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Patients with neuromuscular conditions are frequently seen in final professional clinical examinations as they have good clinical signs, which often point towards the underlying diagnosis. This paper outlines some of the most common neuromuscular disorders that you are likely to come across in orthopaedic practise.  相似文献   
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The current study examined the role of trauma‐related guilt on posttraumatic stress disorder (PTSD) symptom change during prolonged exposure therapy (PE) as well as the efficacy of PE in reducing three dimensions of guilt (responsibility, wrongdoing, and lack of justification) during treatment. Participants were 331 active duty U.S. military personnel seeking treatment for PTSD who were randomized to one of four groups: massed PE (10 sessions delivered over 2 weeks), spaced PE (10 sessions delivered over 8 weeks), present‐centered therapy (PCT; 10 sessions delivered over 8 weeks), or minimal contact control (MCC; weekly therapist phone check‐in for 4 weeks). The results showed that baseline guilt did not predict reductions in PTSD symptoms for spaced PE or for PCT, ps = .178–.387, ds = ?0.02–0.07. Treatment condition (massed PE vs. MCC; spaced PE vs. PCT) did not moderate reductions in guilt for spaced PE versus PCT. Guilt decreased significantly over treatment in all groups, p < .001 to p = .038, ds = ?0.19 to –0.42, except concerning justification in the spaced PE and PCT groups, p = .140, d = ?0.10. The findings suggest that guilt may be reduced significantly following active PTSD treatment and attention control and that PTSD recovery is not impacted by baseline levels of trauma‐related guilt in military personnel with PTSD, although reported levels of guilt were low to moderate in this sample.  相似文献   
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Myopathies due to recessive MYH7 mutations are exceedingly rare, reported in only two families to date. We describe three patients from two families (from Australia and the UK) with a myopathy caused by recessive mutations in MYH7. The Australian family was homozygous for a c.5134C > T, p.Arg1712Trp mutation, whilst the UK patient was compound heterozygous for a truncating (c.4699C > T; p.Gln1567*) and a missense variant (c.4664A > G; p.Glu1555Gly). All three patients shared key clinical features, including infancy/childhood onset, pronounced axial/proximal weakness, spinal rigidity, severe scoliosis, and normal cardiac function. There was progressive respiratory impairment necessitating non-invasive ventilation despite preserved ambulation, a combination of features often seen in SEPN1- or NEB-related myopathies. On biopsy, the Australian proband showed classical myosin storage myopathy features, while the UK patient showed multi-minicore like areas. To establish pathogenicity of the Arg1712Trp mutation, we expressed mutant MYH7 protein in COS-7 cells, observing abnormal mutant myosin aggregation compared to wild-type. We describe skinned myofiber studies of patient muscle and hypertrophy of type II myofibers, which may be a compensatory mechanism. In summary, we have expanded the phenotype of ultra-rare recessive MYH7 disease, and provide novel insights into associated changes in muscle physiology.  相似文献   
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A 29‐year‐old woman presented to detox for treatment of an opioid use disorder with illicit fentanyl. While in detox, she was started on opioid agonist treatment with buprenorphine/naloxone. Unfortunately, she continued to have withdrawal symptoms despite being optimised to a dose of 32 mg. She was given additional PRNs of buprenorphine/naloxone to a total daily dose of 40 mg, which helped to alleviate her symptoms of withdrawal and cravings. She was stabilised on buprenorphine/naloxone 40 mg daily without any side effects and was discharged to a rehabilitation centre.  相似文献   
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Abstract

In this commentary, we discuss health professions’ education (HPE) leadership in relation to planetary health emergencies, suggesting that an ‘eco-ethical leadership’ approach is highly relevant. Building on both traditional and more contemporary leadership approaches and the need for HPE to be socially and environmentally accountable, we define the key features of eco-ethical leadership and its underpinning beliefs and values, then expand on these features in terms of leadership at intrapersonal, interpersonal, team, organisational and system levels. Eco-ethical leadership is needed to tackle a range of ‘wicked’ problems – a changing climate, environmental pollution, deforestation, all of which threaten global biodiversity and human civilisation. Such leadership requires passionate individuals to role model the behaviours and actions that are required to bring people along with them, not least the learners, many of whom are already concerned about their future. Eco-ethical leadership (and followership) offers an integrated approach for HPE, centred around sustainability, values, collaboration, justice, advocacy and, if need be, activism. The environment cannot not wait. Eco-ethical leaders already exist but their numbers are small. They are required in key positions in academia and healthcare to drive the agenda in partnership with learners, many of whom are already environmental advocates and activists.  相似文献   
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Interventional procedures in the airway can be performed in interventional radiology suites or the operating room, by radiologists or other specialists. The most common therapeutic interventions carried out by radiologists are balloon dilatation, stenting, and the treatment of certain airway fistulas. These operations can be very challenging for anesthetists in terms of planning, airway management, the identification and treatment of procedural complications and postoperative care. In particular, a multidisciplinary approach to decision‐making and planning is important to obtain the best results.  相似文献   
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Aim and objective of the audit. The purpose of this audit was to identify the number of people prescribed antipsychotic medication who are at risk of developing metabolic syndrome in a community mental health service area with the aim of improving and standardising metabolic screening practices within this setting. Community mental health services are secondary care services in which individuals are referred from Primary Care (General Practitioners). The catchment area of this audit is within the South East Region of Ireland and offers adults community mental health services to a population of approximately 57 000. For the purpose of this audit we focused on one community mental health team within the service.  相似文献   
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