Meeting the Students on Their Own Territory

BackgroundMedical students receive communication skills training but there is little research into how effectively, or indeed whether, these skills can be transferred into clinical settings. This paper reflects upon a project aimed at supporting students in communicating with patientsin clinical settings during their undergraduate years.MethodDuring 2012, 36 year medical students were directly observed leading consultations with real patients in in-patient settings by a communications skills expert. Each observed session involved focused feedback on performance and agreeing areas for future practice involving a student peer and the member of faculty.Results and DiscussionStudents positively evaluated this work-based experience, specifically, valuing the authenticity of engaging with ‘real patients’ in ‘real settings’. They reported learning to deal with environmental issues such as noise, interruptions – the hallmark of busy clinical settings. They gained from observing the Communication Skills teacher model effective communication within the consultation process and receiving immediate focused one-to-one feedback. Moreover, they were able to maximise the feedback through immediately applying it to further consultations. The challenges of rolling out such a programme to more students are discussed.ImplicationsObserved practice in work-based settings helps students to recontextualise knowledge learnt in the classroom setting. Their learning is greatly enhanced by having the supported opportunity to apply their skills in an authentic setting. However, implementing such a project can be resource intensive and logistically challenging

Therapy-based exercise from the perspective of adult patients: a qualitative systematic review conducted using an ethnographic approach

© The Author(s) 2019.Objectives: Many patients do not meet recommended levels of therapy-based exercise. This review aims to explore how adult patients view being prescribed therapy-based exercise, the information/education they are given and receive and if/how they independently practise and adhere. Design: A qualitative systematic review conducted using an ethnographic approach and in accordance with the PRISMA statement. Sources: PubMed, CINAHL, SCOPUS and EMBASE databases (01 January 2000–31 December 2018). Methods: Qualitative studies with a focus on engagement/adherence with therapy-based exercise were included. Data extraction and quality appraisal were undertaken by two reviewers. Results were discussed and data synthesized. Results: A total of 20,294 titles were screened, with data extracted from 39 full texts and data from 18 papers used to construct three themes. ‘The Guidance received’ suggests that the type of delivery desired to support and sustain engagement was context-dependent and individually situated. ‘The Therapist as teacher’ advocates that patients see independent therapy-based exercise as a shared activity and value caring, kind and professional qualities in their therapist. ‘The Person as learner’ proposes that when having to engage with and practise therapy-based exercise because of ill-health, patients often see themselves as new learners who experience fear and uncertainty about what to do. Patients may have unacknowledged ambivalences about learning that impact on engagement and persistence. Conclusion: The quality of the interaction between therapists and patients appears integral to patients engaging with, and sustaining practice of, rehabilitation programmes. Programmes need to be individualized, and health care professionals need to take patients’ previous experiences and ambivalences in motivation and empowerment into account.Peer reviewe

A cembranoid from tobacco prevents the expression of nicotineinduced withdrawal behavior in planarian worms

Using an adaptation of published behavioral protocols, we determined that acute exposure to the cholinergic compounds nicotine and carbamylcholine decreased planarian motility in a concentration-dependent manner. A tobacco cembranoid (1S,2E,4R,6R,7E,11E)-cembra-2,7,11- triene-4,6-diol (4R-cembranoid), also decreased planarian motility. Experiments in the presence of 1 μM 4R-cembranoid did increase the IC50 for nicotine- but not carbamylcholine-induced decrease in planarian motility. When planarians were exposed for 24 h to either nicotine or carbamylcholine at concentrations near their respective IC50 values and then transferred to plain media, nicotineexposed, but not carbamylcholine- or cembranoid-exposed worms displayed withdrawal-like distress behaviors. In experiments where planarians were pre-exposed to 100 μM nicotine for 24 h in the presence of 1 μM 4R-cembranoid, the withdrawal-like effects were significantly reduced. These results indicate that the 4R-cembranoid might have valuable applications for tobacco abuse research. This experimental approach using planarians is useful for the initial screening of compounds relevant to drug abuse and dependence

Clinical pharmacist services within intensive care unit recovery clinics: An opinion of the critical care practice and research network of the American College of Clinical Pharmacy

Intensive care unit recovery clinics (ICU- RCs) have been proposed as a potential mechanism to address the multifaceted unmet needs of intensive care unit (ICU) survivors and caregivers. The needs of this population include, but are not limited to, medication optimization, addressing physical function and psychological needs, coordination of care, and other interventions that may help in improving patient recovery and reducing the rate of preventable readmissions. The objective of this opinion paper is to identify and describe clinical pharmacy services for the management of ICU survivors and their caregivers in an ICU- RC. The goals are to guide the establishment and development of clinical pharmacist involvement in ICU- RCs and to highlight ICU recovery research and educational opportunities. Recommendations provided in this paper are based on the following: a review of published data on clinical pharmacist involvement in the ICU- RCs; a consensus of clinical pharmacists who provide direct patient care to ICU survivors and caregivers; and a review of published guidelines and literature focusing on the management of ICU survivors and caregivers. These recommendations define areas of clinical pharmacist involvement in ICU- RCs. Consequently, clinical pharmacists can promote education on Post Intensive Care Syndrome and Post Intensive Care Syndrome- Family; improve medication adherence; facilitate appropriate referrals to primary care providers and specialists; ensure comprehensive medication management and medication reconciliation; provide assessment of inappropriate and appropriate medications after hospitalization; address adverse drug events, medication errors, and drug interactions; promote preventive measures; and facilitate medication acquisition with the goal of improving patient outcomes and reducing health care system costs.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/163579/2/jac51311.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/163579/1/jac51311_am.pd

COVID Isolation Eating Scale (CIES): Analysis of the impact of confinement in eating disorders and obesity-A collaborative international study

Confinement during the COVID-19 pandemic is expected to have a serious and complex impact on the mental health of patients with an eating disorder (ED) and of patients with obesity. The present manuscript has the following aims: (1) to analyse the psychometric properties of the COVID Isolation Eating Scale (CIES), (2) to explore changes that occurred due to confinement in eating symptomatology; and (3) to explore the general acceptation of the use of telemedicine during confinement. The sample comprised 121 participants (87 ED patients and 34 patients with obesity) recruited from six different centres. Confirmatory Factor Analyses (CFA) tested the rational-theoretical structure of the CIES. Adequate goodness-of-fit was obtained for the confirmatory factor analysis, and Cronbach alpha values ranged from good to excellent. Regarding the effects of confinement, positive and negative impacts of the confinement depends of the eating disorder subtype. Patients with anorexia nervosa (AN) and with obesity endorsed a positive response to treatment during confinement, no significant changes were found in bulimia nervosa (BN) patients, whereas Other Specified Feeding or Eating Disorder (OSFED) patients endorsed an increase in eating symptomatology and in psychopathology. Furthermore, AN patients expressed the greatest dissatisfaction and accommodation difficulty with remote therapy when compared with the previously provided face-to-face therapy. The present study provides empirical evidence on the psychometric robustness of the CIES tool and shows that a negative confinement impact was associated with ED subtype, whereas OSFED patients showed the highest impairment in eating symptomatology and in psychopathology.This manuscript and research was supported by grants from the Ministeriode Economía y Competitividad (PSI2015-68701-R), Instituto de Salud Carlos III (ISCIII) (FIS PI14/00290/ INT19/00046nd PI17/01167) and co-funded by FEDER funds/European Regional Development Fund (ERDF), a way to build Europe. CIBERobn, CIBERsam and CIBERDEM are all initiatives of ISCIII. GMB is supported by a postdoctoral grant from FUNCIVA. This initiative is supported by Generalitat de Catalunya. LM is supported by a postdoctoral grant of the mexican institution Consejo Nacional de Ciencia y Tecnología (CONACYT). PPM was supported, in part, by a Portuguese Foundation for Science and Technology grant (POCI-01-0145-FEDER-028145). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript

MMTV-Wnt1 and -ΔN89β-Catenin Induce Canonical Signaling in Distinct Progenitors and Differentially Activate Hedgehog Signaling within Mammary Tumors

Canonical Wnt/β-catenin signaling regulates stem/progenitor cells and, when perturbed, induces many human cancers. A significant proportion of human breast cancer is associated with loss of secreted Wnt antagonists and mice expressing MMTV-Wnt1 and MMTV-ΔN89β-catenin develop mammary adenocarcinomas. Many studies have assumed these mouse models of breast cancer to be equivalent. Here we show that MMTV-Wnt1 and MMTV-ΔN89β-catenin transgenes induce tumors with different phenotypes. Using axin2/conductin reporter genes we show that MMTV-Wnt1 and MMTV-ΔN89β-catenin activate canonical Wnt signaling within distinct cell-types. ΔN89β-catenin activated signaling within a luminal subpopulation scattered along ducts that exhibited a K18+ER−PR−CD24highCD49flow profile and progenitor properties. In contrast, MMTV-Wnt1 induced canonical signaling in K14+ basal cells with CD24/CD49f profiles characteristic of two distinct stem/progenitor cell-types. MMTV-Wnt1 produced additional profound effects on multiple cell-types that correlated with focal activation of the Hedgehog pathway. We document that large melanocytic nevi are a hitherto unreported hallmark of early hyperplastic Wnt1 glands. These nevi formed along the primary mammary ducts and were associated with Hedgehog pathway activity within a subset of melanocytes and surrounding stroma. Hh pathway activity also occurred within tumor-associated stromal and K14+/p63+ subpopulations in a manner correlated with Wnt1 tumor onset. These data show MMTV-Wnt1 and MMTV-ΔN89β-catenin induce canonical signaling in distinct progenitors and that Hedgehog pathway activation is linked to melanocytic nevi and mammary tumor onset arising from excess Wnt1 ligand. They further suggest that Hedgehog pathway activation maybe a critical component and useful indicator of breast tumors arising from unopposed Wnt1 ligand

Impact of COVID-19 Lockdown in Eating Disorders: A Multicentre Collaborative International Study

Background. The COVID-19 lockdown has had a significant impact on mental health. Patients with eating disorders (ED) have been particularly vulnerable. Aims. (1) To explore changes in eating-related symptoms and general psychopathology during lockdown in patients with an ED from various European and Asian countries; and (2) to assess differences related to diagnostic ED subtypes, age, and geography. Methods. The sample comprised 829 participants, diagnosed with an ED according to DSM-5 criteria from specialized ED units in Europe and Asia. Participants were assessed using the COVID-19 Isolation Scale (CIES). Results. Patients with binge eating disorder (BED) experienced the highest impact on weight and ED symptoms in comparison with other ED subtypes during lockdown, whereas individuals with other specified feeding and eating disorders (OFSED) had greater deterioration in general psychological functioning than subjects with other ED subtypes. Finally, Asian and younger individuals appeared to be more resilient. Conclusions. The psychopathological changes in ED patients during the COVID-19 lockdown varied by cultural context and individual variation in age and ED diagnosis. Clinical services may need to target preventive measures and adapt therapeutic approaches for the most vulnerable patients

Endovascular strategy or open repair for ruptured abdominal aortic aneurysm: one-year outcomes from the IMPROVE randomized trial.

AIMS: To report the longer term outcomes following either a strategy of endovascular repair first or open repair of ruptured abdominal aortic aneurysm, which are necessary for both patient and clinical decision-making. METHODS AND RESULTS: This pragmatic multicentre (29 UK and 1 Canada) trial randomized 613 patients with a clinical diagnosis of ruptured aneurysm; 316 to an endovascular first strategy (if aortic morphology is suitable, open repair if not) and 297 to open repair. The principal 1-year outcome was mortality; secondary outcomes were re-interventions, hospital discharge, health-related quality-of-life (QoL) (EQ-5D), costs, Quality-Adjusted-Life-Years (QALYs), and cost-effectiveness [incremental net benefit (INB)]. At 1 year, all-cause mortality was 41.1% for the endovascular strategy group and 45.1% for the open repair group, odds ratio 0.85 [95% confidence interval (CI) 0.62, 1.17], P = 0.325, with similar re-intervention rates in each group. The endovascular strategy group and open repair groups had average total hospital stays of 17 and 26 days, respectively, P < 0.001. Patients surviving rupture had higher average EQ-5D utility scores in the endovascular strategy vs. open repair groups, mean differences 0.087 (95% CI 0.017, 0.158), 0.068 (95% CI -0.004, 0.140) at 3 and 12 months, respectively. There were indications that QALYs were higher and costs lower for the endovascular first strategy, combining to give an INB of £3877 (95% CI £253, £7408) or €4356 (95% CI €284, €8323). CONCLUSION: An endovascular first strategy for management of ruptured aneurysms does not offer a survival benefit over 1 year but offers patients faster discharge with better QoL and is cost-effective. CLINICAL TRIAL REGISTRATION: ISRCTN 48334791

Key signaling nodes in mammary gland development and cancer: β-catenin

β-Catenin plays important roles in mammary development and tumorigenesis through its functions in cell adhesion, signal transduction and regulation of cell-context-specific gene expression. Studies in mice have highlighted the critical role of β-catenin signaling for stem cell biology at multiple stages of mammary development. Deregulated β-catenin signaling disturbs stem and progenitor cell dynamics and induces mammary tumors in mice. Recent data showing deregulated β-catenin signaling in metaplastic and basal-type tumors suggest a similar link to reactivated developmental pathways and human breast cancer. The present review will discuss β-catenin as a central transducer of numerous signaling pathways and its role in mammary development and breast cancer