Naresuan University Journal
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Who should teach rheumatology to medical students, a rheumatologist or an internist?
No full text Introduction: Rheumatology is listed as a special topic in the Thai medical competency assessment criteria of the 2012 national license examination. Lacking of rheumatologist in the affiliate medical centers may affect students’ performances in rheumatology. This study compared medical students’ knowledge scores on rheumatology examination between students taught by a rheumatologist and an internist, and surveyed students’ opinions on teaching of rheumatology by a rheumatologist.
Methods: It was a non-randomized cross-sectional study in 6 medical education centers (MECs). The study was conducted with the sixth-year medical students (n=109). Rheumatologists in 3 MECs directly taught rheumatology to students while in 3 MECs the internists did so. Sixty multiple choice questions (MCQs) with one best response from 5 choices and a questionnaire, which surveyed students’ opinions on teaching of rheumatology by a rheumatologist.
Results: The knowledge scores from the 60 MCQs revealed that students in the rheumatologist teaching group had slightly higher but not significantly different total scores than students in the internist teaching group (31.74±5.47 vs. 30.49±7.37, p value 0.32). The scores from “must know” items were also not significantly different between the two groups (20.57±4.27 vs. 20.42±5.92, p value 0.88). However, the scores on “should know” items of students from the rheumatologist teaching group had significantly higher scores than the internist teaching group (11.18±2.15 vs. 10.06±2.60, p value 0.03. Most medical students expressed the need to learn rheumatology from a rheumatologist with the expectation that a rheumatologist provides more emphasis on clinical and practical points than the internist does.
Conclusions: In the 3 MECs where the sixth-year medical students were taught by rheumatologists, a significant difference was found in “should know” knowledge of rheumatology but the “must know” and total scores were not significantly different. Most sixth-year medical students believed that teaching by rheumatologists would help them focus on clinical and practical points more than teaching by general internal medicine staff.
Keywords: Musculoskeletal, Undergraduate, Rheumatologist, Internis
Towards standardisation and improved understanding of sleep restriction therapy for insomnia disorder: A systematic examination of CBT-I trial content
No full textHolistic assessment of women with hyperemesis gravidarum:A randomised controlled trial
No full textBackground: Hyperemesis gravidarum or severe nausea and vomiting of pregnancy affects women's physical, social and psychological wellbeing and often requires frequent hospital admissions. Current standard care may be too medically focussed to meet all of women's complex needs. Aim: The aim of this study is to test where using a validated questionnaire, the Hyperemesis Impact of Symptoms tool, delivered by a nurse to assess the overall effect of hyperemesis on an individual woman's life and to provide advice tailored to her specific needs, will help her cope better with her symptoms and reduce admissions to hospital. Design: This study was a two arm randomised controlled trial in which women with hyperemesis from four hospitals were randomly allocated to one of two groups: (1) usual care and (2) usual care plus assessment with the Hyperemesis Impact of Symptoms questionnaire and a care plan tailored to their responses. Participants and methods: Recruitment was from women who were admitted with hyperemesis gravidarum; diabetic women or those over 14 weeks gestation were excluded. Those who consented completed questionnaires to assess their quality of life and the severity of symptoms at baseline and at three time points over the following 6 weeks. Results: Women's average social functioning, Hyperemesis Impact of Symptom scores and average number of admissions were not significantly different between either group. The average number of days in hospital for the questionnaire and tailored plan group was significantly lower, 4.97, compared with 6.14 in the usual care group. Using the questionnaire to plan individualised care was not associated with significant reduction in health care costs. Conclusion: Using the Hyperemesis Impact of Symptoms questionnaire to tailor a care plan to address women's individual needs was not associated with any significant improvements in the quality of life. The cost effectiveness analysis did not indicate that the questionnaire is cost saving. The Hyperemesis Impact of Symptoms questionnaire is a practical tool for nurses and midwives to assess the overall impact of hyperemesis gravidarum on the individual and could be useful for assessing symptoms and evaluating physical, social and psychological changes following treatment in either clinical or research settings.</p
Diffusion of organic contaminants in triple layer composite liners-An analytical modelling approach
No full textEngaging the community pharmacy sector in research: lessons learned from a national study of clinical productivity:lessons learned from a national study of clinical productivity
No full textPathological axonal death through a MAPK cascade that triggers a local energy deficit.
No full textAxonal death disrupts functional connectivity of neural circuits and is a critical feature of many neurodegenerative disorders. Pathological axon degeneration often occurs independently of known programmed death pathways, but the underlying molecular mechanisms remain largely unknown. Using traumatic injury as a model, we systematically investigate mitogen-activated protein kinase (MAPK) families and delineate a MAPK cascade that represents the early degenerative response to axonal injury. The adaptor protein Sarm1 is required for activation of this MAPK cascade, and this Sarm1-MAPK pathway disrupts axonal energy homeostasis, leading to ATP depletion before physical breakdown of damaged axons. The protective cytoNmnat1/Wld(s) protein inhibits activation of this MAPK cascade. Further, MKK4, a key component in the Sarm1-MAPK pathway, is antagonized by AKT signaling, which modulates the degenerative response by limiting activation of downstream JNK signaling. Our results reveal a regulatory mechanism that integrates distinct signals to instruct pathological axon degeneration
Influencing Absorption and Desorption of Ions in Human Hair
No full textThe amorphous, keratin-associated proteins (KAPs) are a major structural component of the inner hair structure. This highly cross-linked, amorphous matrix material absorbs and desorbs water depending on the humidity of the environment. Since chemical hair treatments and oxidative hair colouring processes are mainly occurring in the matrix they influence water desorption and absorption processes. The partly crystalline keratin intermediate filaments (IFs), also referred to as microfibrils, are embedded in this amorphous matrix of KAPs. This IF-reinforced keratin composite structure is the basis for the high mechanical longitudinal strength of human hair. Therefore, the mechanical and thermo stability of the hair fiber strongly depends on KAP/IF-cohesion. Oxidative hair treatments, such as bleaching and dying, modify the KAP-matrix structure through the cleavage of disulfide bonds. Cysteic acid is formed and the protein structure becomes highly charged. As a consequence fibril/matrix-interactions decrease and hair fibre weakening occurs. Chemically treated hair appears to show an enhanced absorption of unwanted metal ions like copper and a related increased fading of artificial hair colorants. By means of treatments with specific metal ions and organic acids the cohesion of the amorphous matrix can be can also be enhanced. The keratin structure regains mechanical and thermal stability by supporting the KAP-IF interaction. Especially multivalent ions are acting here as ionic matrix-cross-linkers. This crosslink process is strongly influenced by the pH value and the choice of organic acids. The absorption of unwanted metal ions into hair and the desorption of artificial hair colours can be strongly influenced by ion-induced changes of hair matrix properties
Effects of Persistent Atrial Fibrillation- Induced Electrical Remodeling on Atrial Electro-Mechanics – Insights from a 3D Model of the Human Atria
No full textAIMS: Atrial stunning, a loss of atrial mechanical contraction, can occur following a successful cardioversion. It is hypothesized that persistent atrial fibrillation-induced electrical remodeling (AFER) on atrial electrophysiology may be responsible for such impaired atrial mechanics. This simulation study aimed to investigate the effects of AFER on atrial electro-mechanics. METHODS AND RESULTS: A 3D electromechanical model of the human atria was developed to investigate the effects of AFER on atrial electro-mechanics. Simulations were carried out in 3 conditions for 4 states: (i) the control condition, representing the normal tissue (state 1) and the tissue 2-3 months after cardioversion (state 2) when the atrial tissue recovers its electrophysiological properties after completion of reverse electrophysiological remodelling; (ii) AFER-SR condition for AF-remodeled tissue with normal sinus rhythm (SR) (state 3); and (iii) AFER-AF condition for AF-remodeled tissue with re-entrant excitation waves (state 4). Our results indicate that at the cellular level, AFER (states 3 & 4) abbreviated action potentials and reduced the Ca2+ content in the sarcoplasmic reticulum, resulting in a reduced amplitude of the intracellular Ca2+ transient leading to decreased cell active force and cell shortening as compared to the control condition (states 1 & 2). Consequently at the whole organ level, atrial contraction in AFER-SR condition (state 3) was dramatically reduced. In the AFER-AF condition (state 4) atrial contraction was almost abolished. CONCLUSIONS: This study provides novel insights into understanding atrial electro-mechanics illustrating that AFER impairs atrial contraction due to reduced intracellular Ca2+ transients