Progress testing in the Netherlands has a long history. It was first introduced at one medical school which had a problem-based learning (PBL) curriculum from the start. Later, other schools with and without PBL curricula joined. At present, approximately 10,000 students sit a test every three months. The annual progress exam is not a single test. It consists of a series of 4 tests per annum which are summative in the end. The current situation with emphasis on the formative and summative aspects will be discussed. The reader will get insight into the way progress testing can be used as feedback for students and schools.
Cinnamaldehyde (CNA), the main component of cinnamon essential oil, is one of the most active plant compounds against nosocomial pathogen Pseudomonas aeruginosa. Exposure of wild-type strain PA14 (MIC 700 µg/mL) for 5 to 10 days to fixed (900 µg/mL) or increasing (from 900 to 1400 µg/mL) concentrations of this natural antibacterial resulted in emergence of resistant mutants CNA-A1 to A3, and CNA-B1 to B7, respectively. Genome sequencing experiments showed that each of CNA-A1 to A3 mutants differed from PA14 by one SNP, and a slight increase in CNA resistance level (from 700 to 900 µg/mL). By comparison, mutants B1 to B7 were more resistant (up to 1100 µg/mL); each of them harbored multiple SNPs (from 24 to 39) likely as a consequence of alteration of DNA mismatch repair gene mutS. Of the ten mutants selected, eight contained mutations in gene nalC, which indirectly downregulates expression of the operon that codes for multidrug efflux system MexAB-OprM, and showed increased resistance (up to 16-fold versus PA14) to antibiotic molecules exported by the pump, including ß-lactams and fluoroquinolones. Of the six mutants with the highest CNA resistance, five were no longer motile because of alteration of genes flgJ, fliE and/or pilJ genes. Altogether, our data show that P. aeruginosa is able to adapt to strong electrophilic molecules such as CNA by upregulating its intrinsic efflux pump MexAB-OprM, and through less well-characterized pleiotropic changes. Whether multidrug-resistant mutants can emerge in patients using cinnamon essential oil as self-medication needs to be assessed further.
New Drug MechanismsIn this series we draw attention to medicines that have entered the European market with an entirely new mechanism of action.Publication is not to be confused with endorsement of use in clinical practice.Copyright of the images belongs to Leiden University, but use of the images (
Abstract Background Active engagement with feedback is crucial for feedback to be effective and improve students' learning and achievement. Medical students are provided feedback on their development in the progress test (PT), which has been implemented in various medical curricula, although its format, integration and feedback differ across institutions. Existing research on engagement with feedback in the context of PT is not sufficient to make a definitive judgement on what works and which barriers exist. Therefore, we conducted an interview study to explore students' feedback use in medical progress testing. Methods All Dutch medical students participate in a national, curriculum‐independent PT four times a year. This mandatory test, composed of multiple‐choice questions, provides students with written feedback on their scores. Furthermore, an answer key is available to review their answers. Semi‐structured interviews were conducted with 21 preclinical and clinical medical students who participated in the PT. Template analysis was performed on the qualitative data using a priori themes based on previous research on feedback use. Results Template analysis revealed that students faced challenges in crucial internal psychological processes that impact feedback use, including ‘awareness’, ‘cognizance’, ‘agency’ and ‘volition’. Factors such as stakes, available time, feedback timing and feedback presentation contributed to these difficulties, ultimately hindering feedback use. Notably, feedback engagement was higher during clinical rotations, and students were interested in the feedback when seeking insights into their performance level and career perspectives. Conclusion Our study enhanced the understanding of students' feedback utilisation in medical progress testing by identifying key processes and factors that impact feedback use. By recognising and addressing barriers in feedback use, we can improve both student and teacher feedback literacy, thereby transforming the PT into a more valuable learning tool.
IndicationAbatacept is licensed for the treatment of rheumatoid arthritis (RA) in combination with methotrexate.The indication includes moderate to severe RA unresponsive to other disease-modifying antirheumatic drugs including at least one tumour necrosis factor (TNF)a blocker, or where patients have been intolerant of such drugs. MechanismAbatacept (CTLA4Ig) is a fusion protein of the extracellular domain of the human cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) linked to a modified Fc of human immunoglobulin 1 (IgG1).Abatacept inhibits the activation of T lymphocytes that play an important role in the early stages of pathogenesis of RA.Activation of a T cell requires two signals from the antigen-presenting cell (APC).The first signal is antigen specific and arises when antigenic peptides are presented to the T cell through the Major Histocompatibility Complex.A second signal, so-called co-stimulation, develops from the interaction between CD80 or CD86 antigen on the APC and CD28 antigen on the T cell.Abatacept binds with the extracellular domain of CTLA-4 to CD80 or CD86 antigen on the APC with a higher affinity than CD28, preventing the essential second signal for T-cell activation.T-cell activation and the production of inflammatory mediators and cytokines (TNF-a, interferon-gamma and interleukin-2) are consequently reduced.Trials in patients with RA have shown that abatacept slows progression of joint damage and improves function. Adverse effectsAn increased incidence of all kinds of infections caused by abatacept is explained by its mechanism of suppressing the immune response.Headache, hypertension, dizziness, gastrointestinal disorders and rash are other common adverse effects.A small percentage of treated patients develop anti-abatacept antibodies.
