Objective Through a peer-assisted learning conference in pediatric bedside learning (BSL), we investigated how providing lectures to and receiving lectures from colleagues affects learning in medical students.
Design Ninety medical students were asked to participate in a pediatric BSL course at Juntendo University.
Methods A “medical student peer-assisted learning conference” was held, and medical students were given the opportunity to present lectures. One student played the role of a lecturer, and the other students acted as students. All the students took turns playing the role of the lecturer. A questionnaire survey was conducted on the participants to allow them to reflect on their own presentations.
Results Many students who played lecturers provided lively presentations. For them, listening to the excellent presentations of their colleagues was a stimulus for learning. Altogether, 25.6% students realized that their own lectures should be improved, and this awareness may have made them more interested in their colleagues’ lectures. Many students had positive opinions about the choice of themes. The Department of Pediatrics, with its wide variety of fields, also seemed to contribute to the students’ active choice of themes.
Conclusions The conference was very effective as an educational opportunity that not only piqued the interest of students but also provided a good opportunity for them to reflect on and recognize deficiencies in their own presentations. However, this study did not obtain sufficient evidence that demonstrated a continuous increase in the motivation to learn among students. Continuously increasing such opportunities is essential in medical education.
In patients with type 2 diabetes, proteinuria is generally considered to be a major factor in the progression to end-stage kidney disease (ESKD) and cardiovascular events. The exacerbation of proteinuria is mainly associated with high blood glucose, hypertension and dyslipidemia. This study is a single-center retrospective cohort study using a large number of patients with type 2 diabetes to investigate the correlation among proteinuria, blood glucose, blood pressure and renal function based on the standard treatment. Patients with type 2 diabetes (n=739) were divided into three groups according to their HbA1c levels, such as HbA1c < 7% ; Group L, 7%≤ HbA1c < 8% ; Group M, and 8% ≤ HbA1c; Group H. A multiple logistic regression model was used to identify the risk associated with those parameters in type 2 diabetes. There was a significant relationship between the increase of proteinuria and the unsatisfactory control of blood pressure (systolic blood pressure of more than 130 mmHg) in all patients with type 2 diabetes. Under the satisfactory control of blood glucose (HbA1c < 7% ; Group L), the annual change of proteinuria (ΔuACR/year) and renal function (ΔeGFR/year), in the patients with an sBP of less than 130mmHg with or without renin-angiotensin system inhibitor (RASI) were milder than in those patients with an sBP of more than 130 mmHg. Therefore, simultaneous strict control of HbA1c and blood pressure with or without renin-angiotensin system inhibitor (RASI) administration are essential in for maintaining renal function in patients with type 2 diabetes.
Objective To identify pulmonary thromboembolism (PTE) using the thrombus attenuation value on unenhanced computed tomography (CT).
Design Single-center retrospective study (January 2015-Marcg 2020).
Methods Patients who underwent both unenhanced and enhanced CT for suspected PTE were enrolled. Patients with a hyperdense lumen on unenhanced CT and thrombi in the peripheral pulmonary artery (PA) were excluded. Patients were classified into two groups: thrombi (thrombi detected in PA by enhanced CT) and non-thrombi (attenuations of the main PA evaluated as thrombi). Mean CT attenuation values of the thrombi, main PA, and pulmonary trunk (blood pool) were measured. The attenuation values of the thrombus (T) and the thrombus to blood-pool (T/P), thrombus to hemoglobin (T/Hb), and thrombus to hematocrit (T/Ht) ratios were evaluated. The cut-off attenuation value of the thrombus was calculated by a receiver operating characteristic curve and its accuracy in detecting PTE was determined.
Results Of the 260 patients enrolled, 40 were included, of whom 24 had confirmed PTE. The mean T was 27.25 Hounsfield units(HU) and 36.66HU (p<0.001), and the T/P ratio was 0.74 and 0.99 (p=0.004) in the PTE and non-PTE groups, respectively. The thrombus cut-off value for PTE diagnosis was 30.85 HU. The sensitivity and specificity were 79. 9% and 87.5%.
Conclusions Measuring and evaluating the attenuation value for the central PA and T/P ratio on unenhanced CT improves the diagnostic ability of central PTE in patients suspected to have PTE but cannot tolerate contrast medium.
Objective To elucidate the impact of activity restrictions associated with the pandemic on diabetes management.
Materials This study evaluated all patients visiting our facility who were determined to have diabetes during the observation periods. To determine the impacts of the emergency declared on April 7, 2020, we examined 345, 1109, and 752 patients whose hemoglobin A1c (HbA1c) levels were measured in March and April, May, or in June, respectively. Patients were compared to data from other subjects evaluated in 2019 under the same conditions. The 2019 subjects included 469, 1315, and 783 patients whose HbA1c levels were measured in March and April, May, or June, respectively.
Methods Comparison of the HbA1c levels in April, May, and June minus the HbA1c levels in March of both 2019 and 2020 were used to assess the impact of pandemic-related activity restrictions on diabetes management. HbA1c levels greater than 0 were defined as patients who “worsened”, while differences in HbA1c levels ≤0 were defined as patients who conditions were “not worsened”. Comparisons of the deterioration/improvement rates for the HbA1c levels in 2019 and 2020 were then performed.
Results Compared to 2019, the number of patients exhibiting a worsened diabetes management increased from March to April 2020 [122 (26.0%) vs. 137 (39.7%), p<0.01], while the number of patients with worsened diabetes management decreased from March to June 2020 [305 (39.0%) vs. 240 (31.9%), p<0.01].
Conclusions When compared to 2019, there was no sustained increase in patients with worsening diabetes management during the 2020 observation period.