The issue of ‘informed consent’ in medical student introductions

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Evaluating on-line health information for patients with polymyalgia rheumatica: a descriptive study

BACKGROUND: The Internet is increasingly used to access health information, although the quality of information varies. The aim of this study was to evaluate the readability, and quality of websites about polymyalgia rheumatica (PMR). METHODS: Three UK search engines (Google, Yahoo and Bing) were searched for the term 'polymyalgia rheumatica'. After deleting duplicates, the first 50 eligible websites from each were evaluated. Readability was assessed using the Flesch Reading Ease and 'Simple Measure of Gobbledygook (SMOG) Readability' indicators. Credibility was assessed using a previously published Credibility Indicator. RESULTS: Of the 52 unique websites identified, the mean (standard deviation) Flesch Reading Ease and SMOG Readability scores were 48 (15) and 10 (2), respectively. The mean (SD) Credibility Indicator was 2 (1). Fifty (96%) of websites were accurate. Website design and content was good, with an average of 68 and 64% respectively, of the assessed criteria being met. CONCLUSIONS: Most websites about PMR require a higher readability age than is recommended. Thus whilst websites are often well designed and accurate this study suggests that their content could be refined and simplified to maximise patient benefit

Chronic pain in families:A cross-sectional study of shared social, behavioural, and environmental influences

Chronic pain is common and creates a significant burden to the individual and society. Emerging research has shown the influence of the family environment on pain outcomes. However, it is not clear what shared factors between family members associate with chronic pain. This study aimed to investigate the family-level contribution to an individual's chronic pain status. This was a cross-sectional study using the Generation Scotland: Scottish Family Health Study data set. This study focused on a nested cohort of dyads (only 2 relatives per family, n = 2714). Multi-level modelling was first performed to estimate the extent of variance in chronic pain at the family level. Then each member of the dyad was randomly assigned as either the exposure or outcome family member, and logistic regression was used to identify shared factors associated with the outcome of chronic pain status. Multi-level modelling showed just under 10% of variation in chronic pain status was at a family level. There was an increase in odds of chronic pain if exposure family member had chronic pain (odds ratio [OR]: 1.30, 95% confidence interval [CI]: 1.02-1.65), if both were women (OR: 1.39, 95% CI: 0.99-1.94), if both were older in age (OR: 1.80, 95% CI: 1.31-2.48), and if both had low household income (OR: 3.27, 95% CI: 1.72-6.21). These findings show that most explanation for chronic pain is still at the individual level. However, some significant shared effects between family members associate with chronic pain, and this highlights the influence of the family context

Transient central hypoxemia due to intermittent high-degree atrioventricular block in a heart-transplanted patient diagnosed during routine electroencephalography: a case report.

BACKGROUND Bradycardia frequently occurs in heart-transplanted patients, mainly as a temporally restricted manifestation early after transplantation and often without symptoms. A high-degree atrioventricular block is mostly symptomatic through cerebral hypoxia induced through cerebral hypoperfusion. Only a few published cases show this specific electroencephalography result in this context. The purpose of this case is to bring attention to atypical manifestations of typical cardiac complications after heart transplantation and the importance of perseverance in the diagnostic. CASE PRESENTATION A Central European man in his 50s with history of heart transplantation 31 years previously was admitted to the internal medicine ward for short-lived recurrent episodes of generalized weakness with multiple falls but without loss of consciousness. During routine electroencephalography, the patient perceived this recurrent sensation. This episode coincided with a transient third-degree atrioventricular block followed 8-10 seconds later by a generalized slowing of the electroencephalography, reflecting cerebral hypoxia due to cerebral hypoperfusion. Holter monitoring confirmed the diagnosis. A pacemaker was implanted, consequently resolving the episodes. CONCLUSION This case report illustrates the pathophysiological central hypoxemic origin of episodes of generalized weakness caused by a high-degree atrioventricular block in a patient surviving 29 years after heart transplant. It highlights the benefit of electroencephalography as a diagnostic tool in well-selected patients

Parity of publication for psychiatry

Background: There is an established disparity between physical and mental healthcare. Parity of research outputs has not been assessed internationally across influential medical journals.Aims: To assess parity of publication between physical and mental health, and within psychiatry.Method: Four major medical disciplines were identified and their relative burden estimated. All publications from the highest-impact general medical journals in 2001, 2006 and 2011 were categorised accordingly. The frequency of psychiatry, cardiology, oncology and respiratory medicine articles were compared with the expected proportion (given illness burdens). Six subspecialties within psychiatry were also compared.Results: Psychiatry was consistently and substantially underrepresented; other specialties were overrepresented. Dementia and psychosis demonstrated overrepresentation, with addiction and anxiety disorders represented proportionately and other disorders underrepresented. The underrepresentation of mood disorders increased more recently.Conclusions: There appears to be an important element of disparity of esteem; further action is required to achieve equivalence between mental and physical health research publications.</p

Technology: changing the focus of medical education?

Sayinthen Vivekanantham, Rahul Prashanth Ravindran Faculty of Medicine, Imperial College London, London, UKWith technology advancing at such a fast rate, our ability to look up and use information quickly and efficiently has improved significantly. With electronic devices capable of accessing information becoming more prevalent within the hospital setting, how this could influence medical education should be brought into question.As we are now able to look up information quickly within the clinical setting, we ask whether medical students should be expected to learn information that can easily be looked up. Instead, we question whether they should use their time to learn skills related to the application of the information, as well as information that would be needed in acute situations where looking up information would not be pragmatic

PHYSICAL HEALTH ASSESSMENT AND MEDICINES RECONCILIATION ON ADMISSION TO AN ACUTE MENTAL HEALTH UNIT: A QUALITY IMPROVEMENT PROJECT

Individuals with mental health disorders are at greater risk of physical health problems. Medicines reconciliation reduces medication errors on admission. The aim of this project was to improve compliance with the completion of physical health assessments and medicines reconciliation forms by using a set standard stating that all patients must have the above completed at the point of admission to an acute mental health unit. The notes for all inpatients were reviewed for evidence of completed physical assessments and medicines reconciliation forms. This was done at three different time points: baseline, 2 months after the introduction of recommendations (1st intervention) and 2 months later when an online system of record keeping was trialled (2nd intervention). At baseline (n=33), 16 (49%) had a physical examination, 15 (46%) had an ECG, 17 (52%) had baseline bloods and 4 (12%) had a completed medicine reconciliation form. After the 2nd intervention (n=31), 25 (81%) had a physical examination, 25 (81%) had an ECG, 23 (74%) had baseline bloods and 23 (74%) had a completed medicine reconciliation form. Physical health assessments and medicines reconciliation are important aspects of patient care. The interventions introduced have improved the quality of practice at an acute mental health unit

Clinical, genetic and omics-based biomarkers that might support the identification of the development of psoriatic arthritis in individuals with psoriasis – a narrative review of the literature

It is known that 25-30% of individuals with cutaneous psoriasis (PsC ) will develop psoriatic arthritis (PsA). To date, the reasons for the development of PsA in individuals with PsC have not been identified. Furthermore, there are considerable delays in diagnosis and treatment of PsA, which lead to joint and bone deformation and chronic pain. It is therefore important to develop more precise diagnostic and screening tools. In this narrative review of the literature, clinical risk factors and novel molecular biomarkers (genetic markers, blood and inflammatory markers, lipid, metabolite and protein biomarkers) have been evaluated. The review included 38 publications that were reported between May 2020 to May 2024. Similar to previous reviews, nail involvement was one of the strongest clinical risk factors for the development of PsA, while molecular biomarkers did not provide a clear and robust differentiation between PsC and PsA groups. The seemingly poor performance of molecular markers may be largely attributed to small study populations and heterogeneity in study designs. Data and sample sharing in large consortia such as the HIPPOCRATES consortium could help to overcome the limitations of small studies and enable the development of more robust diagnostic and screening tools for PsA