The eQuality Toolkit: Practical Skills for LGBTQ and DSD-Affected Patient Care

The eQuality Toolkit is a training manual that helps healthcare providers build a foundation of inclusive clinical skills to competently care for lesbian, gay, bisexual, transgender, and queer-identified (LGBTQ) patients and individuals born with differences of sex development (DSD). Although this toolkit was designed for medical students, any healthcare provider who wants to learn inclusive clinical skills can benefit from this accessible, brief primer through its actionable steps to improve clinical care.https://ir.library.louisville.edu/medicine_ume/1000/thumbnail.jp

Recent scientific advances in leiomyoma (uterine fibroids) research facilitates better understanding and management [v1; ref status: indexed, http://f1000r.es/54a]

Uterine leiomyomas (fibroids) are the most prevalent medical problem of the female reproductive tract, but there are few non-surgical treatment options. Although many advances in the understanding of the molecular components of these tumors have occurred over the past five years, an effective pharmaceutical approach remains elusive. Further, there is currently no clinical method to distinguish a benign uterine leiomyoma from a malignant leiomyosarcoma prior to treatment, a pressing need given concerns about the use of the power morcellator for minimally invasive surgery. This paper reviews current studies regarding the molecular biology of uterine fibroids, discusses non-surgical approaches and suggests new cutting-edge therapeutic and diagnostic approaches

Strategies to Combat Burnout During Intense Studying: Utilization of Medical Student Feedback to Alleviate Burnout in Preparation for a High Stakes Examination

Purpose: The purpose of this study was to understand medical students’ levels of burnout symptoms and their strategies to combat burnout during the United States Medical Licensure Examination (USMLE) Step 1 study period. Methods: We administered a survey to three cohorts of medical students after they had taken the Step 1 examination. We gauged their perceptions on what worked well while studying including any insight into strategies to alleviate burnout. We used a qualitative approach to describe their experiences. Results: Out of the 477 students surveyed, 370 responded (RR = 77.6%), and we developed 12 key strategies to alleviate burnout during an intense study period: exercise, take days off, limit study hours per day, take breaks, develop support system, dedicate time for fun, eat well, minimize distractors, sleep well, study with others, identify suitable study space(s), and recognize feelings of burnout are normal. We provide further insight into each of these strategies. Discussion: By using these strategies, medical students can minimize levels of burnout and maintain wellness throughout the study period. We believe these strategies could be used not only for medical students, but also in the context of any intensive examination preparation period or for a major research paper such as a dissertation. Research has shown that burnout is real and we as researchers and educators must continue to develop strategies to combat it

Neuroinflammation and pain

ABSTRACT Background: Persistent pain that remains long after the physiological trigger has been resolved is a disabling condition. A possible mechanism for the transition from acute physiological pain to persistent pain involves low-grade inflammation in the central nervous system, in which inflammatory-activated astrocytes play a significant role. Aims: The aims of this thesis were to explore novel means for the restoration of inflammatory-activated astrocytes and to investigate whether such experimentally obtained findings, when translated into a clinical setting, are associated with improved pain relief in patients with persistent pain. Methods: For the experimental studies in cell cultures, Ca2+ imaging, Western blot analysis, immunocytochemistry, and enzyme-linked immunosorbent assay (ELISA) were performed. In the clinical study, patients were treated with continuous intrathecal infusions of morphine in combination with naloxone or a placebo. Results: Inflammatory-activated astrocytes were restored to their normal state and function using a combination of the μ-opioid agonist endomorphin-1, ultralow doses of naloxone, and the antiepileptic drug levetiracetam. For patients with persistent pain who were treated with an ongoing intrathecal morphine infusion, the addition of an ultralow dose of naloxone significantly improved their perceived quality of sleep. Conclusion: We demonstrated that astrocyte dysfunction, which occurs as a component of low-grade neuroinflammation during prolonged pain states, is experimentally restorable by the combined actions of morphine, naloxone, and levetiracetam. To achieve this response, the choice of an ultralow dose of naloxone seems to be particularly crucial. Additionally, our findings in patients with difficult-to-treat pain show that intrathecal administration of an ultralow dose of naloxone in combination with morphine significantly improves perceived quality of sleep, although concurrent alterations in pain relief were not statistically significant. The concept of targeting inflammatory-activated astrocytes to reduce the development of persistent pain is a promising path that merits further evaluation in clinical settings. Keywords: Persistent pain, neuroinflammation, astrocytes, morphine, naloxon