The frequent answer to the question ‘Why do you want to study medicine’ at the medical school interview is ‘I want to save lives’. A scientist colleague used to greet me with the line ‘How many lives have you saved today?’ The truth is that while we can easily kill a patient if we are not careful, rarely can we intervene to turn the tide and save a life. As a clinical pharmacologist with an interest in medication errors, I know that a careful and alert doctor is better for the patient than a caring...
ObjectivesDepression and suicide often affect young physicians coping with the demands of residency training. To support effective prevention programmes, we aim to assess depression, quality of life (QoL) and coping style of doctors prior to beginning residency training. MethodsA cross-sectional study of physicians prior to their first year of residency training at the Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand, was conducted. Questionnaires including the Thai versions of...
ObjectivesJunior doctors are frequently exposed to occupational and traumatic stress, sometimes with tragic consequences. Mindfulness-based and fitness interventions are increasingly used to mitigate this, but have not been compared. We conducted a randomised, controlled pilot trial to assess the feasibility, acceptability and effectiveness of these interventions in junior doctors. MethodsWe randomised participants (n=21) to weekly 1-hour sessions of personalised, trauma-informed yoga (n=10),...
Purposes of the studyTo identify the challenges to well-being experienced by general practice postgraduate trainees and to explore how the trainees respond to those challenges. Study designQualitative focus group study with doctors in their final year of general practice training (n=16). The participants in the study were recruited from one training scheme in South West England. Data were thematically analysed. ResultsParticipants reported challenges to well-being relating to dysfunctional relationships...
A 74-year-old man with Alzheimer’s disease was brought to the emergency department for aphagia of 1 day duration. He was noticed to be drooling saliva with otherwise stable vital signs. Oral cavity inspection showed the absence of dentition over the upper jaw with pooling of saliva over the hypopharynx. Assessment of the head and neck regions were unremarkable. An X-ray of the cervical (lateral view) was performed with findings coherent with clinical assessment, suggestive of an impacted foreign...
BackgroundBurnout results from chronic exposure to stress: comprising emotional exhaustion (EE), depersonalisation (DP) and a reduced sense of personal achievement (PA). Only a few studies have examined burnout in Canadian residents, and no multispecialty studies using the Maslach Burnout Inventory-Health Sciences Survey (MBI-HSS) exist. The purpose of our study is to identify burnout prevalence, contributory factors and solutions. MethodsA prospective 62-item survey, including the 22-item MBI-HSS,...
Professional burnout is characterised by increased perception of emotional exhaustion (EE) and depersonalisation (DP) with a concomitantly decreased sense of personal accomplishment (PA).1 Burnout among physicians is common, particularly in trainees and early-career physicians. Among internal medicine (IM) trainees in particular, recent data suggests that burnout is present in approximately 30%–40% of postgraduate first-year trainees (PGY-1), reaching up to 80% by the PGY-2 year.2 Significant research...
IntroductionThe role of a foundation year 1 (FY1) doctor has evolved over the years. Many doctors report significant anxiety and stress during this period. In this Quality Improvement Project, we looked at the difficulties FY1s face in their working day and if these issues could be resolved by implementing some structural changes. MethodsThe project was conducted in three cycles, each lasting 5 days (Monday to Friday), over three consecutive weeks. Week 1 consisted of shadowing of Surgical FY1s...
The theme of this issue of the Postgraduate Medical Journal is burnout. As Professor Bernard Cheung makes clear in his editorial1 physician burnout is not due to failings on the part of any individual. It is far more a consequence of social, cultural and technological pressures that affect the profession as a whole. Few young people applying for medical school can imagine what most medical careers nowadays are actually like: a decade or more in further studies, working hours that may be twice as...
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Minimally invasive approaches have been used increasingly in the management of infected necrotizing pancreatitis. This study presents a modified minimal‐access retroperitoneal pancreatic necrosectomy procedure assisted by carbon dioxide insufflation, instead of saline. A clear field of view without necrotic debris floating in saline makes the technique safe and efficient. High degree of success http://www.bjs.co.ukVIDEO Presented in part to the Joint Congress of the Sixth Biennial Congress...
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Abstract Alzheimer’s disease (AD) is the most prevalent dementia in the world. Its cause(s) are presently largely unknown. The most common explanation for AD, now, is the amyloid cascade hypothesis, which states that the cause of AD is senile plaque formation by the amyloid β peptide, and the formation of neurofibrillary tangles by hyperphosphorylated tau. A second, burgeoning theory by which to explain AD is based on the infection hypothesis. Much experimental and epidemiological...
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Abstract The Coronavirus disease 2019 (COVID‐19) pandemic has unveiled the stark racial disparities that are present in United States (US) and other developed countries today. In recent weeks, several states have released demographic data that highlights the disproportionate rate of COVID‐19 infections in racial/ethnic minorities1. These disparities are likely a result of the structural inequities that minorities face due to factors such as racism, neighborhood segregation, income, housing and education...
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The results of this meta‐analysis showed that patients receiving low‐molecular‐weight heparin anticoagulant therapy to prevent venous thromboembolism can benefit from anti‐Xa monitoring, for which the trough level may be the more appropriate time status to monitor. Abstract What is known and objective Low‐molecular‐weight heparin (LMWH) is widely used in the prevention and treatment of venous thromboembolism (VTE), and anti‐Xa assay is the gold standard for monitoring LMWH. However, it is still...
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Abstract To evaluate serum levels of the following cytokines in rheumatoid arthritis subjects with periodontal disease: Interleukin-6, -10, -17, and -23. Patients with rheumatoid arthritis frequently suffer from periodontal disease. Both diseases partly result from a dysregulated immune response. The current study aimed to quantify Interleukin-6, -10, -17, and -23 levels in rheumatoid arthritis. It should be investigated if the periodontal disease would have additional modifying...
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Background and Objective The laser‐induced stress relaxation provides new prospects to obtain stable long fragments of costal cartilage for autoimplantation avoiding the risk of spontaneous deformation and poor engraftment. However, the age‐related alterations of cartilage may sufficiently influence its interaction with infrared (IR) laser radiation and disrupt the effectiveness and safety of the technique. The aim of the work is to study the influence of the structural quality of costal cartilage...
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Abstract Background Antimicrobial resistance is cited as one of the leading causes for the increased morbidity and mortality in infectious diseases globally. Antibiotic misuse can accelerate the advent and spread of resistant antimicrobial strains and antibiotic self-medication is one of the main practices of antibiotic misuse. Even though plethora of evidence is available on antibiotic self-medication among health care providers, evidence derived from community-based studies...
Abstract Background The World Health Organization estimates that over 50% medicines are prescribed inappropriately and the main driver of antimicrobial resistance globally. There have only been a limited number of studies evaluating prescribing patterns against national standard treatment guidelines (STGs) in sub-Saharan African countries including Namibia. This is important given the high prevalence of both infectious and non-infectious diseases in sub-Saharan Africa alongside...
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IntroductionTuberculosis (TB), a major public health concern in Ethiopia, is distributed heterogeneously across the country. Mapping TB prevalence at national and subnational levels can provide information for designing and implementing control strategies. Data for spatial analysis can be obtained through systematic review of the literature, and spatial prediction can be done by meta-analysis of published data (geospatial meta-analysis). Geospatial meta-analysis can increase the power of spatial...
IntroductionChildhood infections, particularly those caused by helminths are considered to be important environmental exposures influencing the development of allergic diseases. However, epidemiological studies focusing on the relationship between helminth infections and risk of allergic diseases, performed worldwide, show inconsistent findings. Previous systematic reviews of observational studies published 10 or more years ago showed conflicting findings for effects of helminths on allergic diseases....
IntroductionVitamin B12 deficiency is widely prevalent across many low- and middle-income countries, especially where the diet is low in animal sources. While many observational studies show associations between B12 deficiency in pregnancy and infant cognitive function (including memory, language and motor skills), evidence from clinical trials is sparse and inconclusive. Methods and analysisThis double-blind, multicentre, randomised controlled trial will enrol 720 vegetarian pregnant women in...
ObjectiveTo investigate social inequalities underlying low birthweight (LBW) outcomes in Sri Lanka. DesignCross-sectional study. SettingThis study used the Sri Lanka Demographic and Health Survey 2016, the first such survey to cover the entire country since the Civil War ended in 2001. ParticipantsBirthweight data extracted from the child health development records available for 7713 babies born between January 2011 and the date of interview in 2016. Outcome measuresThe main outcome variable...
IntroductionAchieving parenthood is challenging in individuals receiving renal replacement therapy (RRT; dialysis or kidney transplantation) for end-stage kidney disease. Decision-making regarding parenthood in RRT recipients should be underpinned by robust data, yet there is limited data on parental factors that drive adverse health outcomes. Therefore, we aim to investigate the perinatal risks and outcomes in parents receiving RRT. Methods and analysisThis is a multijurisdictional probabilistic...
IntroductionSurgical site infections (SSI) are a common postoperative complication. During the development of the new WHO guidelines on SSI prevention, also in the Netherlands was concluded that perioperative care could be optimised beyond the current standard practice. We selected a limited set of readily available, cheap and evidence-based interventions from these new guidelines that are not part of standard practice in the Netherlands and formulated an Enhanced PeriOperative Care and Health bundle...
IntroductionAntimicrobial resistance is rising, largely due to the indiscriminate use of antimicrobials. The human gut is the largest reservoir of antibiotic resistant bacteria (ARB). Individuals colonised with ARB have the potential to spread these organisms both in the community and hospital settings. Infections with ARB such as extended spectrum beta-lactamase producing enterobacteriales (ESBL-E) and carbapenemase producing enterobacteriales (CPE) are more difficult to treat and are associated...
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We appreciate the thoughtful and supportive comments from Dr. Masters1 and agree that coercive parent–child relationships were often what was addressed and modified during hospitalization. Lowering seclusion and restraint rates by prohibiting them, without lowering rates of aggression, is not the desired outcome. As we noted in our paper, evidence-based treatments are sorely needed for young children whose severe and destructive outbursts get them psychiatrically hospitalized.
I read with interest the article “Behavior Modification Is Associated With Reduced Psychotropic Medication Use in Children With Aggression in Inpatient Treatment: A Retrospective Cohort Study” by Carlson et al.,1 and I believe it raises important developmental questions regarding the application of adult criteria for seclusion and restraint (S/R) management to time out (T/O) procedures on child psychiatric inpatient units and the reliance on verbal de-escalation options to address behavioral crises...
In the April 2020 issue of the Journal, (J Am Acad Child Adolesc Psychiatry 59:566–567), in the Book Forum review of LSD: My Problem Child and Insights/Outlooks, reviewer Ely Fish was incorrectly listed as Dr. Fish and with Tel Aviv University. Mr. Fish is an MD candidate and student at Tel Aviv University. The author regrets this error.
The following describes the case of Miguel and a missed diagnosis in an undocumented minor.Miguel Estrada (all names changed to protect identity) was a 10-year-old boy of Central American origin initially seen at age 8 years in our university outpatient child psychiatry clinic. During the initial evaluation with a native Spanish-speaking provider, his mother, Mrs. Estrada, reported behavioral problems beginning at age 5 with diagnoses of attention-deficit/hyperactivity disorder and intellectual disability;...
The book’s title is the best starting place; forgiveness is really strange. It is an unexpected reaction to hurt. And besides being unexpected, it is a difficult response that takes extraordinary effort. In our post-Puritan society, our entire political spectrum is focused on questions of justice, whether in the form of criminal sentencing or as racial reparations. Justice is often the only solution offered for hurt. Demands for reckoning can lead to cycles of “eye for eye” retribution or can leave...
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