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Reflection on Clinical Decision-Making Between Vietnam and the UK: Medical Elective Report
Full text linkThis article explores contrasting models of clinical decision-making observed during a medical elective at Bach Mai Hospital, Vietnam, and Sheffield Children’s Hospital (SCH), UK. It highlights how cultural, systemic and ethical contexts shape decision-making and how these differences influence patient autonomy. The reflection concludes by considering how these insights will inform future practice, particularly in balancing decisiveness with multidisciplinary team (MDT) involvement when delivering patient-centred care in clinical environments
Communication Skills Through Peer-Assisted Learning: A Study on Perceived Confidence Among Peer Tutors and Tutees in a New Medical School
Full text linkBackground: Peer-assisted learning (PAL) is a well-established pedagogical strategy in medical education. It continues to be utilised within the medical field in a number of ways including communication skills teaching, where there is a wide collection of data surrounding its overall efficacy. However, the research rarely measures the effect PAL has on perceived confidence as a concept. This project aims to explore and gain greater insight to this gap in knowledge.
Methods: This study employed a mixed methods approach using survey data to determine the impact PAL had in developing perceived confidence in communication skills among the participants. Year 4 medical students assumed the role of peer tutors and year 1 students assumed the role of tutees. Ethical considerations were planned and implemented in order to ensure the welfare of all participants. There were three communication skills teaching sessions over a period of three weeks where both groups of participants were able to give feedback about the sessions they attended.
Results: A vast majority of tutors and tutees affirmed a narrative of high perceived confidence in the quantitative section of the survey. This was further validated in the qualitative results, where the main themes and codes corresponded with the notion of developing perceived confidence. There were, however, themes that were not directly related to the topic of perceived confidence but gave insight into the potential strategies that might be utilised should an established PAL scheme be implemented in the medical school.
Conclusions: The findings from this project not only contributed to the data on PAL and perceived confidence, but also indicated a potential need for a more established PAL scheme at the medical school. This has the potential to have a positive effect on the cohort both short- term as students and long-term as healthcare professionals
When Silence Makes Sense: The Trivialization of Rape in Côte d’Ivoire
Full text linkRape was made a criminal offense in Côte d’Ivoire in 1981. However, it was not until the decade of political and military crisis in Côte d’Ivoire – beginning in 2002 – that rape was marked as a matter of public concern. Prior to this decade, and despite criminalization in 1981, rape was shrouded in both institutional and social silence. This article argues that the silence observed during this period reflects the trivialization of rape in Côte d’Ivoire. This argument draws from data including rape decisions reported in the press between 1960 and 2002. It also draws from interviews that were conducted with representatives from national and international institutions, victims and perpetrators of rape, their families and civil society players. Study data were interpreted in the light of Élisabeth Noëlle-Neumann's ‘spiral of silence’ theory. According to this theory, fear of isolation can lead to silencing individuals (or the State) who renounce their own judgement if their opinion contradicts the opinion shared in their social (or political) environment
The impact of pharmacogenomics on opioid induced adverse drug reactions in patients with perioperative pain
Full text linkBackground: The management of perioperative pain is critical for postoperative recovery, with opioids being a primary treatment option. However, opioid induced adverse drug reactions (ADRs) can significantly affect patient outcomes. Research indicates that genetic variation may influence the incidence and severity of opioidADRs. However, a comprehensive review into this relationship is lacking. This systematic review aims to fill this gap in the literature by exploring the impact of pharmacogenomics on opioid induced ADRs in the perioperative setting.
Methods: This review was led by the Prisma guidelines, to ensure a rigorous and consistent methodology. A thorough and comprehensive search of databases PubMed and Embase was done. Inclusion and exclusion criteria were applied to identify relevant papers. Data on opioid use, ADRs, and genetic polymorphisms were extracted and synthesized. Data was collected on two primary outcomes concerning the ADRs associatedwith opioid usage, and the frequency and severity of opioids in relation to specific genetic polymorphisms.
Results: 624 papers were initially identified, from this, 20 met the inclusion criteria for analysis and qualitative synthesis. This resulted in a wide range of key genes reported. These were implicated in drug transport (ABCB1, ABCC3), opioid receptor function (OPRK1, OPRM1, OPRD1), and metabolic pathways (CYP2D6, CYP3A4, CYP2B6, UGT2B7, COMT). Additionally, genes related to ion channel function (KCNJ6, KCNJ9)and other molecules (FAAH, OCT1, CGRP) were also assessed. Key findings suggest significant associations between selected genetic polymorphisms in the cytochrome enzyme family, OPRM1, FAAH, OCT1 andABBC3 genes, and the occurrence of opioid ADRs including respiratory depression, nausea, and vomiting.
Conclusions: This systematic review has explored the potential role of pharmacogenomics in perioperativeADRs. It can be concluded that while pharmacogenomics may look promising for enhancing personalized medicine, in the context of perioperative opioid induce ADRs, the current evidence does not yet allow for clinical application. Future larger studies are needed that could provide the statistical power to clarify the relationships observed. This could lead to a reduction of the burden of perioperative opioid induced ADRs through personalised medicine strategies
Judith Butler, Who’s Afraid of Gender? (New York: Penguin Books, 2024)
Full text linkReview of Judith Butler's Who's Afraid of Gender? (2024)
'We Are Not Leaving the Istanbul Convention': Disappearance of Istanbul Convention from Turkiye and presence of unlikely feminist legal spaces in international law-making
Full text linkInternational law is typically a State-centric space, consisting of a body of positive laws made by sovereign States. Law and the production of laws are dominated by vertical and linear legal spaces, governed by a hierarchical normative order, whose single author is the State. Feminist engagements with law can sometimes be reduced to interactions with the laws made within those vertical legal spaces and pertain to demanding new rights. As pointed out by Margaret Davies, an absence of feminist legal spaces is presumed when feminist analyses of law are made. In this article, we investigate feminist legal spaces that are part of the legal realm, but not an extension of vertical normativity. Feminist legal spaces co-constitute law, along with different scales of law, including vertical State law. Therefore, those feminist spaces create feminist legality, and they are not visible when looked at through vertical and linear lenses. In this article, we put our untraditional lenses on, decentralising the vertical sight of law while aiming to find feminist legal spaces within the feminist resistance against Türkiye’s withdrawal from the Istanbul Convention. With this aim, we interviewed eight activists who resisted Türkiye’s withdrawal from the Istanbul Convention. Considering law as a non-vertical space, we examined the interviews through a combined reading of Zoe Pearson’s ‘unlikely’, Sally Engle Merry’s ‘hybrid’, and Margaret Davies’ ‘horizontal’ or ‘flat’ analyses of legal spaces. Following their analyses, we deprioritise vertical legalities, focussing instead on the middle, sideways, backwards, around, hybrid, horizontal, unexpected, and unpopular spaces of international law-making. In the example of resistance against Türkiye’s withdrawal from the Istanbul Convention, we identified feminist legal spaces in the activists’ words, emotions and campaign slogans, emerging from the land and found on platforms and in courtrooms
"Two Cats and a Monkey": : A Translated and Morphologically Analyzed Cherokee Text with Guidance for Second-Language Learners
No full textWe extend the small corpus of morphologically analyzed Cherokee-language texts through our examination of a version of an Aesop’s fable published,without English translation, in an 1828 issue of the Cherokee Phoenix (TsalagiTsulehisanvhi). Our analysis, framed by observations on the document’s historical andcultural context, is intended for language researchers interested in polysynthesis indiscourse. At the same time, we have aimed to maximize accessibility for avocationaland second-language learners. To this end, we first review basic features of Cherokeeverb morphology, then illustrate, with examples from the text, how Cherokee verbscombine separable units of meaning (morphemes) to convey complex ideas and createdistinctive communicative possibilities
Won’t You Be My (Allotment) Neighbor? Mapping Cherokee Homelands in Diaspora
Full text linkContributing to work collected in Allotment Stories (2021), this article highlights the continuities of Cherokee relations that the US federal Indian policy of allotment has left fragmented and attenuated. The article brings the author's personal journal entries and critical reflections on encounters with allotment lands into collective conversation with other family, community, and oral history narratives that "re-member" allotment's legacy of fragmentation, separation, and division. By bringing together these diverse engagements with allotment, the article traces an enduring Cherokee relationality that has developed in multiple places and that remains grounded in Cherokee values and relations to Cherokee mountains, waterways, and cemetery places. 
Is Aripiprazole an effective adjunct to reduce metabolic adverse effects cause by Clozapine in Schizophrenic Patients: A Systematic Review
Full text linkBackground: Clozapine is an atypical antipsychotic drug which is used in the treatment of psychotic disorders such as schizophrenia. It has been associated with adverse effects such as, hyperglycaemia, hypercholesterolaemia and weight gain. It has been suggested that Aripiprazole (a newer atypical antipsychotic) reduces some of the metabolic adverse effects caused by Clozapine. This systematic review aims to assess the evidence regarding the effectiveness of adjunctive Aripiprazole (to Clozapine) to reduce these adverse effects
Methods: A systematic review was conducted with a narrative synthesis (due to heterogeneity in the data) by one individual. A comprehensive search strategy was developed and applied to five academic search engines. Using the PRISMA flow diagram, the search had a total of 52 results with final inclusion of 8 research articles. Based on specific inclusion and exclusion criteria, a broad range of study designs were included in the review to investigate the effect of adjunctive Aripiprazole on Clozapine induced metabolic adverse effects. Key outcomes were identified which included: glucose levels, lipid profile, body weight and waist circumference. The results were narratively synthesised, and conclusions were drawn based on the information found.
Results: Adjunctive Aripiprazole may have a role in improving LDL and total cholesterol levels in addition to body weight in those receiving treatment with Clozapine. Fasting glucose levels and waist circumference showed some improvement, but overall evidence is currently limited. Since there is limited research in the form of randomised control trials, further research is required in order to provide accurate evidence-based guidelines for clinical practice.
Conclusions: Adjunctive Aripiprazole showed variable effects on metabolic parameters with Clozapine use, however reductions in LDL, total cholesterol and bodyweight appeared consistent among the majority of the data. This showed that Aripiprazole does have some effect in reducing metabolic adverse effects caused by Clozapine however, the complex nature of possible factors that could determine metabolic changes highlights a need for further investigation and consideration of individual subject factors. In addition, gaps in the current research such as longer RCTs, boarder demographics and limited research regarding effective dose response, prompt the need for further investigation
How can fracture risk be minimised in people living with HIV in the United Kingdom? A systematic review.
Full text linkBackground: The extended life expectancy of people living with human immunodeficiency virus (PLWH), has increased the risk of age-related non-communicable comorbidities, such as osteopenia, osteoporosis, and fragility fractures (FFs). The risk arises from the virus itself, antiretroviral therapy (ART) and traditional risk factors of low bone mineral density (BMD) which may be more widespread in this population. BMD loss in PLWH begins a decade earlier than the general population, therefore earlier assessment and intervention is warranted. There is a lack of national consensus on the approach to prevent FFs and optimise bone health in PLWH within the UK. This systematic review evaluated the evidence for interventions to minimise fracture risk in PLWH through bone health assessment, risk stratification, osteoprophylaxis and osteotherapy.
Methods: MEDLINE, EMBASE and Cochrane library were searched in English language. Eligibility criteria included PLWH over the age of 16 with no geographical restrictions. Studies were included if they fulfilled one or more of the predefined themes: assessment and screening, osteoprophylaxis or osteotherapeutic interventions. Pre-existing guidelines from reputable professional bodies were also included. One reviewer was involved in data extraction, synthesis, quality assessment and analysis. Data was narratively synthesised.
Results: Out of 6233 studies identified, 56 studies and 6 guidelines were included in this review. 4 studies fulfilled criteria for the ‘assessment and screening’ theme, 30 fulfilled ‘bone prophylaxis’ objectives and 22 studies evaluated ‘treatment.’ 41565 PLWH were included, of whom were primarily Caucasian males. The fracture risk assessment tool (FRAX) underestimated fracture risk in PLWH. Predictive accuracy increased when HIV was included as a secondary risk factor for osteoporosis, or by the addition of BMD evaluation by Dual-energy X-ray absorptiometry (DXA). Various interventions, such as testosterone replacement, vitamin D supplementation and switching to bone-protective ART regimens were effective in attenuating BMD loss in PLWH. In terms of osteotherapeutic interventions, multimodal exercise programmes, bisphosphonates, and denosumab were beneficial in improving BMD.
Conclusions: This review recommends that all PLWH should have lifestyle interventions initiated and considerations around ART prescribed at the point HIV diagnosis or at ART initiation. After identification of PLWH high risk of FF using FRAX (with HIV added as a secondary cause of osteoporosis) or in all PLWH ³50, BMD evaluation by DXA is indicated, and considerations of osteotherapy with regular review is advised. Further studies should be conducted considering the effects of osteoprophylaxis and osteotherapies on FF incidence in PLWH
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