Diagnostic ability in relation to clinical seminars and extended-matching questions examinations.

Context: At the Katholieke Universiteit Leuven, Belgium, final year medical students participate in 70 problem-solving clinical seminars over a period of 2 months, concentrating on clinical reasoning for formulating differential diagnoses. The clinical seminars end in an examination consisting of 200 extended-matching questions (EMQs).

Objectives: This study asks whether problem-solving clinical seminars improve clinical reasoning and whether the EMQ examination measures clinical decision making.

A new methodology for teaching clinical reasoning skills: problem solving clinical seminars.

In the final year of the medical curriculum of the Faculty of Medicine of the Katholieke Universiteit Leuven (Belgium), a new methodology for teaching clinical skills was introduced: Problem Solving Clinical Seminars (PSCS). Two eight-week series of 70 seminars were offered. Students prepared for the seminars in groups of five students who worked on one or more clinical cases followed by half-open questions.

Do extended matching multiple-choice questions measure clinical reasoning?

Purpose: At the Faculty of Medicine at the Katholieke Universiteit Leuven, Belgium, we have developed a final examination that consists of extended matching multiple-choice questions. Extended matching questions (EMQs) originate from a case and have 1 correct answer within a list of at least 7 alternatives. If EMQs assess clinical reasoning, we can assume there will be a difference between the ways students and experienced doctors solve the problems within the questions.

Screening for alcohol abuse and dependence in older people using DSM criteria: a review.

Alcohol abuse and dependence in older people are important problems, which frequently remain undetected by health services. Therefore, screening instruments for alcohol abuse and dependence in elderly people would be useful in clinical practice. To assess the quality of screening instruments we performed a literature search in Medline (1966-2002) and PsycINFO (1967-2002).

Are extended-matching multiple-choice items appropriate for a final test in medical education?

At the Faculty of Medicine of the KU Leuven a 'final' test is being developed, part of which consists of extended matching multiple-choice questions (EMQs). These are problem-oriented questions referring to a realistic case, with the correct answer to be chosen from a list of 7-26 possible answers. The same list can be used for several questions (cases).

[Treatment of insomnia in demented nursing home patients: a review].

Insomnia and fragmentation are features of the sleep of these patients. In order to list the factors disturbing the sleep of demented nursing home patients and the interventions improving their sleep quality, the literature was reviewed. A Medline search over the period 1966-2000 was performed.

[Sleep and intellectual functioning in the elderly: the role of sleep quality and apnea--literature survey].

In both relatively healthy and in demented elderly people mental abilities and sleep quality decrease in becoming older and nocturnal respiratory disturbance increases. Perhaps there is an association between sleep and cognition. The hypothesis that specific sleep phenomena are necessary to assure an adequate level of cognitive functioning is called the sleep cognition hypothesis.

[Elderly and humor: a review].

Ageing can be associated with physical, cognitive and/or social loss. Most older people, however, cope well with this loss, perhaps by using humour. In this review the research findings concerning humour were collected.

[Sleep disorders in elderly, the sleep apnea syndrome in particular: are they a cause of insomnia? A review of literature].

In this publication a review is presented based on the findings resulting from sleep-wake investigations searching for sleep disorders associated with insomnia in relatively healthy elderly. 44 Relevant journal articles published between 1980-1998 were found. The four most important sleep disorders which can be accompanied by sleeplessness in relatively healthy elderly people are periodic leg movements disorder (PLM), restless legs syndrome (RLS), REM sleep behaviour disorder (RBD) and sleep apnea syndrome (SAS).

[Determinants of insomnia in relatively healthy elderly. A literature review].

A review is presented based on the findings resulting from interview and questionnaire research concerning factors that determine insomnia in relatively healthy elderly. The investigated factors include modes of living, sleep wishes and personality aspects. During the period 1988-1997 18 published reports were found.

[Medical students' image of the elderly and the effect of medical education: a literature review].

In American studies in the sixties and seventies caregivers, including physicians, showed a negative attitude towards the elderly. There are indications that such a negative attitude affects the quality of care and the communication with the elderly. Based on predominantly American literature this article reviews research on medical students' knowledge about and attitudes towards older people as well as the impact of geriatric training on the image of older patients and physician-patient communication.

The use of standardized patients in research in general practice.

Standardized patients (SPs) are simulated patients or actual patients who have been carefully coached to present their illness in a standardized way. Much is known about the use of standardized patients in medical education. This article reviews advantages and disadvantages, reliability and validity of the use of standardized patients in general practice and primary care research.

Nightmares in psychiatry.

Nightmares are frightening dreams awakening the dreamer. In psychiatry they are often considered as an indication of psychopathology or even as a feature of schizophrenia. Assumptions are made that nightmares occur more often in psychiatric patients than in the normal population and that they are accompanied by an elevated anxiety level in the daytime.

[Light therapy can restore a disturbed sleep/wake rhythm in dementia: but what is the basis of its efficacy?].

In dementia short nocturnal sleep length, agitation and naps in the day-time suggest a chronobiological disturbance. Bright light therapy seems indicated because of its chronobiological activity. However, dementia is accompanied by a decrease in volume and number of active cells of the suprachiasmatical nuclei, the internal clock.

Psychological and neurophysiological dysfunctioning during wakefulness in narcolepsy.

Memory complaints and altered states of consciousness with automatic behaviour of narcoleptic patients indicate cognitive dysfunctioning. Although more problems arise while performing attention tasks than memory tasks, the neuropsychological test inquiry doesn't indicate one particular neuropsychological function as consistently impaired. They often perform well because they compensate impaired wakefulness by an increased willingness to respond.

Melatonine en stemmingsstoornissen.

Melatonin is a hormone secreted by the pineal gland mainly during the night. The discovery that this melatonin secretion decreases under the influence of bright light, gave rise to the use of light therapy in some affective disorders. The literature on the relationship between melatonin secretion and mood is reviewed concerning seasonal affective disorder, non-seasonal affective disorder and premenstrual syndrome.

[An afternoon nap does not affect the quality of sleep in the elderly].

Insomnia complaints increase with age and are frequently made by elderly people. Recently non-pharmacological treatments have been proposed more often, among which stimulus control. One of the stimulus control instructions is the advice not to nap in the daytime, based on the assumption that napping affects sleep quality the following night, due to a decrease of sleep need.