Інтеграція клінічних випадків у медичну навчальну програму з метою набуття комплексних практичних навичок на прикладі фетального алкогольного синдрому

In the article, on an example of a topic that deals with fetal alcohol syndrome, the relationship between the study of basic neuroscience and clinical practice is described. To this end, the Center for Disease Control and Prevention, together with the National Alcohol Fetopathy Organization, as well as the Los Angeles West Regional Center for Personnel Training on the Impact of Alcohol on Fruit, developed and proposed integrating materials related to Fetal Alcohol Syndrome, to the curriculum of the students of the first year of medical university. Results Quantitative and qualitative assessment of the results showed the effectiveness of studying materials, which affected the level of knowledge and mastery of practical skills, which concerned not only the actual alcoholic fetopathy, but also embryology, neurogenesis, developmental psychopathology and medical ethics. Conclusion. Creating comprehensive topics that combine basic theoretical knowledge with clinical knowledge and skills is an effective method for quality training of students from medical universities in the field of prevention and treatment of the most common health problems.У статті на прикладі теми, яка присвячена фетальному алкогольному синдрому, описується зв’язок вивчення базових нейронаук із клінічною практикою. З цією метою Центр контролю та профілактики захворювань разом із Національною організацією з питань алкогольної фетопатії, а також Лос-Анджелеський західний регіональний центр підготовки кадрів по впливу алкоголю на плід розробили та запропонували інтегрувати матеріали, що стосуються фетального алкогольного синдрому, до навчального плану студентів першого курсу медичного університету. Результати. Кількісна та якісна оцінка отриманих результатів свідчила про ефективність вивчення матеріалів, що позначалася на підвищенні рівня знань та оволодінні практичними навичками, які стосувались не лише власне алкогольної фетопатії, а також ембріології, нейрогенезу, психопатології розвитку та медичної етики. Висновок. Створення комплексних тем, що поєднують у собі базові теоретичні знання із клінічними відомостями та навичками, є ефективним методом на шляху до якісної підготовки студентів медичних університетів у галузі профілактики та лікування найбільш поширених проблем у сфері охорони здоров’я

Correction for heart rate variability during 3D whole heart MR coronary angiography.

PURPOSE: To evaluate the effect of a real-time adaptive trigger delay on image quality to correct for heart rate variability in 3D whole-heart coronary MR angiography (MRA). MATERIALS AND METHODS: Twelve healthy adults underwent 3D whole-heart coronary MRA with and without the use of an adaptive trigger delay. The moment of minimal coronary artery motion was visually determined on a high temporal resolution MRI. Throughout the scan performed without adaptive trigger delay, trigger delay was kept constant, whereas during the scan performed with adaptive trigger delay, trigger delay was continuously updated after each RR-interval using physiological modeling. Signal-to-noise, contrast-to-noise, vessel length, vessel sharpness, and subjective image quality were compared in a blinded manner. RESULTS: Vessel sharpness improved significantly for the middle segment of the right coronary artery (RCA) with the use of the adaptive trigger delay (52.3 +/- 7.1% versus 48.9 +/- 7.9%, P = 0.026). Subjective image quality was significantly better in the middle segments of the RCA and left anterior descending artery (LAD) when the scan was performed with adaptive trigger delay compared to constant trigger delay. CONCLUSION: Our results demonstrate that the use of an adaptive trigger delay to correct for heart rate variability improves image quality mainly in the middle segments of the RCA and LAD

Effect of thyroid hormone therapy on fatigability in older adults with subclinical hypothyroidism: a nested study within a randomized placebo-controlled trial

Background: Fatigue often triggers screening for and treatment of subclinical hypothyroidism. However, data on the impact of levothyroxine on fatigue is limited and previous studies might not have captured all aspects of fatigue.Method: This study is nested within the randomized, placebo-controlled, multicenter TRUST trial, including community-dwelling participants aged >= 65 and older, with persistent subclinical hypothyroidism (TSH 4.60-19.99 mIU/L, normal free thyroxine levels) from Switzerland and Ireland. Interventions consisted of daily levothyroxine starting with 50 mu g (25 mu g if weight = 15 points for the physical score [n = 88] or >= 13 points for the mental score [n = 41]), the adjusted between-group differences at 1 year were 0.4 (95% CI -3.6 to 2.8, p = .79) and -2.2 (95% CI -8.8 to 4.5, p = .51).Conclusions: Levothyroxine in older adults with mild subclinical hypothyroidism provides no change in physical or mental fatigability

Thyroid antibodies and levothyroxine effects in subclinical hypothyroidism: A pooled analysis of two randomized controlled trials

Background Antithyroid antibodies increase the likelihood of developing overt hypothyroidism, but their clinical utility remains unclear. No large randomized controlled trial (RCT) has assessed whether older adults with subclinical hypothyroidism (SHypo) caused by autoimmune thyroid disease derive more benefits from levothyroxine treatment (LT4). Objective To determine whether older adults with SHypo and positive antibodies derive more clinical benefits from LT4 than those with negative antibodies. Methods We pooled individual participant data from two RCTs, Thyroid Hormone Replacement for Untreated Older Adults with Subclinical Hypothyroidism and IEMO 80+. Participants with persistent SHypo were randomly assigned to receive LT4 or placebo. We compared the effects of LT4 versus placebo in participants with and without anti-thyroid peroxidase (TPO) at baseline. The two primary outcomes were 1-year change in Hypothyroid Symptoms and Tiredness scores on the Thyroid-Related Quality-of-Life Patient-Reported Outcome Questionnaire. Results Among 660 participants (54% women) >= 65 years, 188 (28.5%) had positive anti-TPO. LT4 versus placebo on Hypothyroid Symptoms lead to an adjusted between-group difference of -2.07 (95% confidence interval: -6.04 to 1.90) for positive antibodies versus 0.89 (-1.76 to 3.54) for negative antibodies (p for interaction = 0.31). Similarly, there was no treatment effect modification by baseline antibody status for Tiredness scores-adjusted between-group difference 1.75 (-3.60 to 7.09) for positive antibodies versus 1.14 (-1.90 to 4.19) for negative antibodies (p for interaction = 0.98). Positive anti-TPO were not associated with better quality of life, improvement in handgrip strength, or fewer cardiovascular outcomes with levothyroxine treatment. Conclusions Among older adults with SHypo, positive antithyroid antibodies are not associated with more benefits on clinical outcomes with LT4.Pathophysiology, epidemiology and therapy of agein