Edward P. Finnerty

Aging, peripheral nerve injury and nociception: effects of the antioxidant 16-desmethyltirilazad.

Peripheral neuropathies increase with aging, and reactive oxygen species contribute to the symptomatology of neuropathic pain disorders. In this study, we examined age-related differences in the therapeutic efficacy of pre- or post-treatments of the amino-steroidal antioxidant 16-desmethyltirilazad in delaying the onset and/or limiting the duration of tactile-evoked allodynia following the induction of peripheral mononeuropathies in rats. Two different models of nerve injury were utilized to induce allodynia in young and aged rats: (1) the chronic constriction injury (CCI) model of Bennett and Xie [Bennett GJ, Xie Y-K. A peripheral mononeuropathy in rat that produces disorders of pain sensation like those seen in man. Pain 1988;33:87-107]; (2) the partial sciatic nerve ligation (PSNL) model of Seltzer et al. [Seltzer Z, Dubner R, Shir YA. Novel behavioral model of neuropathic pain disorders produced in rats by partial sciatic nerve injury. Pain 1990;43:205-18]. Calibrated von Frey filaments were used to examine changes in paw withdrawal threshold values. The results demonstrated that pre-treating young and aged rats with 16-desmethyltirilazad prior to the induction of peripheral mononeuropathies prevented the onset of neuropathic pain. However, once post-operative tactile allodynia was established, post-treatment therapy was ineffective at reversing the symptoms. These findings support the mediatory role of reactive oxygen species in neuropathic pain disorders, and suggest that the antiallodynic efficacy of antioxidant intervention is dependent on the time course of administration.

A Prematriculation Intervention to Improve the Adjustment of Students to Medical School

Background and purpose: The transition from a baccalaureate program to a medical curriculum can be a difficult period for some students. Our study asked whether providing students with review materials and a means of assessing their degree of preparedness prior to matriculation influenced actual and perceived performance in 1st-year basic science courses. Methods: Didactic review materials in basic science subjects encountered in the 1st year were made available to prematriculants online. Access to materials for each subject was contingent upon completion of a pretest. Prematriculants were free to use the materials as they saw fit. Once students matriculated, performance in basic science subjects was compared between those who had accessed the materials and those who had not. Students who accessed the materials were also surveyed to determine if they perceived any benefit from their use. Results: More than half of matriculants chose to access the intervention materials. There was no significant difference in MCAT, prerequisite grade point average, or total grade point average between those students who chose to access the intervention materials and those who did not. Students who accessed the intervention materials reported gains in confidence in their ability to perform well in medical school. Those students who accessed the intervention materials had significantly higher examination scores in an early basic science course than those who did not. Conclusions: An online prematriculation intervention can provide useful background material to interested students. Access to this material increased performance in a 1st-year basic science course and was perceived as valuable by students.

Acute Stroke Care in a Neurologically Underserved State: Lessons Learned from the Iowa Stroke Survey

Prior studies have suggested that stroke care is more fragmented in rural or neurologically underserved areas. The purpose of this study was to determine the availability of diagnostic and treatment services for acute stroke care in Iowa and to identify factors influencing care. Each of the 118 facilities in Iowa with emergency departments was surveyed by telephone. This survey consisted of 10 questions, focusing on the existence of pre-hospital and emergency room acute stroke protocols and the availability of essential personnel and diagnostic and treatment modalities essential for acute stroke care. Of the 118 hospitals with emergency departments, 109 (92.4%) had CT available. Within the subset having CT capabilities, 89.9% (98/109) had intravenous tissue plasminogen activator (IV t-PA) available. Of those facilities with both CT and IV t-PA, 46% (45/98) had around-the-clock in-house physician coverage. Further, 31% (14/45) of sites with CT, t-PA, and an in-house physician had a radiology technician on site. Only 12% (14/118) of centers could offer all essential components. Despite 88% of Iowa hospitals not providing all of these components, only 31% of these hospitals reported protocols for stabilization and immediate transfer of acute stroke patients. These findings indicate that the development of a stroke system is still in its infancy in Iowa. Collaborative efforts are needed to address barriers in rural Iowa and to assist facilities in providing the best possible care. Creativity will be paramount in establishing a functional statewide system to ensure optimum care for all Iowans.

An e-Learning Intervention to Enhance Medical Student's Competence in Oxygen Delivery Methods

PurposeStudent performance in a comprehensive clinical simulation exercise at the end of the 3rd year had demonstrated some deficiencies in oxygen delivery methods. A tutorial exercise was developed to remedy this issue. This study assessed if an e-learning intervention improved the student’s competence in oxygen delivery methods during the comprehensive clinical simulation lab.MethodsAn independent study tutorial describing proper oxygen delivery methods was developed and made available to all 3rd year students through our course management system. The tutorial program consisted of a pre-test, video illustrating the proper use of oxygen delivery equipment and a post-test. The pre-test was required to be completed before the video was made available and the post-test was only available after the video was viewed. The post-test and the course evaluation included questions regarding student satisfaction. Video recording of the group simulation exercises were made of the classes before the tutorial was introduced and after for comparison.ResultsOf the 217 students in the course, 136 (63%) completed the pre-test and 119 of those completed the post-test. There was a significant improvement in performance on the post-test compared to the pre-test (87% ± 14 vs. 61% ± 13; paired t-test, p < 0.001). There was an overwhelming perception of value with 92% responding favorably that the program increased their knowledge of oxygen delivery methods. A large majority (88%) were satisfied with the ease of use of the tutorial video. Evaluation of the video records did not reveal any appreciable differences, though a number of the recordings were not useable and could not be assessed with our scoring rubric.ConclusionsThe results of the study demonstrate that students who utilized the tutorial program improved their knowledge of oxygen delivery methods. A limitation of this study is that we were unable to ascertain if the knowledge translated into an improved performance in the simulation exercise. This study does show that an independent e-learning module can enhance medical students’ education.