Hasil untuk "Medicine (General)"

E. Brown, R. Lydic, N. Schiff

This review discusses the clinical and neurophysiological features of general anesthesia and their relationships to sleep and coma, focusing on the neural mechanisms of unconsciousness induced by selected intravenous anesthetic drugs.

T. Woedtke, S. Reuter, K. Masur et al.

V. Lorian

L. Goldman, J. Bennett

Hatice Merve Alptekin, Seval Ulubay, Seda Cansu Yeniğün Akbulut

Abstract Background Thinking about surgery generally causes fear and anxiety among patients. These negative feelings may affect the healing process. This study aimed to investigate the effects of a stress ball on surgical fear, anxiety and comfort among patients undergoing cholecystectomy. Method This randomized controlled study was performed with 90 patients from 03 April to 30 November 2024 in the preoperative waiting unit of an operating room in a public hospital. The intervention group received stress balls before surgery, and the control group received no intervention. The participants were randomly allocated to the intervention and control groups. Data were collected before and after the intervention via the Patient Description Form, Surgical Fear Questionnaire, Visual Analog Scale-Anxiety (VAS-A) and General Comfort Questionnaire. The data were analysed via the SPSS version 27.0 program. Descriptive statistics, t tests, Pearson chi-square tests, and stepwise multiple linear regression were applied, with significance set at p < 0.05. Results In terms of the measures taken after the stress ball intervention, patients in the intervention group had significantly lower surgical fear (t = 8.607; p < 0.001) and anxiety (t = 10.776; p < 0.001), whereas the general comfort level was greater (t = 15.765; p < 0.001). When the surgical fear subscales were investigated, the intervention group had lower values for both short- and long-term surgical fear than did the control group (t = 8.480 and 8.613; p < 0.001). Conclusion Stress balls appear to be effective, low-cost, mobile and practical tools for reducing preoperative fear and anxiety while increasing patient comfort. Their integration into routine nursing practice as a nonpharmacological intervention could contribute to better emotional preparedness and potentially improve overall surgical outcomes. Trial registration no NCT06345768 (Registration date:02.04.2024) https://clinicaltrials.gov/study/NCT06345768 .

Yunhuan Li, Xiaolin Hu

Background: Chinese lung cancer patients experience various cancer-related symptoms during the course of disease, which usually occur as symptom clusters, leading to heavy symptom burden and low quality of life. Identifying symptom cluster and core symptom is conducive to developing symptom management interventions so as to improve health-related outcomes of patients with lung cancer. To investigate the symptom clusters and core symptom of Chinese patients with lung cancer. Methods: Approved by the ethics committee, a cross-sectional study was conducted at one of the most influential general hospitals in Southwest China. The MD Anderson Symptom Inventory and the revised lung cancer-specific module were utilized to collect symptom experience of patients with lung cancer. R within the RStudio platform was used to conduct descriptive statistics, exploratory factor analysis and network analysis. Findings: A total of 219 lung cancer patients were recruited. Four symptom clusters were identified as psychoneurological, respiratory, gastrointestinal and fatigue-related symptom clusters, which could explain 59% of the total variance. The results of the symptom severity network analysis revealed that short of breath (rc= 1.35) was the symptom with the highest closeness score among all symptoms. In the symptom clusters network, short of breath (rc= 1.35), lack of appetite (rc= 1.27), fatigue (rc= 1.04) and feeling drowsy (rc= 0.82) were the symptoms with the closeness score in the four symptom clusters, respectively. Interpretation: Chinese lung cancer patients experienced four symptom clusters among lung cancer patients, which highlighted the significance of addressing general symptoms and cancer-specific symptoms in cancer symptom cluster management. The identification of core symptoms offered health care professionals potential interventional targets in future clinical practice in symptom management among patients with lung cancer. Tailored interventions based on symptom clusters are needed to synergistically reduce the symptom burden, thereby improving patients’ outcomes.

Lauren D. Branditz, Andrew P. Kendle, Cynthia G. Leung et al.

Background The transition from medical student to intern is a recognized educational gap. To help address this, the Association of American Medical Colleges developed the Core Entrustable Professional Activities for entering residency. As these metrics outline expectations for all graduating students regardless of specialty, the described procedural expectations are appropriately basic. However, in procedure-heavy specialties such as emergency medicine, the ability to perform advanced procedures continues to contribute to the disconnect between undergraduate and graduate medical education. To prepare our graduating students for their internship in emergency medicine, we developed a simulation-based mastery learning curriculum housed within a specialty-specific program. Our overall goal was to develop the students’ procedural competency for central venous catheter placement and endotracheal intubation before graduation from medical school.Methods Twenty-five students participated in a simulation-based mastery learning procedures curriculum for ultrasound-guided internal jugular central venous catheter placement and endotracheal intubation. Students underwent baseline assessment, deliberate practice, and post-test assessments. Both the baseline and post-test assessments used the same internally developed checklists with pre-established minimum passing scores.Results Despite completing an emergency medicine rotation and a critical care rotation, none of the students met the competency standard during their baseline assessments. All twenty-five students demonstrated competency on both procedures by the end of the curriculum. A second post-test was required to demonstrate achievement of the central venous catheter and endotracheal intubation minimum passing scores by 16% and 28% of students, respectively.Conclusions Students demonstrated procedural competency for central venous catheter placement and endotracheal intubation by engaging in simulation-based mastery learning procedures curriculum as they completed their medical school training. With three instructional hours, students were able to achieve basic procedural competence for two common, high-risk procedures they will need to perform during emergency medicine residency training.

Nika Sterina Skripsiana, Farida Heriyani, Widya Nursantari

Sasirangan is a typical cloth from the South Kalimantan which is produced by the Banjarist people in home industries. The production of sasirangan has a very positive impact on the welfare of Banjarist people. However, the processing and liquid waste resulting from the production process can have a negative impact on workers' health and the environment because it contains synthetic dyes and heavy metals. This is caused by poor worker behavior in processing and disposing of liquid waste from sasirangan cloth. Worker behavior can be related to worker education and knowledge. This research aims to analyze the relationship between education, knowledge and the behavior of sasirangan workers in processing and disposing of waste in the home-based sasirangan industry in Banjarmasin. This research is an analytical observational study with a cross sectional approach, carried out at 3 (three) sasirangan production locations: Sungai Jingah, Seberang Masjid Village and Surgi Mufti subdistricts. Sampling used a purposive sampling technique with a sample size of 30 workers. Data analysis was carried out using descriptive and statistical analysis using the Chi Square test with the alternative Fisher Exact Test. The results of data analysis show the p value of the education variables (p=0.032) and knowledge (p=0.049). There is a significant relationship between education and knowledge and worker behavior in processing and disposing of waste in the sasirangan home industry in Banjarmasin. This is in accordance with Lawrence Green's theory, the better the worker's education and knowledge, the better the worker's behavior. The existence of a significant relationship between education and knowledge and workers' behavior in processing and disposing of waste in the sasirangan home industry in Banjarmasin requires follow-up in the form of efforts to increase education and knowledge regarding the processing and disposal of sasirangan waste for workers in the sasirangan home industry in Banjarmasin.

Murad Alam

Kewei Wang, Kewei Wang, Rong Zhang et al.

Background and aimsWnt/β-catenin signaling plays an important role in regulating hepatic metabolism. This study is to explore the molecular mechanisms underlying the potential crosstalk between Wnt/β-catenin and mTOR signaling in hepatic steatosis.MethodsTransgenic mice (overexpress Wnt1 in hepatocytes, Wnt+) mice and wild-type littermates were given high fat diet (HFD) for 12 weeks to induce hepatic steatosis. Mouse hepatocytes cells (AML12) and those transfected to cause constitutive β-catenin stabilization (S33Y) were treated with oleic acid for lipid accumulation.ResultsWnt+ mice developed more hepatic steatosis in response to HFD. Immunoblot shows a significant increase in the expression of fatty acid synthesis-related genes (SREBP-1 and its downstream targets ACC, AceCS1, and FASN) and a decrease in fatty acid oxidation gene (MCAD) in Wnt+ mice livers under HFD. Wnt+ mice also revealed increased Akt signaling and its downstream target gene mTOR in response to HFD. In vitro, increased lipid accumulation was detected in S33Y cells in response to oleic acid compared to AML12 cells reinforcing the in vivo findings. mTOR inhibition by rapamycin led to a down-regulation of fatty acid synthesis in S33Y cells. In addition, β-catenin has a physical interaction with mTOR as verified by co-immunoprecipitation in hepatocytes.ConclusionsTaken together, our results demonstrate that β-catenin stabilization through Wnt signaling serves a central role in lipid metabolism in the steatotic liver through up-regulation of fatty acid synthesis via Akt/mTOR signaling. These findings suggest hepatic Wnt signaling may represent a therapeutic strategy in hepatic steatosis.

Ciro Gargiulo Isacco, Mario G. Balzanelli, Stefania Garzone et al.

<i>Chlamydia trachomatis</i> and human papillomavirus (HPV) are the most common pathogens found in sexually transmitted infections (STIs), and both are known to increase the risk of cervical cancer (CC) and infertility. HPV is extremely common worldwide, and scientists use it to distinguish between low-risk and high-risk genotypes. In addition, HPV transmission can occur via simple contact in the genital area. From 50 to 80% of sexually active individuals become infected with both <i>C. trachomatis</i> and HPV viruses during their lifetime, and up to 50% become infected with an HPV oncogenic genotype. The natural history of this coinfection is strongly conditioned by the balance between the host microbiome and immune condition and the infecting agent. Though the infection often regresses, it tends to persist throughout adult life asymptomatically and silently. The partnership between HPV and <i>C. trachomatis</i> is basically due to their similarities: common transmission routes, reciprocal advantages, and the same risk factors. <i>C. trachomatis</i> is a Gram-negative bacteria, similar to HPV, and an intracellular bacterium, which shows a unique biphasic development that helps the latter continue its steady progression into the host throughout the entire life. Indeed, depending on the individual’s immune condition, the <i>C. trachomatis</i> infection tends to migrate toward the upper genital tract and spread to the uterus, and the fallopian tubes open up a pathway to HPV invasion. In addition, most HPV and <i>C. trachomatis</i> infections related to the female genital tract are facilitated by the decay of the first line of defense in the vaginal environment, which is constituted by a healthy vaginal microbiome that is characterized by a net equilibrium of all its components. Thus, the aim of this paper was to highlight the complexity and fragility of the vaginal microenvironment and accentuate the fundamental role of all elements and systems involved, including the <i>Lactobacillus</i> strains (<i>Lactobacillus gasseri, Lactobacillus jensenii, Lactobacillus crispatus</i>) and the immune–endocrine system, in preserving it from oncogenic mutation. Therefore, age, diet, and genetic predisposition together with an unspecific, persistent low-grade inflammatory state were found to be implicated in a high frequency and severity grade of disease, potentially resulting in pre-cancerous and cancerous cervical lesions.

Kateryna Metersky PhD, RN, Rezwana Rahman MN(c), BScN, RN, Jennifer Boyle PhD

Patient-partners are invaluable in health professions’ education. Sharing their lived experiences with prospective and current healthcare providers can provide an opportunity for these participants to hone their patient-centric skills. However, sharing stories publicly is a vulnerable role and may feel emotionally risky for patient-partners. Using reflective dialogue, this manuscript outlines recommendations through the Sender-Receiver Model of Communication for Patient-Partners encounters when working with patient-partners in health professions’ education. These recommendations include recognizing that: Patient-partners need to consider if they are ready to share their story. Some stories are wounds requiring further healing; other stories are scars fully processed by patient-partners and ready to be shared publicly. The audience should differentiate between questions that can promote critical thinking versus feel like a “personal attack.” Audiences should recognize vulnerability patient-partners may experience in sharing their stories and engage accordingly. Pre-session and post-session debriefs are important. Shared stories may elicit intense emotions from patient-partners and audiences. Both groups should be given an opportunity to process and work through emotions.

A. Bhagra, D. Tierney, H. Sekiguchi et al.

J. Leyenaar, S. Ralston, M. Shieh et al.

Omar Hasan, D. Meltzer, S. Shaykevich et al.

BackgroundPrevious studies of hospital readmission have focused on specific conditions or populations and generated complex prediction models.ObjectiveTo identify predictors of early hospital readmission in a diverse patient population and derive and validate a simple model for identifying patients at high readmission risk.DesignProspective observational cohort study.PatientsParticipants encompassed 10,946 patients discharged home from general medicine services at six academic medical centers and were randomly divided into derivation (n = 7,287) and validation (n = 3,659) cohorts.MeasurementsWe identified readmissions from administrative data and 30-day post-discharge telephone follow-up. Patient-level factors were grouped into four categories: sociodemographic factors, social support, health condition, and healthcare utilization. We performed logistic regression analysis to identify significant predictors of unplanned readmission within 30 days of discharge and developed a scoring system for estimating readmission risk.ResultsApproximately 17.5% of patients were readmitted in each cohort. Among patients in the derivation cohort, seven factors emerged as significant predictors of early readmission: insurance status, marital status, having a regular physician, Charlson comorbidity index, SF12 physical component score, ≥1 admission(s) within the last year, and current length of stay >2 days. A cumulative risk score of ≥25 points identified 5% of patients with a readmission risk of approximately 30% in each cohort. Model discrimination was fair with a c-statistic of 0.65 and 0.61 for the derivation and validation cohorts, respectively.ConclusionsSelect patient characteristics easily available shortly after admission can be used to identify a subset of patients at elevated risk of early readmission. This information may guide the efficient use of interventions to prevent readmission.

WANG Xiaohua, JI Xiaope, ZHANG Jixiao et al.

Objective To find out the causes of anterior femoral notching in 3D printed patient-specific patient-specific instrumentation (PSI) assisted total knee arthroplasty (TKA). Methods A retrospective analysis was carried out on the consecutive cases undergoing PSI assisted TKA in the Peking University International Hospital from January 2019 to September 2021. The clinical data of those having anterior femoral notching were collected. 3D CT scanning was performed on the knee joint after intraoperative osteotomy and the intraoperative bone fragments. Rapidform software (Version 2006) was used to reconstruct 3D images and to perform image registration and comparison analysis with the preoperatively planned 3D models. The anterior femoral notching depth was measured, and the differences in the thickness of bone fragments between preoperatively planned and intraoperative bone cutting in order to analyze the causes of the anterior femoral notching. Results A total of 86 consecutive cases (94 knees) were included and 17 cases (18/94, 19.1%) of them had anterior femoral notching. The causes of anterior femoral notching were summarized into 3 categories: abnormal position of the PSI (10 cases, 83.3%), intraoperative reduction of the femoral prosthesis size (2 cases, 16.7%), and overextension of the femoral prosthesis (1 case, 8.3%). Conclusion Abnormal femoral PSI position, intraoperative reduction of femoral prosthesis size, and preoperative femoral prosthesis overextension design are the main causes of anterior femoral notching after PSI assisted knee arthroplasty.

Huifang Lian, Huifang Lian, Huifang Lian et al.

PurposeFungal keratitis is a sight-threatening corneal infection caused by fungal pathogens, and the pathogenic mechanisms have not been fully elucidated. The aim of this study was to determine whether NOD-like receptor family pyrin domain containing 3 (NLRP3) inflammasome-mediated pyroptosis contributes to Candida albicans (C. albicans) keratitis and explore the underlying mechanism.MethodsAn in vivo mouse model of C. albicans keratitis and an in vitro culture model of human corneal epithelial cells (HCECs) challenged with heat-killed C. albicans (HKCA) were established in this study. The degree of corneal infection was evaluated by clinical scoring. Gene expression was assessed using reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and western blot analysis or immunofluorescence staining was performed to evaluate protein expression. TdT-mediated dUTP nick end labeling (TUNEL) staining was performed to examine the pyroptotic cell death. A lactate dehydrogenase (LDH) release assay was performed to assess cytotoxicity.ResultsCompared with the mock-infected group, we observed that the mRNA levels of NLRP3, caspase-1 (CASP1), interleukin (IL)−1β and gasdermin-D (GSDMD) in C. albicans-infected mice cornea was significantly increased. Our data also demonstrated that the protein expression of NLRP3 and the pyroptosis-related markers apoptosis-associated speck-like protein containing a CARD (ASC), cleaved CASP1, N-GSDMD, cleaved IL-1β and cleaved IL-18 as well as pyroptotic cell death were dramatically elevated in the mouse model of C. albicans keratitis. More importantly, NLRP3 knockdown markedly alleviated pyroptosis and consequently reduced corneal inflammatory reaction in C. albicans keratitis. In vitro, the presence of activated NLRP3 inflammasome and pyroptotic cell death were validated in HCECs exposed to HKCA. Furthermore, the potassium (K+) channel inhibitor glyburide decreased LDH release and suppressed NLRP3 inflammasome activation and pyroptosis in HCECs exposed to HKCA.ConclusionIn conclusion, the current study revealed for the first time that NLRP3 inflammasome activation and pyroptosis occur in C. albicans-infected mouse corneas and HCECs. Moreover, NLRP3 inflammasome-mediated pyroptosis signaling is involved in the disease severity of C. albicans keratitis. Therefore, This NLRP3 inflammasome-dependent pathway may be an attractive target for the treatment of fungal keratitis.

Aymen M. Madkhali, Ahmad Hassn Ghzwani, Hesham M. Al-Mekhlafi

This cross-sectional study aimed to assess the performances of a rapid diagnostic test (RDT)—the AllTest Malaria p.f./p.v., microscopy, and nested polymerase chain reaction (PCR) for diagnosing <i>Plasmodium falciparum</i> malaria in 400 febrile patients from a low-transmission region (Jazan) in southwestern Saudi Arabia. Diagnostic performance of all three methods was compared using microscopy and nested PCR as reference methods. Overall, 42 (10.5%), 48 (12.0%), and 57 (14.3%) samples were found positive by microscopy, RDT, and PCR, respectively. With PCR as reference method, the RDT showed higher sensitivity (79% vs. 71.9%), similar specificity (99.1% vs. 99.7%), and better NLR (0.20 vs. 0.27) and area under the curve (89.0% vs. 85.8%) than microscopy. The sensitivity of RDT and microscopy decreased as age increased, and false negatives were associated with low parasite density. In addition, the sensitivity of RDT and microscopy was higher in non-Saudi than in Saudi participants. Against microscopy, both RDT and PCR showed high sensitivity (83.3% vs. 97.6%), specificity (96.4% vs. 95.5%), and NPVs (98.0% vs. 99.7%), but reduced PPVs (72.9% vs. 71.9%), respectively. The results showed that the performance of the AllTest Malaria p.f./p.v RDT was better than that of microscopy in diagnosing <i>P. falciparum</i> malaria among febrile patients in the Jazan region when nested PCR was used as the reference. However, further studies are required to assess malaria diagnostic methods among asymptomatic individuals in the region.

M. Petruzzi, M. De Benedittis

Irene W. Y. Ma, Shane Arishenkoff, J. Wiseman et al.

Bedside point-of-care ultrasound (POCUS) is increasingly used to assess medical patients. At present, no consensus exists for what POCUS curriculum is appropriate for internal medicine residency training programs. This document details the consensus-based recommendations by the Canadian Internal Medicine Ultrasound (CIMUS) group, comprising 39 members, representing 14 institutions across Canada. Guiding principles for selecting curricular content were determined a priori. Consensus was defined as agreement by at least 80% of the members on POCUS applications deemed appropriate for teaching and assessment of trainees in the core (internal medicine postgraduate years [PGY] 1–3) and expanded (general internal medicine PGY 4–5) training programs. We recommend four POCUS applications for the core PGY 1–3 curriculum (inferior vena cava, lung B lines, pleural effusion, and abdominal free fluid) and three ultrasound-guided procedures (central venous catheterization, thoracentesis, and paracentesis). For the expanded PGY 4–5 curriculum, we recommend an additional seven applications (internal jugular vein, lung consolidation, pneumothorax, knee effusion, gross left ventricular systolic function, pericardial effusion, and right ventricular strain) and four ultrasound-guided procedures (knee arthrocentesis, arterial line insertion, arterial blood gas sampling, and peripheral venous catheterization). These recommendations will provide a framework for training programs at a national level.