Medical Interview Research Articles

The mitigated carbon emissions of transitioning to virtual medical school and residency interviews: A survey-based study.

Prior to COVID, thousands of medical school and residency applicants traversed their countries for in-person interviews each year. However, data on the greenhouse gas emissions from in-person interviews is limited. This study estimated greenhouse gas emissions associated with in-person medical school and residency interviews and explored applicant interview structure preferences. From March to June 2022, we developed and distributed a nine-question, website-based survey to collect information on applicant virtual interview schedule, demographics and preference for future interview format. We calculated theoretical emissions for all interviews requiring air travel and performed a content analysis of interview preference explanations. We received responses from 258 first-year and 253 fourth-year medical students at 26 allopathic US medical schools who interviewed virtually in 2020-2021 and 2021-2022, respectively. Residency applicants participating in the study were interviewed at a mean of 15.3 programs (SD 5.4) and had mean theoretical emissions of 4.31 tons CO2 eq. Medical school applicants participating in the study were interviewed at a mean of 6.9 programs and had mean theoretical emissions of 2.19 tons CO2 eq. Ninety percent of medical school applicants and 91% of residency applicants participating in the study expressed a preference for hybrid or virtual interviews going forward. In-person medical training interviews have significant greenhouse gas emissions. Virtual and hybrid alternatives have a high degree of acceptability among applicants.

Implementation of best practice goal-setting in five rehabilitation services: A mixed-methods evaluation study.

This implementation study aimed to enhance the key elements of clinical practice goal-setting across 5 rehabilitation services. This study followed a participatory action research approach guided by the Knowledge to Action framework. Medical record audits and structured client interviews were conducted prior to and following 12 weeks of implementation, in order to evaluate the success of the goal-setting implementation package. Medical record audits and interviews conducted pre-implementation (audits n = 132, interviews n = 64), post-implementation (audits n = 130, interviews n = 56) and at 3-month follow-up (audits n = 30) demonstrated varied success across sites. Following implementation 2 sites significantly improved their common goal focus (site 1 p ≤ 0.001, site 2 p = 0.005), these sites also demonstrated a significant increase in clients reporting that they received copies of their rehabilitation goals (site 1 p ≤ 0.001, site 2 p ≤ 0.001). Four sites improved client action planning, feedback and review, and 3 sites enhanced their specificity of goal-setting. At 3-month follow-up 4 sites had continued to improve their common goal focus; however, all sites decreased the specificity of their goal-setting. Elements of the implementation package were successful at enhancing the goal-setting process; however, how the package is implemented within the team may impact outcomes.

Contemporary treatment options for male hypogonadism

Introduction
 Male hypogonadism is a disease in which testicular function is impaired. Its symptoms are due to testosterone deficiency and most of them show low specificity. These include reduced libido, erectile dysfunction and mood disorders, among others. The biochemical indicator of hypogonadism is a testosterone concentration below 350 ng/ml (12nmol/L), according to the European Association of Urology (EAU). The increased incidence of hypogonadism is associated with aging and the presence of comorbidities such as type II diabetes and obesity. Men with testosterone deficiency have an increased risk of cardiovascular disease and premature death.
 Goals
 Summary of current reports on the diagnosis and treatment of hypogonadism. An overview of the advantages and disadvantages of the different types of formulations used in testosterone replacement therapy.
 MethodsReview of literature available in PubMed and Google Scholar databases.
 Conclusions
 The medical interview, physical examination and ancillary tests help to classify hypogonadism appropriately. Measuring the concentration of gonadotropins, helps diversify primary from secondary hypogonadism. Testosterone replacement therapy (TRT) uses formulations that have varying release profiles, route of administration and drug formulation. The choice of testosterone product should involve age, lifestyle, and individual preferences of the patient.

Quantification of identifying cognitive impairment using olfactory-stimulated functional near-infrared spectroscopy with machine learning: a post hoc analysis of a diagnostic trial and validation of an external additional trial

BackgroundWe aimed to quantify the identification of mild cognitive impairment and/or Alzheimer’s disease using olfactory-stimulated functional near-infrared spectroscopy using machine learning through a post hoc analysis of a previous diagnostic trial and an external additional trial.MethodsWe conducted two independent, patient-level, single-group, diagnostic interventional trials (original and additional trials) involving elderly volunteers (aged > 60 years) with suspected declining cognitive function. All volunteers were assessed by measuring the oxygenation difference in the orbitofrontal cortex using an open-label olfactory-stimulated functional near-infrared spectroscopy approach, medical interview, amyloid positron emission tomography, brain magnetic resonance imaging, Mini-Mental State Examination, and Seoul Neuropsychological Screening Battery.ResultsIn total, 97 (original trial) and 36 (additional trial) elderly volunteers with suspected decline in cognitive function met the eligibility criteria. The statistical model reported classification accuracies of 87.3% in patients with mild cognitive impairment and Alzheimer’s disease in internal validation (original trial) but 63.9% in external validation (additional trial). The machine learning algorithm achieved 92.5% accuracy with the internal validation data and 82.5% accuracy with the external validation data. For the diagnosis of mild cognitive impairment, machine learning performed better than statistical methods with internal (86.0% versus 85.2%) and external validation data (85.4% versus 68.8%).InterpretationIn two independent trials, machine learning models using olfactory-stimulated oxygenation differences in the orbitofrontal cortex were superior in diagnosing mild cognitive impairment and Alzheimer’s disease compared to classic statistical models. Our results suggest that the machine learning algorithm is stable across different patient groups and increases generalization and reproducibility.Trial registrationClinical Research Information Service (CRiS) of Republic of Korea; CRIS numbers, KCT0006197 and KCT0007589.Graphical

Long term outcome after surgical treatment for hypothalamic hamartoma

PurposeTo determine long-term outcome for seizure control and clinical predictors for seizure freedom in patients undergoing surgical treatment for epilepsy associated with hypothalamic hamartoma (HH). Methods155 patients underwent surgical treatment for HHs and treatment-resistant epilepsy at one center (Barrow Neurological Institute at St. Joseph’s Hospital and Medical Center, Phoenix, Arizona, USA) between February 2003 and June 2010. Data collection included medical record review and direct follow-up interviews to determine seizure outcome. Statistical analysis included descriptive summaries of patient characteristics and time-to-event analysis for seizure freedom. ResultsLong-term survival with follow-up of at least five years since first surgical treatment was available for 108 patients (69.7% of the treatment cohort). The surgical approach for first HH intervention consisted of transventricular endoscopic resection (n = 57; 52.8%), transcallosal interforniceal resection (n = 35; 32.4%), pterional resection (n = 7; 6.5%), and gamma knife radiosurgery (n = 9; 8.3%). Multiple surgical procedures were required for 39 patients (36.1%). There were 10 known deaths from all causes in the treatment cohort (6.5%). Of these, one (0.6%) was related to immediate complications of HH surgery, three (1.9%) were attributed to Sudden Unexpected Death in Epileptic Persons (SUDEP), and one (0.6%) to complications of status epilepticus. For surviving patients with long-term follow-up, 55 (50.9%) were seizure-free for all seizure types. Univariable analysis showed that seizure-freedom was related to 1) absence of a pre-operative history for central precocious puberty (p = 0.01), and 2) higher percentage of HH lesion disconnection after surgery (p = 0.047). Kaplan-Meier survival analysis shows that long-term seizure outcome following HH surgery is comparable to short-term results. SummaryThese uncontrolled observational results show that long-term seizure control following HH surgical treatment is comparable to other forms of epilepsy surgery. Late relapse (at least one year after surgery) and SUDEP do occur, but in a relatively small number of treated patients. These results inform clinical practice and serve as a comparable benchmark for newer technologies for HH surgery, such as magnetic resonance imaging-guided laser interstitial thermal therapy, where long-term outcome results are not yet available.

Prognostic impact of the controlling nutritional status score in Chinese patients undergoing cardiac surgery

Prognostic impact of the controlling nutritional status score in Chinese patients undergoing cardiac surgery

Physical fitness, hormonal profile, nutritional and psychological aspects assessment of transgender women volleyball players submitted to physical tests: protocol paper of a prospective cohort

To evaluate aerobic capacity, strength and other physiological, nutritional, and psychological variables which may influence the performance of transgender women (TW) athletes and compare them to cisgender women (CW) and...

Abrikossoff’s tumor in a 23-year-old womanunsuccessfully treated with cryosurgery

<b>Introduction:</b> Abrikossoff’s tumor (AT), also known as granular cell tumor or granular cell myoblastoma, is a rare and usually benign neoplasm. It can occur anywhere in the body, but the tongue is the most often reported location.</br></br> <b>Aim:</b> To describe a diagnostically difficult case of Abrikossoff’s tumor.</br></br> <b>Case report:</b> A 23-year-old woman presented primarily to the dermatology clinic due to hidradenitis suppurativa (HS) lesions located in the right groin. During the medical interview, she additionally reported a “tongue scar” that had been present for the past 3 years. The patient was overweight and had 5-year smoking history (5 pack-years). The physical examination revealed a well-circumscribed, painless mucosal nodule of fibrous texture on the right border of the tongue. The nodule on the tongue had been ineffectively treated with cryosurgery. A biopsy was taken from the lesion. The patient was later referred to the otolaryngology unit, where a radical excision and diagnostic imaging were performed.</br></br> <b>Discussion:</b> The histological results from the biopsy were significant for AT, with positive immunohistochemical staining for S-100. While surgical excision remains the best therapeutic approach for AT, cryosurgery seems to be ineffective. It is difficult to distinguish between the benign and malignant forms of AT based solely on a histopathological picture. Therefore, patients with AT should have further diagnostics performed to exclude the potential of a malignant tumor.</br></br> <b>Conclusion:</b> Clinicians should be aware of AT when examining patients with nodular, painless, and well-demarcated mucosal lesions on the tongue. Surgical excision is the best treatment option for AT.

Obstructive sleep apnea screening in different age groups: performance of the Berlin, STOP-Bang questionnaires and Epworth Sleepiness Scale

ObjectiveTo evaluate the performance of the Berlin Questionnaire, the STOP-Bang Questionnaire, and the Epworth Sleepiness Scale in screening for the disease in adults of different age groups by comparing them with polysomnography. MethodsCross-sectional study with prospective patient allocation, in which individuals underwent a medical interview, completion of the three screening instruments, and polysomnography. Individuals were categorized into three age groups: 18–39, 40–59, and ≥60 years. The results of the screening instruments were compared to the diagnostic criteria of the International Classification of Sleep Disorders—third edition. Performance was assessed using 2×2 contingency tables, estimating sensitivity, specificity, predictive value, likelihood ratio, and accuracy. Receiver Operating Characteristic curves were also constructed and the area under the curve was estimated for each instrument by age group. ResultsWe obtained a sample with 321 individuals suitable for analysis. The mean age was 50 years, with a predominance of females (56%). The prevalence of the disease in the overall sample was 79%, more prevalent in males in any age group and more frequent in the middle age group. The analyzes revealed that STOP-Bang performed better, both for the overall sample and for all age groups, followed by Berlin Questionnaire and Epworth Sleepiness Scale. ConclusionIn an outpatient setting with individuals with characteristics similar to those in this study, it seems sensible to choose the STOP-Bang as a screening tool for the disease, regardless of age group. Level of evidence according the guide for authorslevel 2.

Medical improvisation-based motivational interviewing for internal medicine residents: Mixed-methods evaluation of a novel course

Purpose Develop and assess a novel medical improvisation-based motivational interviewing (MI) curriculum for residents. Materials and methods A 6-h medical improv-based MI curriculum occurred in 2022 for internal medicine residents. A mixed-methods evaluation included: pre- and post-role plays using the Motivational Interviewing Treatment Integrity Score (MITI) to assess MI competency, a post-course survey assessing confidence, and focus groups to understand learning through improvisation. Results Participants increased their confidence in applying MI skills after the curriculum in responding to a patient’s argument against change (29% pre vs. 72% post, p < 0.001), eliciting change talk (21% vs. 86%, p < 0.001), and providing information in an MI-centric way (39% vs. 86%, p < 0.001). All role-play participants achieved at least beginning proficiency on MITI technical and relational global summary scores post-course. MI-adherent behaviors increased, and MI-non-adherent behaviors decreased in post-course role plays. Themes on learning through improvisation included: (1) improvisation can enhance the learning of MI skills, (2) using non-medical scenarios in improvisation exercises has benefits, and (3) trying improvisation had positive effects on the learning environment. Discussion A medical improvisation-based course is a promising, engaging way to teach residents MI skills and can improve competence and confidence with MI.

Relationship between nonrestorative sleep and heartburn among a Japanese occupational population.

Nonrestorative sleep (NRS) is a symptom of insomnia and is clearly more associated with objective indices than other insomnia symptoms. Gastroesophageal reflux disease (GERD) and insomnia are known to be strongly related. However, the link between NRS and heartburn, a main symptom of GERD, is poorly understood. Therefore, the relationships between them were investigated in addition to sleep duration. The results of a single year's medical examinations were investigated for 29,475 Japanese active office workers who were 20 to 59years old. NRS and heartburn were investigated in a medical interview using a personal computer. The relationships between NRS and heartburn in addition to sleep duration were also analyzed. The subjects were 46.6 ± 8.7years old (mean ± SD) and 27% and 13% of them had NRS and heartburn, respectively. The presence of NRS together with a sleep duration of ≤ 5, 6, 7 or ≥ 8hours was an independent comorbid factor for heartburn compared with the absence of NRS together with a sleep duration of seven hours (reference; odds ratio [OR], 2.38; 95% confidence interval [CI], 2.11-2.69, OR, 2.44; 95% CI, 2.16-2.76, OR, 2.33; 95% CI, 1.94-2.79; and OR, 1.72; 95% CI, 1.14-2.52). The absence of NRS together with a sleep duration of ≤ 5hours was also an independent comorbid factor for heartburn compared with the reference (OR, 1.20; 95% CI, 1.05-1.37). NRS in active workers may contribute to heartburn comorbidity despite the sleep duration as in other workers without NRS.

Medical resident’s pursuing specialty and differences in clinical proficiency among medical residents in Japan: a nationwide cross-sectional study

ImportanceStandardized examinations assess both learners and training programs within the medical training system in Japan. However, it is unknown if there is an association between clinical proficiency as assessed by the General Medicine In-Training Examination (GM-ITE) and pursuing specialty.ObjectiveTo determine the relative achievement of fundamental skills as assessed by the standardized GM-ITE based on pursuing career specialty among residents in the Japanese training system.DesignNationwide cross-sectional study.SettingMedical residents in Japan who attempted the GM-ITE in their first or second year were surveyed.ParticipantsA total of 4,363 postgraduate years 1 and 2 residents who completed the GM-ITE were surveyed between January 18 and March 31, 2021.Main measuresGM-ITE total scores and individual scores in each of four domains assessing clinical knowledge: 1) medical interview and professionalism, 2) symptomatology and clinical reasoning, 3) physical examination and treatment, and 4) detailed disease knowledge.ResultsWhen compared to the most pursued specialty, internal medicine, only those residents who chose general medicine achieved higher GM-ITE scores (coefficient 1.38, 95% CI 0.08 to 2.68, p = 0.038). Conversely, the nine specialties and “Other/Not decided” groups scored significantly lower. Higher scores were noted among residents entering general medicine, emergency medicine, and internal medicine and among those who trained in community hospitals with higher numbers of beds, were more advanced in their training, spent more time working and studying, and cared for a moderate but not an extreme number of patients at a time.ConclusionsLevels of basic skill achievement differed depending on respective chosen future specialties among residents in Japan. Scores were higher among those pursuing careers in general medical fields and lower among those pursuing highly specialized careers. Residents in training programs devoid of specialty-specific competition may not possess the same motivations as those in competitive systems.

Iodine deficiency and real-life supplementation ineffectiveness in Polish pregnant women and its impact on thyroid metabolism.

Iodine is a pivotal component of thyroid hormones, and its deficiency leads to negative pregnancy outcomes. Therefore, during gestation, additional iodine supplementation is recommended. By evaluating a group of women from western Poland, the study updated on iodine status during pregnancy and the effectiveness of iodine supplementation in relation to the maternal and neonatal thyroid function. A total of 91 women were recruited before the delivery between 2019 and 2021. During the medical interview, the patients declared their dietary supplements intake. Thyroid parameters (TSH, ft3, ft4, a-TPO, a-Tg, and TRAb) were measured in the serum of mothers and in the cord blood of newborns after birth. Urinary iodine concentration (UIC) and urine/creatinine (UIC/crea) ratio were assessed in single urine samples using a validated high-performance liquid chromatography with ultraviolet detection (HPLC-UV). Neonatal TSH screening from dried blood spot was analyzed. Pregnant women showed a median (interquartile range) UIC of 106 (69-156) µg/liter and UIC/crea ratio of 104 (62-221) µg/g, whereas approximately 20% had UIC/crea below 50 µg/g, indicating iodine deficiency. The iodine supplementation ratio was 68%. No significant differences in UIC, UIC/crea and thyroid parameters were found between iodine supplemented and non-supplemented groups; however, the highest ioduria was detected when iodine was supplemented in addition to levothyroxine in comparison with both substances administered separately. Patients with UIC/crea within 150-249 µg/g demonstrated the lowest TSH and a-TPO levels. Screening TSH was above 5 mIU/liter in 6% of children. Despite the national salt iodization and the recommendation to supplement iodine during gestation, the status of the abovementioned microelement and real-life intake revealed the ineffectiveness of the current iodine-deficiency prophylaxis model in pregnancy.

Animal-based ketogenic diet puts severe anorexia nervosa into multi-year remission: A case series

Background: Anorexia nervosa is a devastating condition that increases risk of death over five-fold and is associated with a high rate of relapse. Considering the growing field of metabolic psychiatry, anorexia can be framed as a ‘metabolic-psychiatric’ condition that may benefit from treatment with metabolic health interventions with neuromodulatory properties. Ketogenic diets, very low carbohydrate high-fat diets, are one such neuromodulatory intervention with a long history of use in epilepsy and more recently in other systemic, neurological and mental health conditions.Aim: To describe clinical cases that highlight the potential of ketogenic diets in the treatment of anorexia and the need for further research.Setting: Patient interviews were conducted via telemedicine.Methods: Medical interviews and chart reviews were conducted with three patients with severe anorexia. Written informed consent was provided by all participants.Results: Patients with anorexia, body mass index (BMI) nadirs of 10.7 kg/m2, 13.0 kg/m2 and 11.8kg/m2 and refractory to standard of care therapy, each achieved remission of between 1–5 years to date on a high-fat animal-based ketogenic diet. Patients exhibited not only improvements in weight, with weight gain of over 20 kg each, but also diminution of anxiety and overall enhanced mental well-being.Conclusion: These cases suggest a ketogenic diet may be useful for some patients with anorexia. Further research is needed.Contribution: This case series is the first to document treatment of anorexia with unimodal ketogenic diet intervention and raises provocative questions about the role of this neuromodulatory dietary treatment for patients with anorexia, as well as the neurometabolic nature of the disease itself.

Respiratory Syncytial Virus Infection Among Hospitalized Infants in Four Middle-Income Countries.

Understanding respiratory syncytial virus (RSV) global epidemiology is important to inform future prevention strategies. Hospitalized infants <1-year-old with acute illness were enrolled prospectively in Albania, Jordan, Nicaragua, and Philippines during respiratory seasons in 2015-2017. Medical chart review, parental interview, and post-discharge follow up were conducted. Respiratory specimens were tested using real-time RT-PCR for RSV. Infant characteristics associated with very severe illness (intensive care unit [ICU] admission or receipt of supplemental oxygen) were assessed using logistic regression to adjust for potential confounders (age, sex, study site, and preterm birth). Of 3634 enrolled hospitalized infants, 1129 (31%) tested positive for RSV. The median age of RSV-positive infants was 2.7 (IQR: 1.4-6.1) months and 665 (59%) were male. Very severe illness in 583 (52%) RSV-positive infants was associated with younger age (aOR 4.1, 95% CI: 2.6-6.5 for 0-2 compared to 9-11-months; P < .01), low weight-for-age z-score (aOR 1.9, 95% CI: 1.2-2.8; P < .01), ICU care after birth (aOR 1.6, 95% CI: 1.0-2.5; P = .048), and cesarean delivery (aOR 1.4, 95% CI: 1.0-1.8; P = .03). RSV subgroups A and B co-circulated at all sites with alternating predominance by year; subgroup was not associated with severity (aOR 1.0, 95% CI: 0.8-1.4). Nine (0.8%) RSV-positive infants died during admission or within ≤30 days of discharge, of which 7 (78%) were <6-months-old. RSV was associated with nearly a third of infant acute illness hospitalizations in four middle-income countries during the respiratory season, where, in addition to young age, factors including low weight-for-age might be important predictors of severity. RSV prevention strategies targeting young infants could substantially reduce RSV-associated hospitalizations in middle-income countries.

Accuracy of the American College of Surgeons Minimum Criteria for Full Trauma Team Activation for Children.

Pediatric trauma centers use reports from emergency medical service providers to determine if a trauma team should be sent to the emergency department to prepare to care for the patient. Little scientific evidence supports the current American College of Surgeons (ACS) indicators for trauma team activation. The objective of this study was to determine the accuracy of the ACS Minimum Criteria for Full Trauma Team Activation for children as well as the accuracy of the modified criteria used at the local sites for trauma activation. Emergency medical service providers who transported an injured child aged 15 years or younger to a pediatric trauma center in 1 of 3 cities were interviewed after emergency department arrival. Emergency medical service providers were asked if each of the activation indicators were present based on their evaluation. The need for full trauma team activation was determined through a medical record review using a published criterion standard definition. Undertriage and overtriage rates and positive likelihood ratios (+LRs) were calculated. Emergency medical service provider interviews were conducted and outcome data were obtained for 9483 children. There were 202 (2.1%) cases that met the criterion standard for need for trauma team activation. Based on the ACS Minimum Criteria, 299 (3.0%) cases should have received a trauma activation. The ACS Minimum Criteria undertriaged 44.1% and overtriaged 20% (+LR, 27.9; 95% confidence interval, 23.1-33.7). Based on the actual activation status using the local criteria, 238 cases received a full trauma activation, 45% were undertriaged, and 1.4% were overtriaged (+LR, 40.1; 95% confidence interval, 32.4-49.7). There was 97% agreement between the ACS Minimum Criteria and the actual local activation status at the receiving institution. The ACS Minimum Criteria for Full Trauma Team Activation for children have a high rate of undertriage. Changes that individual institutions have made to improve the accuracy of activations at their institutions seem to have had a limited effect on decreasing undertriage.

Anterior Cervical Pain Syndromes: Defining the Patient Population and Approach to Treatments.

Objective This study aimed to evaluate patients with anterior cervical pain syndromes (ACPSs) by describing patient characteristics, therapeutic interventions, and response to treatments. Study Design This is a retrospective observational study. Methods Patients treated for diagnoses associated with ACPSs over a seven-year period in one laryngology practice at a tertiary care center were identified and evaluated via a review of clinical and surgical records. Patients identified to have undergone any treatment for ACPSs via medication, trigger-point injections of local anesthetics mixed with steroids, and/or surgical resection of the greater cornu of the hyoid bone and superior cornu of the thyroid cartilage were included. Participants subsequently underwent a medical record review and telephone interview to determine response to treatments. Results Twenty-seven patients met the inclusion criteria, including 12 patients (44.4%) with superior laryngeal neuralgia (SLN), seven patients (25.9%) with superior thyroid cornu syndrome (STCS), and eight patients (29.6%) with hyoid bone syndrome (HBS)/clicking larynx syndrome. The most common symptoms were neck/throat pain (27, 100%), globus sensation (20, 74.1%), and dysphagia (20, 74.1%). A total of 24 patients (93.3%) underwent point injections of bupivacaine and dexamethasone. Of these, 12 patients (52.2%) demonstrated a complete response that was permanent in six patients (26.1%). Seven patients (25.9%) underwent surgical intervention, with at least partial improvement noted in six patients (85.7%). Conclusion ACPSs constitute a number of complex diagnoses that remain poorly characterized in the literature. The use of point injections of local anesthetics with steroids appears efficacious with surgical options available for those with an incomplete response or return of symptoms.

Evaluating the History-Taking Process of Sexual Reproductive Health Problems in Tanzania: Lessons from a Study of Health Students and Practitioners.

Building trust and therapeutic relationships between healthcare providers and patients are crucial for delivering high-quality, comprehensive sexual and reproductive health (SRH) services. Yet, while patients face substantial SRH disparities in Tanzania, little is known about health care professionals' [HCPs] SRH history-taking practices and experiences. This paper describes HCPs' interdisciplinary practices, experience in conducting SRH taking, and the critical lessons learned to optimize quality SRH care. We conducted 18 focus group discussions in June 2019 in Dar es Salaam, Tanzania, with 60 healthcare practitioners and 61 students in midwifery, nursing, and medicine. We implemented a purposive, stratified sampling design to explore the experiences and perspectives of HCPs regarding providing sexual health services. We employed a grounded theory approach to perform the analysis. We provided seven scenarios to participants to discuss how they would manage SRH health problems. The scenarios helped us evaluate the practice and experience of SRH in Tanzania. Four broad themes and sub-themes emerged during the discussion; 1) SRH history-taking practices and experiences in the health care facilities; 2) the perceived benefit of effective SRH history-taking; 3) Factors hindering the SRH history-taking process; 4) The power of confidence. These findings have implications for strengthening a sexual health curriculum for medical students and continuing education programs for practicing health professionals designed to address the observed health disparities in Tanzania. These findings affirm that proper SRH history-taking requires a conducive environment, knowledge of relevant SRH-related laws and regulations; application of evidence-based techniques; and giving patients autonomy to make decisions for their health while making recommendations regarding standard care. Comprehensive SRH history-taking identifies critical data for illness diagnosis, provides foundational information for risk-reduction behavioural change counselling, and reduces medical costs. Therefore, the primary goal is to optimize health professional training on SRH issues and history-taking skills within the medical interview.

Abnormal visual and olfactory sensations during radiation therapy: a prospective study

PurposePatients sometimes report phosphene and phantosmia during radiation therapy (RT). However, the detail features and related factors are not well understood. Our prospective study aimed to investigate the characteristics of phantosmias and phosphenes, to identify factors that influence the occurrence, intensity and hedonic (pleasantness/unpleasantness) ratings of such sensations during RT.MethodsWe included a total of 106 patients (37 women), who underwent RT in regions of the brain, ear, nose, throat (ENT), and other areas of the body for a duration of 43 ± 5 days. Medical history and treatment parameters were collected in a structured medical interview. Olfactory function was measured using the Sniffin’ Stick Odor Identification Test at baseline. Phantosmia and phosphene were recorded weekly based on a self-report questionnaire.ResultsThere were 37% of the patients experiencing phantosmias, 51% experiencing phosphenes, and 29% simultaneously experiencing both sensations. Phosphenes were typically perceived as a flashily blue, white and/or purple light, phantosmias were typically perceived as a chemical-like, metallic or burnt smell. Younger age (F = 7.81, p < 0.01), radiation in the brain region (χ2 = 14.05, p = 0.02), absence of taste problems (χ2 = 10.28, p = 0.01), and proton RT (χ2 = 10.57, p = 0.01) were related to these abnormal sensations. History of chemical/dust exposure predicted lower intensity (B = −1.52, p = 0.02) and lower unpleasantness (B = 0.49, p = 0.03) of phantosmia. In contrast, disease (tumor) duration (B = 0.11, p < 0.01), food allergy (B = 2.77, p < 0.01), and epilepsy (B = −1.50, p = 0.02) influence phosphenes intensity. Analgesics intake predicted a higher pleasantness of the phosphenes (B = 0.47, p < 0.01).ConclusionsPhantosmias and phosphenes are common during RT. The treatment settings and individual arousal level influence the occurrence, intensity and hedonic of such abnormal sensations. Phantosmias and phosphenes may involve more central neural than peripheral mechanism, and they could be elicited with activation of areas that are not regarded to be part of the olfactory or visual network.

Longitudinal association between multimorbidity, cognitive decline and neuropsychiatric symptoms

AbstractBackgroundAlzheimer’s disease (AD) is the most common form of dementia afflicting more than 5.8 million older adults in the United States. In AD, cognitive decline and neuropsychiatric symptoms are more pronounced in those who have chronic conditions. These chronic conditions often co‐occur with other chronic conditions, known as multiple chronic conditions (MCCs). This study aimed to examine the longitudinal association between the number of chronic conditions with cognition and neuropsychiatric symptoms by cognitive status.MethodsParticipants were 21,219 community dwelling individuals from the longitudinal National Alzheimer’s Coordinating Center (NACC, U24 AG072122) database (mean age = 71.8 ± 9.8; 42.8% male). Participants completed a medical history interview, cognitive assessment, and the Neuropsychiatric Inventory (NPI), approximately every two years over a 15‐year period. Number of MCCs was characterized as the sum of clinician‐diagnosed chronic conditions (i.e., cardiovascular, metabolic, sleep, respiratory, and psychological conditions;range 0‐18). The analysis focused on memory (Craft Story 21 recall immediate and delayed), processing speed (Trails A), and executive function (Trails B, Coding, animal naming). We used mixed effect models to test whether the number of MCCs was associated with a change on each cognitive test and number neuropsychiatric symptoms by clinician diagnosed cognitive status (i.e., normal cognition, mild cognitive impairment (MCI) presumed AD etiology, MCI presumed without AD etiology, MCI with AD etiology, dementia with AD etiology, dementia with non‐AD etiology).ResultsWe found that the mean number of chronic conditions were, 2.2 ± 1.8 in cognitively normal individuals, 2.8 ± 2.0 in MCI with AD etiology, 2.8 ± 2.0 in MCI with non AD etiology, 2.7±1.9 in dementia with AD etiology, 3.0±2.1 in dementia with non‐AD etiology. Compared to cognitively normal adults, individuals with more severe cognitive impairment (i.e., groups with dementia) and a higher number of MCCs demonstrated greater decline in immediate and delayed memory recall, Trails A, animal naming, and coding (p &lt;0.05), as well as the number of neuropsychiatric symptoms (p &lt;0.05) over time accounting for age, sex, and education.ConclusionThe findings suggest that having a higher number of chronic conditions is associated with longitudinal decline in cognition and neuropsychiatric symptoms.