Search

Ksheerabdhi Sankar, Kuppusamy Anand, Swetha Ramani, Balasubramaniam Gayathri Department of Anesthesiology, SRM Medical College Hospital and Research Centre, Potheri, 603203, IndiaCorrespondence: Kuppusamy Anand, Department of Anesthesiology, SRM Medical College Hospital and Research Centre, Room No. 206, B Block, Second Floor, Potheri, 603203, India, Tel +91-98652 82288, Email anandk@srmist.edu.inBackground and Aim: Percutaneous nephrolithotomy (PCNL) under epidural anesthesia has been reported to have few advantages over general anesthesia, like lower postoperative pain and less need for analgesics. There are limited studies on PCNL being performed under neuraxial anesthesia in supine position. Hence the present study was conceived to compare hemodynamic parameters in patients undergoing percutaneous nephrolithotomy (PCNL) in the supine position under combined spinal-epidural with general anesthesia (GA).Material and Methods: A prospective, randomized control trial was conducted among 90 patients who were posted to undergo elective percutaneous nephrolithotomy in the the supine position, after obtaining Institutional Ethical Committee (IEC) approval and CTRI (Clinical Trial Registry - India) registration. Patients were randomly allotted to undergo surgery either under general anesthesia (group GA) or combined spinal epidural anesthesia (group CSE) by computer-generated random number method. Hemodynamic parameters, postoperative analgesic requirement and incidence of blood transfusion were recorded and analyzed.Results: There was no significant difference between the two groups with respect to gender, ASA grade, surgery duration, calculus size and pulse rate. There was a statistically significant reduction in mean arterial pressure from 5 to 50 minutes of surgery and less incidence of blood transfusion in patients in the CSE group. Patients who underwent PCNL in the supine position under CSE required lesser analgesics postoperatively compared to those under general anesthesia.Conclusion: Combined spinal epidural analgesia can be used as an alternative to general anesthesia for patients undergoing PCNL in the supine position in view of less MAP and reduced postoperative analgesic and blood transfusion requirement.Keywords: pulse rate, mean arterial pressure, percutaneous nephrolithotomy, ureteroscopy, supine position

Background: Pre-eclampsia remains an important maternal health problem in India. WHO makes a strong recommendation for supplementation of pregnant women with 1.5 grams to 2.0 grams of elemental calcium per day in areas with low dietary calcium intake and for women at high risk of developing hypertensive disorders during pregnancy. Objectives: 1) To evaluate the efficacy of calcium carbonate in reducing the incidence of pre-eclampsia and 2) to study the maternal and fetal outcomes, in antenatal women with hypertensive disorders of pregnancy. Methods: This was a prospective, observational study done in the department of obstetrics and gynaecology, Government Head Quarters Hospital, Dindigul, Tamil Nadu. 600 pregnant women in early second trimester, from 14 weeks to 20 weeks, attending during October 2018 to February 2020, were recruited. The subjects were divided into two groups of 300 each (calcium lactate and calcium carbonate). All the descriptive and inferential statistics were analysed using SPSS software 22 version. P value of

Marina E Zambrotta,1,2 Patricia Aylward,3 Christopher L Roy,1,2 Emily Piper-Vallillo,1,4 Stephen R Pelletier,2 James P Honan,4 Noah Heller,4 Subha Ramani,1,2 Helen M Shields1,2 1Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA; 2Harvard Medical School, Boston, MA, USA; 3Department of Nursing, Brigham and Women’s Hospital, Boston, MA, USA; 4Harvard Graduate School of Education, Cambridge, MA, USACorrespondence: Marina E Zambrotta; Helen M ShieldsDepartment of Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, 02115, USATel +1 401-499-3874; +1 617-678-6077Fax +1 918-233-2180; +1617-525-8740Email Mzambrotta@partners.org; Hmshields@bwh.harvard.eduIntroduction: High levels of interprofessional collaboration are beneficial for patients and healthcare providers. Co-teaching may be one method for creating a collaborative environment. This pilot study designed, developed, and implemented Nurse-Doctor Co-Teaching on an inpatient medicine service.Methods: Ten Nurse-Doctor Co-Teaching pairs designed 30-minute, structured co-teaching sessions with learning objectives, evidence-based content, interactive teaching strategies and a Take-Away of key content with the help of a coaching team. Each session was presented by a nurse and senior doctor to nurse and resident learners. Our assessment blueprint included: 1. Anonymous surveys assessing the overall rating of each session and 2. Pre- and post-anonymous surveys assessing measures of interprofessional collaboration and communication between nurses and residents before and after the series of ten co-teaching sessions.Results: Data from ten post-session surveys included 121 of 156 participants (77.6%). Attendance at each session ranged from 13– 19 participants with 8– 17 participants completing a survey per session for an average of 12.1 surveys analyzed. All Nurse-Doctor Co-Teaching sessions scored in the excellent range between 1.00 and 1.43 on a Likert scale (1 is excellent and 5 is poor). In response to the question “What did you like best?”, interactive teaching strategies was the most frequent spontaneous answer. A significant correlation between the number of interactive teaching strategies and enjoyability of the session (p-value=0.01) was observed. Measures of interprofessional collaboration and communication did not change significantly in the pre-intervention compared to post-intervention period.Conclusion: We created a unique model of interprofessional co-teaching on an inpatient service. The overall excellent ratings of our interactive sessions indicate that Nurse-Doctor Co-Teaching is a valued form of learning. Our structured format is adaptable to various medical settings and could be expanded to include additional allied health professionals. We plan further studies to assess if Nurse-Doctor Co-Teaching improves measures of interprofessional collaboration.Keywords: interprofessional co-teaching, interactive teaching strategies, nursing education, resident education, coaching team, faculty development

Aggression and violence are themes which characterize a significant proportion of many close romantic relationships. Both women and men may find themselves caught in a web of intimate terror – controlled, manipulated, and hurt by a coercive and violent partner. In this brief review article, we summarize existing literature on the form of intimate partner violence known as coercive controlling violence (CCV), domestic abuse, or intimate terrorism. We begin by discussing the nature and consequences of CCV relationships. Personal or individual (e.g., biological sex, age, immigrant status, socioeconomic status, attitudes and beliefs, mental health and psychopathology), relational or interpersonal (e.g., relationship type, relationship satisfaction), and environmental (e.g., economic strain, social isolation) risk factors associated with the occurrence of domestic abuse are identified. Finally, potential preventative measures at the individual, interpersonal, and sociocultural level that may serve to reduce the likelihood of this pernicious interpersonal phenomenon are considered.

We examined how two critical constructs, health beliefs and sensation seeking, influence combination antiretroviral therapy adherence in HIV + African Americans, and whether these factors mediate the association between age and adherence. Two hundred and eighty-six HIV + African Americans participated in this observational study. Path analyses revealed that higher levels of a specific health belief, perceived utility of treatment, and lower levels of a sensation seeking component, Thrill and Adventure Seeking, directly predicted optimal adherence. The influence of age on adherence was partially mediated by lower Thrill and Adventure Seeking levels. Depression predicted adherence via perceived utility of treatment and Thrill and Adventure Seeking, whereas current substance abuse and dependence did via Thrill and Adventure Seeking. Poorer neurocognitive function had a direct, adverse effect on adherence. Our findings suggest that supporting the development of more positive perceptions about HIV treatment utility may help increase medication adherence among African Americans. This may be particularly relevant for those with higher levels of depression symptoms, which were directly associated with negative perceptions about treatment. Additionally, clinicians can assess sensation seeking tendencies to help identify HIV + African Americans at risk for suboptimal adherence. Compensatory strategies for medication management may help improve adherence among HIV + individuals with poorer neurocognitive function.

ABSTRACT Salicylic acid (SA) is an important signaling molecule in local and systemic plant resistance. Following infection by microbial pathogens and the initial oxidative burst in plants, SA accumulation functions in the amplification of defense gene expression. Production of pathogenesis-related proteins and toxic antimicrobial chemicals serves to protect the plant from infection. Successful microbial pathogens utilize a variety of mechanisms to rid themselves of toxic antimicrobial compounds. Important among these mechanisms are multidrug-resistance pumps that bring about the active efflux of toxic compounds from microbial cells. Here, we show that a combination SA and its precursors, t-cinnamic acid and benzoic acid, can activate expression of specific multidrug efflux pump-encoding genes in the plant pathogen Erwinia chrysanthemi and enhance survival of the bacterium in the presence of model as well as plant-derived antimicrobial chemicals. This ability of plant-pathogenic bacteria to co-opt plant defense-signaling molecules to activate multidrug efflux pumps may have evolved to ensure bacterial survival in susceptible host plants.

Health professions education is that part of the education system which applies educational philosophy, theory, principles and practice in a complex relationship with busy clinical services, where education is not the primary role. While the goals are clear--to produce the health workforce that society needs to improve health outcomes--both education and healthcare systems continue to evolve concurrently amidst changes in knowledge, skills, population demographics and social contracts. In observing a significant anniversary of this journal, which sits at the junction of education and healthcare systems, it is appropriate to reflect on how the relationship is evolving. Health professions educators must listen to the voices of regulators, employers, students and patients when adapting to new service delivery models that emerge in response to pressures for change. The recent COVID-19 pandemic is one example of disruptive change, but other factors, such as population pressures and climate change, can also drive innovations that result in lasting change. Emerging technology may act as either a servant of change or a disruptor. There is a pressing need for interdisciplinary research that develops a theory and evidence base to strengthen sustainability of change.

We examined how two critical constructs, health beliefs and sensation seeking, influence combination antiretroviral therapy adherence in HIV+ African Americans, and whether these factors mediate the association between age and adherence. Two-hundred-and-eighty-six HIV+ African Americans participated in this observational study. Path analyses revealed that higher levels of a specific health belief, perceived utility of treatment, and lower levels of a sensation-seeking component, Thrill and Adventure Seeking, directly predicted optimal adherence. The influence of age on adherence was partially mediated by lower Thrill and Adventure Seeking levels. Depression predicted adherence via perceived utility of treatment and Thrill and Adventure Seeking, whereas current substance abuse and dependence did via Thrill and Adventure Seeking. Poorer neurocognitive function had a direct, adverse effect on adherence. Our findings suggest that supporting the development of more positive perceptions about HIV treatment utility may help increase medication adherence among African Americans. This may be particularly relevant for those with higher levels of depression symptoms, which was directly associated with negative perceptions about treatment. Additionally, clinicians can assess sensation-seeking tendencies to help identify HIV+ African Americans at risk for suboptimal adherence. Compensatory strategies for medication management may help improve adherence among HIV+ individuals with poorer neurocognitive function.

Objective: Although most agree that poor adherence to antiretrovirals is a common problem, relatively few factors have been shown to consistently predict treatment failure. In this study, a theoretical framework encompassing demographic characteristics, health beliefs/attitudes, treatment self-efficacy, and neurocognitive status was examined in relationship to highly active antiretroviral therapy adherence. Design: Prospective, cross-sectional observational design. Main Outcome Measures: Neuropsychological test performance, health beliefs and attitudes, and medication adherence tracked over a 1-month period using electronic monitoring technology (Medication Event Monitoring System caps). Results: The rate of poor adherence was twice as high among younger participants than with older participants (68% and 33%, respectively). Results of binary logistic regression revealed that low self-efficacy and lack of perceived treatment utility predicted poor adherence among younger individuals, whereas decreased levels of neurocognitive functioning remained the sole predictor of poor adherence among older participants. Conclusion: These data support components of the health beliefs model in predicting medication adherence among younger HIV-positive individuals. However, risk of adherence failure in those ages 50 years and older appears most related to neurocognitive status.