Medical Perspective Research Articles

Scientific debate, misinformation, and the COVID-19 pandemic: Considerations from a medical regulatory perspective

Scientific debate, misinformation, and the COVID-19 pandemic: Considerations from a medical regulatory perspective

Undergraduate general medicine education in Japan: A nationwide cross‐sectional survey of medical trainees' perspectives

AbstractBackgroundThe 2022 revised version of the Model Core Curriculum (MCC) for Medical Education in Japan includes “generalism” as a new expertise quality and ability, based on the results of surveys of experts in health professions education. However, the perspectives of medical trainees under the pre‐2022 MCC revision were under‐examined. Here, we investigated what these trainees felt they had learned about general medicine (GM)‐related topics.MethodsWe performed a nationwide cross‐sectional study using an anonymous online questionnaire, which was developed with reference to the 2022 revised MCC. The questionnaire consisted of 14 items. For all items, we asked, “Did you learn enough during medical school?” Respondents were asked to respond on a 5‐point Likert scale (from 1 = strongly disagree to 5 = strongly agree).ResultsThree hundred and eighty‐six participants (response rate 55.4%) were included in the analysis. For the item “Behavioral science,” the number of participants who chose “3 = neither agree nor disagree” was highest, at 171 (44.3%) and with an average of 3.28, indicating that this item was perceived as insufficiently studied. Approximately half of the participants chose “4 = agree” for all items other than “Behavioral science.”ConclusionsThe study suggested that behavioral science may be underlearned among medical trainees of the pre‐2022 MCC generation. Medical educators in Japan should formulate curricula in accordance with the 2022 revision MCC and improve curricula regarding behavioral science. Future research should survey the generation of trainees who receive 2022 revision MCC‐compliant medical education; comparison of results with those of this study would be valuable in examining the effects of the revised guideline and inform international medical educators.

Ayahuasca rituals for the treatment of substance use disorders: Three narratives of former patients of a neo‐shamanic center from Uruguay

AbstractAyahuasca is a psychedelic beverage from the Amazon rainforest, used in spiritual and religious settings for medical purposes. Since the 1990s onwards, several religious and neo‐shamanic groups have been using it in Uruguay within the psychospiritual networks. Some participants go to rituals of ayahuasca looking for therapeutic alternatives to certain ailments, such as substance use disorders (SUDs). In this chapter, three cases of former patients who recovered in a neo‐shamanic center that uses ayahuasca for the treatment of SUDs are described and analyzed. The center is conducted by a psychologist trained in the Peruvian vegetalismo tradition. An ethnographic description of the ritual setting as well as the process of psychotherapeutic intervention of the center are described. In‐depth interviews were used to collect the narratives of the three patients. A medical anthropology perspective is used, focusing on different subjective trajectories: the general biographic trajectory, SUDs trajectory, spiritual trajectory, and the trajectory under the entheogenic field, ayahuasca included. As we discuss, the impact of ayahuasca rituals ceremonies should be explained not only by ayahuasca as a psychedelic compound, but as a psychotherapeutic tool immersed in a social, cultural, and spiritual setting aimed at the treatment of SUDs.

The One Health concept: a holistic approach to protect human and environmental health - how does it work in Total Worker Health strategy.

Human well-being is affected by demographic, geographical, environmental and economic changes in the modern world. Advanced and rapid technological advances have left countries without an adequate structural framework. The One Health concept, rooted in the interconnectedness of human health, animal health and the environment, addresses today's global health challenges. These include non-communicable and zoonotic diseases, antimicrobial resistance, ecosystem degradation and food security. All of these require a holistic approach, bringing together multiple disciplines. Therefore, an exploration of the One Health concept was undertaken, which focuses on the collaboration of professionals from different disciplines, as well as looking at human health in a multi-faceted way. The aim of the study was to explore how the One Health concept could contribute to effective pandemic prevention and a broader holistic understanding of human health. It was also relevant to identify its application in occupational medicine. The narrative review was adopted as the research method of choice. The authors emphasise the importance of interdisciplinary collaboration, education and international partnerships in preparing for future health emergencies. Human health should not only be assessed from a medical perspective, but also from an environmental point of view. International cooperation is therefore essential to prepare a unified response to threats and challenges. The system of teaching medical personnel needs to be improved, returning to anthropological assumptions. With zoonotic diseases systematically emerging, health professionals should be as prepared as possible for emergencies. Qualified teams are needed to assess risks and hazards in the workplace in a multidisciplinary manner. An in-depth knowledge of zoonotic pathogen transmission is crucial. The impact of environmental degradation on the immune system must be taken into account. A holistic view of workers' health is needed, taking into account ecological, environmental, social and economic factors. Med Pr Work Health Saf. 2024;75(5).

A Study on the Medical Students' Perspectives of Their Educational Environment Using the Dundee Ready Educational Environment Measure (DREEM) at a Tertiary Care Teaching Hospital in Telangana, India

A Study on the Medical Students' Perspectives of Their Educational Environment Using the Dundee Ready Educational Environment Measure (DREEM) at a Tertiary Care Teaching Hospital in Telangana, India

Virtual dissection applications in learning human anatomy: international medical students' perspectives.

Understanding human anatomy is fundamental to building medical competencies. This study explored the diverse perceptions of medical students in Saudi Arabia and Egypt concerning virtual dissection applications. Students from different Saudi and Egyptian governmental universities were invited. The online questionnaire covered the sociodemographic characteristics, students' perception of the advantages of virtual anatomy applications, satisfaction with their efficiency, and their recommendation to use them. Comparisons were performed in country-wise and then university-wise patterns. Significance was considered with a P < 0.05. The mean age of 401 participants was 20 ± 1.6. Females were 63% and the males were 37%. Saudi universities participated by 47% and Egyptian universities by 53% with various academic levels. The traditional program covers 25% of the participants and 75% are in integrated programs. Virtual dissection applications were used by 84% of the sample while the remaining 16% did not use them. No significant differences between Saudi participants and those from Egypt in the adopted teaching methods and the usual use of virtual dissection applications. However, significant differences in considering the ease of virtual applications (P = 0.016), their perfectness in lectures (P = 0.04), and their perception (P = 0.034). Also, there was no significant difference in satisfaction while their recommendation differed significantly (P = 0.034). The university-wise comparisons elaborated significant differences in the feasibility, reality, usefulness, preference, and perfectness of virtual dissection applications in lecturing. Technology can be an efficient complementary, not a replacement resource to support the educational process. Also, students' perceptions are valuable in maximizing the educational benefits of curricula.

Discoveries or doubts: a qualitative study of the transformative potential of portfolio meetings.

To adapt to medical school, students need to change their approaches to learning and study. Transformative learning through critical reflection on disorienting learning experiences supports perspective change to direct new activity. We explored how portfolio meetings support changes in students' perspectives towards learning and study during the transition to studying medicine. This qualitative mixed methods study explored changes in medical students' perspectives before and after two portfolio meetings with a mentor during the first year of medicine. Adopting a constructionist approach, we analyzed interview transcripts and written reflections from a diverse sample of students using reflexive thematic analysis. The findings were integrated during analysis. Transformative learning theory was our interpretive lens. Our analysis revealed five themes. Two themes represented students' initial apprehension about portfolio meetings: The Disclosure Dilemma and A Question of Priorities. The theme "Seeing the Big Picture" described new perspectives from reflection on learning while preparing for meetings. Clarity from Dialogue described changed perspectives to learning and study after meetings. In the theme Dialogue Disappointment, meetings perceived as unhelpful led to persisting doubts about the value of portfolio meetings. Transformative learning was evident when students described new insights into their learning leading to goal-setting and new study strategies. When initial meetings were helpful, doubts about portfolio meetings were dispelled, enhancing student engagement in future meetings. Not all meetings were transformative, highlighting the importance of student and mentor preparation and training. Further research is needed to determine whether early portfolio experiences shape later engagement in clinical contexts.

Extending Child Protection Law to the Unborn: Maternal Liability for Unborn Injury in Malaysia

The debate about the value of life is very important in discussions about abortion rights, with one side arguing that unborn children should be completely protected from harm. This view enhances with the widely held belief that pregnant women need strong legal protections to keep both of them and their unborn children safe. In Malaysia, the rights of unborn children are not clearly defined by law. The current laws try to protect pregnant women from harm caused by others but not from their own actions that could harm the unborn child. This lack of clarity leads to many legal, ethical, and social questions, especially concerning the rights of unborn children in cases of criminal acts. This article suggests a detailed legal approach that considers both scientific and medical perspectives. It argues that unborn children should be recognised as victims of crime, even when the crime is committed by their mothers.

Neuropsychiatric Constructs as Bridges Between Psychopathology and Neuropathology: A Medical Perspective

Neuropsychiatric Constructs as Bridges Between Psychopathology and Neuropathology: A Medical Perspective

Specific anti-toxic immunotherapy: use in medical practice and perspectives

The results of use of approaches and means of antitoxic immunotherapy in medical practice are summarized: passive transfer of various variants of antibodies specific to toxic compounds, vaccination – specific active immunization with vaccines carrying determinants of the immunochemical specificity of target toxic compounds. The practical effectiveness of the known approaches of passive transfer and vaccination is associated with the ability of specific antibodies, by binding target bioactive compounds with pronounced toxicity, to change the availability of corresponding structures in the body-targets and, in the presence of a sufficient number of specific antibodies with high binding ability to the target compounds, neutralize their toxicity. In medical practice, polyspecific heterologous antisera or the gamma globulin fraction of antisera (extremely rare monoclonal antibodies of narrow specificity) are widely used for passive transfer as antidotes in the treatment of victims in order to prevent deaths and extensive necrosis of soft tissues at the site of the bite of poisonous snakes and insects. Active immunization – vaccination with appropriate antigenic drugs should create in immunized individuals a state of humoral immunity with the corresponding characteristics of antibody formation specific to the target compound. When a target toxic compound enters an immunized organism, it is also possible to neutralize its toxicity. The most successful experience in using the principles of active immunization as a technology for specific antitoxic therapy is associated with the practice of using toxoids for toxinemic infections. Specific practical techniques used to achieve the effectiveness of possible approaches to specific antitoxic immunotherapy in the form of passive transfer of specific antibodies or their fragments are considered: to combat lethal infections in the pathogenesis of which the toxic effects of bacterial exotoxins are significant; when treating victims of snake and insect bites, exposure to poisons of marine organisms, algae and plant toxins; in the treatment of severe intoxication with certain low molecular weight toxic substances: digoxin, colchicine, tricyclic antidepressants. The most successful experiences of using the principles of active immunization as a technology for specific antitoxic therapy, based on the use of toxoids with specificity for diphtheria, tetanus, botulism, cholera, typhoid fever, dysentery, gas gangrene and other toxinemic infections, are also considered. The fairly high immunogenicity of toxoids with the possibility of activating both constitutional and adaptive immunity has become the basis for their use as macromolecular carriers of hapten analogues of narcotic substances – a promising direction in drug addiction, in the implementation of which a number of experimental molecular and combined vaccines of opiates, methamphetamine, cocaine, and nicotine. This variant of practical efforts in medicine can be regarded as a new direction of specific antitoxic immunotherapy – an option to combat drug addiction by vaccinating drug addicts.

Perspectives of osteopathic medical students on preclinical urology exposure: a single institution cross-sectional survey.

There is an increasing number of medical school graduates opting for surgical specialties, and the osteopathic applicant match rate for urology is lower than that of allopathic applicants. Factors influencing this may include alack of interest, perceived challenges in matching into urology, insufficient urology mentorship, limited research opportunities, and inadequate osteopathic representation in urology. The objective of this survey is to assess osteopathic medical students' perspectives on pursuing urology and enhancing preclinical exposure to and knowledge of urology. A 20-question survey addressing experiences andthe factors influencing osteopathic medical students' specialty selection and their interest in and perception of urology was designed by the investigators on Research Electronic Data Capture (REDCap) software. This survey was distributed via email listserv to all current osteopathic medical students attending Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine over 2months. Responses were collected and analyzed utilizing Fisher's exact test. Among 150 respondents, 91 % found mentors crucial in selecting a medical specialty, 95 % emphasized the importance of early exposure, and 68 % lacked familiarity with urology, with more M1 students unfamiliar with urology compared to M2 (70.4 % vs. 59 %). A larger proportion of combined M1 and M2 (preclinical) students are considering urology as a specialty compared to M3 and M4 (clinical) students who are actively on rotations (56.5 % vs. 28.6 %; p=0.0064). Also, a greater percentage of males are considering urology compared to females (64.2 % vs. 42.7 %; p=0.0164). Among those considering urology (n=75), 57.3 % lack awareness of urology's scope, and 84 % report no preclinical discussions with urologists. Those students who report that they are considering urology value early exposure significantly more than others (98.7 % vs. 78.7 %; p=0.0001). They also express greater interest in having acore urology course (73.3 % vs. 38.7 %; p<0.0001). More urology-considering students are interested in extracurricular urology-related workshops, seminars, or conferences (61.3 % vs. 17.3 %; p<0.0001). Students who are considering urology as a specialty show greater interest in having a mentorship program (85.3 % vs. 28 %; p<0.0001). Results suggested that increased urology exposure during the preclinical years is important. Urology elective offerings and urology mentorship are of high interest among those considering urology. However, additional investigation is needed to determine the impact ofpreclinical urology curricula implementation on urology match outcomes.

Medical learner perspectives on elements of an educational rural generalist pathway: survey outcomes

IntroductionThe Northern Ontario School of Medicine University (NOSM U) continues to be challenged in meeting its social accountability mandate of addressing the rural health human resource crises in its catchment of Northern Ontario. Its new educational initiative, the Rural Generalist Pathway (RGP) aims to graduate family physicians specifically prepared for rural practice. This study elicits the perspective of NOSM U learners on the various components being considered for this educational pathway.MethodsA mixed methods survey was created for each of two medical learner groups, undergraduate NOSM U students and its family medicine residents. Quantitative data was analyzed for frequencies and percentages and qualitative data underwent thematic analysis.ResultsWith a response rate of 24.6% for undergraduates and 37.9% for residents, the survey discovered undergraduates consider rural clinical rotations as the most valuable experiences in rural medicine. Among the findings, both the majority of medical students and residents (87.3% and 87.9% respectively) agreed that support for a resident’s family well-being and community integration was the element of the pathway most likely to influence them in pursuing the RGP. Mentorship by a practicing rural physician was an element highly supported by 81% of undergraduate and 81.8% of postgraduate learners as likely to influence them to take the RGP.DiscussionIncorporating learner perceptions into the development of the RGP could help focus institutional resources and enhance learner participation in this pathway, producing more rural family doctors to serve Northern Ontario.

Key aspects in the development of gender identity and sexual orientation according to trans and gender diverse people: a qualitative approach.

For decades, the sexuality of trans and gender diverse people has been researched from a pathologising and medical perspective. This approach makes assumptions about the experiences of trans people, limiting concern for unique and individual experiences, especially for those with non-binary or gender diverse identities. A growing number of articles however are beginning to take the viewpoints of trans people seriously, taking into consideration their unique experiences and insights within the context of sexual and romantic relationships. This study examines the development of gender identity and sexual orientation of a group of trans individuals in Spain. Thirteen self-identified trans participants were interviewed about their sexual orientation, gender identity and the interplay between both those aspects. A constructivist grounded theory methodology was employed to analyse the data. Five major categories were identified: reinterpreting experiences through identification with gender identity and sexual orientation; questioning gender identity and sexual orientation norms; understanding the interplay between gender identity and sexual orientation; developing as a couple; and building a community. Findings highlight the dynamic and relational nature of gender identity and sexual orientation and provide further insight into the interaction of these aspects in the development of trans and gender diverse identities.

Atezolizumab plus bevacizumab and chemotherapy versus bevacizumab plus chemotherapy for metastatic cervical cancer: a cost-effectiveness analysis.

The objective of this study is to conduct a cost-effectiveness analysis in order to evaluate the economic advantages of incorporating atezolizumab into a standard bevacizumab plus platinum regimen for the treatment of metastatic cervical cancer from the Chinese medical system perspective. We developed a partitioned survival model based on data obtained from the recently published BEATcc clinical trial and economic cost data. Our model utilized a tree-based decision analysis approach to simulate two different treatment strategies for metastatic cervical cancer: the standard bevacizumab plus platinum regimen, and the addition of atezolizumab to the standard treatment regimen. The economic assessment data included the costs of the drugs, costs related to treatment-induced adverse events. The cost-effectiveness metrics used in the analysis were quality-adjusted life-year (QALY) and incremental cost-effectiveness ratio (ICER). The robustness of our model was assessed through sensitivity analysis. The total costs of the atezolizumab group were $128179.56, while the costs of chemotherapy group were $42065.89. The atezolizumab group gained 3.52 QALYs, whereas the chemotherapy group gained 2.35 QALY. The atezolizumab regimen resulted in an increase of 1.17 QALYs at an incremental cost of $86113.67. This led to an ICER of $73601.43, which exceeds the willingness-to-pay (WTP) threshold of $39855.79 in China. Sensitivity analysis demonstrated none of the parameters within a margin of ±25% result in significant alterations to the analysis findings. Atezolizumab plus bevacizumab and chemotherapy was not to be a cost-effective option for the treatment of metastatic cervical cancer compared to bevacizumab plus chemotherapy.

Communication Skills of Medical Interpreters: A Qualitative Explanatory Study of Healthcare Professionals' and Medical Interpreters' Perceptions.

Background/Objectives: Medical interpreters support communication between medical professionals and foreign patients. However, the communication skills required of medical interpreters in the field are currently unclear. The purpose of this study was to investigate what medical professionals and medical interpreters consider to be most important communication skills of medical interpreters, and whether there are differences in perceptions between medical professionals and medical interpreters. Methods: From December 2023 to February 2024, we interviewed 10 medical professionals and medical interpreters (five medical professionals and five medical interpreters) working throughout Japan and in the United States. The narratives collected in the interviews were analyzed and evaluated in a conceptual framework. Results: Healthcare professionals and medical interpreters exhibited differences in perceptions regarding the most important communication skills for medical interpreters. The narratives of medical professionals and medical interpreters regarding medical interpreters' communication skills were divided into a 2 × 2 grid consisting of four quadrants with two axes (intervention and perspective). Regarding the communication skills of medical interpreters, medical professionals were primarily concerned with the transmission of medical information and felt that it was necessary for interpreters to understand medical professionals' perspectives and what they wanted to say in order to convey it accurately. In contrast, medical interpreters emphasized the importance of empathy and communication skills for respecting the other person and understanding the other person's opinion and perspective. Additionally, to understand the patient's perspective, medical interpreters reported that it was important to understand the cultural background of the patient and to maintain good relationships with all of the people around the patient. Conclusions: We explored the communication skills of medical interpreters and the characteristics of the perceptions and narratives of medical professionals and medical interpreters. Concepts regarding the communication skills of medical interpreters were divided into two axes (intervention and perspective) and presented as a 2 × 2 grid with four quadrants. The results of our study suggested that medical interpreters should actively intervene in interpretation situations involving foreign patients.

Sex-specific socioeconomic risk factors for spontaneous subarachnoid hemorrhage-a case-control study during the 5 years before ictus.

There is a difference in the incidence of spontaneous subarachnoid hemorrhage (SAH) between sexes, with the majority of cases occurring in female patients. Although this phenomenon has been studied from a medical perspective, the reasons for the predominance of female cases are still unclear. Non-medical factors, such as a patient's socioeconomic situation, can differ between female and male patients, with health implications. The aim of the study was to identify socioeconomic profiles for both sexes that may be vulnerable to developing SAH. This information could potentially be used for active preventive health efforts. This study was based on a 7-year consecutive cohort of 890 patients with SAH treated at Uppsala University Hospital, along with a sex- and age-matched 5:1 control group from Statistics Sweden. The collected information included demographic data, income that was analyzed through "earnings" (EAs), which is defined as the sum of income and other economic compensations related to work, and "disposable income" (DI), which is the net amount that an individual can use. Pension and sickness-related absence from work were measured using early pension (EP), old age pension (OAP), sickness absence (SA), and disability pension (DP). Univariate and multivariate analyses were used. Among the women, the socioeconomic risk profile for SAH included lower education, unemployment, being registered as living single, residing in a sparsely populated municipality, and increased age. For the men, the risk profile included residing in a sparsely populated municipality and changes in civil status. Both women and men with SAH had lower EAs and DI compared to the controls. Notably, a significantly higher proportion of the women with SAH received DP compared to the controls. Residing in a sparsely populated area was associated with an increased risk for SAH for both women and men. The women with SAH were more economically vulnerable, whereas the men faced a different type of vulnerability related to changes in civil status. We suggest that healthcare organizations use this information to identify individuals at risk and actively implement preventive measures according to stroke guidelines for both groups.

“Begging to be heard”: The Profession’s Exclusion and Marginalization of Neurodivergent Librarians

While libraries are increasingly implementing practices and services designed to serve neurodivergent patrons, such efforts have not yet been extended to neurodivergent library employees, resulting in a lack of research or best practices for workplace neuroinclusion. This research addresses that gap by investigating neuroinclusion in public and academic library workplaces and identifying barriers to and enablers of inclusion and empowerment. This work highlights the voices of neurodivergent librarians and their journey of negotiating identity and deploying embodied knowledge to navigate the barriers and enablers they encounter in their workplace and profession. This study will inform how libraries can alter their workplace environment, practices, and professional norms to improve the recruitment, retention, and advancement of neurodivergent librarians. Historically, neurodiversity research has been conducted on neurodivergent people from a medicalized perspective, focusing on diagnosis and characteristics of individuals and proposing interventions or changes to the individual or their behavior. This study instead centers neurodivergence by adopting a neurodiversity paradigm and critical disability approach to conducting research with and by neurodivergent people themselves, in accordance with their priorities and values. This study will expand library literature by attending to the various intersecting identities of neurodivergent people and analyzing the impact of professional norms and expectations on the workplace experiences of neurodivergent librarians. Through the development of this unique critical approach to ‘centering neurodivergence,’ this work will also contribute a new research paradigm for future research on neurodiversity. Furthermore, this dissertation will highlight neuroinclusive workplace practices that librarians can enact in their library workplaces.

The Jain Fast to Death: Exploring Some Legal, Medical, and Philosophical Perspectives

The Jain Fast to Death: Exploring Some Legal, Medical, and Philosophical Perspectives

Weighing Down My Career? An Exploration of the Mechanisms for Body Fat’s Impact on Long-Term Career Success and the Moderating Role of Employee Sex and Industry

ABSTRACT Much of the worldwide population is obese or overweight. However, the effects of body fat on a person’s workplace success, especially in the long term, are not well known. Further, we have little insight on the dominant mechanisms by which body fat influences career outcomes. Aiming to understand if, how, and when employee body fat impacts career success over time, we challenge prior theory (i.e. stigma theory) and employ a novel medical perspective to suggest that an employee’s health – in the form of illnesses like cardiovascular disease and diabetes – determines the relationship between employee body fat levels and long-term work success. Furthermore, we integrate research from evolutionary biology to consider the moderating role of employee sex in the health process and probe effects by industry. Longitudinal results from a nationally representative, multi-wave sample (across 20 years) show that employee health – but not stigmatization or other explanations – mediates the negative relationship between employee body fat levels and career success. Moreover, findings reveal that employee sex does not moderate this indirect effect, indicating that high body fat men and women equally experience adverse career effects due to the serious medical impairments they incur. Industry further qualifies these effects.

Palliative medicine during the pandemic: a medical student's perspective

Tucked away in the outskirts of Cork City is Marymount University Hospital and Hospice. This facility with 44 beds houses the most frail, immunocom- promised and terminally ill patients from all across Munster. That being said, providing palliative care was significantly affected by the challenges brought on from the ongoing global pandemic.