purpose] The purpose of this study was to investigate the effects of energy expenditure rate on work productivity performance at different levels of production standard time. [Subjects and Methods] Twenty industrial workers performed repetitive tasks at three different levels of production standard time, normal, hard, and very hard. Work productivity and energy expenditure rate were recorded during the experimental tasks. [Results] The work productivity target was not attainable for the hard and very hard production standard times. This was attributed to the energy expenditure rate, which increased as the level of production standard time became harder. The percentage change in energy expenditure rate for the very hard level (32.5%) relative to the normal level was twice that of the hard level (15.5%), indicating a higher risk of work-related musculoskeletal disorders for the harder production standard time. The energy expenditure rate for the very hard production standard time (1.36 kcal/min) was found to exceed the maximum energy expenditure rate recommended for light repetitive tasks involving both arms (1.2 kcal/min). [Conclusion] The present study shows that working with an energy expenditure rate that is either equal to or above the maximum energy expenditure rate of the tasks results in decreased work productivity performance due to the onset of physical fatigue and a higher risks of work-related musculoskeletal disorders.

Muscle activity, time to fatigue, and maximum task duration at different levels of production standard time

[Purpose] This study investigated the variations in muscle fatigue, time to fatigue, and maximum task duration at different levels of production standard time. [Methods] Twenty subjects performed repetitive tasks at three different levels of production standard time corresponding to "normal", "hard" and "very hard". Surface electromyography was used to measure the muscle activity. [Results] The results showed that muscle activity was significantly affected by the production standard time level. Muscle activity increased twice in percentage as the production standard time shifted from hard to very hard (6.9% vs. 12.9%). The muscle activity increased over time, indicating muscle fatigue. The muscle fatigue rate increased for the harder production standard time (Hard: 0.105; Very hard: 0.115), which indicated the associated higher risk of work-related musculoskeletal disorders. Muscle fatigue was also found to occur earlier for hard and very hard production standard times. [Conclusion] It is recommended that the maximum task duration should not exceed 5.6, 2.9, and 2.2 hours for normal, hard, and very hard production standard times, respectively, in order to maintain work performance and minimize the risk of work-related musculoskeletal disorders.

White tea (Camellia sinensis) inhibits proliferation of the colon cancer cell line, HT-29, activates caspases and protects DNA of normal cells against oxidative damage

Tea (Camellia sinensis) is one of the most consumed beverages in the world. White tea is made from the buds and young leaves of the tea plant which are steamed and dried, whilst undergoing minimal oxidation. The MTT assay was used to test the extract on the effect of the proliferation of the colorectal cancer cell line, HT-29. The extract inhibited the proliferation of HT-29 cells with an IC50 of 87μg/ml. The extract increased the levels of caspase-3, -8, and -9 activity in the cells. DNA damage in 3T3-L1 normal cells was detected by using the comet assay. The extract protected 3T3-L1 cells against H2O2-induced DNA damage. The results from this study show that white tea has antioxidant and antiproliferative effects against cancer cells, but protect normal cells against DNA damage. Regular intake of white tea can help to maintain good health and protect the body against disease.

Effect of precocious locomotor activity on the development of motoneurones and motor units of slow and fast muscles in rat

We have investigated the effect of precociously increasing locomotor activity during early postnatal development by daily treatment with the monoaminergic precursor L-DOPA on the survival of motoneurones supplying the slow soleus (SOL) muscle and the fast, tibialis anterior (TA) and extensor digitorum longus (EDL) muscles as well as the contractile and histochemical properties of these muscles. L-DOPA treatment resulted in a significant loss of motoneurones to the slow SOL muscle, but not to the fast TA and EDL muscles. Moreover, motoneurones to fast muscles also die as when exposed to increased activity in early life, if their axons are repeatedly injured. The loss of normal soleus motoneurones was accompanied by an increase in force of the remaining motor units and sprouting of the surviving axons suggesting a remodelling of motor unit organisation. The time to peak contraction of both SOL and EDL muscles from L-DOPA treated rats was prolonged at 8 weeks of age. At 4 weeks the soleus muscles of the L-DOPA treated animal developed more tension than the saline treated one. This difference between the two groups did not persist and by 8 weeks of age the muscle weight and tetanic tension from either group were not significantly different from control animals. The present study shows that early transient, precocious locomotor activity induced by L-DOPA is damaging to normal soleus but not to normal EDL/TA motoneurones.

Motoneurones that innervate the rat soleus muscle mature later than those to the tibialis anterior and extensor digitorum longus muscles

The response of motoneurones that innervate either the soleus or tibialis anterior (TA) and extensor digitorum longus (EDL) muscles to increased locomotor activity or to nerve injury at different stages after birth was examined. Increased locomotor activity of rat pups was induced by daily treatment with L-dopa during the first 12 days after birth, and the number of surviving motoneurones to the soleus or TA/EDL muscles was established by retrograde labelling. Treatment with L-dopa resulted in the loss of a significant number of motoneurones within the soleus motor pool but had no effect on the survival of those motoneurones innervating the TA/EDL. Furthermore, following nerve injury during the first few days postnatally, more motoneurones within the soleus motor pool die than in the TA/EDL pool. These results indicate that motoneurones to the soleus muscle mature later than those to the TA/EDL muscles.

Influence of fungi associated with bananas on nutritional content during storage

Botryodiplodia theobromae, Rhizopus oryzae, Aspergillus niger, A. flavus and Fusarium equiseti were found to be associated with the ripening of bananas and also caused rot during storage. Bananas stored in baskets with ash fire wood ripened 2-3 days earlier than bananas stored in fibre sacks and under constant light. The infected bananas showed a decrease in the quantity of total soluble sugars, protein, lipid, crude fibre, ash, ascorbic acid and mineral elements when compared with the control fruit. Paper chromatographic studies showed the presence of glucose, sucrose, fructose, maltose and raffinose in healthy control fruit, while only sucrose appeared during storage in bananas infected with B. theobromae. The total soluble sugar and crude protein contents increased during ripening.

Transient muscle paralysis in neonatal rats renders motoneurons susceptible to N-methyl-D-aspartate-induced neurotoxicity

Paralysis of the soleus muscle in newborn rats causes a large proportion of motoneurons to die by 10 weeks of age. However, all of these neurons are still present at three to four weeks of age. We have previously shown that although nerve injury at five days does not result in any motoneuron death, it does render these neurons susceptible to the toxic effects of the glutamate agonist N-methyl-D-aspartate. Using retrograde labelling of soleus motoneurons, in this study we show that an increased susceptibility to glutamate also plays a role in the eventual death of those motoneurons which survive for three weeks after interruption of neuromuscular transmission at birth but die by 10 weeks. Treatment with dizocilpine maleate an antagonist of the N-methyl-D-aspartate receptor increased the survival of motoneurons to alpha-bungarotoxin-treated soleus muscles. By 10 weeks of age the size of motoneurons to alpha-bungarotoxin-treated soleus muscles is smaller than that of controls, but after treatment with dizocilpine maleate the sizes of motoneurons to control and treated muscles are similar. Moreover, only 55 +/- 2.7% of motoneurons to the soleus muscle paralysed at birth with alpha-bungarotoxin survive for three weeks after a single injection of N-methyl-D-aspartate at 12 days of age. This motoneuron death is due to the application of N-methyl-D-aspartate since treatment with alpha-bungarotoxin alone causes no loss of neurons at this age.(ABSTRACT TRUNCATED AT 250 WORDS)

Monoclonal antibody-mediated, immunodiagnostic competitive enzyme-linked immunosorbent assay for equine monocytic ehrlichiosis

Competitive enzyme-linked immunosorbent assay (CELISA), mediated by a monoclonal antibody designated HybI, was developed for the diagnosis of equine monocytic ehrlichiosis. Inhibition of binding of HybI by the horse antibodies to Ehrlichia risticii was optimum at dilutions of 1:20 for serum and 1:10,000 for HybI. Mean optical densities (ODs) of positive and negative sera were 0.158 and 0.855, respectively. A comparison of ODs obtained by CELISA and indirect enzyme-linked immunosorbent assay (ELISA) indicated a marked tendency of positive and negative samples to cluster separately with respect to CELISA ODs, whereas the ELISA results displayed a continuum of ODs from negative to positive. Analysis of diagnosis by indirect fluorescent-antibody test (IFA), ELISA, and CELISA for 66 field-collected serum samples indicated that CELISA was superior to IFA and ELISA. Among 11 acute-phase serum samples negative by IFA which were obtained from horses that subsequently seroconverted, CELISA clearly demonstrated antibodies in 8 of these acute-phase sera, whereas 5 were borderline positive by ELISA. The presence of agent-specific humoral antibodies could be demonstrated conclusively by 14 days after infection. The results suggest that CELISA is more sensitive than IFA and ELISA and, owing to the marked differences between positive and negative samples, can be easily adapted for use in the field for detection of horse antibodies to E. risticii.