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Cureus Dec 2023Introduction The dynamism inherent in general medicine, particularly since its recognition as a distinct specialty in 2019, necessitates constant revision and refinement...
Introduction The dynamism inherent in general medicine, particularly since its recognition as a distinct specialty in 2019, necessitates constant revision and refinement of the curriculum. As general medicine programs proliferate throughout Japan, understanding the revision processes, especially concerning the pivotal concept of lateral integrations, becomes critical. Lateral integrations, which pertain to the interconnectedness between learning contents and contexts, ensure a cohesive learning experience for medical students. In this study, we sought to explore the intricacies and experiences of revising these integrations within the general medicine curriculum. Methods A qualitative thematic analysis rooted in relativist ontology and constructivist epistemology was conducted. The research was carried out at the Unnan City Hospital, Shimane Prefecture, focusing on trainees transitioning between diverse medical settings. Semi-structured interviews were employed to gauge perceptions regarding these transitions, and thematic analysis was used to interpret the data. Reflexivity was ensured by the diverse expertise of the research team, with rigorous discussions to mitigate biases. Results The following four themes emerged from the analysis: (1) confusion due to the transition from acute to chronic clinical settings, with trainees feeling overwhelmed and resistant to focus solely on chronic care; (2) monotony due to the loss of some clinical experiences, indicating challenges in maintaining motivation after transitioning to clinics; (3) disconnection between learning contexts, where participants desired stronger links to their primary training hospitals; and (4) anxiety as community leaders, highlighting the need for instilling leadership skills and a deeper understanding of diverse community healthcare professions. Conclusion This study shed light on the tangible challenges faced by general medicine trainees during transitions between different learning environments. These insights are valuable for educators in refining curriculum structures, ensuring smooth transitions, and enhancing lateral integrations. Addressing these challenges will bolster the quality and relevance of general medicine education in Japan, fostering the creation of adaptable, well-rounded physicians who are attuned to the multifaceted needs of their communities.
PubMed: 38249198
DOI: 10.7759/cureus.50874 -
Journal of Clinical Medicine Dec 2023Within the practice of pain management, one of the most commonly encountered events is low back pain. Lumbar radiculopathy (LR) is a pain syndrome caused by the...
Within the practice of pain management, one of the most commonly encountered events is low back pain. Lumbar radiculopathy (LR) is a pain syndrome caused by the compression or irritation of the nerve roots in the lower back due to lumbar disc herniation, vertebra degeneration, or foramen narrowing. Symptoms of LR include low back pain that propagates toward the legs, numbness, weakness, and loss of reflexes. The aim of this study is to assess the long-term effectiveness of quantum molecular resonance disc decompression and its combination with a percutaneous microdiscectomy using Grasper© forceps (QMRG) in patients with persistent lumbar radiculopathy (LR) in relation to patient physical stress status. The main outcome measures of this prospective observational study were DN4, NRS, ODI, SF12, PGI, CGI, and MOS Sleep Scale. An improvement 12 months post-intervention was observed in patients without physical stress, presenting better overall results. The mean change was over the minimal clinically important difference in 64.3% of outcome measures studied for the whole sample. QMRG appears to be an effective treatment option for LR, but a reduction in physical stress is needed to ensure long-term effectiveness.
PubMed: 38202241
DOI: 10.3390/jcm13010234 -
Journal of Medicine and Life Sep 2023Approximately two-thirds of the Guillain-Barré syndrome (GBS) cases are preceded by upper respiratory tract infection or enteritis. There has been previous...
Approximately two-thirds of the Guillain-Barré syndrome (GBS) cases are preceded by upper respiratory tract infection or enteritis. There has been previous documentation of a clear association between Covid-19 and GBS. Covid-19 can affect the nervous tissue either through direct damage or through triggering a host immune response with subsequent development of autoimmune diseases such as GBS. Covid-19 can affect the host`s immune system through the activation and interaction of the T-and B-lymphocytes with subsequent production of antibodies that cross-react with the gangliosides. Depending on the nature of the neuronal autoimmune destruction, the affected individual may have either a demyelinating or axonal subtype of GBS. These subtypes differ not only in symptoms but also in the likelihood of recovery. This report presents two cases of GBS that developed after the respiratory symptoms of Covid-19. Their neurological features indicated demyelination, axonal damage, irritation of spinal nerve roots, and impaired sensory and motor transmission with additional facial nerve palsy in the second-studied case. This case report highlights the relationship between GBS and Covid-19 infection.
Topics: Humans; Guillain-Barre Syndrome; COVID-19; Research
PubMed: 38107719
DOI: 10.25122/jml-2023-0275 -
BMC Psychology Nov 2023Existential loneliness is a feeling which stems from a sense of fundamental separation from others and the world. Although commonly mentioned in the loneliness...
BACKGROUND
Existential loneliness is a feeling which stems from a sense of fundamental separation from others and the world. Although commonly mentioned in the loneliness literature, there is relatively little empirical work on this construct, and existing work tends to focus on older and seriously ill individuals. The present study aimed to understand how people experience existential loneliness without specific constraints on precipitating factors like illness or age.
METHODS
A qualitative online survey collected data from 225 adults aged 16 to 72 years old. Participants were asked to write about their experiences of existential loneliness and how these experiences compared to non-existential loneliness. Data were analysed using reflexive thematic analysis.
RESULTS
Of 225 participants, 51% knew the meaning of "existential loneliness" upon accessing the survey and in total, 83% had experienced existential loneliness. 93% of these participants had also experienced loneliness that was not existential in nature. 175 participants provided qualitative data regarding their experiences of existential loneliness, from which four themes were identified: Existential loneliness is (1) A deeper form of loneliness, and (2) A feeling of deep disconnection, in which (3) Cognitive evaluations and negative emotions are central elements, and (4) Stress and mental health issues are perceived as relevant factors.
CONCLUSIONS
Existential loneliness is a deeply rooted and impactful form of loneliness which involves feelings of profound separateness. This aspect of loneliness is deserving of further attention. Future research directions are suggested.
Topics: Adult; Humans; Adolescent; Aged; Young Adult; Middle Aged; Loneliness; Emotions; Existentialism
PubMed: 37990348
DOI: 10.1186/s40359-023-01452-4 -
Journal of Clinical Medicine Oct 2023Chiari malformation type 1 (CM1) includes various congenital anomalies that share ectopia of the cerebellar tonsils lower than the foramen magnum, in some cases... (Review)
Review
Chiari malformation type 1 (CM1) includes various congenital anomalies that share ectopia of the cerebellar tonsils lower than the foramen magnum, in some cases associated with syringomyelia or hydrocephalus. CM1 can cause dysfunction of the brainstem, spinal cord, and cranial nerves. This functional alteration of the nervous system can be detected by various modalities of neurophysiological tests, such as brainstem auditory evoked potentials, somatosensory evoked potentials, motor evoked potentials, electromyography and nerve conduction studies of the cranial nerves and spinal roots, as well as brainstem reflexes. The main goal of this study is to review the findings of multimodal neurophysiological examinations in published studies of patients with CM1 and their indication in the diagnosis, treatment, and follow-up of these patients, as well as their utility in intraoperative monitoring.
PubMed: 37892608
DOI: 10.3390/jcm12206472 -
Frontiers in Pediatrics 2023Pediatric spinal cord injury without radiographic abnormality (SCIWORA) caused by backbend practice is increasing. This study proposed an underlying 'combined injury...
OBJECTIVE
Pediatric spinal cord injury without radiographic abnormality (SCIWORA) caused by backbend practice is increasing. This study proposed an underlying 'combined injury mechanism' related to the spinal cord and femoral nerve overstretching.
METHODS
Pediatric patients diagnosed with backbend-associated SCIWORA at the China Rehabilitation Research Center during 2017-2021 were recruited. Clinical and imaging data were collected, and each patient's clinical course and prognosis were determined. Healthy dancers were recruited to simulate the backbend, obtain images, and estimate the spinal cord and femoral nerve stretch ratio. A model for the 'combined injury mechanism' was established using 4-week-old SD rats.
RESULTS
Forty-two SCIWORA female patients with an average age of 6 (SD 1) years and an average hospitalization time of 91 (SD 43) days were assessed. The primary initial symptom was pain in the back and/or lower extremities (33, 79%). The average time from injury onset to severe paralysis was 2.0 (SD 0.6) hours. Most patients had complete paraplegia (32, 76%), and neurological levels were distributed mainly in thoracic segments (38, 91%). Patients with elicited tendon reflexes on admission tended to have an incomplete spinal cord injury ( = 0.001) and improved motor recovery ( = 0.018). After one year, the most common complications were scoliosis (31, 74%) and abnormal hips (14, 33%). Injury of the caudal spinal cord torn by nerve roots was confirmed by surgical exploration in a case. The thoracic spinal cord and femoral nerves were overstretched by 148.8 ± 3.6% and111.7 ± 4.0%, respectively, in a full backbend posture. The 'combined injury mechanism' was partially replicated in the animal model.
CONCLUSION
Spinal overstretch and transient dislocation are considered the primary mechanisms by which SCIWORA occurs in children. Overstretching the femoral nerve aggravates spinal cord injuries caused by backbend practice.
PubMed: 37881636
DOI: 10.3389/fped.2023.1263280 -
BMJ Open Oct 2023We will launch a national survey in Serbia to document the prevalence of two types of questionable health behaviours: (1) intentional non-adherence to medical...
INTRODUCTION
We will launch a national survey in Serbia to document the prevalence of two types of questionable health behaviours: (1) intentional non-adherence to medical recommendations and (2) use of traditional, complementary and alternative medicine practices, as well as the relation between the two. We will also investigate their psychological roots, including (a) 'distal' predictors such as HEXACO personality traits (plus Disintegration) and thinking dispositions (rational/experiential thinking and cognitive reflexivity), and (b) 'proximal' predictors under the umbrella 'irrational mindset' (set of unfounded beliefs consisting of conspiratorial thinking, superstition, magical health beliefs as well as selected cognitive biases), which have more content-wise overlap with the health behaviours.
METHODS AND ANALYSIS
In this cross-sectional study, a research agency will collect data from a nationally representative sample (n=1043; age 18-75 years; estimated start/end-June/November 2021) recruited online (approximately, 70% of the sample, aged 18-54; 11 years) and face-to-face (approximately, 30% of the sample, aged 55-75 years). Participants will complete a battery of tests assessing questionable health behaviours, basic personality traits, thinking dispositions, irrational mindset, sociopolitical beliefs, sociodemographic and health-related variables. Prevalence rates will be calculated using descriptive statistics. To explore the relation between (psychological) predictors and questionable health behaviours, we will use hierarchical regression and partial mediation models (path analysis or full SEM models).
ETHICS AND DISSEMINATION
Ethical Committees of the Faculty of Philosophy in Belgrade (#935/1), Faculty of Special Education and Rehabilitation (#139/1) and Faculty of Media and Communications (#228) approved the protocol. Only participants who provide informed consent will participate in the study. A research report based on the study results will be submitted to peer-reviewed journals and results will be made available to stakeholders through reports on the project website https://reasonforhealth.f.bg.ac.rs/en/ and disseminated via social media.
TRIAL REGISTRATION NUMBER
NCT05808660.
Topics: Humans; Serbia; Cross-Sectional Studies; Prevalence; Health Behavior
PubMed: 37827738
DOI: 10.1136/bmjopen-2023-075274 -
BMC Health Services Research Sep 2023Clinical academic allied health professionals can positively impact patient care, organisational performance, and local research culture. Despite a previous national...
BACKGROUND
Clinical academic allied health professionals can positively impact patient care, organisational performance, and local research culture. Despite a previous national drive to increase these roles, they remain low in number with no clear strategy for growth. Reported barriers to this growth cite organisational and economic factors with little recognition of the challenges posed to individuals. There is a lack of research to help allied health professionals understand the personal challenges of clinical academic training and practice. The aim of this study is to explore the character traits and behaviours of clinical academic allied health professionals to understand the individual attributes and strategies taken to pursue a career in this field.
METHODS
A semi-structured interview study design was used to collect data from aspiring and established clinical academic allied health professionals. Participants were recruited voluntarily through social media advertisement (aspiring) and purposively through direct email invitation (established). Participants were asked about their experience of pursuing a clinical academic career. The interviews were conducted virtually using Zoom and were audio recorded. The data were transcribed verbatim prior to reflexive thematic analysis. Informed consent was gained prior to data collection and the study was approved by the university's research ethics committee.
RESULTS
Twenty participants from six allied health professions were interviewed. We developed five themes: risk and reward, don't wait to be invited, shifting motivations, research is a team sport, and staying the course. Clinical academic allied health professionals demonstrated traits including inquisitiveness, intuition, motivation, and resilience. The source of their motivation was rooted in improving clinical services, conducting research, and personal achievement.
CONCLUSION
Clinical academic allied health professionals describe personal traits of high inquisitiveness, opportunism, motivation, and determination in pursuing their career ambitions. The tolerance of rejection, failure, and risk was considered important and viewed as an essential source for learning and professional development. Future research should concentrate on ways to reduce the over-reliance on individual strength of character to succeed in this field and explore programmes to increase the preparedness and support for clinical academics from these professions.
Topics: Humans; Motivation; Qualitative Research; Allied Health Occupations; Allied Health Personnel; Data Collection
PubMed: 37741969
DOI: 10.1186/s12913-023-10044-2 -
Molecules (Basel, Switzerland) Aug 2023The traditional use of L. roots to enhance male sexual performance prompted us to assess the in silico, in vitro, and in vivo aphrodisiac activities of its...
The traditional use of L. roots to enhance male sexual performance prompted us to assess the in silico, in vitro, and in vivo aphrodisiac activities of its hydroethanolic extract using normal male rats. Spectroscopic characterization indicated the presence of ß-D-glucopyranoside, methyl-1,9-benzyl-2,6-dichloro-9H-purine, and Bis-(2-ethylhexyl)-phthalate; these compounds have a significant inhibitory effect on the phosphodiesterase-5 (PDE-5) enzyme in silico evaluation and minerals (including zinc, cadmium, and magnesium). Other phytochemical analyses revealed the presence of phenolic compounds and flavonoids. These phytochemicals and minerals may contribute to the aphrodisiac activities of the extract. Additionally, the in vivo study revealed that the administration of root extract (300 mg/kg) significantly enhanced ( < 0.01, < 0.03) mount, intromission, and ejaculation frequencies while significantly ( < 0.05) decreasing the mount and intromission latencies, as well as the post-ejaculatory interval time, in comparison with the standard drugs sildenafil and ginseng, resulting in enhanced erection and sexual performance in the rats. Furthermore, the extract significantly ( < 0.05) increased penile reflexes and also elevated the levels of testosterone and luteinizing hormones. Extract (300 mg/kg) significantly ( < 0.05) inhibited the PDE-5 enzyme in an in vitro study. Concludingly, the comprehensive findings of this study suggest that a standardized herbal extract derived from roots alleviates erectile dysfunction and premature ejaculation in male rats. root extract proved to be an alternative treatment for erectile dysfunction and premature ejaculation.
Topics: Male; Animals; Rats; Humans; Aphrodisiacs; Mirabilis; Erectile Dysfunction; Premature Ejaculation; Phytochemicals; Plant Extracts
PubMed: 37687143
DOI: 10.3390/molecules28176314