Medical Interview Research Articles

Dorsal brain activity reflects the severity of menopausal symptoms.

The severity of menopausal symptoms, despite being triggered by hormonal imbalance, does not directly correspond to hormone levels in the blood; thus, the level of unpleasantness is assessed using subjective questionnaires in clinical practice. To provide better treatments, alternative objective assessments have been anticipated to support medical interviews and subjective assessments. This study aimed to develop a new objective measurement for assessing unpleasantness. Fourteen participants with menopausal symptoms and two age-matched participants who visited our outpatient section were enrolled. Resting-state brain activity was measured using magnetoencephalography. The level of unpleasantness of menopausal symptoms was measured using the Kupperman Kohnenki Shogai Index. The blood level of follicle-stimulating hormone and luteinizing hormone were also measured. Correlation analyses were performed between the oscillatory power of brain activity, index score, and hormone levels. The level of unpleasantness of menopausal symptoms was positively correlated with high-frequency oscillatory powers in the parietal and bordering cortices (alpha; P = 0.016, beta; P = 0.015, low gamma; P = 0.010). The follicle-stimulating hormone blood level was correlated with high-frequency oscillatory powers in the dorsal part of the cortex (beta; P = 0.008, beta; P = 0.005, low gamma; P = 0.017), whereas luteinizing hormone blood level was not correlated. Resting-state brain activity can serve as an objective measurement of unpleasantness associated with menopausal symptoms, which aids the selection of appropriate treatment and monitors its outcome.

Design of a Tool for Patient Classification Based on Pharmacotherapeutic Attitudes

Perception and relief of pain exhibit variability among individuals. Age, gender, ethnicity, educational level, actual stress level, mood, or medical conditions can modify the personal interpretation of pain and responses to pharmacological treatment. These differences may play a significant role in the effects, sometimes unwanted, of analgesic treatment. Define patient typologies with Failed Back Syndrome regarding attitudes toward the disease, treatment, healthcare, and the follow-up they receive from their healthcare professionals. Create a tool for patient profile identification. A clinical case series study, observational, descriptive, and cross-sectional. Study population: patients from the Pain Unit of Nuestra Señora de La Candelaria University Hospital (HUNSC) in Tenerife, conducted in three phases: collection of medical history data (F0), initial visit (F1), and personal interview (F2). Five patient typologies are obtained based on responses to 17 items. Regression equations are calculated from these responses to predict the patient type. They are grouped into "Classics," "Dependents," "Critics," "Unconscious," and "Responsible." Additionally, two tools with 17 items and another with 7 optimized items are developed to simplify the process. These tools enable Community Pharmacy (CP) to identify patients based on their characteristics to direct personalized strategies for each of them.

Assessing Residents in the Department of Surgery at a Tertiary Care Centre Using Mini-Clinical Evaluation Exercise (Mini-CEX).

This study aimed to introduce, sensitize, and train our postgraduate students and faculty of the department of general surgery with the use of mini-Clinical Evaluation Exercise (mini‑CEX) and to assess the perception of students and faculty towards it. A cross‑sectional observational study was conducted over a period of four months. Ten surgery residents in the department were asked to volunteer to participate and five professors conducted the session. Five sessions of mini‑CEX(nine points) were conducted for each resident in different settings of the out‑patient department (OPD) and in‑patient department (IPD). A total of five skills were tested. Feedback from faculty and residents regarding the perception of mini‑CEX was alsotaken. A statistically significant difference in mean scores of all domains was observed comparing the first and last assessment (p<0.05). Hundred percent of the residents scored superior category (7-9) in the final assessment in all domains, whereas the maximum was in a satisfactory scoring grade in 1st assessment. The time taken for the assessment significantly reduced from 1st assessment to the last assessment in OPD and IPD settings (p=0.001). The mini-CEX assessment tool got 100% feedback from faculty in terms of skill improvement, method, attitude of residents, and ability to identify gaps in knowledge. However, one assessor thought that "time given for assessment" was inadequate and more effort was required than the usual traditional assessment methods. The most identified problem faced by residents was that the "time given during assessment" was less (50%); however, overall residents also found it valid, effective, and helpful in identifying knowledge gaps and improving clinical and communication skills. Mini‑CEX improves the learning environment in residency and also leads to improvement in medical interviewing skills, physical examination skills, humanistic qualities/professionalism, and counseling skills. So, it can be used for residency training in clinical departments.

Development of a validated assessment tool for medical students using simulated patients: an 8-year panel survey

BackgroundThe use of simulated patients (SPs) to assess medical students’ clinical performance is gaining prominence, underscored by patient safety perspective. However, few reports have investigated the validity of such assessment. Here, we examined the validity and reliability of an assessment tool that serves as a standardized tool for SPs to assess medical students’ medical interview.MethodsThis longitudinal survey was conducted at Keio University School of Medicine in Japan from 2014 to 2021. To establish content validity, the simulated patient assessment tool (SPAT) was developed by several medical education specialists from 2008 to 2013. A cohort of 36 SPs assessed the performance of 831 medical students in clinical practice medical interview sessions from April 2014 to December 2021. The assessment’s internal structure was analyzed using descriptive statistics (maximum, minimum, median, mean, and standard deviation) for the SPAT’s 13 item total scores. Structural validity was examined with exploratory factor analysis, and internal consistency with Cronbach’s alpha coefficients. The mean SPAT total scores across different SPs and scenarios were compared using one way analysis of variance (ANOVA). Convergent validity was determined by correlating SPAT with the post-clinical clerkship obstructive structured clinical examination (post-CC OSCE) total scores using Pearson’s correlation coefficient.ResultsOf the 831 assessment sheets, 36 with missing values were excluded, leaving 795 for analysis. Thirty-five SPs, excluding one SP who quit in 2014, completed 795 assessments, for a response rate of 95.6%. Exploratory factor analysis revealed two factors, communication and physician performance. The overall Cronbach’s alpha coefficient was 0.929. Significant differences in SPAT total scores were observed across SPs and scenarios via one-way ANOVA. A moderate correlation (r =.212, p <.05) was found between SPAT and post-CC OSCE total scores, indicating convergent validity.ConclusionsEvidence for the validity of SPAT was examined. These findings may be useful in the standardization of SP assessment of the scenario-based clinical performance of medical students.

Transcending medical consultations

Abstract The role of healthcare interpreters has attracted much interest over the years, with particular emphasis on the distance between an invisible, uninvolved prescribed behaviour that contrasts with the interpreters’ behaviour in practice as active participants. However, much of the existing literature focuses on unfolding medical consultations where providers, patients and interpreters are simultaneously present, often overlooking situations when interpreters are left alone with patients. This involves areas of special role complexity in which interpreters must choose whether or not to become visible to the patient in what has been defined as the in-between (Shaffer, 2020). This contribution aims to observe the healthcare interpreter’s role beyond the very act of the medical interview. Inspired by Shaffer (2020), we examine 66 moments “in-between” involving a sample of six interpreters (including four student interns) that took place prior, mid and end of consultations in a Spanish hospital. Rather than staying invisible, our analysis reveals that interpreters of the sample often participate in moments in-between (89.39%) to enact different roles (i.e., companion/confidant, advocate for the profession, mediator, institutional navigator, and healthcare ambassador). Among other aspects, triggers for role adoption in the in-between space include preventing conflict and deploying empathy. In this study, the behaviour of interpreters has demonstrated to influence the subsequent development of medical consultations (e.g., saving time or facilitating history taking). In light of preliminary findings that must be interpreted considering our research context, the next step is to examine how the healthcare interpreter’s behaviour in the in-between zone can facilitate interprofessional collaboration to provide patients with quality-care.

Nirmatrelvir-Ritonavir Reduced Mortality in Hospitalized Patients with COVID-19 During the Omicron Outbreak: Real-World Evidence from Beijing.

The efficacy of nirmatrelvir-ritonavir for hospitalized patients with COVID-19 has not been fully established. We conducted a retrospective analysis of hospitalized COVID-19 patients with high risk for disease progression at Beijing Chaoyang Hospital from October 15, 2022, to March 31, 2023. Patients ≥18 years old who were hospitalized with COVID-19 within 5 days of symptom onset were included. Baseline data were obtained from the routine electronic health record database of the hospital information system. Outcomes were monitored at 28 days via electronic medical record reviews or telephone interviews. We identified 1120 patients hospitalized with COVID-19 during the study period. After exclusions, 167 nirmatrelvir-ritonavir users and 132 controls were included. 28-day all-cause mortality rate was 12.0% (20/167) in the nirmatrelvir-ritonavir group, versus 22.7% (30/132) in the control group (unadjusted log-rank p = 0.010; HR = 0.49, 95% confidence interval [CI] = 0.28-0.86, IPTW-adjusted HR = 0.58, 95% CI = 0.40-0.86). The 28-day disease progression rates did not differ between the two groups (unadjusted HR = 0.59, 95% CI = 0.34-1.02, IPTW-adjusted HR = 0.73, 95% CI = 0.50-1.06). Nirmatrelvir-ritonavir significantly reduced all-cause mortality and disease progression within 28 days among patients aged ≥65 years without ≥2 vaccine doses. We found significantly reduced all-cause mortality in the nirmatrelvir-ritonavir group, particularly in elderly patients who were incompletely vaccinated. Future randomized controlled studies are needed to validate our findings.

Vascular In-person for Students In the match Trial: An investigation of postinterview site visits to address the limitations of virtual interviews

PurposeThe graduate medical education community implemented virtual residency interviews in response to travel restrictions during the COVID-19 pandemic, and this approach has persisted. Although many residency applicants wish to visit in-person prospective training sites, such opportunities could bias programs toward those who are able to meet this financial burden, exacerbating equity concerns. One proposed solution is to offer applicants the opportunity to visit only after a program’s rank list is “locked,” avoiding favoritism to applicants who visit, but allowing applicants to experience some of the camaraderie, geography, and local effects of an in-person visit. As debate about the optimal format of residency interviews continues, it is important to investigate whether in-person program visits, completed after program rank list certification, provide meaningful benefits to applicants in the residency match process. MethodsAll vascular programs entering the 2023 integrated vascular surgery residency match were invited to participate. Programs agreed to certify their National Resident Matching Program rank lists by February 1, 2023. Applicants then had the opportunity to visit the programs at which they interviewed. The particulars of the visit were determined by the individual programs. Applicants completed their standard rank list and locked on the standard date: March 1, 2023. Applicants then completed a survey regarding the impact of the visits on their rank order list decision-making. Program directors (PDs) completed a survey regarding their experiences as well. Data were collected using REDCap. ResultsTwenty-one of the 74 (28%) programs participated. Nineteen PDs completed the postinterview site visit survey (response rate 90%). Applicants interviewing at the participating programs (n = 112) were informed of the study, offered the opportunity to attend postinterview site visits, and received the survey. Forty-seven applicants responded (response rate 42%). Eighty-six percent of applicants stated that the visit impacted their rank list. Most important factors were esprit de corps of the program (86%), the faculty/trainees/staff (81%), and the physical setting (62%). Seventy-one percent of those participating spent ≤$800 on their visit. Eighty-one percent were satisfied with the process. Twenty-one percent of PDs would have changed their rank list if they could have based on the applicants’ in-person visit. Sixty-three percent of the visit sessions cost the programs ≤$500, and 63% were satisfied with the process. ConclusionsThis study is the first to document the impact of in-person site visits by applicants on a graduate medical education match process in one specialty. Our results suggest that this process provides meaningful data to applicants that helped them with their decision-making evidenced by most altering their rank lists, while avoiding some of the critical equity issues that accompany traditional in-person interviews. This may provide a model for future interview processes for residency programs.

Impact of patient-centered communication on patient satisfaction scores in patients with chronic life-limiting illnesses: an experience from Kenya.

Patient satisfaction remains a key area of interest worldwide; utilizing a patient-centered communication approach, particularly with patients with chronic life-limiting illnesses may be one way to achieve this. However, there is a dearth of empirical information on the effect of patient-centered communication strategies in patients with chronic life-limiting illnesses in Kenya on patient satisfaction. The objective of this study was to assess the impact of patient-centered communication on patient satisfaction. We conducted our study at a tertiary teaching and referral hospital in Kenya. We utilized a quasi-experimental pre-test post-test study design and engaged 301 adult medical in-patients with chronic life limiting conditions. We randomized them to receive patient-centered communication, and evaluated the change in patient satisfaction scores using an adapted Medical Interview satisfaction Scale 21 (MISS 21). Two hundred and seventy-eight out of 301 recruited participants completed the study. The baseline characteristics of the participants randomized to the control and intervention arms were similar. Although both the control and intervention arms had a decline in the mean difference scores, the intervention arm recorded a larger decline, -15.04 (-20.6, -9.47) compared to -7.87 (-13.63, -2.12), with a statistically significant mean difference between the two groups at -7.16 (-9.67, -4.46). Participants in the intervention arm were less likely to: understand the cause of their illness (p < 0.001), understand aspects of their illness (p < 0.001), understand the management plan (p < 0.001), receive all the relevant information on their health (p < 0.001), and to receive adequate self-care information (p < 0.001). They were also less likely to acknowledge a good interpersonal relationship with the healthcare providers (p < 0.001), to feel comfortable discussing private issues (p < 0.004), and to feel that the consultation time was adequate (p < 0.001). Contrary to expectation, patient-centered communication did not result in improved patient satisfaction scores. Further studies can evaluate factors affecting and explaining this relationship and assess intermediate and long-term effects of provision of a patient-centered communication in diverse global contexts.

Severe Pneumonia Caused by Respiratory Syncytial Virus and Adenovirus in Children from 2 to 24 Months at Children's Hospital 1 in Ho Chi Minh City, Vietnam.

In Vietnam, due to the lack of facilities to detect respiratory viruses from patients' specimens, there are only a few studies on the detection of viral pathogens causing pneumonia in children, especially respiratory syncytial virus (RSV) and adenovirus (Adv). Here, we performed a cross-sectional descriptive prospective study on 138 children patients from 2 to 24 months old diagnosed with severe pneumonia hospitalized at the Respiratory Department of Children's Hospital 1 from November 2021 to August 2022. The number of patients selected in this study was based on the formula n = ([Z(1 - α/2)]2 × P [1 - P])/d2, with α = 0.05, p = 0.5, and d = 9%, and the sampling technique was convenient sampling until the sample size was met. A rapid test was used to detect RSV and Adv from the nasopharyngeal swabs and was conducted immediately after the patient's hospitalization. Laboratory tests were performed, medical history interviews were conducted, and nasotracheal aspirates were collected for multiplex real-time PCR (MPL-rPCR) to detect viral and bacterial pathogens. The results of the rapid test and the MPL-rPCR in the detection of both pathogens were the same at 31.9% (44/138) for RSV and 8.7% (7/138) for Adv, respectively. Using MPL-rPCR, the detection rate was 21% (29/138) for bacterial pathogens, 68.8% (95/138) for bacterial-viral co-infections, and 6.5% (9/138) for viral pathogens. The results showed few distinctive traits between RSV-associated and Adv-associated groups, and the Adv group children were more prone to bacterial infection than those in the RSV group. In addition, the Adv group experienced a longer duration of treatment and a higher frequency of re-hospitalizations compared to the RSV group. A total of 100% of Adv infections were co-infected with bacteria, while 81.82% of RSV co-infected with bacterial pathogens (p = 0.000009). This study might be one of the few conducted in Vietnam aimed at identifying viral pathogens causing severe pneumonia in children.

Clinico Pathological Study of Rheumatoid Arthritis Association with C -Reactive Protein (CRP); a Potential Biomarker of Cartilage Damage

Objective: To explore the association between rheumatoid arthritis (RA) and C-reactive protein (CRP) levels as a potential biomarker of cartilage damage. Methodology: This case control study was done at Department of pathology Ziauddin University Clifton Campus, Karachi from June 2018 to May 2019. Patients diagnosed with rheumatoid arthritis (RA) according to established criteria, aged 18 years or older and both male and female participants were included. Clinical data was collected through medical record review and direct patient interviews. Blood samples were collected from participants for CRP measurement using standard laboratory assays. Serum CRP levels were quantified using high-sensitivity CRP assays in a certified clinical laboratory. CRP levels was defined based on established cutoff values, typically exceeding 3 mg/L. Statistical Analysis: Statistical analysis will be performed using SPSS version 26. Results: Mean age of patients was 43.38+.56 years, while control group subjects had a slightly lower mean age of 42.33+6.93 years (p = 0.412). Gender distribution showed a predominant female representation, with 76 female patients (88.4%) and 75 female controls (87.2%) (p = 0.816). There was a strong positive correlation was observed between DAS28 and CRP levels, with a Pearson correlation coefficient of r= 0.745 and (p &lt; 0.01), indicating a significant association between disease activity and CRP concentration. Conversely, the correlation between DAS28 and ESR was weaker and not statistically significant (r = 0.123, p = 0.258). Conclusion: Study revealed that the significant elevation of serum CRP levels in RA patients compared to healthy individuals. The positive correlation between serum CRP levels and the extent of joint damage observed radiographically, suggesting CRP's potential as a biomarker for estimating disease severity and cartilage deterioration in RA.

Sleep disorders in Parkinson’s disease, an early and multiple problem

In Parkinson’s disease (PD), it remains unclear whether sleep disorders including insomnia, REM sleep behavior disorder (RBD), excessive daytime sleepiness (EDS), restless legs syndrome (RLS) and sleep-disordered breathing (SDB), are isolated or combined, interact with each other and are associated with clinical factors. We sought to determine the prevalence and combinations of the main sleep disorders, and their clinical and polysomnographic associations in early stage PD. Sleep disorders were systematically diagnosed after medical interview and video-polysomnography in 162 participants with early stage PD and 58 healthy controls from the baseline of the longitudinal ICEBERG cohort. Demographic, clinical (motor, cognitive, autonomic, psychological and sensory tests), therapeutic and polysomnographic associations of sleep disorders were investigated. Sleep disorders were frequent (71%) and combined in half of the patients. The number of sleep disorders increased with disease duration and dysautonomia. Insomnia was the most common (41%), followed by definite RBD (25%), EDS (25%), and RLS (16%). These disorders were more frequent than in controls whereas SDB was rare, moderate and similar in both groups. In patients, insomnia (mainly difficulties maintaining sleep) was associated with female gender, shorter sleep time and RLS, but not with motor or psychological symptoms. RBD was associated with dysautonomia and advanced age, but not with motor and cognitive measures. EDS was associated with psychiatric and motor symptoms as well as the sedative effects of dopamine agonists but not with other sleep disturbances. Sleep disturbances are frequent and combined in early patients with PD. Their determinants and markers are more organic than psychological.

Technology impact on postpartum culture implementation: Javanese and Chinese culture

After giving birth, maternal care still continues. Keeping tabs on women’s mental well-being is crucial for creating a conducive surrounding needed for both the mother and her baby. Neglecting the mother’s emotional health can produce certain negative side effects starting from Baby Blues (postpartum depression) to the extent of physical bleeding. Consequently, these side effects need to be mitigated by society adopting the proper knowledge on the matter. Sadly, today’s practice of treating mothers during this period may differ due to cultural varieties across nations. Indonesia is home to thousands of cultures, that being said, Javanese and Chinese are two ethnicities that populate Java Island. Both have their ways of caring for mothers during postpartum. However, many cultural practices have been concluded to be misconduct in the mother’s care. Among many mistreatments, the urge to be completely immobile is still encouraged in these two cultures along with some irrational taboos. In the dawn of Internet of Things (IoT), mothers can benefit from the use of technology. AI has the potential to be an epoch-making development in maternal care. By utilizing researched medical findings and interviews, it is found that AI can help to alternate society’s belief towards old postpartum care traditions.

The impact of COVID-19 on treatment follow-up and medication adherence among patients with epilepsy at a referral hospital in Ethiopia.

The world continues to be challenged by the Coronavirus disease 2019 (COVID-19) and preventive measures like maintaining social distancing and lockdowns challenge patients to attend regular follow-ups and get a refill for medication that causes adherence problems. Hence, this study attempts to assess the impact of COVID-19 on treatment follow-up and medication adherence among patients with epilepsy. A total of 276 patients with epilepsy were enrolled in the study. Data collection was carried out through medical record reviews and patient interviews. Patients who visited Zewditu Memorial Hospital from August to September 2021 and those who had follow-up at least for two years before the outbreak of the pandemic were included. The data was analyzed using SPSS v.24. About 69.6% of patients were adherent to their treatment and 83.3% of the patients had a seizure-free period of less than 1 year. Ninety (32.6%) of the participants missed their treatment follow-up during the pandemic, mainly due to fear of being infected with COVID-19. Sixty-eight (24.6%) patients have experienced increased seizure episodes during the pandemic as compared to the previous times. Moreover, 56 (20.3%) participants were not taking their antiseizure medications (ASMs) during the pandemic because of the unavailability of medications and they discontinued hospital visits for their medication refills. Among those who missed their treatment follow-up, 20% had seizure-related physical injuries. Only educational level has a significant association with visiting health facilities during the pandemic. Thus, participants who completed college and above (OR = 2.58, 95% CI (1.32-6.38)) were more likely to attend their follow-up during the pandemics as compared to participants who can't read and write. The present study revealed that COVID-19 might have impacts on treatment follow-up and medication adherence due to fear of infection, travel restrictions and the indirect impact on the availability and affordability of medications. These might lead to poor treatment outcomes like increased seizure frequency and seizure-related physical injuries.

Depression follow-up monitoring with the PHQ-9: an open cluster-randomised controlled trial.

Outcome monitoring of depression treatment is recommended but there is a lack of evidence on patient benefit in primary care. To test monitoring depression using the Patient Health Questionnaire (PHQ-9) with patient feedback. An open cluster-randomised controlled trial was undertaken in 141 group practices. Adults with new depressive episodes were recruited through record searches and opportunistically. The exclusion criteria were as follows: dementia; psychosis; substance misuse; and suicide risk. The PHQ-9 was administered soon after diagnosis, and 10-35 days later. The primary outcome was the Beck Depression Inventory (BDI-II) score at 12 weeks. The secondary outcomes were as follows: BDI-II at 26 weeks; Work and Social Adjustment Scale (WSAS) and EuroQol EQ-5D-5L quality of life at 12 and 26 weeks; antidepressant treatment; mental health and social service contacts; adverse events, and Medical Interview Satisfaction Scale (MISS) over 26 weeks. In total, 302 patients were recruited to the intervention arm and 227 to the controls. At 12 weeks, 254 (84.1%) and 199 (87.7%) were followed-up, respectively. Only 40.9% of patients in the intervention had a GP follow-up PHQ-9 recorded. There was no significant difference in BDI-II score at 12 weeks (mean difference -0.46; 95% confidence interval [CI] = -2.16 to 1.26; adjusted for baseline depression, baseline anxiety, sociodemographic factors, and clustering by practice). EQ-5D-5L quality-of-life scores were higher in the intervention arm at 26 weeks (adjusted mean difference 0.053; 95% CI = 0.013 to 0.093. A clinically significant difference in depression at 26 weeks could not be ruled out. No significant differences were found in social functioning, adverse events, or satisfaction. In a per-protocol analysis, antidepressant use and mental health contacts were significantly greater in patients in the intervention arm with a recorded follow-up PHQ-9 (P = 0.025 and P = 0.010, respectively). No evidence was found of improved depression outcome at 12 weeks from monitoring. The findings of possible benefits over 26 weeks warrant replication, investigating possible mechanisms, preferably with automated delivery of monitoring and more instructive feedback.

Application of ALSO course in standardized training Resident in Obstetric

ObjectiveTo explore the teaching effect of Advanced Life Support in Obstetrics (ALSO) Course in the standardized training resident in obstetric.Methods60 residents of obstetrics from January 2021 to December 2022 were randomly divided into two groups, observation group and control group. The experimental group used ALSO teaching method, and the control group used traditional teaching method. The teaching effect was evaluated by theoretical examination, direct observation of procedural skills (DOPS) scale and mini clinical evaluation (Mini-CEX) scale.ResultsThe theoretical achievements of the observation group were significantly higher than that of the control group (P < 0.05). The pre-procedural preparation, safe analgesia, technique of procedure, aseptic technique, seeks help when necessary, post-procedural management, communication skills, humanistic care and overall performance score of the DOPS in the experimental group were higher than those in the control group (P < 0.05). The organization efficiency, humanistic qualities, manipulative skills, clinical judgment, medical interviewing skills and overall clinical competence score of the Mini-CEX in the experimental group were higher than those in the control group (P < 0.05).ConclusionsALSO teaching method has an ideal effect in the standardization training of residents of obstetrics, indicating the prospect of active in-depth research and expanded application.

Development and initial evaluation of the usefulness of a question prompt list to promote patients' level of information about work-related medical rehabilitation: a pilot study.

The purpose of this study was to develop a question prompt list (QPL) to support patients undergoing work-related medical rehabilitation in obtaining relevant information and to explore how patients and physicians rate the QPL regarding its usefulness, practicability, and perceived (additional) effort. An initial item pool was assessed by rehabilitation patients (N = 3) in cognitive interviews, rated by physicians and other health professionals (N = 11), and then further modified. The final QPL version (16 items) was used by patients (N = 36) in medical admission interviews in an inpatient medical rehabilitation facility and then evaluated. Physicians evaluated the QPL after each interview with a study participant (N = 6; k = 39 interviews). The QPL was used by 50% of patients who rated its usefulness and comprehensibility positively. Neither the need for information nor satisfaction with the information received was correlated with QPL use. The physicians' assessment showed a positive evaluation regarding the provision of information and structuring of the conversation, but also a higher perceived time expenditure. While initial testing of the QPL in work-related medical rehabilitation as a tool to support patient-provider communication generally showed a favorable evaluation by patients using it and physicians, future research should address its validity and effectiveness.

Relationship in development of malocclusions to polymorphisms of selected vitamin D receptors.

The development of malocclusion is related to various factor, many of which are still not fully explained. The steroid hormone, 1,25-dihydroxyvitamin D3, has pleiotropic effects. It plays a key role in skeletal metabolism and the control of cell repair by attaching to the nuclear vitamin D steroid receptor (VDR). This vitamin affects bone turnover through the processes of bone tissue formation and resorption via its action on cells of the osteoblastic and osteoclastic lineage, exerts a modulating effect on the immune system, and is involved in the regulation of cell proliferation and differentiation. The role of vitamin D3 (VD3) and its receptor polymorphisms is a rarely studied topic in dentistry. Due to the proven influence on bone turnover processes and immune responses, the main research topic is its relation to periodontal diseases, but so far, its role in the formation and development of malocclusions has not been assessed. This study aimed to assess the association of selected VDR polymorphisms: Cdx2 (rs11658820), TaqI (rs7975232), BsmI (rs1544410), ApaI (rs7975232), and FokI (rs2228570) with the development of malocclusions. A prospective observational study was performed. The examination consisted of a medical interview, intraand extraoral orthodontic diagnosis, alginate impression, cone beam computed tomography (CBCT), and venous blood sample to obtain genomic DNA and assess VDR polymorphisms. The rs11658820 polymorphism causes an almost 4-fold increase in the probability of the presence of a malocclusion. GT and TT genotypes of rs7975232 are also associated with a similar risk - almost 6 and almost 5 times higher, respectively. In turn, the effect of the rs2228570-AG and GG genotype polymorphisms on the occurrence of transversal anomalies was demonstrated (odds ratio (OR) = 8.46 and OR = 6.92, respectively). The association of individual polymorphisms with specific malocclusions should be carefully assessed, especially since some trends have been indicated.

Clinical Characteristics and Quality of Life in a Cohort of Polish Pediatric Patients with Hereditary Angioedema.

Hereditary angioedema (HAE) is a rare genetic disease. It is characterized by recurrent attacks of angioedema. Evidence to what extent it affects patient functioning is limited in the pediatric population. We aimed to determine the clinical characteristics and management of Polish children with HAE and to measure the health-related quality of life (HRQoL) of these patients. This cross-sectional study was conducted among 21 pediatric patients and their caregivers, as well as 21 respective controls randomly selected from the general population. During routine follow-up visits, standardized pediatric quality of life questionnaires (PedsQLTM 4.0) were administered to all caregivers and adolescents (≥13 years). Caregivers also completed a structured medical interview regarding the clinical characteristics and treatment of children with HAE during the previous six months. During this period, 57% of patients had low (group I), 24% moderate (group II), and 19% high (group III) HAE activity, corresponding to ≥10 attacks per 6 months. None of the patients received long-term prophylaxis. The children in group III had a lower HRQoL than other groups and controls on all dimensions of the PedsQLTM 4.0. The lowest scores in all groups were observed in the emotional functioning domain. Our data demonstrate that the burden of HAE on the quality of life of pediatric patients and their families encompasses a wide range of daily functioning.

Patient-physician interaction education in Korea: a systematic review.

Patient-physician interaction (PPI) is an important area in medical education, but in-depth discussions on the content of the outcome of patient-doctor education are rare. Therefore, in this study, we will systematically analyze the research on PPI education in Korea. In this study, papers searched with keywords related to PPI education from Korea's academic journal service were targeted according to a systematic literature analysis method. The scope of the study was to include papers published in academic journals that are candidates for Korea Citation Index registration, excluding dissertations, research reports, posters, conference presentations, books, and internet materials. The content included papers targeting medical education and medical school students was set as the range. As a result of the analysis, although communication between PPI has many positive effects in the PPI in medical education at medical schools, obstacles do occur, and various ways to overcome them were suggested. Therefore, although medical interview training between patients and doctors in medical schools is necessary, it was analyzed as being based on overseas research or lacking in specific content. The core of PPI education appears to be medical interviews, and it seems necessary to discuss whether empathy or patient-centered medical care are appropriate as the main principles of PPI education in Korea. Therefore, education on the patient-doctor relationship is an important element in medical humanities and medical humanities education, and it is expected that research and education on this will progress more actively.

The Climate Impact of Medical Residency Interview Travel in the United States and Canada: A Scoping Review.

Background The change from in-person to virtual interviews for graduate medical education (GME) provides the opportunity to compare the potential environmental effects. Objective To explore and summarize the existing literature on the potential climate impact of medical residency interview travel through a scoping review. Methods The search was conducted in October 2022 using 5 research databases. Results were screened for inclusion by 2 reviewers in a 2-tiered process. Inclusion criteria were limited to English language articles from the United States and Canada, with no limitations on the type of study, type of applicant (allopathic, osteopathic, or international medical graduate), or type of residency. A thematic analysis focusing on the objectives and main findings of identified studies was conducted and an iteratively created standardized data extraction worksheet was used such that all studies were explicitly assessed for the presence of the same themes. Results The search identified 1480 unique articles, of which 16 passed title and abstract screening and 13 were ultimately included following full-text review. There were 3 main themes identified: the carbon footprint of residency travel, stakeholders' perspectives on virtual interviews, and advocacy for virtual interviews. All 13 articles employed persuasive language on interview reform, ranging from neutral to strongly in favor of virtual interviews based wholly or in part on environmental concerns. Conclusions Two main findings were identified: (1) Though carbon footprint estimates for in-person interviews vary, in-person interviews create considerable carbon emissions and (2) those working in GME are concerned about the climate effects of GME practices and describe them as a compelling reason to permanently adopt virtual interviewing.