Search

Problem-Based Learning (PBL) is an effective teaching method in many fields, in particular the medical disciplines. Clinical embryology deals with all aspects of assisted conception including insemination and embryo transfer. Clinical embryologists deal with daily issues that require troubleshooting and problem solving. The aim of this study was to explore and share the use of PBL teaching in a clinical embryology training programme. Students were given real-case scenarios and tasked with formulating a solution. A survey of questions to evaluate the PBL session was developed using a 5-point Likert scale. The scores obtained from these tests were assessed and analysed using Mann-Whitney U-tests (p = 0.05). The PBL teaching offered a format for students to develop critical problem-solving skills in a safe environment, which encourages learning through problem solving by creating a usable body of knowledge and clinical skill, which are imperative for clinical practice. [ABSTRACT FROM AUTHOR]

The scope and burdens of mental health challenges in today's world are staggering. Among the available psychological treatment approaches, cognitive and behavioral therapies, and their combinations, have garnered the strongest evidence base. That said, progress has not always been linear and most of the work is still ahead of us. Against this backdrop, Behavior Therapy has launched its State of the Science series—an exciting new journal feature offering a curated set of authoritative reviews of research in major areas of relevance to applied cognitive-behavioral science, written by distinguished scientists in each area and peer-reviewed. The vision for the Behavior Therapy State of the Science series is to launch with an initial set of articles that make up this special journal issue, with continued publication of additional State of the Science articles in future journal issues. The current article launches the State of the Science series, providing a brief summary of progress in cognitive and behavioral practice and related areas, as well as various missteps and harmful legacies that remind us that the state of the science for research focused on mental health and the alleviation of human suffering is always in flux and evolving. The 16 inaugural reviews in this special issue are then introduced one by one. Collectively, these State of the Science reviews take stock of what has been learned across key areas in the field, highlight critical knowledge gaps in need of research, and provide expert guidance for improving the effectiveness and reach of care, particularly for marginalized and underserved populations. [ABSTRACT FROM AUTHOR]

Laporan kasus pengobatan kasus penyakit Blount bilateral yang berat pada anak laki laki umur 7 tahun dengan closed wedge osteotomy tibialis proksimal dan fiksasi dengan tension band wiring (TBW). Anak dengan deformitas genu varum bilateral progresif, berat, sulit berjalan, dan nyeri lutut. Radiografi terlihat sudut metaphyseal-diaphyseal (MD) 33° di sisi kanan dan 46° di sisi kiri, dan dikategorikan sebagai Langenskiöld stadium V bilateral. Koreksi dengan closed wedge osteotomy tibialis proksimal bilateral dan fiksasi dengan menggunakan tension band wiring secara bertahap, dimulai tungkai kiri, dan 3 bulan kemudian pada tungkai kanan. Pasca operasi, dilakukan pemasangan gips atas lutut enam minggu, mobilisasi bertahap dan fisioterapi. Setelah 6 bulan, deformitas genu varum berkurang dan anak berjalan mendekati normal. Radiografi terlihat penyatuan tulang yang baik pada bekas osteotomi dan perbaikan sudut MD hingga 9° bilateral. Tehnik closed wedge osteotomy dan fiksasi dengan TBW dapat dilakukan untuk koreksi deformitas varus yang berat,sekaligus stabilisasi yang baik dan mobilisasi pada anak lebih awal. Tehnik ini dapat dianggap sebagai metode fiksasi alternatif pada kasus penyakit Blount yang berat, khususnya pada fasilitas dengan sumber daya yang terbatas, di mana implan yang lebih mahal dan lebih komplek mungkin tidak tersedia.

The status of mental health for adolescents and young adults has aptly been termed a "crisis" across research, clinical, and policy quarters. Arguably, the status quo provision of mental health services for adolescents and young adults is neither acceptable nor salvageable in its current form. Instead, only a wholesale policy transformation of mental health sciences can address crises of this scope. Pandemic-related impacts on mental health, particularly among young adults, have clearly exposed the need for the mental healthcare field to develop a set of transformative priorities to achieve long overdue, systemic changes: (1) frequent mental health tracking, (2) increased access to mental health care, (3) working with and within communities, (4) collaboration across disciplines and stakeholders, (5) prevention-focused emphasis, (6) use of dimensional descriptions over categorical pronouncements, and (7) addressing systemic inequities. The pandemic required changes in mental healthcare that can and should be the beginning of long-needed reform, calling upon all mental health care disciplines to embrace innovation and relinquish outdated traditions.

Aims/hypothesis: The aim of the present study was to conduct a randomised, placebo-controlled, double-blind, crossover trial to determine whether pre-meal ketone monoester ingestion reduces postprandial glucose concentrations in individuals with type 2 diabetes. Methods: In this double-blind, placebo-controlled, crossover design study, ten participants with type 2 diabetes (age 59±1.7 years, 50% female, BMI 32±1 kg/m2, HbA1c 54±2 mmol/mol [7.1±0.2%]) were randomised using computer-generated random numbers. The study took place at the Nutritional Physiology Research Unit, University of Exeter, Exeter, UK. Using a dual-glucose tracer approach, we assessed glucose kinetics after the ingestion of a 0.5 g/kg body mass ketone monoester (KME) or a taste-matched non-caloric placebo before a mixed-meal tolerance test. The primary outcome measure was endogenous glucose production. Secondary outcome measures were total glucose appearance rate and exogenous glucose appearance rate, glucose disappearance rate, blood glucose, serum insulin, β-OHB and NEFA levels, and energy expenditure. Results: Data for all ten participants were analysed. KME ingestion increased mean ± SEM plasma beta-hydroxybutyrate from 0.3±0.03 mmol/l to a peak of 4.3±1.2 mmol/l while reducing 2 h postprandial glucose concentrations by ~18% and 4 h postprandial glucose concentrations by ~12%, predominately as a result of a 28% decrease in the 2 h rate of glucose appearance following meal ingestion (all p<0.05). The reduction in blood glucose concentrations was associated with suppressed plasma NEFA concentrations after KME ingestion, with no difference in plasma insulin concentrations between the control and KME conditions. Postprandial endogenous glucose production was unaffected by KME ingestion (mean ± SEM 0.76±0.15 and 0.88±0.10 mg kg–1 min–1 for the control and KME, respectively). No adverse effects of KME ingestion were observed. Conclusions/interpretation: KME ingestion appears to delay glucose absorption in adults with type 2 diabetes, thereby reducing postprandial glucose concentrations. Future work to explore the therapeutic potential of KME supplementation in type 2 diabetes is warranted. Trial registration: ClinicalTrials.gov NCT05518448. Funding: This project was supported by a Canadian Institutes of Health Research (CIHR) Project Grant (PJT-169116) and a Natural Sciences and Engineering Research Council (NSERC) Discovery Grant (RGPIN-2019-05204) awarded to JPL and an Exeter–UBCO Sports Health Science Fund Project Grant awarded to FBS and JPL. [ABSTRACT FROM AUTHOR]

The purpose of this article is to provide a brief overview of how clinical psychology evolved in the United States as a prelude to discussing the emergence of psychological clinical science in the closing years of the 20th century. Despite the growth of clinical psychology, mental disorders remain highly prevalent, compelling us to envision new ways to deliver services in an effective but efficient manner. Topics include the dissemination gap, the affordable access gap, and the Psychological Clinical Science Accreditation System (PCSAS). Examples of novel methods for addressing the problem of public mental health in the 21st century are discussed. Finally, I close by considering the potential relevance of our experience in America for European clinical psychology.

Health inequities have persisted in scientific examination and subsequent efforts related to prevention, detection, and, particularly, treatment of mental health disorders and symptoms over most of the history of our field. In the past decade, the tide has been slowly turning to make the promotion of mental health care equity across all segments of the population more mainstream, and the momentum to do so has further accelerated in the past 5 years. This review provides a brief summary of what we currently know about mental health care inequities (across a range of identity markers), and a brief discussion about what the role of social justice and advocacy has been and can continue to be in the field of clinical science. Following this, several specific areas of scholarship are reviewed in terms of their contributions to promoting mental health care equity, namely: community-based research and community-driven mental health treatment adaptations, task-shifting efforts in domestic and global settings, utilization of technology innovations to promote such work and increase access, and policy efforts stemming from such work. The review ends off with a commentary on lessons learned and potential future directions for the field. Taken together, it is hoped that it will be clearer for clinical science scholars and trainees to grasp what role we can and should have as clinical psychologists in promoting mental health care equity in the communities we serve and in society at large. [ABSTRACT FROM AUTHOR]

Psychological science is committed to the research and use of evidence-based practice. To address the burden of mental illness, there is also a need to use psychological science for mental health advocacy and promotion. However, psychology training programs often focus on individual-level intervention instead of public health prevention in teaching, care delivery, and scholarship. Preparing psychologists to address population mental health and adequately serve all communities, especially those on the margins which our current system fails, will require moving beyond individual treatment and integrating public health values in training programs. We reflect on ways the Public Health Code of Ethics can be used to revise the current American Psychological Association psychology training competencies and discuss strategies psychology training programs can implement to train public-health oriented psychologists to move toward more ethical and effective practice. [ABSTRACT FROM AUTHOR]

Osteoartritis (OA) memengaruhi 303 juta orang di dunia dan menjadi salah satu masalah kesehatan yang harus diwaspadai. Terapi penyembuhan OA secara total belum ada. Platelet-rich plasma (PRP) saat ini menjadi target peneliti untuk penanganan pasien OA. Tujuan: Mengetahui efektivitas terapi adjuvan injeksi PRP pada pasien OA sendi lutut yang mendapatkan NSAIDs. Metode: Studi observasional dengan pendekatan cohort retrospektif dilakukan pada pasien osteoartritis sendi lutut di Rumah Sakit Jember Klinik dan Rumah Sakit Daerah Balung. Jumlah sampel yang didapatkan sebanyak 16 pasien. Penelitian ini membandingkan terapi non-steroidal anti-inflammatory drugs (NSAID) tunggal dan NSAID dengan adjuvan PRP. Evaluasi terapi dengan menilai perubahan derajat keparahan gambaran klinis menggunakan kuesioner Western Ontario and Mcmaster Universities Osteoarthritis Index (WOMAC). Uji Fisher’s exact digunakan untuk membandingkan efektivitas terapi. Hasil: terdapat perubahan derajat keparahan gambaran klinis dari 16 sampel pasien. Sebanyak 11 pasien mengalami penurunan derajat keparahan gambaran klinis, dengan rincian 8 pasien (72,7%) dari kelompok terapi NSAIDs dengan adjuvan PRP dan 3 pasien (27,3%) dari kelompok pasien OA yang mendapatkan NSAIDs tanpa adjuvan PRP. Simpulan: Terapi adjuvan injeksi PRP pada pasien OA yang mendapatkan NSAIDs lebih efektif memperbaiki derajat keparahan gambaran klinis penyakit dibandingkan dengan pasien OA yang mendapatkan NSAIDs tanpa adjuvan injeksi PRP.

Phenomenon: According to adult learning theories, effective cognitive integration of basic and clinical science may promote the transfer of knowledge to patient care. The placement of the U.S. Medical Licensing Examination (USMLE) Step 1 after the core clerkships is one strategy intended to facilitate cognitive integration, though learner experiences with this model are unexplored. The purpose of this study is to understand students' perspectives on basic and clinical science integration in a post-clerkship Step 1 curriculum. Approach: Focus groups were conducted between August and September 2020 with senior medical students from the University of California, San Francisco School of Medicine and University of Michigan Medical School. Data were analyzed using a constructivist approach to thematic analysis. Findings: Thirty-three students participated in six focus groups. Participants described multiple barriers to cognitive integration in the clerkship learning environment, though they also identified examples of teaching and learning that facilitated integration. Early in their clerkships, students struggled to integrate because of their tenuous basic science foundation, cognitive overload, and difficulty perceiving the relevance of basic science to patient care. They felt that educators primarily focused on clinical science, and many basic science teaching sessions during clerkships felt irrelevant to patient care. However, students also described experiences that made the connection between basic and clinical science more explicit, including modeling by educators and clerkship learning activities that more overtly encouraged the application of basic science to clinical care. In addition, the return to basic science studying during the post-clerkship dedicated Step 1 study period offered powerful integration opportunities. These facilitators of cognitive integration helped students recognize the value of integration for enduring learning. Insights: There are myriad barriers to cognitive integration of basic and clinical science during clerkships in a post-clerkship Step 1 curriculum. The relevance of basic science to patient care needs to be made more explicit to students through modeling by clinician educators to augment the potential benefits of curricular change. The post-clerkship Step 1 study period appears to offer a unique opportunity for cognitive integration later in a learner's trajectory that may be related to curricular design. When learners recognize the applicability of basic science to patient care, they may more intentionally transfer basic science knowledge to clinical practice. [ABSTRACT FROM AUTHOR]

This invited commentary evaluates eight target articles that offer ambitious theoretical frameworks intended to advance psychopathology research. We discuss their consideration of the perspectives and priorities of treatment-seekers, including respect for and promotion of individuals' agency and self-determination; their positioning of individuals within dynamic social systems and their consideration of interventions beyond the individual level; their assumptions and proposals about the relationship between psychological and biological concepts and phenomena, relative to the reductionism that has been dominant but unsuccessful in the psychopathology literature in recent decades; and their implications for clinical care and for individual and community health. Despite some overlapping features, the articles cover very different ground and offer different challenges to the status quo, which has seen strikingly slow progress for decades. None of the proposed theories is comprehensive, but each has unique appeals; each has limitations, and each warrants consideration and development. General Scientific Summary: Strong theory is invaluable in guiding research. To date, the clinical research literature proposing theories of mental health problems has been limited, with no prevailing model for many years. This invited commentary critically reviews eight new proposals that show considerable promise for guiding the study, treatment, and prevention of mental illness. [ABSTRACT FROM AUTHOR]

Patients suffering from parasitic diseases face considerable unmet therapeutic needs. Recent scientific advances in drug discovery technology, and in pharmacological and clinical sciences, present an opportunity to expedite drug discovery for parasitic diseases. These scientific advances have accelerated drug discovery for neglected parasitic infections at the Novartis Institute for Tropical Diseases and elsewhere. However, there are still critical scientific gaps that need to be addressed to further hasten the discovery of new antiparasitic drugs. While prevention is a bedrock of public health, innovative therapeutics are needed to complement the armamentarium of interventions required to achieve disease control and elimination targets for neglected diseases. Extraordinary advances in drug discovery technologies have occurred over the past decades, along with accumulation of scientific knowledge and experience in pharmacological and clinical sciences that are transforming many aspects of drug R&D across disciplines. We reflect on how these advances have propelled drug discovery for parasitic infections, focusing on malaria, kinetoplastid diseases, and cryptosporidiosis. We also discuss challenges and research priorities to accelerate discovery and development of urgently needed novel antiparasitic drugs. [ABSTRACT FROM AUTHOR]

Purpose: This mixed methods study aims to investigate faculty members' perceptions of early clinical exposure through clinical shadowing program (CSP) at one academic dental institution. Methods: After ethical approval was received, concurrent data collection using quantitative and qualitative methods was integrated for this study design. For the quantitative data, a validated instrument (Likert scale) was distributed to all basic and clinical science faculty members regarding the CSP. Qualitative semi‐structured interviews of basic and clinical science faculty members were conducted to explore their perceptions of the CSP. Descriptive statistics were completed for the quantitative data, and thematic analysis was carried out for the transcribed interviews. Results: Faculty members from basic and clinical sciences participated in this mixed methods study, 97% (n = 74) participants in the quantitative and 12 participants in the qualitative. The majority of faculty (67%; n = 44) strongly agreed that CSP helps predoctoral students in the application of basic science knowledge to clinical practice. All basic science respondents (n = 10; 100%) and many clinical science faculty (60%; n = 35) strongly agreed that CSP requires coordination between basic and clinical science educators (p = 0.042). Some faculty suggested the inclusion of training for educators on the program and regular periodic student assessments of the program's effectiveness. Conclusion: The current study reported positive faculty perception toward the proposed method of integration. Furthermore, opportunities to foster coordination between basic and clinical science educators may be provided by administrators to strengthen the existing CSP framework. [ABSTRACT FROM AUTHOR]

Background: The SARS-COV-2's spread from continent to the continent has resulted in an increased number of mutations in the viral gene encoding proteins. As a result, mutations in target proteins provide a significant challenge in creating antiviral drugs and vaccines. The present review discussed the COVID-19 epidemiology and the effects of drugs being tested against COVID-19/SARS-COV-2. Dosage of these drugs along with associated challenges was also discussed. Methodology: Systematic review was conducted after a thorough search in the "PubMed, NIH, Elsevier, Scopus, Web of Science, Science Direct, and Google Scholar database. 45 studies on drugs associated with COVID-19 fulfilled the inclusion criteria and were selected for this review. Results: The FDA only accepted the Remdesivir drug against SARS-COV-2, as the hospitalized patients recovered very quickly by taking it. Antiviral EIDD-2801 has been found to make the SARS-COV-2 unable to infect cells by causing genetic modifications in the virus RNA. Similarly, Nitazoxanide appeared beneficial against SARS-COV-2 in a primary intervention and severe conditions (including pregnancy) without undesirable effects on the newborns. Children with mild cases can be handled solely by proper caring. Conclusion: Although Remdesivir and Dexamethasone are recommended in severe cases, clinical trials are ongoing to investigate other possible therapies like MAb and Convalescent Plasma antibodies for COVID-19. Older drugs (usually used to treat other conditions) are also under-tested by researchers to see if they are effective for COVID-19. Further tests are essential to validate whether any of the mentioned above possible therapies would be helpful for COVID-19 treatment.

Health systems science addresses the complex interactions in healthcare delivery. At its core, health systems science describes the intricate details required to provide high-quality care to individual patients by assisting them in navigating the multifaceted and often complicated US healthcare delivery system. With advances in technology, informatics, and communication, the modern physician is required to have a strong working knowledge of health systems science to provide effective, low-cost, high-quality care to patients. Medical educators are poised to introduce health systems science concepts alongside the basic science and clinical science courses already being taught in medical school. Because of the common overlap of women's healthcare subject matter with health systems science topics, such as interprofessional collaboration, ethics, advocacy, and quality improvement, women's health medical educators are at the forefront of incorporating health systems science into the current medical school educational model. Here, the authors have described the concept of health systems science and discussed both why and how it should be integrated into the undergraduate medical education curriculum. Medical educators must develop physicians of the future who can not only provide excellent patient care but also actively participate in the advancement and improvement of the healthcare delivery system. [ABSTRACT FROM AUTHOR]

• Beck's influence on my early journey and development in becoming a psychologist. • Beck's emphasis on the importance of thinking and thought, but also phenomenology. • Need to consider the different functional meanings of cognitions across different populations. The author discusses how his early exposure to Dr. Beck's work shaped and directed his development as an emerging psychologist. Focusing on Beck's assessment of hopelessness, the author discusses how he developed an appreciation for both the multidimensionality and multifunctionality of the construct in his own works focusing on cultural differences. The author argues that Beck's early strategy to use a phenomenological approach to understanding clinical conditions remains important for appreciating the different functional meanings that cognitions might embody for different individuals. [ABSTRACT FROM AUTHOR]

Abstract Background Few validated assessment tools are available to increase understanding and measure factors associated with sustainment of clinical practices, an increasingly recognized need among clinicians. We describe the development of the Clinical Sustainability Assessment Tool (CSAT), designed to assess factors that contribute to sustainable practices in clinical settings. Methods Sixty-four participants from clinical and research fields participated in concept mapping and were recruited to brainstorm factors that lead to sustained clinical practices. Once repeated factors were removed, participants sorted items based on similarity and rated them by importance and feasibility. Using concept mapping analyses, items were grouped into meaningful domains to develop an initial tool. We then recruited pilot sites and early adopters, for a total of 286 practicing clinicians, to pilot and evaluate the tool. Individuals were recruited from clinical settings across pediatric and adult medical and surgical subspecialties. The data were analyzed using confirmatory factor analysis (CFA) to test hypothesized subscale structure in the instrument. We used root mean square error of approximation (RMSEA) and the standardized root mean square residual (SRMR) to assess fit and thus the ability of CSAT to measure the identified domains. Results The concept mapping produced sorted statements that were edited into items that could be responded to, resulting in the creation of a tool with seven determinant domains and 47 items. The pilot and CFA testing resulted in a final CSAT instrument made up 35 items, five per domain. CFA results demonstrated very good fit of the seven domain structure of the CSAT (RMSEA = 0.049; SRMR = 0.049). Usability testing indicated the CSAT is brief, easy to use, easy to learn, and does not require extensive training. Additionally, the measure scored highly (18/20) on the Psychometric and Pragmatic Evidence Rating Scale (PAPERS). The seven final CSAT domains were engaged staff and leadership, engaged stakeholders, organizational readiness, workflow integration, implementation and training, monitoring and evaluation, and outcomes and effectiveness. Conclusions The CSAT is a new reliable assessment tool which allows for greater practical and scientific understanding of contextual factors that enable sustainable clinical practices over time.

Beginning with efforts in the late 1940s to ensure that clinical psychologists were adequately trained to meet the mental health needs of the veterans of World War II, the accreditation of clinical psychologists has largely been the province of the Commission on Accreditation of the American Psychological Association. However, in 2008 the Psychological Clinical Science Accreditation System began accrediting doctoral programs that adhere to the clinical science training model. This review discusses the goals of accreditation and the history of the accreditation of graduate programs in clinical psychology, and provides an overview of the evaluation procedures used by these two systems. Accreditation is viewed against the backdrop of the slow rate of progress in reducing the burden of mental illness and the changes in clinical psychology training that might help improve this situation. The review concludes with a set of five recommendations for improving accreditation.

SUMMARY: Forensic psychiatry services have grown and become more complex in structures, processes and pathways. Legacy customs, practices and changing policy are now organised into formal models of care. These are written accounts of how a health service is delivered, outlining best practice and services for patients progressing through the stages of their condition and the care and treatment available. This article explores the four key elements of a model of care: goals; pathways and processes; treatment programmes; and systematic evaluation. It describes the most common model of care in forensic services, which builds on structures of stratified therapeutic security. It also considers variations on this basic or standard model matched to needs arising from the complex interrelationship with other parts of the mental health service for the population served and with criminal justice, primary care and physical health, housing and welfare agencies. [ABSTRACT FROM AUTHOR]

Background: Uncertainty remains concerning association between long-term physical activity and incident type 2 diabetes mellitus (DM). We intended to evaluate physical activity participation over a 6-year span and assess association with subsequent 10-year incident DM risk, as well as examine mediation role by obesity. Methods: A total of 9757 community-dwelling adults aged ≥ 50 years in England were included in the population-based cohort. Physical activity participation, including trajectories and cumulative participation were assessed using weighted Z score over a 6-year span from wave 1 (2002–2003) to wave 4 (2008–2009). Incident DM recorded over a 10-year span from wave 4 (2008–2009) to wave 9 (2018–2019) was outcome. Results: 5 distinct activity trajectories were identified, including persistently low (N=3037, incident DM=282), initially low then improving (1868, 90), initially high then declining (325, 20), persistently moderate (2489, 170), and persistently high (2038, 108). Compared with persistently low, participants of initially low then improving, persistently moderate and high were associated with lower incident DM risk, with multivariable-adjusted hazard ratios (HR) of 0.41 (95% confidence interval [CI]: 0.32 to 0.53, P <0.001), 0.70 (95% CI: 0.56 to 0.89, P =0.004) and 0.49 (95% CI: 0.37 to 0.65, P < 0.001), respectively. Elevated cumulative activity was also associated with lower DM risk, with each quintile increment in cumulative weighted Z score corresponding to HR of 0.76 (95% CI: 0.71 to 0.82, P < 0.001). Mediation analysis found that body mass index, waist circumference and change in body mass index mediate 10% (P < 0.001), 17% (P < 0.001) and 9% (P < 0.001) of the observed association between activity and incident DM, respectively. Conclusions: For middle aged and older adults, both gradually improved and persistently active participation in physical activity were associated with subsequent lower risk of incident DM, with obesity playing a potential mediator. Strategies focusing on improving and maintaining active participation in physical activity might be beneficial from DM prevention perspective. [ABSTRACT FROM AUTHOR]