Health and needs assessment of geriatric patients: results of a survey at a teaching hospital in Karachi

Objective: To study the health and needs of geriatric patientsMethods: A questionnaire based survey of patients visiting the out-patient department of Aga Khan University was carried out. Ethical requirements were met and included administration of informed consent and provision of confidentiality to patients. Convenience sampling was used without any randomization for interviews. Epi-info and SPSS software were used for data management.Results: Four hundred and two (402) subjects above the age of 65 were surveyed. Most of the subjects were retired (40.5%) married (76.4%) men (69.7%). Ages ranged from 65 to 90 years, the mean being 70.57 years and 291 (72.4%) had five or more health problems. Mobility impairment, urinary incontinence, dyspnoea, fatigue and visual impairment had the worst impact on the life of the individual. Hypertension (42.5%), diabetes mellitus (28.1%) and arthritis (26.6%) were the most commonly reported chronic ailments. Two hundred and three (50.5%) respondents were taking three or more different medications daily. A large number of people had religion (61.4%), reading (36.1%), socializing (53%) and watching television (49.5%) as a regular activity. Eighty five (21.1%) respondents reported having financial problems. Three hundred and sixty five (90.8%) respondents had spiritual needs and 264 (72.3%) reported that their spiritual needs increased with aging

Medical undergraduates' use of behaviour change talk: The example of facilitating weight management

BACKGROUND: Obesity, an increasing problem worldwide, is a leading cause of morbidity and mortality. Management principally requires lifestyle (i.e. behavioural) changes. An evidence-base exists of behaviour change techniques for weight loss; however, in routine practice doctors are often unsure about effective treatments and commonly use theoretically-unfounded communication strategies (e.g. information-giving). It is not known if communication skills teaching during undergraduate training adequately prepares future doctors to engage in effective behaviour change talk with patients. The aim of the study was to examine which behaviour change techniques medical undergraduates use to facilitate lifestyle adjustments in obese patients. METHODS: Forty-eight medical trainees in their clinical years of a UK medical school conducted two simulated consultations each. Both consultations involved an obese patient scenario where weight loss was indicated. Use of simulated patients (SPs) ensured standardisation of key variables (e.g. barriers to behaviour change). Presentation of scenario order was counterbalanced. Following each consultation, students assessed the techniques they perceived themselves to have used. SPs rated the extent to which they intended to make behavioural changes and why. Anonymised transcripts of the audiotaped consultations were coded by independent assessors, blind to student and SP ratings, using a validated behaviour change taxonomy. RESULTS: Students reported using a wide range of evidence-based techniques. In contrast, codings of observed communication behaviours were limited. SPs behavioural intention varied and a range of helpful elements of student’s communication were revealed. CONCLUSIONS: Current skills-based communication programmes do not adequately prepare future doctors for the growing task of facilitating weight management. Students are able to generalise some communication skills to these encounters, but are over confident and have limited ability to use evidence-based theoretically informed techniques. They recognise this as a learning need. Educators will need to tackle the challenges of integrating theoretically informed and evidence based behaviour change talk within medical training

Mitochondrial Arrest on the Microtubule Highway—A Feature of Heart Failure and Diabetic Cardiomyopathy?

From Frontiers via Jisc Publications RouterHistory: collection 2021, received 2021-03-31, accepted 2021-06-08, epub 2021-07-02Publication status: PublishedA pathophysiological consequence of both type 1 and 2 diabetes is remodelling of the myocardium leading to the loss of left ventricular pump function and ultimately heart failure (HF). Abnormal cardiac bioenergetics associated with mitochondrial dysfunction occurs in the early stages of HF. Key factors influencing mitochondrial function are the shape, size and organisation of mitochondria within cardiomyocytes, with reports identifying small, fragmented mitochondria in the myocardium of diabetic patients. Cardiac mitochondria are now known to be dynamic organelles (with various functions beyond energy production); however, the mechanisms that underpin their dynamism are complex and links to motility are yet to be fully understood, particularly within the context of HF. This review will consider how the outer mitochondrial membrane protein Miro1 (Rhot1) mediates mitochondrial movement along microtubules via crosstalk with kinesin motors and explore the evidence for molecular level changes in the setting of diabetic cardiomyopathy. As HF and diabetes are recognised inflammatory conditions, with reports of enhanced activation of the NLRP3 inflammasome, we will also consider evidence linking microtubule organisation, inflammation and the association to mitochondrial motility. Diabetes is a global pandemic but with limited treatment options for diabetic cardiomyopathy, therefore we also discuss potential therapeutic approaches to target the mitochondrial-microtubule-inflammatory axis

Awareness of surgeons and surgical trainees of online web-based techniques for teaching laparoscopic surgery in north Queensland

Background: For generations, surgical training has followed the example of an apprenticeship model. However, many doctors see this training as insufficient and potentially unsafe for the patient. Web-based simulation training for teaching laparoscopic surgery is not only becoming increasingly popular but is cheaper in comparison to the traditional apprenticeship method. Objective is to assess the educational value of web-based training videos Methods: Data was obtained through questionnaires sent to consultant surgeons and surgical trainees at three sites in North Queensland. Study invited participants to complete a 24-item questionnaire on knowledge and attitudes. The questionnaires were distributed using online survey monkey software to send emails to the three Government Hospitals. Results: There was a response rate of 11.40%, Consultant surgeons (13/17; 72.20%) and surgical trainees (4/17; 22.20%). Majority of participant`s sources of learning laparoscopic surgery was from supervisors in operating theatre (64.30%) and online Web-based training video (WBTV; 7.10%), although satisfaction with current web-based training video resources was found to vary widely for a variety of reasons. WBTV were used mainly when required for clinical rotation. Conclusions: There was a response rate of 11.40%, Consultant surgeons (13/17; 72.20%) and surgical trainees (4/17; 22.20%). Majority of participant`s sources of learning laparoscopic surgery was from supervisors in operating theatre (64.30%) and online Web-based training video (WBTV; 7.10%), although satisfaction with current web-based training video resources was found to vary widely for a variety of reasons. WBTV were used mainly when required for clinical rotation

The potential of IFN-λ, IL-32γ, IL-6, and IL-22 as safeguards against human viruses: a systematic review and a meta-analysis

Many studies have investigated the antiviral activity of cytokines, including interleukin-6 (IL-6), interleukin-22 (IL-22), interleukin-32 gamma (IL-32γ), and interferon-lambda (IFN-λ) in diverse populations. This study aims to evaluate the role of these cytokines in inhibition of various human and animal viruses when administered exogenously. A comprehensive meta-analysis and systematic review were conducted on all the relevant studies from three databases. Standard mean differences (SMDs) of overall viral inhibition were used to generate the difference in the antiviral efficacy of these cytokines between control and experimental groups. A total of 4,618 abstracts for IL-6, 3,517 abstracts for IL-22, 2,160 abstracts for IL-32γ, and 1,026 abstracts for IFN-λ were identified, and 7, 4, 8, and 35 studies were included, respectively, for each cytokine. IFN-λ (SMD = 0.9540; 95% CI: 0.69–0.22) and IL-32γ (SMD = 0.459; 95% CI: 0.02–0.90) showed the highest influence followed by IL-6 (SMD = 0.456; CI: −0.04–0.95) and IL-22 (SMD = 0.244; 95% CI: −0.33–0.81). None of the cytokines represented heterogeneity (tau² > 0), but only IFN-λ indicated the funnel plot asymmetry (p = 0.0097). Results also indicated that IFN-λ and IL-32γ are more potent antivirals than IL-6 and IL-22. The collective findings of this study emphasize that exogenously administered pro-inflammatory cytokines, specifically IFN-λ and IL-32, exhibit a significant antiviral activity, thereby underscoring them as potent antiviral agents. Nonetheless, additional research is required to ascertain their clinical utility and potential for integration into combinatorial therapeutic regimens against viral infections

Subcutaneous Administration of D-Luciferin is an Effective Alternative to Intraperitoneal Injection in Bioluminescence Imaging of Xenograft Tumors in Nude Mice

Currently, intraperitoneal (IP) injection of D-luciferin is the preferred method of providing substrate for bioluminescence imaging (BLI); however it has a failure rate of 3–10% due to accidental intestinal injection. The present study evaluates the quality of BLI after subcutaneous (SC) injection of D-luciferin and demonstrates the effectiveness of SC injection in anatomically disparate tumor models. Mice bearing luciferase-expressing tumors underwent BLI after SC or IP injection of D-luciferin. The average time to maximal luminescence was 6 min (range 5–9 min) after SC injection and 8 min (range 5–8 min) after IP injection. Within 7 minutes of injection, SC and IP routes yielded similar luminescence in subcutaneous, intracranial, tongue, and lung xenograft tumor models. In a model of combined subcutaneous and intracranial xenografts, SC injection resulted in proportional luminescence at all sites, confirming that preferential delivery of substrate does not occur. While tumors were occasionally not visualized with IP injection, all tumors were visualized reliably with SC injection. Thus, SC injection of D-luciferin is a convenient and effective alternative to IP injection for BLI in nude mice. It may be a preferable approach, particularly for tumors with weaker signals and/or when greater precision is required