Res Medica (E-Journal)
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The Virtue of Medical Ethics Education
Full text linkThe teaching of medical ethics in UK Medical Schools has come a long way over the last 40 years, though there remains wide variation in the quantity and content of material delivered across medical schools. Attempts to improve and standardize medical ethics teaching has come from the Institute of Medical Ethics in the form of a Consensus Statement, which details a core content of learning consistent with GMC guidance on undergraduate education. All graduating medical students must be aware of and understand the main ethical and legal issues they will face in clinical practice. However, as recent events at the Mid Staffordshire NHS Trust and Vale of Leven Hospital illustrate, medical ethics education still has a long way to go and medical educators must strive to understand what underpins moral decision making in reality. A recent appointment to develop medical ethics education locally has led me to question what an effective medical ethics education should deliver to our students. This requires rethinking what “medical ethics” means to students and, in doing so, move away from the notion of ethics as a separate discipline characterized by “dilemmas”. Whilst such cases are useful for illuminating the role of ethical theories or principles, good ethics teaching must deal with everyday ethics and all the factors that affect decision-making in reality. To do so we must find a role for avirtue-based ethics theory and the space for moral learning
Transcranial Direct Current Stimulation: A viable therapeutic option for depression?
Full text linkTranscranial direct current stimulation (tDCS) is a form of neurostimulation that has recently regained popularity in its experimental use. tDCS utilizes a direct current applied to the scalp via electrodes to induce long-term changes to cortical excitability. A series of recent studies and reviews concluded its efficacy as a potential treatment for major depressive disorder. However, further research is required to establish effective montages and intensities of treatment to promote efficacy while reducing adverse effects. These potential future studies should include wider representative samples with more detailed reporting of adverse effects. Until then, this perspective piece argues that tDCS should continue to be considered as a potential addition to the therapies used to manage depression
Classical Hodgkin’s Lymphoma: Pathogenesis and Future Treatment Directions
Full text linkClassical Hodgkin Lymphoma is a germinal center B cell malignancy. Over the past 40 years, through greater understanding of disease pathogenesis, advancements in treatment have lead to greater than 80% long-term survival rates after standard first line therapy. Currently, first-line management of the disease varies, most commonly involving the use of a standard chemotherapy regime (i.e. ABVD or BEACOPP), with or without the use of additional chemotherapies or involved-field radiation therapy. Treatment selection is influenced by disease staging at diagnosis and the need to maintain therapeutic efficacy, whilst minimising the risk of late and potentially fatal therapy-associated side effects. Consequently, higher than acceptable drug-associated toxicities and patient relapse represent the future challenges of this disease. Novel therapies, targeting the aberrant signalling pathways and phenotypic features of the malignant cell pool, and its associatedinflammatory infiltrate, are the future direction of disease management. Currently, combination therapies targeting the PI3K/Akt/mTOR pathway and transcription modulation have shown the greatest clinical efficacy in improving survival outcomes in previously heavily treated cHL patients, with minimal side effects. Whilst these therapies do not yet achieve the clinical efficacy of first line therapies, preliminary stage I and II trials havedemonstrated a reduction in drug associated toxicities and side effects relative to existing treatments for relapse. This paper will investigate current understanding of the pathogenesis of cHL, and how this has shaped the targets of novel therapies for the disease
Diagnosis & Management of Vitamin B12 Deficiency in Primary Care – Are we following the guidelines?
Full text linkBackground: Vitamin B12 deficiency is common in primary care but its treatment practices vary across centres. One important cause of B12 deficiency is pernicious anaemia (identified by intrinsic factor antibodies), which is a risk factor for developing gastric carcinoma, and should be excluded. Additionally, recent evidence has suggested that some patients have been continued on B12 injections with no clear clinical indication. Recently,guidelines were produced to improve the investigation and management of B12 deficiency. Hence, this audit studied the investigation and management of B12 deficiency and adherence to clinical guidelines in a general practice (GP) in north-west England.Aim: To evaluate the appropriate diagnosis and management of vitamin B12 deficiency in our primary care centre against recognized standards.Methods: Clinical data of patients currently on oral cyanocobalamin and/or intramuscular hydroxocobalamin injections over a 1-year period were audited.Results: Thirty-eight patients (66% females, 34% males) receiving treatment for B12 deficiency were identified. Of these, 55% (21/38) had intrinsic factor antibodies checked and 52% (13/25) were managed according to the guidelines. 100% (8/8) of patients with dietary B12 deficiency (non-vegans) and 75% (3/4) of B12-deficient patients on long-term metformin have had follow-up serum B12 monitoring.Discussion: There is a need to improve the investigation for B12 deficiency, adherence to clinical guidelines, and documentation of patients’ diagnoses, treatment plans, dietary statuses, and required monitoring. We anticipate that adhering to guidelines when appropriate, with clear documentation, will improve the diagnosis and management of vitamin B12 deficiency so that safe prescribing and potential cost savings can be achieved
Feedback for Sheffield Children\u27s Hospital Sexual Assault Referral Centre: Are we getting it right?
Full text linkIntroduction: The Sexual Assault Referral Centre (SARC) at Sheffield Children’s Hospital is a relatively new service for children who have been victims of sexual assault or rape. Assessment of these children involves taking a full history of the assault as well as a medical and sexual history, and is followed by both a general and intimate examination. Feedback is essential to improve the services the SARC offers to victims and their familiesat such a traumatic time.Aims: To assess user satisfaction and suggest improvements to the existing SARC service.Method/Results: Completed questionnaires from SARC users were collected over a period of 13 months and the data analysed. Analysis of the 38 returned questionnaires demonstrated that the majority of feedback from users was positive. There were only four responses that could be interpreted as neutral. There were numerous positive and few negative comments in the free-text boxes.Conclusion: Child sexual abuse victims use the service at a difficult time. After such a traumatic experience one would expect at least some negative feedback. However, the analysis of the small numbers giving feedback demonstrated that the majority of them found the experience to be positive or very positive.Learning points: Patient feedback is a valuable tool in service evaluation and improvement. It can be used for quality improvement in a SARC setting
A Clinical Review on The Holism of Ophthalmology - The Associations Between Systemic Diseases and Ocular Conditions
Full text linkThis is an up-to-date review on the holism of ophthalmology, covering the associations between eyes and systemic diseases.
Ophthalmology teaching in the undergraduate medical curriculum is often very brief, which seems reasonable in view of other specialties such as internal medicine which have many life-and-death issues and numerous diseases across a wide spectrum of subspecialties. By contrast, ophthalmology gives the impression of being more specialized. However, the value which vision holds in people’s hearts is usually underestimated when compared to life or limb. Moreover, the severity of visual impairment in relation to its impact on daily life is also often not proportional; in other words, mild visual impairment may have a detrimental effect on daily life, functionally and emotionally.
This review aims to provide an overview of ocular pathologies that are associated with systemic diseases with emphasis on cardiovascular and autoimmune conditions. In addition, we discuss the potential role of retinal microvascular analysis in the prevention and management of cardiovascular diseases, which has been gaining attention in recent years
Communication With Ventilated Patients In ICU: Perceptions On Existing Communication Methods And Needs
Full text linkIntroduction: Recent research has highlighted the need to improve communication with mechanically ventilated patients. There are a number of studies currently evaluating the usefulness of augmentative and alternativen communication methods (AACs), but a significant gap still exists in understanding patients’ key needs during the ventilation period.Aims: 1) To determine the perceptions of patients and healthcare staff on the use of AACs. 2) To find out patients’ key needs during ventilator treatment, within the context of Ward 118 in the Royal Infirmary of Edinburgh. 3) To use the results of this study to propose larger scale research into adapting a specific electronic device (Predictable) to aid communication.Methods: This qualitative study adopted semi-structured interviews lasting 10–20 minutes with 13 patients and 18 members of healthcare staff and applied thematic analysis in interpreting interview findings.Results: There was a mismatch between patient and staff perceptions on the usefulness of closed yes/no questions and lip reading. Aided AACs, such as picture boards, pen and paper, and sketch boards are also underused. Most patients and staff used a combination of methods rather than any one method alone. This study also found that patients’ key needs include addressing discomfort related to the ventilator, bed or breathing, emotional needs, trust building with healthcare staff and the need for more information.Conclusion: This study highlights the need for personalized, patient-centred care to facilitate effective communication with ventilated patients
Why is Breast-feeding a risk factor for HIV-1 transmission despite HIV-1 infected mothers receiving combination ART (cART)?
Full text linkMother-to-child transmission (MTCT) of human immunodeficiency virus type 1 (HIV-1) is an important source of HIV-1 infection in infants, and can occur at any point, including in utero, at the time of delivery, and via breastfeeding. In the absence of intervention, such as the use of antiretroviral therapy (ART), MTCT of HIV-1 during pregnancy or delivery can affect approximately 15–25% of infants, with a further 5–20% of infants becoming infected postnatally during breastfeeding. The use of maternal ART while breastfeeding reduces the MTCT risk from 35% without any intervention to less than 5%. Although a significant improvement, 5% of infants continue to be infected.i Maternal factors that contribute to this continued risk of transmission despite taking ART include the method of feeding, breast health, RNA and DNA viral load in breast milk and plasma, and maternal nutrition. Infantfactors such as the disruption in the integrity of the gastrointestinal mucosal surfaces also contribute to an increased rate of MTCT.Aims: This literature review aimed to investigate why breastfeeding is still a risk factor despite HIV-1-infected mothers being on effective combination ART (cART)? This review will explore the associated factors that contribute to the increased risk of HIV-1 transmission to the infant via breastfeeding