Creating space for Indigenous healing practices in patient care plans

Background: The Truth and Reconciliation Commission of Canada’s Calls to Action ask that those who can effect change within the Canadian healthcare system recognize the value of Indigenous healing practices and support them in the treatment of Indigenous patients. Methods: We distributed a survey to the Canadian Rheumatology Association membership to assess awareness of Indigenous healing practices, and attitudes informing their acceptance in patient care plans. Results: We received responses from 77/514 members (15%), with most (73%) being unclear or unaware of what Indigenous healing practices were. Nearly all (93%) expressed interest in the concept of creating space for Indigenous healing practices in rheumatology care plans. The majority of support was for the use in preventive or symptom management strategies, and less as adjuncts to disease activity control. Themes identified through qualitative analysis of free-text responses included a desire for patient-centered care and support for reconciliation in medicine, but with a colonial construct of medicine, demonstration of an evidence bias, and hierarchy of medicines. Conclusions: Overall, respondents were open to the idea of inclusion of Indigenous healing practices in patient’s car plans, emphasizing importance for patient empowerment and patient-centered care. However, they cited concerns that provide the indication for further learning and reconciliation in medicine

Methods for assessment of patient adherence to removable orthoses used after surgery or trauma to the appendicular skeleton:a systematic review

Background:&nbsp;Patient adherence to treatment is a key determinant of outcome for healthcare interventions. Whilst non-adherence has been well evidenced in settings such as drug therapy, information regarding patient adherence to orthoses, particularly in the acute setting, is lacking. The aim of this systematic review was to identify, summarise, and critically appraise reported methods for assessing adherence to removable orthoses in adults following acute injury or surgery. Methods:&nbsp;Comprehensive searches of the Ovid versions of MEDLINE, Embase, AMED, CINAHL, Central, the Cochrane Database of Systematic Reviews, and SPORTDiscus identified complete papers published in English between 1990 and September 2018 reporting measurement of adherence to orthoses in adults following surgery or trauma to the appendicular skeleton. Only primary studies with reference to adherence in the title/abstract were included to maintain the focus of the review. Data extraction included study design, sample size, study population, orthosis studied, and instructions for use. Details of methods for assessing adherence were extracted, including instrument/method used, frequency of completion, number of items (if applicable), and score (if any) used to evaluate adherence overall. Validity and reliability of identified methods were assessed together with any conclusions drawn between adherence and outcomes in the study. Results:&nbsp;Seventeen papers (5 randomised trials, 10 cohort studies, and 2 case series) were included covering upper (n&nbsp;=&thinsp;13) and lower (n&nbsp;=&thinsp;4) limb conditions. A variety of methods for assessing adherence were identified, including questionnaires (n&nbsp;=&thinsp;10) with single (n&nbsp;=&thinsp;3) or multiple items (n&nbsp;=&thinsp;7), home diaries (n&nbsp;=&thinsp;4), and discussions with the patient (n&nbsp;=&thinsp;3). There was no consistency in the target behaviour assessed or in the timing or frequency of assessment or the scoring systems used. None of the measures was validated for use in the target population. Conclusions:&nbsp;Measurement and reporting of adherence to orthosis use is currently inconsistent. Further research is required to develop a measurement tool that provides a rigorous and reproducible assessment of adherence in this acute population. Trial registration:&nbsp;PROSPERO:&nbsp;CRD42016048462. Registered on 17/10/2016.</p

Chemistry and the Science of Transformation in Mary Shelley’s Frankenstein

This essay reads the novel in a new way, examining the way that Victor Frankenstein's chemical education (he does not train to be a doctor!) enables his creation of the monster. It reveals that chemists of the period had a different worldview to others where they saw the world in constant transformation and flux. I have written this essay co-written the introduction to the special issue, and co-edited the whole

Self-management and HeAlth Promotion in Early-stage dementia with e-learning for carers (SHAPE): Study protocol for a multi-centre randomised controlled trial

Background: With an increasing number of people with dementia worldwide and limited advancement in medical treatments, the call for new and cost-effective approaches is crucial. The utility of self-management has been proven in certain chronic conditions. However, very little work has been undertaken regarding self-management in people with dementia. Methods: The SHAPE trial will include 372 people with mild to moderate dementia to evaluate the effectiveness and cost-effectiveness of an educational programme combining approaches of self-management, health promotion, and e-learning for care partners. The study is a multi-site, single-randomised, controlled, single-blinded trial with parallel arms. The intervention arm is compared with treatment as usual. The intervention comprises a 10-week course delivered as group sessions for the participants with dementia. The sessions are designed to develop self-management skills and to provide information on the nature of the condition and the development of healthy behaviours in a supportive learning environment. An e-learning course will be provided for care partners which covers similar and complementary material to that discussed in the group sessions for the participant with dementia. Discussion: This trial will explore the effect of the SHAPE group intervention on people with mild to moderate dementia in terms of self-efficacy and improvement in key health and mental health outcomes and cost-effectiveness, along with carer stress and knowledge of dementia. Trial registration: ClinicalTrials.gov Identifier: NCT04286139, registered prospectively February 26, 2020, https://clinicaltrials.gov/ct2/show/NCT0428613

Implications of direct-to-consumer whole-exome sequencing in South Africa

This editorial examines a number of vitally important ethical, legal and scientific concerns that have to be addressed to ensure proper and ethical implementation of direct-to-consumer whole-exome sequencing in South Africa. Individuals taking part in this endeavour must be fully informed of the positive and negative sequelae

Duchamp's Erotic Stereoscopic Exercises

This article explores certain links between medicine and art, with regard to their use of stereoscopy. I highlight a work by the artist Marcel Duchamp (the ready-made Stéréoscopie a la Main) and stereoscopic cards used in ophthalmic medicine. Both instances involve the drawing of graphic marks over previously existing stereoscopic cards. This similarity between Stéréoscopie a la Main and stereoscopic cards is echoed in the form of "stereoscopic exercises." Stereoscopic exercises were prescribed by doctors to be performed with the stereoscope as early as 1864. Stereoscopic cards were widely diffused in the 19th century, often promoted as "stay-at-home travel." It was over such kinds of materials that both Marcel Duchamp and doctors of ophthalmic medicine drew their graphic marks. I explore Duchamp's Stéréoscopie a la Main as a hypothetical basis for stereoscopic exercises of different types, proposing that this rectified ready-made is the locus for erotic stereoscopic exercises.Este artigo busca explorar certos elos entre a medicina e a arte por meio da estereoscopia. Destaca-se uma obra do artista Marcel Duchamp (o ready-made Stéréoscopie a la Main) e cartões estereoscópicos usados na oftalmologia. As duas instâncias envolvem o desenho de marcas gráficas sobre cartões estereoscópicos pré-existentes. A similaridade entre Stéréoscopie a la Main e os ditos cartões ecoa também na forma dos exercícios estereoscópicos. O cartão estereoscópico foi amplamente difundido na segunda metade do séc. XIX, frequentemente na forma da "viagem sem sair de casa." Foi sobre esse tipo de material que tanto médicos quanto Marcel Duchamp desenharam suas marcas. Explora-se a obra Stéréoscopie a la Main como um sítio hipotético para uma espécie de exercício, propondo que tal ready-made retificado seja um lugar para exercícios estereoscópicos eróticos

BRCA2 polymorphic stop codon K3326X and the risk of breast, prostate, and ovarian cancers

Background: The K3326X variant in BRCA2 (BRCA2*c.9976A&gt;T; p.Lys3326*; rs11571833) has been found to be associated with small increased risks of breast cancer. However, it is not clear to what extent linkage disequilibrium with fully pathogenic mutations might account for this association. There is scant information about the effect of K3326X in other hormone-related cancers. Methods: Using weighted logistic regression, we analyzed data from the large iCOGS study including 76 637 cancer case patients and 83 796 control patients to estimate odds ratios (ORw) and 95% confidence intervals (CIs) for K3326X variant carriers in relation to breast, ovarian, and prostate cancer risks, with weights defined as probability of not having a pathogenic BRCA2 variant. Using Cox proportional hazards modeling, we also examined the associations of K3326X with breast and ovarian cancer risks among 7183 BRCA1 variant carriers. All statistical tests were two-sided. Results: The K3326X variant was associated with breast (ORw = 1.28, 95% CI = 1.17 to 1.40, P = 5.9x10- 6) and invasive ovarian cancer (ORw = 1.26, 95% CI = 1.10 to 1.43, P = 3.8x10-3). These associations were stronger for serous ovarian cancer and for estrogen receptor–negative breast cancer (ORw = 1.46, 95% CI = 1.2 to 1.70, P = 3.4x10-5 and ORw = 1.50, 95% CI = 1.28 to 1.76, P = 4.1x10-5, respectively). For BRCA1 mutation carriers, there was a statistically significant inverse association of the K3326X variant with risk of ovarian cancer (HR = 0.43, 95% CI = 0.22 to 0.84, P = .013) but no association with breast cancer. No association with prostate cancer was observed. Conclusions: Our study provides evidence that the K3326X variant is associated with risk of developing breast and ovarian cancers independent of other pathogenic variants in BRCA2. Further studies are needed to determine the biological mechanism of action responsible for these associations