REFLECTING ON THE HUMANITIES, RELATED TO EXPERIENCES OF ILLNESS, WITH A CREATIVE EXPLORATION OF METAPHORIC SPACES

Every patient has a story to tell, and every experienced physician has a bank of stories to recall. A patient’s visit is not chance but a search for a cure, amelioration of state, advice, guidance, a prescription, or for seeking reassurance, comfort, and in some circumstances, permission to "be well". From the simplest tale to the most complex, narratives abound. Sometimes, the most intimate information shared with the physician confidante, go dark and deep, with a yearning to "tell all" after a period of suppression. Successful communication and rapport also depends on the carer\u27s response, the degree of concentration, listening skills, body language, eye contact engagement, the patient relationship and empathy. How do we as physicians cope with emotion on both sides when it comes to listening to a narrated story, keeping matters in perspective, recognizing the effects of depression, grieving, anger, forgiveness, or the strength of the patient to be able to face their demons when cowardly acts of abuse have been committed. The professionalism of doctors should always be at the highest level, but individuals vary in their responses. A price may be paid with arising stress, unsolved patient problems, an increase in new ones, and the general challenge of coping. Time may not be the only enemy with modern day medical practice. Does narrative medicine have a place in reducing this dissonance, and will learning to share stories, as well as being a good listener, limit adverse outcomes

Sudden Cardiac Arrest in Football

Background: Sudden Cardiac Arrest (SCA) is defined as the abrupt loss of heart function as an occurrence without physical contact (absent commotio cordis). SCA's morbidity ratio is 1:50,000 of all deaths. The published estimates on SCA suggest that 11% of all victims have a normal heart. Current screening investigations include electrocardiography (ECG), echography, 24-hour ECG monitoring, eliciting stress history, and cardiac Magnetic Resonance Imaging. Some cardiac pathologies screened have never been detected. Athletes who experienced SCA had a survival rate of 50-60% over 30-days, and this rate might reach up to 80-89% in some cohort studies. The survival factors are based on regular and thorough screening checks, and better observation that enables quicker pickups. Players vary in cardiopulmonary resuscitation (CPR) performance and are emotionally involved, as was reported recently with footballer Christian Eriksen in the 2021 European Championship 1 . However, anyone trained in CPR, not just medical professionals, can assist in resuscitation (Figure 1). Evidence-based studies show that Basic Cardiac Life Support (BCLS) is more effective on the sports field than Advanced Cardiac Life Support 2 . The objective of this literature review is to make recommendations to effectively respond to SCA during football tournaments. Methods: PubMed database was used to retrieve articles published in English between 2018 and 2021 related to SCA during football games. Results: There are limited publications in this specific domain. Reports from 67 countries account for 617 players (mean age 34 ± 16 years, 96% men) suffering from SCA or traumatic sudden death during football activities between 2014 - 2018, of whom 142 players (23%) survived 1 . CPR resulted in a survival rate of 85% with the use of an automated external defibrillator (AED) compared to 35% without. Conclusion: Key recommendations from this literature review are listed in Table 1. These are important steps needed to improve survival chance from SCA 3 . Qatar, hosting the Football World Cup 2022, can put in place additional measures to promote effective SCA resuscitation and ensure the safety of all players

Core Interprofessional Education (IPE) health competencies: The process of adaptation and implementation for a local environment

IPE: Interprofessional Healthcare Education (IPE) competencies provide the criteria against which to measure the capacity and capability of fully collaborative healthcare teams to learn and work together. Significant work already exists in the determination of IPE competencies across all disciplines. Although there is still a lack of agreement on a single set of shared core competencies, successive competency iterations enhance its development. IPE competencies need to take into account local and cultural contexts as recommended by WHO, (2010). Here we present a collaborative process that builds on existing competency development, assessing additional academic IPE needs. Core competencies: After the development of a set of shared core IPE competencies a two-day workshop was delivered to healthcare students from four professions. The results and feedback from students showed the value of the competencies. We discuss the evolving process through two major stages: (1) development of a model determining four ..

Thrombospondin 1 is a key mediator of transforming growth factor β-mediated cell contractility in systemic sclerosis via a mitogen-activated protein kinase kinase (MEK)/extracellular signal-regulated kinase (ERK)-dependent mechanism

BACKGROUND: The mechanism underlying the ability of fibroblasts to contract a collagen gel matrix is largely unknown. Fibroblasts from scarred (lesional) areas of patients with the fibrotic disease scleroderma show enhanced ability to contract collagen relative to healthy fibroblasts. Thrombospondin 1 (TSP1), an activator of latent transforming growth factor (TGF)β, is overexpressed by scleroderma fibroblasts. In this report we investigate whether activation of latent TGFβ by TSP1 plays a key role in matrix contraction by normal and scleroderma fibroblasts. METHODS: We use the fibroblast populated collagen lattices (FPCL) model of matrix contraction to show that interfering with TSP1/TGFβ binding and knockdown of TSP1 expression suppressed the contractile ability of normal and scleroderma fibroblasts basally and in response to TGFβ. Previously, we have shown that ras/mitogen-activated protein kinase kinase (MEK)/extracellular signal-regulated kinase (ERK) mediates matrix contraction basally and in response to TGFβ. RESULTS: During mechanical stimulation in the FPCL system, using a multistation tensioning-culture force monitor (mst-CFM), TSP1 expression and p-ERK activation in fibroblasts are enhanced. Inhibiting TSP1 activity reduced the elevated activation of MEK/ERK and expression of key fibrogenic proteins. TSP1 also blocked platelet-derived growth factor (PDGF)-induced contractile activity and MEK/ERK activation. CONCLUSIONS: TSP1 is a key mediator of matrix contraction of normal and systemic sclerosis fibroblasts, via MEK/ERK

Feasibility of a multicentre, randomised controlled trial of laparoscopic versus open colorectal surgery in the acute setting: the LaCeS feasibility trial protocol.

Introduction Acute colorectal surgery forms a significant proportion of emergency admissions within the National Health Service. There is limited evidence to suggest minimally invasive surgery may be associated with improved clinical outcomes in this cohort of patients. Consequently, there is a need to assess the clinical effectiveness and cost-effectiveness of laparoscopic surgery in the acute colorectal setting. However,emergency colorectal surgical trials have previously been difficult to conduct due to issues surrounding recruitment and equipoise. The LaCeS (randomised controlled trial of Laparoscopic versus open Colorectal Surgery in the acute setting) feasibility trial will determine the feasibility of conducting a definitive, phase III trial of laparoscopic versus open acute colorectal resection. Methods and analysis The LaCeS feasibility trial is a prospective, multicentre, single-blinded, parallel group, pragmatic randomised controlled feasibility trial. Patients will be randomised on a 1:1 basis to receive either laparoscopic or open surgery. The trial aims to recruit at least 66 patients from five acute general surgical units across the UK. Patients over the age of 18 with a diagnosis of acute colorectal pathology requiring resection on clinical and radiological/endoscopic investigations, with a National Confidential Enquiry into Patient Outcome and Death classification of urgent will be considered eligible for participation. The primary outcome is recruitment. Secondary outcomes include assessing the safety profile of laparoscopic surgery using intraoperative and postoperative complication rates, conversion rates and patient-safety indicators as surrogate markers. Clinical and patient-reported outcomes will also be reported. The trial will contain an embedded qualitative study to assess clinician and patient acceptability of trial processes. Ethics and dissemination The LaCeS feasibility trial is approved by the Yorkshire and The Humber, Bradford Leeds Research Ethics Committee (REC reference: 15/ YH/0542). The results from the trial will be presented at national and international colorectal conferences and will be submitted for publication to peer-reviewed journals. Trial registration number ISRCTN15681041; Pre-results

Core Interprofessional Education (IPE) health competencies: The process of adaptation and implementation for a local environment

IPE: Interprofessional Healthcare Education (IPE) competencies provide the criteria against which to measure the capacity and capability of fully collaborative healthcare teams to learn and work together. Significant work already exists in the determination of IPE competencies across all disciplines. Although there is still a lack of agreement on a single set of shared core competencies, successive competency iterations enhance its development. IPE competencies need to take into account local and cultural contexts as recommended by WHO, (2010). Here we present a collaborative process that builds on existing competency development, assessing additional academic IPE needs. Core competencies: After the development of a set of shared core IPE competencies a two-day workshop was delivered to healthcare students from four professions. The results and feedback from students showed the value of the competencies. We discuss the evolving process through two major stages: (1) development of a model determining four shared core IPE domains, (2) the development and delivery of a set of IPE workshops explicitly and intentionally based on the model. This process is an example for the future development of IPE and IPP in any local setting. Results: Testing the developed IPE in specific workshops revealed that most clinical scenarios were on a similar standard but also showed a deficit in collaborative patient centered care, an aspect suggestive of deficient interprofessional contact and prioritization.qscienc

The Vibrio cholerae Minor Pilin TcpB Initiates Assembly and Retraction of the Toxin- Coregulated Pilus

Type IV pilus (T4P) systems are complex molecular machines that polymerize major pilin proteins into thin filaments displayed on bacterial surfaces. Pilus functions require rapid extension and depolymerization of the pilus, powered by the assembly and retraction ATPases, respectively. A set of low abundance minor pilins influences pilus dynamics by unknown mechanisms. The Vibrio cholerae toxin-coregulated pilus (TCP) is among the simplest of the T4P systems, having a single minor pilin TcpB and lacking a retraction ATPase. Here we show that TcpB, like its homolog CofB, initiates pilus assembly. TcpB co-localizes with the pili but at extremely low levels, equivalent to one subunit per pilus. We used a micropillars assay to demonstrate that TCP are retractile despite the absence of a retraction ATPase, and that retraction relies on TcpB, as a V. cholerae tcpB Glu5Val mutant is fully piliated but does not induce micropillars movements. This mutant is impaired in TCP-mediated autoagglutination and TcpF secretion, consistent with retraction being required for these functions. We propose that TcpB initiates pilus retraction by incorporating into the growing pilus in a Glu5-dependent manner, which stalls assembly and triggers processive disassembly. These results provide a framework for understanding filament dynamics in more complex T4P systems and the closely related Type II secretion system

Developing a core outcome set for fistulising perianal Crohn's disease

OBJECTIVE: Lack of standardised outcomes hampers effective analysis and comparison of data when comparing treatments in fistulising perianal Crohn's disease (pCD). Development of a standardised set of outcomes would resolve these issues. This study provides the definitive core outcome set (COS) for fistulising pCD. DESIGN: Candidate outcomes were generated through a systematic review and patient interviews. Consensus was established via a three-round Delphi process using a 9-point Likert scale based on how important they felt it was in determining treatment success culminating in a final consensus meeting. Stakeholders were recruited nationally and grouped into three panels (surgeons and radiologists, gastroenterologists and IBD specialist nurses, and patients). Participants received feedback fromtheir panel(in the second round) andall participants(in the third round) to allow refinement of their scores. RESULTS: A total of 295 outcomes were identified from systematic reviews and interviews that were categorised into 92 domains. 187 stakeholders (response rate 78.5%) prioritised 49 outcomes through a three-round Delphi study.The final consensus meeting of 41 experts and patients generated agreement on an eight domain COS. The COS comprised three patient-reported outcome domains (quality of life, incontinence and a combined score of patient priorities) and five clinician-reported outcome domains (perianal disease activity, development of new perianal abscess/sepsis, new/recurrent fistula, unplanned surgery and faecal diversion). CONCLUSION: A fistulising pCD COS has been produced by all key stakeholders. Application of the COS will reduce heterogeneity in outcome reporting, thereby facilitating more meaningful comparisons between treatments, data synthesis and ultimately benefit patient care