Is acupuncture effective in controlling gagging when taking an alginate impressions?

Our community health project aimed to (1) identify the prevalence of gagging among patients attending the Prince Philip Dental Hospital; and to identify socio-demographic variations in reported gagging experiences; and (2) perform a pilot study to evaluate the effectiveness of acupuncture in the control of gagging in the dental setting. Methods: A survey on reported gagging experiences was conducted among patients attending our hospital involving a convenience sample of 225 patients. Participants who reported to previously gag in the dental setting were invited to participate in a pilot study to evaluate the effectiveness of acupuncture in controlling gagging when taking an upper alginate impression. Participants were randomized to receive acupuncture stimulation at a site reported to be effective in the control of gagging on the lower lip (point CV 24) or at a sham site on the upper lip (point GV 26) on their first visit and at their second visit to receive the alternative acupuncture stimulation. Results: The response rate to the survey was 81.3% (183/225). Approximately a third (58/183) reported to have experienced gagging in the dental setting and most frequently encountered this when having a dental impression (among approximately a quarter of participants - 44/183). Half (95/183) reported gagging while performing oral self-care. Four in ten participants (73/183) reported some stress visiting the dentist related to gagging. Sociodemographic variations in reported gagging experiences were evident with respect to age, gender and education level. The response rate to the pilot study was 92.3% (36/39). There was no significant difference in the prevalence of gagging when acupuncture was applied to the test site compared to when acupuncture was applied to the sham site on dental examination (p>0.05) or when taking an upper alginate impression (p>0.05). Conclusions: Gagging in a relative common experience reported by patients attending our hospital – in daily life, in the dental setting and in performing oral self-care. Socio-demographic variations in the prevalence of gagging were apparent. The pilot study does not support the use of acupuncture in controlling gagging in the dental setting.published_or_final_versio

Mindfulness-based cognitive therapy v. group psychoeducation for people with generalised anxiety disorder: randomised controlled trial

Background: Research suggests that an 8-week mindfulness-based cognitive therapy (MBCT) course may be effective for generalised anxiety disorder (GAD). Aims: To compare changes in anxiety levels among participants with GAD randomly assigned to MBCT, cognitive–behavioural therapy-based psychoeducation and usual care. Method: In total, 182 participants with GAD were recruited (trial registration number: CUHK_CCT00267) and assigned to the three groups and followed for 5 months after baseline assessment with the two intervention groups followed for an additional 6 months. Primary outcomes were anxiety and worry levels. Results: Linear mixed models demonstrated significant group × time interaction (F(4,148) = 5.10, P = 0.001) effects for decreased anxiety for both the intervention groups relative to usual care. Significant group × time interaction effects were observed for worry and depressive symptoms and mental health-related quality of life for the psychoeducation group only. Conclusions: These results suggest that both of the interventions appear to be superior to usual care for the reduction of anxiety symptoms

Influência do regime alimentar sobre os parâmetros de crescimento de borregas merinas.

O presente trabalho teve por objetivo avaliar o efeito que três suplementos alimentares (alimento composto comercial (CP), farinha forrageira de milho (FM) e cladódios de Opuntia ficus-indica (OFI)) tiveram sobre os indicadores de crescimento de borregas de substituição de raça Merino Branco alimentadas com feno de consociação (F), como alimento forrageiro base em regime ad libitum controlado, assim como a ingestão de água. Os 24 animais selecionados foram organizados em grupos de 8 borregas cada um, homogéneos em relação ao peso vivo, à idade e ao ganho de peso médio diário do nascimento até ao início do ensaio. Cada grupo de 8 borregas foi organizado em quatro subgrupos de 2 borregas cada um e o controlo da ingestão alimentar foi feito para cada um destes subgrupos. Para cada tratamento avaliou-se os seguintes parâmetros de crescimento e de consumo de alimentos: peso vivo; ganho de peso diário; consumo de feno (MS); consumo de cada um dos suplementos alimentares (MS); consumo de MS/kg0,75; consumo de PB/kg0,75; consumo de EM/kg0,75; consumo de NDF/kg0,75; consumo de NFC/kg0,75; índice de conversão alimentar (kg MS/kg PVG); consumo de água; ingestão total de água. Durante os 63 dias de ensaio, verificou-se que as borregas submetidas ao regime alimentar CP+F (T1) apresentaram maior ingestão (p≤0,05) de MS, MS/kg PV0,75, C, NDF, ADF, PB, PB/kg PV0,75, GB, EM e H2O e menor ingestão (p≤0,05) de NFC e de NFC/kg PV0,75. No regime alimentar FM+F (T2), verificou-se maior ingestão (p≤0,05) de NFC/kg PV0,75 e menor ingestão (p≤0,05) de C. No regime alimentar OFI+FM+F (T3) as borregas ingeriram menos (p≤0,05) NDF, PB/kg PV0,75 e H2O. Não se encontraram diferenças estatísticas significativas entre os tratamentos T2 e T3 relativamente à ingestão média diária de MS, de EM, de PB, de NDF e de ADF (p≤0,05). O maior consumo de H2O foi apresentado no T1 (2,037 kg/dia) (p≤0,05), seguido das borregas do T2 (1,459 kg/dia). O menor consumo médio diário de H2O de bebida ocorreu nas borregas do T3 (0,277 kg/dia ±0,038) (p≤0,05), no entanto as borregas do T3 apresentaram o maior CTH2O (3,900 kg/dia) (p≤0,05). As borregas do T1 apresentaram GPD significativamente mais elevado (0,180 kg/dia ±0,009) (p≤0,05) do que as borregas do T2 e T3 (0,110 kg/dia ±0,020 e 0,131 kg/dia 0,006 respetivamente). No final do ensaio, as borregas do T3 alimentadas com OFI+FM+F apresentaram PV semelhante (29,5 kg; p≤0,05) às borregas do T2 alimentadas com FM+F (27,94 kg), porém inferiores (p≤0,05) às borregas do T1 alimentadas com CP+F (33,01 kg). Considera-se que a baixa concentração proteica dos 2 regimes alimentares OFI+FM+F (85,54 g PB/kg MS ±0,560) e FM+F (84,76 g PB/kg MS ±0,367) terá afetado o crescimento dos animais relativamente aos animais alimentados com CP+F (148,62 g PB/kg MS ±2,914).The objective of this study was to evaluate the effect of three feed supplements (commercial compound (CC), corn flour (CF) and Opuntia ficus-indica (OFI) cladodes) on the growth indicators of Merino Branco female lambs, fed as forage with hay (H) of association based on controlled ad libitum regime, as well water intake. The 24 animals selected were organized in groups of 8 lambs each, homogeneous in relation to live weight, age and average daily weight gain from birth until the beginning of the test. Each group of 8 lambs was organized in four subgroups of 2 lambs each and the food intake control was done for each of these subgroups. For each treatment the following growth and food consumption parameters were evaluated: live weight; daily weight gain; hay consumption (DM); consumption of each dietary supplements (DM); consumption of DM/kg0,75; consumption of CP/kg0,75; consumption of ME/kg0,75; consumption of NDF/kg0,75; consumption of NFC/kg0,75; feed conversion index (kg DM/kg DWG); water consumption; total water intake. During the 63 test days, it has been found that lambs submitted on the diet CC+H (T1) presented the highest intake (p≤0.05) of DM, DM/kg LW0,75, A, NDF, ADF, CP, CP/kg LW0,75, CF, ME and H2O, and the lowest intake (p≤0.05) of NFC and NFC/kg LW0,75. In the CF+H diet (T2), it was verified the highest intake (p≤0.05) of NFC/kg LW0,75 and the lowest intake (p≤0.05) of A. In the OFI+CF+H diet (T3) the lambs ingested less (p≤0.05) NDF, CP/kg LW0,75 and H2O. No statistically significant differences were found between treatments T2 and T3 in relation to the mean daily intake of DM, ME, CP, NDF and ADF (p≤0.05). The T1 showed the highest H2O intake (2.037 kg/day) (p≤0.05), followed by the lambs of T2 (1.459 kg/day). The lowest daily H2O intake occurred in the lambs of T3 (0.277 kg/day ±0.038) (p≤0.05), however the lambs of T3 showed the highest TH2OI (3.900 kg/day) (p≤0.05). The lambs of T1 presented significantly higher DWG (0.180 kg/day ±0.009) (p≤0.05) than lambs of T2 and T3 (0.110 kg/day ±0.020 and 0.131 kg/day 0.006 respectively). At the end of the test, the lambs fed with OFI+CF+H (T3) showed a LW similar (29.5 kg; p≤0.05) to the lambs fed with CF+H (T2) (27.94 kg) but lower (p≤0.05) than the animals fed with CC+H (T1) (33.01 kg). It was considered that the low protein concentration of the 2 feed treatments OFI+CF+H (85.54 g CP/kg DM ±0,560) and CF+H (84.76 g CP/kg DM ±0,367) will have affected the growth of the animals compared to animals feed with CC+H (148.62 g CP/kg DM ±2.914)

The impact of death and dying on the personhood of senior nurses at the National Cancer Centre Singapore (NCCS): a qualitative study.

BackgroundA nurse's role in caring for the dying is fraught with ethical, professional, and psychosocial challenges that impact how they perceive their roles as professionals. When unsupported, nurses caring for the dying experience burnout, career dissatisfaction and leave the profession. Better understanding of how caring for the dying affects the professional identity formation (PIF) of nurses will guide efforts to better support nurses.MethodsGuided by new data on the subject, we adopt the theoretical lens of the Ring Theory of Personhood (RToP) to evaluate how caring for the dying impacts the values, beliefs, principles, professional identities and personhood of nurses. We employ Krishna's Systematic Evidence-Based Approach (SEBA) to guide the design and piloting of the semi-structured interview tool.ResultsAnalysis of interviews with eight senior nurses in Supportive, Palliative and Oncology care revealed three domains: Identity 1) Formation; 2) Conflict and 3) Refinement. Identity Formation occurs early in a nurse's career, upon entering a new specialist field, and at the start of Supportive, Palliative and Oncology care. Identity Formation reveals significant changes to how self-concepts of professional identities are tied to individual concepts of personhood. Caring for the dying, however, resulted in Conflicts between values, beliefs, and principles within regnant concepts of personhood and their professional duties. These conflicts are captured as conflicts within ('disharmony') and/or between ('dyssynchrony') the rings of the RToP. These conflicts can result in changes to self-concepts of personhood and professional identities. Identity Refinement sees experience and timely support helping nurses attenuate the impact of difficult experiences. This reduces the risk of burnout and mitigates changes to their professional identities. Identity Refinement helps them develop a 'rooted identity' which remains relatively consistent in the face of adversity.ConclusionsOngoing Identity Construction amongst nurses, particularly in caring for the dying, underscore the host organisation's role in ensuring structured, longitudinal, accessible, and personalised assessments and support of nurses, especially when they are prone to dyssynchrony and disharmony whilst caring for the terminally ill. Further study into assessment methods and the role of the environment is critical

Mindful gratitude journaling: psychological distress, quality of life and suffering in advanced cancer: a randomised controlled trial

Context Numerous studies have shown that gratitude can reduce stress and improve quality of life. Objective Our study aimed to examine the effect of mindful gratitude journaling on suffering, psychological distress and quality of life of patients with advanced cancer. Methods We conducted a parallel-group, blinded, randomised controlled trial at the University of Malaya Medical Centre, Malaysia. Ninety-two adult patients with advanced cancer, and an overall suffering score ≥4/10 based on the Suffering Pictogram were recruited and randomly assigned to either a mindful gratitude journaling group (N=49) or a routine journaling group (N=43). Results After 1 week, there were significant reductions in the overall suffering score from the baseline in both the intervention group (mean difference in overall suffering score=−2.0, 95% CI=−2.7 to −1.4, t=−6.125, p=0.000) and the control group (mean difference in overall suffering score=−1.6, 95% CI=−2.3 to −0.8, t=−4.106, p=0.037). There were also significant improvements in the total Hospital Anxiety and Depression Scale score (mean difference=−3.4, 95% CI=−5.3 to −1.5, t=−3.525, p=0.000) and the total Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being score (mean difference=7.3, 95% CI=1.5 to 13.1, t=2.460, p=0.014) in the intervention group after 7 days, but not in the control group. Conclusion The results provide evidence that 7 days of mindful gratitude journaling could positively affect the state of suffering, psychological distress and quality of life of patients with advanced cancer

Sleep problems in children with autism spectrum disorder in Hong Kong: a cross-sectional study

BackgroundAutism spectrum disorder (ASD) is a neurodevelopmental disorder with a growing prevalence of sleep problems associated with significant behavioral problems and more severe autism clinical presentation. Little is known about the relationships between autism traits and sleep problems in Hong Kong. Therefore, this study aimed to examine whether children with autism have increased sleep problems than non-autistic children in Hong Kong. The secondary objective was to examine the factors associated with sleep problems in an autism clinical sample.MethodsThis cross-sectional study recruited 135 children with autism and 102 with the same age range of non-autistic children, aged between 6 and 12 years. Both groups were screened and compared on their sleep behaviors using the Children's Sleep Habits Questionnaire (CSHQ).ResultsChildren with autism had significantly more sleep problems than non-autistic children [t(226.73) = 6.20, p < 0.001]. Bed -sharing [beta = 0.25, t(165) = 2.75, p = 0.07] and maternal age at birth [beta = 0.15, t(165) = 2.05, p = 0.043] were significant factors associated with CSHQ score on the top of autism traits. Stepwise linear regression modeling identified that only separation anxiety disorder (beta = 4.83, t = 2.40, p = 0.019) best-predicted CSHQ.ConclusionIn summary, autistic children suffered from significantly more sleep problems and co-occurring separation anxiety disorder brings greater sleep problems as compared to non-autistic children. Clinicians should be more aware of sleep problems to provide more effective treatments to children with autism

Postgraduate ethics training programs: a systematic scoping review

BACKGROUND: Molding competent clinicians capable of applying ethics principles in their practice is a challenging task, compounded by wide variations in the teaching and assessment of ethics in the postgraduate setting. Despite these differences, ethics training programs should recognise that the transition from medical students to healthcare professionals entails a longitudinal process where ethics knowledge, skills and identity continue to build and deepen over time with clinical exposure. A systematic scoping review is proposed to analyse current postgraduate medical ethics training and assessment programs in peer-reviewed literature to guide the development of a local physician training curriculum. METHODS: With a constructivist perspective and relativist lens, this systematic scoping review on postgraduate medical ethics training and assessment will adopt the Systematic Evidence Based Approach (SEBA) to create a transparent and reproducible review. RESULTS: The first search involving the teaching of ethics yielded 7669 abstracts with 573 full text articles evaluated and 66 articles included. The second search involving the assessment of ethics identified 9919 abstracts with 333 full text articles reviewed and 29 articles included. The themes identified from the two searches were the goals and objectives, content, pedagogy, enabling and limiting factors of teaching ethics and assessment modalities used. Despite inherent disparities in ethics training programs, they provide a platform for learners to apply knowledge, translating it to skill and eventually becoming part of the identity of the learner. Illustrating the longitudinal nature of ethics training, the spiral curriculum seamlessly integrates and fortifies prevailing ethical knowledge acquired in medical school with the layering of new specialty, clinical and research specific content in professional practice. Various assessment methods are employed with special mention of portfolios as a longitudinal assessment modality that showcase the impact of ethics training on the development of professional identity formation (PIF). CONCLUSIONS: Our systematic scoping review has elicited key learning points in the teaching and assessment of ethics in the postgraduate setting. However, more research needs to be done on establishing Entrustable Professional Activities (EPA)s in ethics, with further exploration of the use of portfolios and key factors influencing its design, implementation and assessment of PIF and micro-credentialling in ethics practice. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12909-021-02644-5

Mentoring in palliative medicine in the time of covid-19: a systematic scoping review : Mentoring programs during COVID-19.

IntroductionThe redeployment of mentors and restrictions on in-person face-to-face mentoring meetings during the COVID-19 pandemic has compromised mentoring efforts in Palliative Medicine (PM). Seeking to address these gaps, we evaluate the notion of a combined novice, peer-, near-peer and e-mentoring (CNEP) and interprofessional team-based mentoring (IPT) program.MethodsA Systematic Evidence Based Approach (SEBA) guided systematic scoping review was carried out to study accounts of CNEP and IPT from articles published between 1st January 2000 and 28th February 2021. To enhance trustworthiness, concurrent thematic and content analysis of articles identified from structured database search using terms relating to interprofessional, virtual and peer or near-peer mentoring in medical education were employed to bring together the key elements within included articles.ResultsFifteen thousand one hundred twenty one abstracts were reviewed, 557 full text articles were evaluated, and 92 articles were included. Four themes and categories were identified and combined using the SEBA's Jigsaw and Funnelling Process to reveal 4 domains - characteristics, mentoring stages, assessment methods, and host organizations. These domains suggest that CNEP's structured virtual and near-peer mentoring process complement IPT's accessible and non-hierarchical approach under the oversight of the host organizations to create a robust mentoring program.ConclusionThis systematic scoping review forwards an evidence-based framework to guide a CNEP-IPT program. At the same time, more research into the training and assessment methods of mentors, near peers and mentees, the dynamics of mentoring interactions and the longitudinal support of the mentoring relationships and programs should be carried out