The great arteries in normal and some congenitally malformed hearts their internal calibres and tunica media in relation to blood flow

The road from fertilized egg to newborn baby is a fascinating and complicated one. What happens to eggs that actually come in contact with spenns has been stuclied by many authors and has been summarized by Witschi in 1969. About 16% of the eggs do not cleave, either because they are not penetrated by sperms or because the mitotic mechanism does not function. Another 15% are lost during the first week, at various preimplantation stages ( cleavage and blastocyst stages ). The stage of early implantation and development during the second week brings a further lossof 27%. In the third to sixth week there is a loss of 8% and the late abortion loss is about 3%. Live births will then amount to only 31%. It has been shown that 1-12% of all these newborn children carry some major congenital malformation recognizable at or shortly after birth ( Yerushalmy, 1969; Lilienfeld, 1969 ), Reports of congenital malformations show congenital heart malformations in about 0.8% of total births ( Kerrebijn, 1964; Hoffman and Christianson, 1978 ). In the Netherlands with 177.090 newborns in 1976 this will be about 1400 per year of which 123 were surgically corrected and 416 died in the first year of life ( Centraal Bureau voor Statistiek, 1976, 1978 ). The majority of congenital he'art malfonnations are of rmknown etiology and are believed to be the result of the interaction of environmental and genetic influences ( Nora, 1968 ). The risk for recurrence of the same lesion in cases with an affected parent or sibling is small but exceeds the expectation risk for the same lesion in the general population. Vertical transmission of atrial septal defects through four generations has been described (Lynch et al., 1978 ) . These children bom with congenital heart malfonnations are of special interest to the paediatric cardiologist and cardiovascular surgeon

Exploring the dynamic interconnectedness of protective and perpetuating factors of cancer‐related fatigue

ObjectiveApproximately 25% of cancer patients suffer from cancer-related fatigue (CRF) after cancer treatment. CRF is a multi-factorial condition affected by several interrelated protective and perpetuating factors. As most studies merely assessed bivariate associations, more insight into the complex relationships among these constructs is needed. We applied the multivariate network approach to gain a better understanding of how patients' fatigue, perpetuating and protective factors are dynamically interconnected.MethodBetween February and August 2022, 30 cancer patients filled out a carefully developed ecological momentary assessment questionnaire (EnergyInSight) five times a day for at least 21 days while being on the waitlist for psychological care for CRF. We performed a multi-level vector autoregression analysis to examine the interconnectedness among fatigue, protective factors (allowing rest, acceptance, and self-efficacy) and perpetuating factors (worrying, catastrophizing, and feeling guilty).ResultsIn the contemporaneous network (concurrent associations), higher acceptance and self-efficacy were associated with lower fatigue, whereas all other factors were associated with higher fatigue. The strongest relationships were between worrying and feeling guilty and between acceptance and allowing rest. In the temporal network (lagged associations), fatigue was related to two factors: higher self-efficacy preceded lower fatigue, and higher fatigue preceded increased allowing rest.ConclusionsTaking all included factors into account, the networks identified self-efficacy and allowing rest as key protective factors of CRF. Patients may benefit from psychological interventions that cultivate self-efficacy, as it seems to pave the way to reduced fatigue.<br/

Therapist behaviours in a web-based mindfulness-based cognitive therapy (eMBCT) for chronic cancer-related fatigue:Analyses of e-mail correspondence

Web-based mindfulness-based cognitive therapy (eMBCT) has been found effective in decreasing fatigue severity in patients suffering from Chronic Cancer-Related Fatigue (CCRF). In web-based therapy, guidance from a therapist positively affects treatment outcome. So far, less is known about what kind of therapist behaviours contribute to treatment outcome. The present study aimed at 1) identifying therapist behaviours during eMBCT and 2) exploring whether these behaviours were correlated to a decrease in fatigue severity among patients. Qualitative content analyses were performed on 537 feedback e-mails from five therapists sent to 31 patients within a secured portal. Through content analyses, nine therapist behaviours were identified: emphatic utterances, probing self-reflection, informing, psychoeducation, task prompting, paraphrasing, task reinforcement, providing group context and alliance bolstering. Among these behaviours task prompting (19%), paraphrasing (16%) and task reinforcement (15%) were the most common. Linear regression analyses showed a significant association between informing and task prompting on the one hand and a decrease in fatigue severity on the other. Multivariate analysis indicated that informing and task prompting jointly explain the decrease in fatigue. These findings underline the importance for therapists to provide patients with sufficient information and to encourage them to do the exercises

Personalizing psychological care for chronic cancer-related fatigue:A case study on symptom dynamics

Approximately 25% of cancer patients suffer from chronic cancer-related fatigue (CCRF), which is a complex, multifactorial condition. While there are evidence-based interventions, it remains unclear what treatment works best for the individual patient. Psychological network models can offer a schematic representation of interrelations among fatigue and protective and perpetuating factors for the individual patient. We explored whether feedback based on these individual fatigue networks can help personalize psychological care for CCRF. A 34-year old woman with CCRF was referred to our mental healthcare institute for psycho-oncology. During the waitlist period, she filled out an experience sampling app for 101 days, including five daily assessments of fatigue, pain, mood, activity and fatigue coping. The interplay between items was visualized in network graphs at the moment-level and day-level, which were discussed with the patient. For example, acceptance of fatigue in the past three hours was associated with less hopelessness and less fatigue in the following moment. At the day-level, acceptance was also being associated with less fatigue, less hopelessness, a better mood, and more motivation to do things. The patient recognized these patterns and explained how unexpected waves of fatigue can make her feel hopeless. This started a dialogue on how cultivating acceptance could potentially help her handle the fatigue. The patient would discuss this with her therapist. Feedback based on individual fatigue networks can provide direct insight into how one copes with CCRF and subsequently offer directions for treatment. Further research is needed in order to implement this in clinical practice

Exploring power dynamics and their impact on intraprofessional learning

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Using smartphone-based ecological momentary assessment and personalized feedback for patients with chronic cancer-related fatigue:A proof-of-concept study

Introduction Chronic cancer-related fatigue (CCRF) is a complex multidimensional problem warranting person-centered care. Providing patients and therapists personalized feedback based on network analysis applied to ecological momentary assessment (EMA) data could facilitate case conceptualization in psycho-oncological care. The aim was to explore patients' and therapists' experiences of using an EMA app and personalized feedback based on network theory to aid case conceptualization in psycho-oncological care. Methods A n = 5 proof-of-concept study was implemented in routine psycho-oncological care. We purposively selected adult cancer patients suffering from severe CCRF who were on the waitlist for psycho-oncological care. During a 3-week period participants filled out the EMA app Energy InSight (fatigue, mood, activity, responding, and context) five times a day. Participants received a descriptive and network feedback report, which they reflected upon during the first therapy sessions. Thematic analysis was used to analyze user experiences. Results Patients experienced that filling out the Energy InSight app, as well as receiving descriptive and network-based personalized feedback provided them with insight into their CCRF. Although therapists experienced the discussion of network feedback as challenging, it facilitated the case conceptualization. Discussion Using EMA during waitlist for psychological care seemed feasible. Patients experienced beneficial effects from filling out the EMA app and talking over the personalized feedback reports, which in turn aided case conceptualization and personalized care. Based on this evaluation, an improved version of the Energy InSight app and a therapist training for providing network feedback is developed for implementation in psycho-oncological care

How to encourage a lifelong learner? The complex relation between learning strategies and assessment in a medical curriculum

To foster lifelong learning skills, we need new didactic approaches with aligned assessment methods. Therefore, we investigated whether the outcomes of a project assignment show a different relation to learning strategies than a longitudinal knowledge-based assessment. We studied learning strategies of first year students of medicine and biomedical sciences (n = 248) and performed hierarchical regression analyses for the learning strategies and grades of the longitudinal knowledge-based test and project assignment. Scores of students, measured with the Motivated Strategies for Learning Questionnaire (Likert scale 1-7), were relatively low for critical thinking (3.53), compared to rehearsal (4.40), elaboration (4.82), organisation (4.69) and metacognitive self-regulation (4.33). Knowledge based tests showed a significant relation to elaboration (p <0.01). For the project-based assessment, we did not find a significant relation to any learning strategy (p = 0.074). Explained variance of the grades was low for all learning strategies (R-2 <0.043). Different types of assessment did not discriminate between students with high or low scores on learning strategies associated with lifelong learning. An explanation is that the curriculum is not aligned with assessment, or students do not benefit in terms of grades. We conclude that, if assessment is to drive lifelong learning skills, this is not self-evident