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Clinical problem-solving

Andrew Leung Luk, Adrian Fai To Yau
Background: Overseas studies suggest that 10-20% of doctors are depressed, 30-45% have burnout, and many report dissatisfaction with work-life balance. A local study on public doctors showed that 31.4% of the respondents satisfied the criteria for high burnout. Young, but moderately experienced doctors who need to work shifts appeared most vulnerable. This study aims to explore the experiences of those public doctors who have managed their work difficulties and maintained professional enthusiasm for references in medical education and continuing professional training...
2018: Frontiers in Public Health
Meghna Singhal, Manjula Munivenkatappa, John Vijay Sagar Kommu, Mariamma Philip
Subclinical depressive symptoms in adolescents are associated with a host of impairments and constitute a risk factor for future depression. The aim of the present study was to study the efficacy of a school-based group coping skills program for Indian adolescents with subclinical depression. Adolescents (n = 120) across two schools comprised the intervention and control groups and were assessed at baseline, post-intervention, and 3 months no-contact follow-up. The intervention group adolescents received the 8-weekly Coping Skills program in same-gender groups of 4-8 adolescents each, and the control group adolescents received one interactive psycho-educatory session...
March 11, 2018: Asian Journal of Psychiatry
C Ranieri, S Di Tommaso, D C Loconte, V Grossi, P Sanese, R Bagnulo, F C Susca, G Forte, A Peserico, A De Luisi, A Bartuli, A Selicorni, D Melis, M Lerone, A D Praticò, G Abbadessa, Y Yu, B Schwartz, Martino Ruggieri, Cristiano Simone, Nicoletta Resta
Postzygotic mutations of the PIK3CA [phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha] gene constitutively activate the PI3K/AKT/mTOR pathway in PIK3CA-related overgrowth spectrum (PROS) patients, causing congenital mosaic tissue overgrowth that even multiple surgeries cannot solve. mTOR inhibitors are empirically tested and given for compassionate use in these patients. PROS patients could be ideal candidates for enrolment in trials with PI3K/AKT pathway inhibitors, considering the "clean" cellular setting in which a unique driver, a PIK3CA mutation, is present...
March 16, 2018: Neurogenetics
Terhi Toivo, Maarit Dimitrow, Juha Puustinen, Eeva Savela, Katariina Pelkonen, Valtteri Kiuru, Tuula Suominen, Sirkka Kinnunen, Mira Uunimäki, Sirkka-Liisa Kivelä, Saija Leikola, Marja Airaksinen
BACKGROUND: The magnitude of safety risks related to medications of the older adults has been evidenced by numerous studies, but less is known of how to manage and prevent these risks in different health care settings. The aim of this study was to coordinate resources for prospective medication risk management of home care clients ≥ 65 years in primary care and to develop a study design for demonstrating effectiveness of the procedure. METHODS: Health care units involved in the study are from primary care in Lohja, Southern Finland: home care (191 consented clients), the public healthcare center, and a private community pharmacy...
March 16, 2018: BMC Geriatrics
Bronwyn Myers, Crick Lund, Carl Lombard, John Joska, Naomi Levitt, Christopher Butler, Susan Cleary, Tracey Naledi, Peter Milligan, Dan J Stein, Katherine Sorsdahl
BACKGROUND: In low- and middle-income countries (LMIC), it is uncertain whether a "dedicated" approach to integrating mental health care (wherein a community health worker (CHW) has the sole responsibility of delivering mental health care) or a "designated" approach (wherein a CHW provides this service in addition to usual responsibilities) is most effective and cost-effective. This study aims to compare the effectiveness and cost-effectiveness of these two models of service integration relative to treatment as usual (TAU) for improving mental health and chronic disease outcomes among patients with HIV or diabetes...
March 16, 2018: Trials
Li Zhang, Jiasheng Chen, Chunming Gao, Chuanmiao Liu, Kuihua Xu
Hepatocellular carcinoma (HCC) is a leading cause of cancer-related death worldwide. The early diagnosis of HCC is greatly helpful to achieve long-term disease-free survival. However, HCC is usually difficult to be diagnosed at an early stage. The aim of this study was to create the prediction model to diagnose HCC based on gene expression programming (GEP). GEP is an evolutionary algorithm and a domain-independent problem-solving technique. Clinical data show that six serum biomarkers, including gamma-glutamyl transferase, C-reaction protein, carcinoembryonic antigen, alpha-fetoprotein, carbohydrate antigen 153, and carbohydrate antigen 199, are related to HCC characteristics...
March 16, 2018: Medical & Biological Engineering & Computing
Cheng-Han Wu, Bang-Hung Yang, Yuan-Hwa Chou, Shyh-Jen Wang, Jyh-Cheng Chen
99mTc-TRODAT-1 is a type of drug that can bind to dopamine transporters in living organisms and is often used in SPCT imaging for observation of changes in the activity uptake of dopamine in the striatum. Therefore, it is currently widely used in studies on clinical diagnosis of Parkinson's disease (PD) and movement-related disorders. In conventional 99mTc-TRODAT-1 SPECT image evaluation, visual inspection or manual selection of ROI for semiquantitative analysis is mainly used to observe and evaluate the degree of striatal defects...
2018: PloS One
Arun Gupta, Pratima Murthy, Shobini Rao
Chronic use of mind altering substances can lead to a wide variety of neuropsychological deficits, affecting the domains of attention, learning, memory, reasoning. Executive functions such as working memory, cognitive flexibility and inhibitory control may specifically be impaired. These deficits can impact engagement in effective psychosocial interventions. Mild to moderate cognitive dysfunction may not be picked up in routine clinical examination or through commonly used tests like the mini-mental state examination (MMSE)...
February 2018: Indian Journal of Psychiatry
George Zaharias
OBJECTIVE: To raise awareness of narrative-based medicine (NBM) as a valuable approach to the consultation, which, if practised more widely by GPs, would convey considerable benefits to both patients and physicians. SOURCES OF INFORMATION: Principally, the perspectives of 2 of NBM's key proponents, Rita Charon and John Launer. MAIN MESSAGE: This first in a series of 3 articles outlines what NBM is and its benefits. In holding the patient story as central, NBM shifts the doctor's focus from the need to problem solve to the need to understand...
March 2018: Canadian Family Physician Médecin de Famille Canadien
Kyungja Kang, Mi Yu
BACKGROUND: Student self-debriefing promotes self-confidence, helps to increase clinical performance, and is a more cost-effective method than is traditional instructor-led debriefing in simulation-based learning. OBJECTIVES: This study compared the effectiveness of debriefing-in terms of the problem-solving process, team effectiveness, debriefing assessment, and debriefing satisfaction-between an experimental group who received both student self-debriefing (SSD) and instructor debriefing (ID) and a control group who received only instructor debriefing...
March 2, 2018: Nurse Education Today
Junchi Yang, Lumin Bo, Ting Han, Dan Ding, Mingming Nie, Kai Yin
Gastric cancer (GC) has a high incidence and mortality rate. If discovered late, GC tends to have a poor prognosis. Improvements in the prognostic accuracy of GC through combined analysis of multiple relevant genes and clinical factors may solve this problem. In the present study, GSE62254 (including 300 GC tissues), obtained from the Gene Expression Omnibus database, was used as a training set, and the mRNA‑sequencing data of GC (including 384 GC tissues) downloaded from the Cancer Genome Atlas database served as a validation set...
March 9, 2018: Molecular Medicine Reports
Sandra Monteiro, Geoff Norman, Jonathan Sherbino
There is general consensus that clinical reasoning involves 2 stages: a rapid stage where 1 or more diagnostic hypotheses are advanced and a slower stage where these hypotheses are tested or confirmed. The rapid hypothesis generation stage is considered inaccessible for analysis or observation. Consequently, recent research on clinical reasoning has focused specifically on improving the accuracy of the slower, hypothesis confirmation stage. Three perspectives have developed in this line of research, and each proposes different error reduction strategies for clinical reasoning...
March 13, 2018: Journal of Evaluation in Clinical Practice
William E Cunningham, Robert E Weiss, Terry Nakazono, Mark A Malek, Steve J Shoptaw, Susan L Ettner, Nina T Harawa
Importance: Diagnosis of human immunodeficiency virus (HIV) infection, linkage and retention in care, and adherence to antiretroviral therapy are steps in the care continuum enabling consistent viral suppression for people living with HIV, extending longevity and preventing further transmission. While incarcerated, people living with HIV receive antiretroviral therapy and achieve viral suppression more consistently than after they are released. No interventions have shown sustained viral suppression after jail release...
March 12, 2018: JAMA Internal Medicine
Jing Yang, Jian Yang, Chongzhao Ran
Recent large-scale clinical analysis indicates that brown adipose tissue (BAT) mass levels inversely correlate with body-mass index (BMI), suggesting that BAT is associated with metabolic disorders such as obesity and diabetes. PET imaging with 18F-FDG is the most commonly used method for visualizing BAT. However, this method is not able to differentiate between BAT mass and BAT activation. This task, in fact, presents a tremendous challenge with no currently existing methods to separate BAT mass and BAT activation...
2018: Contrast Media & Molecular Imaging
Hongtao Yang, Xinhua Qu, Wenjiao Lin, Cong Wang, Donghui Zhu, Kerong Dai, Yufeng Zheng
Recent studies indicate that there is a great demand to optimize pure Zn with tunable degradation rates and more desirable biocompatibility as orthopedic implants. Metal matrix composite (MMC) can be a promising approach for this purpose. In this study, MMC with pure Zn as a matrix and hydroxyapatite (HA) as reinforcements were prepared by spark plasma sintering (SPS). Feasibility of novel Zn-HA composites to be used as orthopedic implant applications was systematically evaluated. After sintering, HA distributed in the Zn particle boundaries uniformly...
March 9, 2018: Acta Biomaterialia
Fereshteh Aein
BACKGROUND: Interprofessional learning is identified as one of the most innovative ways to encourage students of different disciplines to communicate with each other in interprofessional teams. A review of existing studies identified that inter-professional learning with nursing and midwifery students learning together had not previously been reported. AIM: This qualitative study sought to explore perceptions and experiences of midwifery students from interprofessional learning with nursing students...
March 8, 2018: Women and Birth: Journal of the Australian College of Midwives
Kyung Eun Lee
BACKGROUND: An important goal of nursing education is helping students achieve core competencies efficiently. One proposed way of improving nursing education is team-based learning (TBL). PURPOSE: The aim of this study was to assess the comparative effectiveness of TBL and lecture-style classes in terms of teaching core competencies in nursing education, which include clinical competence skills, problem-solving ability, communication competencies, critical thinking ability, and self-leadership...
April 2018: Journal of Nursing Research: JNR
Sofía S Villar
In a rare life-threatening disease setting the number of patients in the trial is a high proportion of all patients with the condition (if not all of them). Further, this number is usually not enough to guarantee the required statistical power to detect a treatment effect of a meaningful size. In such a context, the idea of prioritizing patient benefit over hypothesis testing as the goal of the trial can lead to a trial design that produces useful information to guide treatment, even if it does not do so with the standard levels of statistical confidence...
April 2018: Probability in the Engineering and Informational Sciences
Prema S Rao, Ryan Endicott, Randy Mullins, U Subrahmanyeswara Rao
Comparison of human genome sequences from different individuals has unraveled that genes involved in the drug efficacy and metabolism are polymorphic, harboring mutations, splicing variations and other alterations. These data provide a reasonable explanation for the inter-individual variations observed in drug therapy. Thus, a detailed molecular analysis and an in-depth knowledge of these genes is a prerequisite to practice pharmacogenomics-based medicine. We have introduced a 6-week laboratory research rotation to train students in the expression analysis of different pharmacogenes combined with bioinformatics tools...
March 8, 2018: Pharmacogenomics Journal
Hsiang-I Tsai, Lijuan Jiang, Xiaowei Zeng, Hongbo Chen, Zihuang Li, Wei Cheng, Jinxie Zhang, Jie Pan, Dong Wan, Li Gao, Zhenhua Xie, Laiqiang Huang, Lin Mei, Gan Liu
The clinical applications of platinum-based antitumor agents are still largely limited by severe side effects as well as multidrug resistance (MDR). To solve these problems, we developed an 1,2-diaminocyclohexane-platinum(II) (DACHPt)-loaded nanoparticle (NP-TPGS-Pt) by self-assembly of poly(amidoamine)-polyglutamic acid- b -D-α-tocopheryl polyethylene glycol 1000 succinate (PAM-PGlu- b -TPGS) and DACHPt. NP-TPGS-Pt showed robust stability and pH-responsive DACHPt release profile in vitro similar to the PEG-containing nanoparticle (NP-PEG-Pt)...
2018: Frontiers in Pharmacology
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