Search

Purpose: Anorexia nervosa-restrictive subtype (AN-R) is a life-threatening disorder relying on behavioural abnormalities, such as excessive food restriction or exercise. Such abnormalities may be secondary to an "objectified" attitude toward body image and self. This is the first study exploring the impact of anomalous self-experience (ASEs) on abnormal body image attitude and eating disorder (ED) symptomatology in individuals with AN-R at onset., Methods: We recruited Italian female participants, 40 with AN-R (mean age 18.3 ± 2.3) and 45 age and educational level-matched healthy controls (HCs) (mean age 18.2 ± 2.6). ASEs, body image attitude, and ED symptom severity were assessed through the examination of anomalous self-experience (EASE), the body uneasiness test (BUT), and the eating disorder examination questionnaire (EDE-Q), respectively. We conducted multivariate analysis of variance to investigate distribution patterns of variables of interest, and mediation analysis to test the effect of ASEs and body image on ED symptomatology., Results: Individuals with AN-R scored higher than HCs on the EASE (p < .0001). A direct effect of ASEs on ED severity (p = 0.009; bootstrapped LLCI = 0.067, ULCI = 0.240) was found in AN-R. After modelling the effect of abnormal body image attitude, the relationship between EASE total score and ED symptomatology was significantly mediated by BUT (p = 0.002; bootstrapped LLCI = 0.001, ULCI = 0.172)., Conclusion: Although the exact pathways linking AN-R to self-disorder remain to be identified, a broader exploration of transdiagnostic features in AN, including explorations of different dimensions of self-experience and intersubjectivity, may shed further light on the clinical phenomenology of the disorder., Level of Evidence: Level III, case-control analytic study., (© 2021. The Author(s).)

Purpose: Recently, some attempts have been made to integrate lung ultrasound (LUS) teaching into medical curricula. However, current education studies of LUS are extremely heterogeneous due to the lack of evidence-based guidelines on LUS education. In particular, the assessment of competencies is poorly standardized and mostly relies on non-validated scales. A new validated tool, the objective structured assessment of lung ultrasound skills (LUS-OSAUS), has the potential to overcome these limitations. Therefore, we adopted the LUS-OSAUS tool to assess the competencies of a group of LUS-trained undergraduates. Existing no prior practical applications of the LUS-OSAUS, our aim was to investigate the practical utility of this tool and its applicability in the evaluation of US-trained medical students., Methods: Eight undergraduates (two males, six females) were enrolled on a voluntary basis to receive a theoretical and practical training in LUS. Once completed their training, each student performed an LUS examination on a different patient hospitalized for respiratory symptoms. The same eight patients were also scanned by a senior resident in emergency medicine for a comparison with students' results. Students and the senior resident were tested by an examiner using the LUS-OSAUS tool. We compared the scores obtained by operators in all areas of competence of the LUS-OSAUS, the total scores, and the time needed to complete the sonographic task., Results: Median students' score in the single items of the scale was significantly lower than the ones obtained by the senior resident (4.0 [3.3-5.0] vs. 5.0 [5.0-5.0]; p < 0.0001). Students scored significantly lower than the senior resident in each item, except for B-line identification, choice of the correct transducer, and suggested focused questions. Median total score was also lower for students compared to the senior resident (70.5 [61.0-74.8] vs. 84.0 [83.5-84.3] (p = 0.0116). Median time required to complete the examination was significantly higher for students (14.1 [12.8-16.1] vs. 4.7 [3.9-5.2] min, p = 0.0117)., Conclusions: The LUS-OSAUS tool allowed for a standardized and comprehensive assessment of student's competencies in lung ultrasound, and helped to discriminate their level of expertise from that of a more experienced operator. The scale also specifically tests the theoretical knowledge of trainees, thus making redundant the use of questionnaires designed for this purpose.

Purpose: The sonographic evaluation of inferior vena cava diameters and its collapsibility-that is also defined as the caval index-has become a popular way to easily obtain a noninvasive estimate of central venous pressure. This is generally considered an easy sonographic task to perform, and according to the American College of Emergency Physicians (ACEP) Guidelines 25 repetitions of this procedure should be sufficient to reach proficiency. However, little is known about the learning process for this sonographic technique. Therefore, we designed this study to investigate the learning curve of inferior vena cava evaluation., Methods: We enrolled a sample of ten ultrasound-naïve medical students who received a preliminary training provided by two Junior Emergency Medicine Residents. Following training, each student performed the sonographic task on 25 different patients who were hospitalized in the internal medicine ward. The students' performance was compared with the results obtained by a consultant in internal medicine with extensive experience in point-of-care ultrasound, who repeated the procedure on the same patients (gold standard). In detail, we evaluated the time to complete the task, the quality of the obtained images, and the ability to visually estimate and measure the caval index., Results: Although most students (9/10) reached the pre-defined level of competence, their overall performance was inferior to the one achieved by the gold standard, with little improvement over time. However, repetition was associated with progressive shortening of the time needed to achieve readable images., Conclusions: Overall, these findings suggest that, although allowing to obtain a pre-defined competence, 25 repetitions are not enough to reach a good level of proficiency for this technique, that needs a longer training to be achieved.

Introduction: In a previous uncontrolled study, a reduction of rectal distensibility and volume thresholds for sensations have been related to the occurrence of fecal urgency and/or increased stool frequency after stapled hemorrhoidopexy., Aim of the Study: The aim of this study was to compare rectal symptoms and sensory-motor function after stapled hemorrhoidopexy and Milligan-Morgan hemorrhoidectomy., Methods: The clinical records of 12 (four women) and ten patients (four women) with third- and fourth-degree hemorrhoids, respectively, who underwent stapled hemorrhoidopexy or Milligan-Morgan's hemorrhoidectomy, were evaluated. One week before and 6 months after surgery, rectal motor and sensory response to distension was assessed by an electronic barostat, and bowel and rectal symptoms were recorded by means of a 7-day diary and Bristol Index scale and psychological symptoms with SCL-90 questionnaire., Results: Rectal distensibility and volume thresholds for sensations were significantly lower after surgery (P < 0.02) in the stapled group. Increased stool frequency and/or fecal urgency arose in 41% of patients in the stapled group and associated with altered rectal distensibility. No difference within and between groups could be demonstrated in SCL-90 score., Conclusions: Rectal distensibility and volume thresholds for sensations decrease after stapled hemorrhoidopexy. Altered rectal distensibility was associated with rectal urgency and/or increased stool frequency.

The recent advances in the nutrition of companion animals has resulted in a longer possible life-span for dogs and cats and an improvement in their quality of life. Numerous studies about geriatric animals show that an aging dog or cat requires a specific nutritional formulation that considers the metabolic changes associated with age. A correct diet plays an important role in the treatment of some chronic pathologies in aging animals, particularly those for which the aging process modifies the organ function. A correct diet can provide therapeutic support to the administration of drugs that can sometimes compromise organ function. In the present study, we identify key aspects of the clinical nutrition during chronic renal disorders of dogs and cats, diseases with an elevated incidence and a major cause of mortality in geriatric animals. The aim of nutritional treatment for dogs and cats affected by chronic renal disorders is to improve the quality and length of life, assuring an adequate amount of energy and slowing the progression of renal failure. To improve treatment efficacy it is necessary to prepare different dietary rations during the various stages of disease, on the basis of clinical signs and laboratory data.