Context Of Medical Practice Research Articles

Blood Biomarkers of Long COVID: A Systematic Review.

Long coronavirus disease (COVID; LC) affects millions of people worldwide. The exact mechanisms which result in a broad, undulating and detrimental symptom profile remain unknown. Blood biomarkers associated with LC have been described; however, consensus on these remains elusive, in part due to a lack of continuity between studies on a universally accepted definition of LC. This systematic review aimed to consolidate current knowledge of blood biomarkers associated with the prevalence of LC on the basis of the World Health Organisation (WHO) clinical definition of this condition. Observational, cross-sectional, and randomised control studies published in the English language that studied blood biomarkers associated with the WHO definition of LC. All studies included participants who were ≥ 18 years old and group sizes ≥ 10 participants, and were compared against a control group without any known co-morbidities. A systematic literature search was conducted according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and prospectively registered on Prospero (ID: CRD42022373121). The Cochrane, Embase, PubMed and Web of Science databases were searched from inception to January 2024. Search results were gathered using Rayyan software and data extracted using Microsoft Excel. The reporting recommendations for tumour markers prognostic studies (REMARK) questionnaire was used to assess the quality of the included studies. A total of 45 observational and one interventional study comprising 4415 participants were included in this review which identified 525 blood biomarkers thought to be associated with LC. Three blood biomarker subtypes were associated with the development of LC: (1) immunological and inflammatory dysfunction, (2) endothelial/vascular dysfunction and (3) metabolic and clotting abnormalities. Our data are consistent with previous findings; however, no single biomarker was sufficiently associated with LC prevalence and instead a profile of biomarkers across various physiological systems may be more clinically useful. In all, 196 studies were excluded due to a lack of an adequately healthy comparator group and/or failure to meet the WHO LC definition. This demonstrates a need for further research incorporating a universal LC definition across all disease severity groups and symptom profiles, and longitudinal data reflecting the relapsing and remitting nature of this condition. Further investigation into blood biomarkers of LC, including clear reporting of healthy comparator groups and the investigation of acute and chronic biomarker changes, within the context of medical practice, may support the development of curative/restorative approaches.

Development and structure of the discipline “Applied chemistry in medicine” (elective course) at the school of medicine

Along with teaching the natural science and medical principles, it is the author's proposal to create a new subject for electives, “How Applied Chemistry Helps in Medication” to see education level of medical application in higher education students within the Faculty of Medicine. This elective tries to amalgamate two different topics involving both chemistry and medicine. Besides this, it places serious emphasis on the importance of public health within the context of medical practice, of the significant role chemical principles may play in the modern health care system. Students have an opportunity to investigate subjects like environmental toxicology, pharmaceutical chemistry, and chemical risk assessment in which they can perceive the chemistry’s face with the public health field. The knowledge about disease prevention strategies, health promotion and community wellness obtained as a result can enhance the skillset students need to work towards evidence-based approaches in disease prevention. The course is designed as a 3.0 credits ECTS specified by the regulatory requirements. Thematic subjects get covered and include chemical principles, toxicology, pharmaceutical chemistry, environmental toxicology, and chemical risk assessment. Sessions are designed to provide a complete picture of the domain and the methodological toolkit, while at the same time they are interactive and practical by applying theoretical concepts to real-life situations. Introduce the development of problem-solving and critical thinking as one of the learning objectives.

Elaborar, compartilhar, narrar: uma análise narrativa de três abordagens de comunicação em Saúde

Abstract Communication, despite being considered a key aspect in medical practice, has not received the corresponding attention both on literature and medical training as has the technological and biomedical aspects. As a reaction to this context emerged fields of knowledge proposing to reflect and strengthen aspects of communication between the physician and the patient. In this article, we perform a narrative analysis of the literature of three of such approaches to communication in health: the Balint Groups, the Patient Centered Care and Narrative-Based Medicine. The study highlights the approximations and distances between these approaches, along with the recognition of the potency of each of them in the different contexts of medical practice.

Beyond the cultural myth of medical meritocracy.

We examine the cultural myth of the medical meritocracy, whereby the "best and the brightest" are admitted and promoted within the profession. We explore how this narrative guides medical practice in ways that may no longer be adequate in the contexts of practice today. Narrative analysis of medical students' and physicians' stories. Hierarchies of privilege within medicine are linked to meritocracy and the trope of the "hero's story" in literature. Gender and other forms of difference are generally excluded from narratives of excellence, which suggests operative mechanisms that may be contributory to observed differences in attainment. We discuss how the notion of diversity is formulated in medicine as a "problem" to be accommodated within merit, and posit that medical practice today requires a reformulation of the notion of merit in medicine, valorising a diversity of life experience and skills, rather than "retrofitting" diversity concerns as problems to be accommodated within current constructs of merit. Three main action-oriented outcomes for a better formulation of merit relevant to medical practice today are suggested: (a) development of assessors' critical consciousness regarding the structural issues in merit assignment; (b) alignment of merit criteria with relevant societal outcomes, and (c) developing inclusive leadership to accommodate the greater diversity of excellence needed in today's context of medical practice. A reformulation of the stories through which medical practitioners and educators communicate and validate aspects of medical practice will be required in order for the profession to continue to have relevance to the diverse societies it serves.

\u2018The Good Doctor\u2019: the Making and Unmaking of the Physician Self in Contemporary South Africa

In this article we examine the figure of the doctor in animated debates around public sector medicine in contemporary South Africa. The loss of health professionals from the South African public system is a key contributor to the present healthcare crisis. South African medical schools have revised curricula to engage trainee doctors with a broader set of social concerns, but the disjunctures between training, health systems failures, and a high disease burden call into question whether junior doctors are adequately prepared or whether conditions of care extend beyond medical training. A concern with 'resilience' suggests a correct ethical relation to a putative obligation to provide care in a struggling system. By examining the ways in which trainee doctors are expected to 'cope' with the demands of medical practice, to adopt the correct moral posture in relation to the urgency of care, and to enact a desirable ethical relation to the broader social and political context of medical practice, we examine the picture of humanist concern that animates the subjectivities and techniques of the self called for by this training, and advocate for endurance as an alternative framework for understanding the political and ethical relations between doctors, patients and health systems.

The world as the new local clinic: A critical analysis of three discourses of global medical competency

The effects of globalization on health are the focus of administrators, educators, policy makers and researchers as they work to consider how best to train and regulate health professionals to practice in a globalized world. This study explores what happens to constructs such as medical competence when the context of medical practice is discursively expanded to include the whole world. An archive of texts was assembled (1970–2011) totaling 1100 items and analyzed using a governmentality approach. Texts were included that articulated rationales for pursuing global education activities, and/or that implicitly or explicitly took a position on medical competencies in relation to practicing medicine in international or culturally diverse contexts, or in dealing with health issues as global concerns. The analysis revealed three distinct visions, representative of a primarily western mentality, for preparing physicians to practice in a globalized world: the universal global physician, the culturally versed global physician and the global physician advocate. Each has its own epistemological relationship to globalization and is supported by an evidence base. All three discourses are active and productive, sometimes within the same context. However, the discourse of the universal global physician is currently the most established. The challenge to policy makers and educators in evolving regulatory frameworks and curricula that are current and relevant necessitates a better understanding of the socio-political effects of globalization on medical education, and the ethical, political, cultural and scientific issues underlying efforts to prepare students to practice competently in a globalized world.

Ethnography and the Making of Modern Health Professionals

Charles Rosenberg’s call to arms for the training of health professionals as optimal medical citizens—concerned with politics, social justice and clinical judgment—recalls a long history of social science engagement with the socioeconomic and political sources and contexts of medical practice (Rosenberg 2007). Social scientists equipped with ethnographic and analytical insights have offered critiques from ‘‘the outside’’ for years, noting how biomedicine engages, knowingly or not, in iatrogenesis (Illich 1982), capitalist exploitation (Navarro 1976), domination (Freidson 1970)and reductionism (Gordon 1988), that it disregards the social conditions of knowledge production (Young 1982) and that it turns life cycle processes and behaviors into objects requiring medical intervention (Conrad 1992; Zola 1972) for example. The examination of medicine as a social and cultural system that reproduces problems of social inequality or injustice, rather than eradicating them, never seems to slow. The route by which this reproduction occurs,

Refugee doctors as doctors' assistants in psychiatry

Refugee doctors differ from other international health professionals in that most left their country of origin under duress, rather than being part of the induced migration of many healthcare workers from low- to highincome countries. There are now over 1000 such doctors registered with the British Medical Association Refugee Council voluntary database of refugee and asylumseeking doctors (British Medical Association, 2006). Having obtained refugee status (or indefinite leave to remain), many wish to use their skills within the National Health Service (NHS) and contribute to their host country. However, they need to obtain the requisite qualifications (i.e. 70% in the International English Language Test and passes in both the written and clinical parts of the Professional and Linguistic Assessment Board) before being registered with the General Medical Council. They also need to gain an understanding of the culture and context of medical practice within the UK, as well as good references, if they are to compete successfully for training posts with UK graduates and other international medical graduates. The most recent figures available (September 2005) show that only 77 of those registered with the database are currently working in the NHS and 207 doctors have the required accreditation but are not yet employed (British Medical Association, 2006).

Medicine and the arts in the undergraduate medical curriculum at the University of Oslo Faculty of Medicine, Oslo, Norway.

The authors describe a course titled Medicine and the Arts, established in 1996, that is part of the first semester of the undergraduate medical curriculum at the University of Oslo Faculty of Medicine. The course comprises four two-hour seminars on literature, visual arts, architecture, and music. The core objectives of the course are to demonstrate how art can be a source of personal and professional development, and also how art represents a source of insight into patients' experiences and the social, cultural, and historical context of medical practice. The course emphasizes that art is ambiguous and many layered and that its interpretation requires sensitivity, engagement, imagination, and reflection. Fostering these skills is a major aim of the course because these skills are also essential for clinical competence and professional development. The course's seminars are integrated into the curriculum but are not compulsory. Although the topics covered by the course have not been explicitly addressed in the formal examination of students, there has been some discussion about doing so, which would be a signal that those topics are as important as others in the curriculum.

Educating physicians to use the digital library.

Skill in creating, finding, managing, and using biomedical information is a vital component of modern medical practice. Medical schools recognize the revolutionary implications of computing technology and use a number of different strategies to integrate "informatics education" into their curricula. In many institutions, leadership for this effort rests with the health sciences library and/or the department of medical informatics. Examples are presented of how nine medical schools have implemented informatics education; no single informatics-education strategy prevails, and these schools' strategies do not exhaust the possibilities. Informatics education programs will require better planning and integration in the future because of the need to keep pace with curriculum reform, the changing context of medical practice, and the speed of technological innovation.