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Biomedical subjects

G D Majoor

Publications and source records attributed to G D Majoor.

At least 19 recordsLinked to original sources
PubMed2006

Internationalization of medical education in the Netherlands: state of affairs.

In the framework of the Bologna Process, internationalization co-ordinators of seven (out of eight) Dutch medical schools completed an electronic survey about internationalization-related aspects of the curriculum. Common features of internationalization in Dutch medical schools were: the numbers of outgoing students exceeded the numbers of incoming students, and most international programmes involved clinical training and research projects. We recommend that Dutch medical schools should pay more attention to 'Internationalization at Home' and focus on conditions that are conducive to participation by foreign students.

Curriculum↗
PubMed2006

The learning processes of international students through the eyes of foreign supervisors.

Semi-structured interviews were conducted with external supervisors of international electives undertaken by Dutch undergraduate students, in order to gain insight into student learning processes during these electives. The interviews served to triangulate information on these learning processes that was obtained from students' self-reports. The results of the case study reported in this paper were largely consistent with findings from prior studies of international electives in which learning processes and sociocultural differences were examined: experiential learning processes appeared to dominate and sociocultural differences occasionally seemed to blur productive learning, especially when the differences between the national cultures of host country and student home country were substantial. It is recommended that students' experiential learning from international electives should be supplemented with 'guided' and 'self-directed' learning with a focus on the sociocultural dimension.

Australia↗
PubMed2006

Does Community-Based Education come close to what it should be? A case study from the developing world: students' opinions.

CONTEXT: There has been an increase in the number of medical schools implementing community-based educational (CBE) programmes. However, there are doubts whether CBE programmes are appropriately implemented. As a case study, the CBE programme of the Medical Faculty of Diponegoro University (MFDU) in Semarang, Indonesia was evaluated. OBJECTIVES: To acquire MFDU's students' opinions on their CBE programme as part of a comprehensive evaluation of that programme, and to generate recommendations for improvement of MFDU's CBE programme. METHODS: Coles and Grant's model for curriculum evaluation was applied. This model recommends triangulation of data generated from comparison of the programme as designed "on paper", as implemented "in action" by the faculty, and "as experienced" by the students. To assess the curriculum as experienced by the students, direct participatory observation was performed and focus group discussions were conducted to collect students' opinions. RESULTS: Students specifically signalled: (1) frequent overlap of lectures given during the CBE clerkship and in the previous part of the curriculum, (2) mismatch between their activities in the community and the community's felt health needs, (3) greater benefits of the CBE programme for Primary Health Care (PHC) centres and students than for target communities, and (4) incidental defective co-operation between students and health providers or community health workers. CONCLUSION: Students' opinions yielded more in-depth information on the CBE programme evaluated and facilitated formulation of recommendations for improvement of that CBE programme.

Community Medicine↗
PubMed2006

A survey validation of generic objectives for community-based education in undergraduate medical training.

INTRODUCTION: A framework for the definition of generic objectives for community-based education (CBE) was developed for undergraduate medical programmes, particularly for developing countries. To probe the validity of the set of CBE objectives generated by this approach, opinions from a wider audience were sought. METHOD: Questionnaires were sent to 72 medical schools in 36 developing countries. Half of the addressees were randomly drawn from the list of institutional members of The Network: Toward Unity For Health (TUFH) and stratified according to developing countries. Another 36 medical schools were randomly drawn from non-Network: TUFH schools from the same country where the selected Network: TUFH addressee was located, or from a neighbouring country. RESULTS: A total of 43 medical schools responded to the questionnaire (60% response rate), 31 out of the 36 addressed Network: TUFH members (86%) and 12 out of 36 addressed non-Network: TUFH schools (33%). Out of all 43 respondents 39 (91%) had implemented CBE in their curricula. Opinions of Network: TUFH and non-Network: TUFH schools on the framework and the generic objectives were not significantly different. Out of the 21 proposed objectives, 17 were scored as relevant by 75% or over of all responders and one out of the four objectives considered to be less relevant by the responders was deleted. CONCLUSION: A framework to develop generic CBE objectives and a derived set of 21 objectives were modified based on input by 43 medical schools residing in developing countries distributed all over the globe. The outcome is a validated set of 20 generic objectives for CBE programmes in developing countries.

Chi-Square Distribution↗
PubMed2005

Does CBE come close to what it should be? A case study from the developing world. Evaluating a programme in action against objectives on paper.

CONTEXT: A growing number of health professions schools have implemented programmes for community-based education (CBE) for their students. There are indications, however, that particularly in developing countries, CBE programmes are not always optimally implemented or sustained. OBJECTIVE: To test the suitability of an established method for curriculum evaluation, combined with a set of generic objectives for CBE programmes, for evaluation of CBE programmes. METHODS: As a case study, Coles and Grant's model for curriculum evaluation was applied to the CBE programme of the Medical Faculty of Diponegoro University (MFDU) in Semarang, Indonesia. Document analysis yielded information on the programme on paper; participatory observation and staff interviews on the programme in action. In addition, MFDU's CBE programme was evaluated against a set of generic objectives for CBE programmes recently designed by us. RESULTS: MFDU has created great opportunities for its CBE programme in which, however, also significant weaknesses were revealed. (1) In the community, much time was spent on formal teaching; (2) Students' work in the community was not jointly identified with community members regarding the community's felt health needs; (3) There was rarely continuity, and evaluation or follow-up of the students' work in the community; and (4) No systematic programme evaluations are carried out. DISCUSSION: This evaluation study showed shortcomings in the implementation of MFDU's CBE programme. The major weaknesses identified point at an underutilization of the opportunities and potential jeopardization of the facilities in the community. On the other hand, more time is needed in the CBE programme to establish the health needs to be addressed jointly with the community and to assess the impact of activities undertaken. A thorough review of the CBE programme, perhaps taking the outcomes of this study into account, could turn MFDU's CBE programme into a fine example for other medical schools in Indonesia and beyond. CONCLUSION: Coles and Grant's method for curriculum evaluation proved suitable for evaluation of a CBE programme in a developing country. After additional comparison with a reference list of objectives for CBE programmes, reasoned suggestions for programme can be made.

Community Health Services↗
PubMed2004

Defining generic objectives for community-based education in undergraduate medical programmes.

RATIONALE: The availability of a framework for the definition of generic objectives for community-based education (CBE) programmes may assist in the rational design of objectives for specific CBE programmes. STRATEGY: Factors impacting on community health from the perspective of a developing country were collected. Potential assistance from medical students to communities to improve their health status was determined. Competencies required in students to execute tasks in the community were defined and eventually educational objectives to develop these competencies in the students were established. METHODS: Factors impacting on community health and activities of medical students in CBE programmes were identified by review of literature and Internet resources. Competencies desired for execution of tasks by students and educational objectives to develop these competencies were defined by us and checked against pertinent literature. A draft table representing the 4 elements of the framework was discussed by an international group of experts for external validation. MAIN OUTCOMES: A total of 26 factors impacting on community health were identified and clustered in 5 domains. Twenty-one generic objectives for CBE programmes were defined to develop the required competencies in students. Analogues of each of these 21 objectives were found in at least 1 publication specifying objectives for specific CBE programmes but none of these publications stated any objective not covered by our list of generic objectives. CONCLUSION: It proved possible to develop a framework to define generic objectives for CBE programmes. An example was elaborated from the perspective of a medical school in a developing country.

Clinical Competence↗
PubMed1993

Susceptibility and resistance to cyclosporin A-induced autoimmunity in rats.

Lethally irradiated Lewis (LEW) rats, reconstituted with syngeneic bone marrow and next given Cyclosporin A (CyA) for several weeks, develop disease (Cyclosporin A-induced autoimmunity; CyA-AI) after withdrawal of CyA. This disease resembles in terms of dermal changes the acute dermatitis and chronic scleroderma also seen in graft-versus-host disease (GVHD). In this study we report the relative resistance of the Brown Norway (BN) rat strain to the induction of CyA-AI. In contrast to LEW rats, in which CyA-AI was originally described, BN rats showed no acute dermatitis or scleroderma-like skin pathology in spite of comparable changes in the thymus and a maturation arrest of CD4+ T cells. The difference was also demonstrated functionally for whereas in LEW rats delayed-type hypersensitivity (DTH) reactions could not be elicited during CyA-AI, these were within normal limits in BN rats subjected to the same protocol; NK activity on the other hand was unaffected in both strains. The observation that BN rats developed very mild late disease as evidenced by a slight though significant weight loss suggests that the BN strain is susceptible to the disease but that lesser effector cell generation or, alternatively, stronger suppressor cell responses may prevent dermal disease. These observations may contribute to the elucidation of the mechanisms involved in this experimental autoimmune disease.

Animals↗
PubMed1992

Antibodies defining rat endothelial cells: RECA-1, a pan-endothelial cell-specific monoclonal antibody.

We have been searching for antibodies reactive with rat endothelial cells. Two monoclonal antibodies (mAb), named RECA-1 and RECA-2 were produced and tested in immunoperoxidase staining on frozen sections of various rat tissues. Staining patterns were compared to those obtained with the mAbs OX-2, OX-26, OX-43, and the polyclonal antibody to von Willebrand Factor (vWF), which all have been described to react with rat endothelial cells. The RECA-2 mAb showed staining patterns similar to those obtained with OX-2. RECA-1 showed to be the only antibody reactive with all vascular endothelium in the tested tissues. In addition, RECA-1 was endothelial cell-specific whereas all other antibodies crossreacted with one or more other cell types. No reactivity of RECA-1 was found in various tested species other than rat. The RECA-1 antibody was successfully applied in staining of paraformaldehyde fixed, plastic embedded tissue material. Immunofluorescence staining of viable endothelial cells demonstrated that RECA-1 recognizes a cell surface antigen. This was supported by intravenous injection of RECA-1, which showed the antibody to localize along the endothelium lining the vasculature in various organs tested. No reactivity of the antibody was seen when applied in immunoblotting of PAGE-run lysates from endothelial cell cultures and stromal cell preparations. We believe RECA-1 to be a promising antibody for rat endothelial cell studies, and in particular for further defining nature and function of endothelial cell-specific antigens.

Animals↗
PubMed1991

On the localization of effector cells in cyclosporin-induced autoimmunity.

Lethally irradiated rats, reconstituted with syngeneic bone marrow and given Cyclosporin A (CyA) for 6 weeks, developed disease resembling allogeneic graft-versus-host disease 2 weeks after withdrawal of CyA. Other studies have demonstrated the pivotal role of the thymus in the etiology of this CyA-induced autoimmune disease (CyA-AI). In this study the question was addressed whether inducer/effector cells of CyA-AI are generated in the thymus during or after CyA administration; whether these cells stay in the thymus, or, if they don't, whether they home to the secondary lymphoid organs. Adoptive transfer of thymocytes from donors treated for induction of CyA-AI obtained one and 14 days after cessation of CyA administration did not elicit CyA-AI in irradiated secondary recipients. Furthermore, adult thymectomy of rats immediately after the course of CyA did not influence the kinetics of development of skin pathology, although weight loss commenced later in thymectomized than in sham-thymectomized rats. Lymph node and spleen cells obtained from donors treated for induction of CyA-AI one and 14 days after withdrawal of CyA-AI caused CyA-AI upon adoptive transfer to secondary recipients, but the symptoms of acute disease (dermatitis, alopecia and weight loss) were strikingly less severe upon transfer of lymphoid cells obtained one day after stopping CyA than 14 days thereafter. Therefore, this study demonstrates that CyA-AI inducer/effector cells are generated in the thymus during the administration of CyA. These cells exit from the thymus during CyA administration; either they home predominantly peripherally (i.e. in the skin) rather than in the secondary lymphoid organs, or they leave the thymus as inducer cells which home in the lymphoid organs where they subsequently may trigger potentially autoreactive lymphocytes as probably also present in normal individuals, or both pathways may be operative.

Animals↗
PubMed1991

Detection of contact dermatitis in rat skin by intravital microscopy.

The sensitivity of fluorescence intravital microscopy for the detection of immunologically elicited inflammatory reactions in the skin was compared to assessment by tissue swelling measurement. Rats were immunized to the contact-sensitizing agent toluene diisocyanate (TDI) by its application to the skin and challenged by the same procedure at a different site one week thereafter. At 2, 6, or 12 hrs after challenge individual rats received a bolus of fluorescently labeled albumin intravenously. Vascular integrity was determined by estimating the surface of areas with increased vascular permeability as observed by fluorescence intravital microscopy; contact dermatitis (CD) was assessed just prior to infusion of labeled albumin determination of tissue swelling by a semi-automatic micrometer. At 12 hrs after challenge, CD was detectable by tissue swelling. Intravital fluorescence microscopy revealed massive extravasation of the fluorescent dye at the site of challenge. At 6 hrs after challenge, CD was not yet discernible by toe thickness measurements. However, by fluorescence intravital microscopy significant leakage of labeled albumin was observed. Thus, at 6 hrs after challenge fluorescence intravital microscopy was more sensitive than determination of tissue thickness increment for detection of a contact hypersensitivity reaction. At 2 hrs after challenge, CD was neither demonstrable by tissue swelling measurements, nor by fluorescence intravital microscopy. Therefore, an early component of a delayed-type hypersensitivity (DTH) reaction to a contact allergen as shown to occur in mice, remains to be demonstrated in the rat. On the other hand, fluorescence intravital microscopy revealed non-immunological skin irritation by a 5% TDI solution within 2 hrs after its application to the skin of non-immunized rats.

Animals↗
PubMed1990

Graft-versus-host disease: the need for a new terminology.

For some decades, graft-versus-host (GVH) reactions seemed readily comprehensible. It was generally accepted that after introduction of immunocompetent, histoincompatible lymphocytes into an immunodeficient host the grafted lymphocytes would start a 'rejection' response against their host. As a result, GVH disease developed. Acute disease might result in death and survivors became chimaeras with varying pathology--chronic GVH disease. In recent years, however, some intriguing exceptions to the general rules for the development of GVH disease have been reported. These exceptions, particularly the activation of GVH disease by stimuli other than histocompatibility barriers prompted Gerard Bos and colleagues to propose this change in terminology.

Animals↗
PubMed1989

Chronic cyclosporine-induced autoimmune disease in the rat: a new experimental model for scleroderma.

The pathogenesis of scleroderma is still elusive, although autoimmune mechanism involvement has been suggested. The present study was designed to investigate whether or not rat scleroderma would appear as one of the symptoms in a recently described model for autoimmune disease. The model is based on manipulation or reconstitution of the immune system after lethal irradiation and syngeneic bone marrow transplantation by temporary administration of the immunosuppressive drug cyclosporine-A. Withdrawal of cyclosporine-A 6-12 wk after bone marrow transplantation gives rise to autoimmune reactions causing clinical pathology similar to graft-versus-host disease. We discuss the chronic phase of this disease, approximately 30 wk after cyclosporine-A was withheld at that time-about one-third of the rats had developed histologic skin lesions comparable to those seen in patients with scleroderma. Therefore, we propose this model as a new, experimental autoimmune model for scleroderma in humans.

Acute Disease↗
PubMed1989

Perturbation of T-cell differentiation in lethally irradiated rats reconstituted with syngeneic bone marrow and treated with cyclosporin-A.

Lethally irradiated rats reconstituted with syngeneic bone marrow and treated for 40 or 80 days with Cyclosporin A (Cy-A) contract disease mimicking graft-versus-host disease about 3 weeks after withdrawal of the drug. We investigated the reconstitution of peripheral blood lymphocytes after this treatment. A selective effect on the regeneration of the CD4+ cells was observed. During Cy-A administration CD4(+)-cell regeneration was almost completely suppressed, but within 3 weeks after withdrawal of the drug such cells reappeared in blood and reached pre-irradiation levels about 6 weeks later. The coincidence of the reappearance of CD4+ cells and the onset of autoimmune disease suggests a causal relation between both events.

Animals↗