Stress and burnout in chiropractic students of European chiropractic colleges:: A cross-sectional study

ObjectiveHigh levels of stress and burnout are known to negatively impact academic success, quality of life, and well-being of students. The purpose of this study was to investigate the degrees of stress and burnout levels of students from several European chiropractic colleges.MethodsStress and burnout were assessed using the Perceived Stress Scale (PSS-10) and the Maslach Burnout Inventory–Student Survey (MBI-SS). Surveys were delivered electronically in November 2017 to chiropractic students from 4 different chiropractic colleges. Data were analyzed using t test and 1-way ANOVA to determine differences between demographic data. Scores in perceived stress and burnout subscales were compared to the general, chiropractic, and medical student populations.ResultsBoth the MBI-SS and PSS had similar response rates (30%–34%) and demonstrated statistically significant differences between institutions, with C-3 demonstrating the highest levels of exhaustion (p < .001) and the highest levels of perceived stress (p = .012). MBI-SS results show that in the general chiropractic student population, 26.4% presented high emotional exhaustion, 18.2% high cynicism, and 43.8% low academic efficacy. Meanwhile, the PSS score indicated “moderate” levels of stress.ConclusionsEuropean chiropractic students experience higher levels of perceived stress than the general population and they may suffer levels of burnout similar to those of medical students. These results suggest that colleges should monitor stress and burnout levels in their students. This may help to establish student support systems in order to improve students'' quality of life and academic performance, as well as help new graduates transition to their professional lives.     

Chiropractic interns' perceptions of stress and confidence

Objective:

Psychological stress has been shown to influence learning and performance among medical and graduate students. Few studies have examined psychological stress in chiropractic students and interns. This preliminary study explored interns'' perceptions around stress and confidence at the midpoint of professional training.

Methods:

This pilot study used a mixed-methods approach, combining rating scales and modified qualitative methods, to explore interns'' lived experience. Eighty-eight interns provided ratings of stress and confidence and narrative responses to broad questions.

Results:

Participants reported multiple sources of stress; stress and confidence ratings were inversely related. Interns described stress as forced priorities, inadequate time, and perceptions of weak performance. Two themes, “convey respect” and “guide real-world learning,” describe faculty actions that minimized stress and promoted confidence.

Conclusion:

Chiropractic interns experience varying degrees of stress, which is managed with diverse strategies. The development of confidence appears to be influenced by the consistency and manner in which feedback is provided. Although faculty cannot control the amount or sources of stress, awareness of interns'' perceptions can strengthen our effectiveness as educators.Key Indexing Terms: education, professional, mixed methods, qualitative studies, stress, psychological     

A National Survey of Mentoring Programs for KL2 Scholars

There is limited information on how academic institutions support effective mentoring practices for new investigators. A national semistructured telephone interview was conducted to assess current “state of the art” mentoring practices for KL2 scholars among the 46 institutions participating in the Clinical Translational Science Awards (CTSA) Consortium. Mentoring practices examined included: mentor selection, articulating and aligning expectations, assessing the mentoring relationship, and mentor training. Telephone interviews were conducted in winter/fall 2009, with 100% of the CTSAs funded (n= 46) through 2009, participating in the survey. Primary findings include: five programs selected mentors for K scholars, 14 programs used mentor contracts to define expectations, 16 programs reported formal mentor evaluation, 10 offered financial incentives to mentors, and 13 offered formal mentoring training. The interviews found considerable variation in mentoring practices for training new investigators among the 46 CTSAs. There was also limited consensus on “what works” and what are the core elements of “effective mentoring practices. Empirical research is needed to help research leaders decide on where and how to place resources related to mentoring. Clin Trans Sci 2010; Volume 3: 299–304     

Hematological changes associated with COVID‐19 infection

BackgroundThe unresolved COVID‐19 pandemic considerably impacts the health services in Iraq and worldwide. Consecutive waves of mutated virus increased virus spread and further constrained health systems. Although molecular identification of the virus by polymerase chain reaction is the only recommended method in diagnosing COVID‐19 infection, radiological, biochemical, and hematological studies are substantially important in risk stratification, patient follow‐up, and outcome prediction.AimThis narrative review summarized the hematological changes including the blood indices, coagulative indicators, and other associated biochemical laboratory markers in different stages of COVID‐19 infection, highlighting the diagnostic and prognostic significance.MethodsLiterature search was conducted for multiple combinations of different hematological tests and manifestations with novel COVID‐19 using the following key words: “hematological,” “complete blood count,” “lymphopenia,” “blood indices,” “markers” "platelet" OR "thrombocytopenia" AND "COVID‐19," "coronavirus2019," "2019‐nCoV," OR "SARS‐CoV‐2." Articles written in the English language and conducted on human samples between December 2019 and January 2021 were included.ResultsHematological changes are not reported in asymptomatic or presymptomatic COVID‐19 patients. In nonsevere cases, hematological changes are subtle, included mainly lymphocytopenia (80.4%). In severe, critically ill patients and those with cytokine storm, neutrophilia, lymphocytopenia, elevated D‐dimer, prolonged PT, and reduced fibrinogen are predictors of disease progression and adverse outcome.ConclusionMonitoring hematological changes in patients with COVID‐19 can predict patients needing additional care and stratify the risk for severe course of the disease. More studies are required in Iraq to reflect the hematological changes in COVID‐19 as compared to global data.     

Unattended compared to traditional blood pressure measurement in patients with rheumatoid arthritis: a randomised cross-over study

BackgroundHypertension is characterised by a high prevalence, low awareness and poor control among rheumatoid arthritis (RA) patients. Correct blood pressure (BP) measurement is highly important in these subjects. The “unattended” BP measurement aims to reduce the “white-coat effect,” a phenomenon associated with cardiovascular risk. Data on “unattended” BP measurement in RA and its impact on hypertensive organ damage are very limited.MethodsBP was measured in the same patient both traditionally (“attended” BP) and by the “unattended” protocol (3 automated office BP measurements, at 1-min intervals, after 5 min of rest, with patient left alone) by a randomised cross-over design. Patients underwent clinical examination, 12-lead electrocardiography and trans-thoracic echocardiography to evaluate cardiac damage.ResultsSixty-two RA patients (mean age 67 ± 9 years, 87% women) were enrolled. Hypertension was diagnosed in 79% and 66% of patients according to ACC/AHA and ESC/ESH criteria, respectively. Concordance correlation coefficients between the two techniques were 0.55 (95%, CI 0.38–0.68) for systolic BP and 0.73 (95%, CI 0.60–0.82) for diastolic BP. “Unattended” (121.7/68.6 mmHg) was lower than “attended” BP (130.5/72.8 mmHg) for systolic and diastolic BP (both p < .0001). Among the two techniques, only “unattended” systolic BP showed a significant association with left ventricular mass (r = 0.11; p = .40 for “attended” BP; r = 0.27; p = .036 for unattended BP; difference between slopes: z = 3.92; p = .0001).ConclusionsIn RA patients, “unattended” BP is lower than traditional (“attended”) BP and more closely associated with LV mass. In these patients, the “unattended” automated BP measurement is a promising tool which requires further evaluation.

KEY MESSAGES

• “Unattended” automated blood pressure registration, aimed to reduce the “white-coat effect” is lower than “attended” value in rheumatoid arthritis patients.
• “Unattended” blood pressure is more closely associated with left ventricular mass than “attende” registration.

     

Maternal Report of Outcomes of Chiropractic Care for Infants

ObjectiveThe purpose of this study was to investigate the report by mothers of their infants’ condition before and after a trial of care provided by registered chiropractic clinicians in addition to ratings of satisfaction, cost of care, and reports of any adverse events or side effects. A second purpose was to report the demographic profile of infants who presented for care to 16 chiropractic clinics in the United Kingdom.MethodsThis observational study prospectively collected reports by mothers of their infants’ demographic profiles and outcomes across several domains of infant behavior and their own mental state using the United Kingdom Infant Questionnaire. Participating registered chiropractors were recruited through the Royal College of Chiropractors annual meeting in January 2016, and 15 clinics and the Anglo-European College of Chiropractic University College teaching clinic volunteered to participate.ResultsIn all, 2001 mothers completed intake questionnaires and 1092 completed follow-up forms. Statistically significant (P < .05) improvements were reported across all aspects of infant behavior studied, including feeding problems, sleep issues, excessive crying, problems with supine sleep position, infant pain, restricted cervical range of motion, and time performing prone positioning. Maternal ratings of depression, anxiety, and satisfaction with motherhood also demonstrated statistically significant improvement (P < .05). In total, 82% (n = 797) reported definite improvement of their infants on a global impression of change scale. As well, 95% (n = 475) reported feeling that the care was cost-effective, and 90.9% (n = 712) rated their satisfaction 8 or higher on an 11-point scale. Minor self-limiting side effects were reported (5.8%, n = 42/727) but no adverse events.ConclusionIn this study, mothers reported that chiropractic care for their infants was effective, safe, and cost-effective. Although the observational design makes it impossible to determine efficacy, the study’s findings indicate that, on average, the changes observed by mothers were positive and may be clinically relevant.     

A Survey of Geriatrics Courses in North American Chiropractic Programs

Purpose:

There has been a growing interest in meeting the health care needs of the anticipated “age wave.” In order to prepare for the current demographic trends, we sought to describe the status of geriatrics curricula in the 18 North American English-speaking chiropractic colleges by reviewing geriatric course syllabi.

Methods:

A cross-sectional survey was conducted using syllabi and catalog information solicited from each English-speaking chiropractic college in North America, collected from January 1, 2007 through June 30, 2007. Information was then summarized.

Results:

As of June 30, 2007, roughly 78% of colleges submitted their current geriatrics course syllabi. The remaining 4 colleges were estimated using online course catalog information. Sixty-one percent of colleges offered a course that was solely dedicated to the topic of geriatrics. Additionally, 37.5% of syllabi indicating credit load offer 4 or more credits to the course containing the geriatrics component. Also, 31.3% of courses include non-classroom clinical experience, while 50% require an independent study project that provides further geriatrics experience. Furthermore, 41.2% of reported courses classify the teaching strategies as lecture only.

Conclusions:

These results warrant a proposal for improved curricula in this specialty population. It is proposed that more time be dedicated for this topic, more experiential learning be required, and more clinical focus be given on the needs of this population. A restructure of curricula will provide more clinical experiences for students to better equip future doctors of chiropractic for the increase in geriatric health care needs.Key Indexing Terms: Chiropractic, Geriatrics, Education     

Correction: Quantum curcumin mediated inhibition of gingipains and mixed-biofilm of Porphyromonas gingivalis causing chronic periodontitis

Correction for ‘Quantum curcumin mediated inhibition of gingipains and mixed-biofilm of Porphyromonas gingivalis causing chronic periodontitis’ by Ashish Kumar Singh et al., RSC Adv., 2018, 8, 40426–40445.

The authors regret the incorrect naming of the bacterial species Actinomycetemcomitans viscosus in the published article. It should be correctly shown as Actinomyces viscosus throughout, on pages 40427 (fifth line of last paragraph), 40436 (sixth line of “Individual isolates & mixed” section), 40437 (Table 2) and 40440 (Table 3).Also, the ATCC number of A. viscosus was incorrectly given as 29522 throughout the published article and should be correctly shown as 15987 in the following places: p. 40429 (“Bacterial strains and culture conditions” section and “Minimum inhibitory concentration determination” section), p. 40430 (“Determination of antibiofilm activity using tissue culture plate assay (TCP)” section), p. 40434 (“Antimicrobial assay of quantum curcumin against clinical isolates of Porphyromonas gingivalis and select reference strains” section and “Determination of minimum inhibitory concentration” section), p. 40435 (“Growth rate analysis” section), p. 40437 (Table 2), and on p. 40438 (caption to Fig. 7 (twice), caption to Fig. 8, and sixth line of “Discussion” section).An error was also present in the published article in the co-author name spelling for K. Sharma. The correct spelling of the author names is as shown here.The Royal Society of Chemistry apologises for these errors and any consequent inconvenience to authors and readers.     

Chiropractic: a critical evaluation

Chiropractic was defined by D.D. Palmer as “a science of healing without drugs.” About 60,000 chiropractors currently practice in North America, and, worldwide, billions are spent each year for their services. This article attempts to critically evaluate chiropractic. The specific topics include the history of chiropractic; the internal conflicts within the profession; the concepts of chiropractic, particularly those of subluxation and spinal manipulation; chiropractic practice and research; and the efficacy, safety, and cost of chiropractic. A narrative review of selected articles from the published chiropractic literature was performed. For the assessment of efficacy, safety, and cost, the evaluation relied on previously published systematic reviews. Chiropractic is rooted in mystical concepts. This led to an internal conflict within the chiropractic profession, which continues today. Currently, there are two types of chiropractors: those religiously adhering to the gospel of its founding fathers and those open to change. The core concepts of chiropractic, subluxation and spinal manipulation, are not based on sound science. Back and neck pain are the domains of chiropractic but many chiropractors treat conditions other than musculoskeletal problems. With the possible exception of back pain, chiropractic spinal manipulation has not been shown to be effective for any medical condition. Manipulation is associated with frequent mild adverse effects and with serious complications of unknown incidence. Its cost-effectiveness has not been demonstrated beyond reasonable doubt. The concepts of chiropractic are not based on solid science and its therapeutic value has not been demonstrated beyond reasonable doubt.     

Examining the validity of chiropractic grade point averages for predicting National Board of Chiropractic Examiners Part I exam scores

ObjectiveThe main objective of this study was to evaluate the validity of grade point average (GPA) for predicting the National Board of Chiropractic Examiners (NBCE) Part I exam scores using chiropractic GPA.MethodsData were collected during the January 2019 computer-based testing administration of the NBCE''s Part I exam. The sample size was n = 2278 of test takers from 18 domestic and 4 international chiropractic educational institutions. Six regression models were developed and tested to predict the Part I domain scores from chiropractic GPA while controlling for self-reported demographic variables. Residuals from the models were disaggregated by pre–chiropractic GPA.ResultsChiropractic GPA revealed a positive, statistically significant correlation with sex. The chiropractic GPA was found to be a significant predictor of the Part I domain scores. A different perspective was obtained when residuals (observed minus predicted) were collected and split by the pre–chiropractic GPA. Very good students tended to be underpredicted, while other students were overpredicted.ConclusionThis study builds on the cascading evidence from educational literature by providing additional results suggesting that undergraduate (prechiropractic) GPA as well as the GPA obtained in doctor of chiropractic programs are related to the future performance on the NBCE Part I exam. The results provide a first glance at the connection between the standardized test scores, which are often used for instructors'' and institutional evaluation and the GPA obtained in a doctor of chiropractic program.     

Attitudes and behaviors of chiropractic interns toward occupational history taking

ObjectiveThis study uses a pre- and post-training program evaluation of chiropractic interns to (1) describe changes in their frequency of occupational history taking before and after a 1-hour training and (2) to document the attitudes and beliefs regarding occupational health and history taking.MethodsAll chiropractic interns at 1 clinic location completed questionnaires assessing their attitudes and perceptions regarding documenting the occupational history of their patients each trimester they were enrolled in the study. Each intern enrolled in the study for 2 or more trimesters participated in a 1-hour-long training session on taking an occupational history. The supervising clinician independently evaluated charting behaviors of interns for the duration of the study.ResultsThe supervising clinician assessed 20 interns'' level of documenting occupational history for 202 new patient or reexamination visits. A majority of interns (85% at baseline) were interested in occupational health, and 80% believed that occupational history taking was “very important.” Intern charting behaviors increased after training related to documentation of past occupation (62.9% from 32.4%) and relating the chief complaint to work (59.7% from 30.0%). Detailed occupational history taking remained low throughout the study but demonstrated a doubling in documentation after training (16.1% from 8.6%).ConclusionChiropractic interns and clinicians should be adequately trained in occupational health history documentation practices as they are likely to care for work-related injuries. Short training modules appear to be effective in demonstrating small changes in documentation related to occupational history taking.     

COVID‐19 in HIV‐positive patients: A systematic review of case reports and case series

IntroductionCoronavirus disease 2019 (COVID‐19) and acquired immune deficiency syndrome (AIDS) are two viral diseases for which there are currently no definitive treatments. Nowadays, because of the health system''s focus on the COVID‐19 epidemic, the control of human immunodeficiency virus (HIV) has received less attention. In this review, we will discuss the characteristics of COVID‐19 in HIV‐positive patients.Material and MethodsUsing the PRISMA guideline, the databases of Scopus, PubMed, and Web of Science were searched systematically from January 1, 2019 to February 24, 2021. The following keywords were used: “Human Immunodeficiency Virus,” “acquired immune deficiency syndrome,” “HIV,” “AIDS,” “COVID‐19,” “severe acute respiratory syndrome coronavirus 2,” “novel coronavirus,” “SARS‐CoV‐2,” “nCoV disease,” “SARS2,” and “2019‐nCoV disease.”ResultsTwenty‐one percent of studies were conducted in the USA (n = 13), 16% in China (n = 10), and 13% in Italy (n = 8), respectively. The majority of the patients were men (74.3%). Tenofovir disoproxil fumarate was used in 47.4% of patients, emtricitabine in 58.4%, and lamivudine in 34.8% to treat HIV. Symptoms of HIV patients with COVID‐19 included coughing (81.3%), fever (62.8%), and dyspnea (60%). Hydroxychloroquine (39.34%) and azithromycin (36.58%) were the common treatment options for COVID‐19. The total death rate in HIV‐positive patients with COVID‐19 was about 9%.ConclusionIn the current systematic review, we demonstrated that HIV‐positive patients co‐infected with COVID‐19 have high comorbidity of hypertension and diabetes mellitus. HIV/COVID‐19 co‐infection might have negatively influenced the HIV treatment and diagnosis, which indicates the need to regularly screen HIV patients in the COVID‐19 pandemic.     

Clinical Characteristics and Treatment Outcome of Central Nervous System Nocardiosis: A Systematic Review of Reported Cases

BackgroundThe clinical spectrum of systemic nocardiosis encompasses pulmonary and disseminated disease. Central nervous system (CNS) involvement is an important feature of disseminated disease with significant mortality and high relapse rate, especially in those with suppressed cell-mediated immunity. This systematic review aimed to evaluate the epidemiology, clinical features, diagnosis, therapeutic interventions, and outcome in patients with CNS nocardiosis.MethodsA literature search was performed in major databases (PubMed, Google Scholar, and Scopus) by using distinct keywords: “CNS disease,” “Nocardia,” “meningitis,” “brain abscess,” “disseminated disease,” and “Cotrimoxazole.” We included all patients ≥18 years with CNS nocardiosis reported between January 2000 and December 2020.ResultsA total of 129 papers were included in the final analysis. The mean age of patients was 55 ± 16 years, and the majority were male (70.8%). Nocardia farcinica was the commonest species (39.6%), followed by Nocardia nova (5.9%). Thirty-four percent of the patients were found to be immunocompetent. Corticosteroid use was the most common predisposing factor (55.8%). Among neuroimaging findings, brain abscess was most common (86.9%), followed by leptomeningeal enhancement (12.1%). The overall case-fatality rate in CNS disease was 22.8%. On multivariate analysis, patients who underwent surgery (OR 2.4, 95% CI 0.99–4.11, p value 0.046) had better survival than those treated with antimicrobial therapy alone. Immunodeficient state (OR 0.32, 95% CI 0.15–0.90, p value 0.019) was independently associated with poor outcome.ConclusionCNS nocardiosis carries significant mortality, especially in immunodeficient patients. We advocate the use of surgery combined with antimicrobials to improve clinical outcome.     

Patient Characteristics Associated With Self-Reported Adherence to Chiropractic Treatment Recommendations: A Feasibility Study

ObjectiveThe purpose of this study was to examine the feasibility of developing and administering a patient adherence survey to assess self-reported adherence to treatment recommendations from a chiropractic doctor within an academic health center.MethodsThe survey items were developed by the authors and vetted by the university's students and faculty, who serve as health care practitioners at an academic health center. Adult patients with spine pain who were seen by a doctor of chiropractic at an academic health center were included in this survey study. A 32-item survey was administered between October 2019 and March 2020.ResultsA total of 62 respondents completed the anonymous survey. We found that 89% of respondents adhered to their clinic appointments. Although 82% of respondents said that their doctor's recommendation made sense, only 44% reported completely following treatment recommendations for at-home stretching and exercise.ConclusionThis study determined that it is feasible to assess patient self-reported adherence to chiropractic treatment within an academic health center setting. In our sample we found that although patient adherence to clinic appointments was high, adherence to treatments was not.     

Top studies of 2021 relevant to primary care: From the PEER team

ObjectiveTo summarize 10 high-quality studies or guidelines from 2021 that have strong relevance to physicians in comprehensive family practice.Selecting the evidenceRoutine literature surveillance of abstracts in high-impact journals and EvidenceAlerts was completed by the PEER (Patients, Experience, Evidence, Research) team, a group of health care professionals with a research interest in evidence-based medicine and primary care. Abstracts were screened, selected, and ranked by the PEER team.Main messageThe articles from 2021 that are most likely to impact primary care practice discuss the following topics: empagliflozin for heart failure with preserved ejection fraction; semaglutide for weight loss; stopping antidepressants in primary care; inhaled budesonide for COVID-19; acetylsalicylic acid for preeclampsia prevention; quarter-dose blood pressure medications for hypertension; aggressive blood pressure control for elderly patients; kangaroo care for low-birth-weight infants; footwear for knee osteoarthritis; and delayed antibiotics for pediatric respiratory infections. Two “honourable mention” studies are also briefly reviewed.ConclusionResearch from 2021 produced several high-quality studies in cardiovascular care but also addressed a variety of conditions relevant to primary care including weight loss, depression, and COVID-19.

Each year, an overwhelming number of medical articles are published, making it challenging for family physicians to keep up to date on the literature. We have summarized our selection of the top 10 articles from 2021, along with 2 “honourable mentions,” that we believe will offer value for physicians in comprehensive family practice.     

Correction: Influence of co-cultures of Streptococcus thermophilus and probiotic lactobacilli on quality and antioxidant capacity parameters of lactose-free fermented dairy beverages containing Syzygium cumini (L.) Skeels pulp

Correction for ‘Influence of co-cultures of Streptococcus thermophilus and probiotic lactobacilli on quality and antioxidant capacity parameters of lactose-free fermented dairy beverages containing Syzygium cumini (L.) Skeels pulp’ by Sabrina Laís Alves Garcia et al., RSC Adv., 2020, 10, 10297–10308. DOI: 10.1039/c9ra08311a

The authors would like to correct an error in the “Materials and methods” section which they noticed after publication of their article.In the first sentence of the first paragraph of Section 2.7. Sensory evaluation of the fermented dairy beverage, “Certificate of Presentation for Ethical Assessment (CAAE) no. 2.229.0000.5187” should read “Certificate of Presentation for Ethical Assessment (CAAE) no. 71428417.5.0000.5187, decision no. 2.229.941”.The first sentence of the first paragraph of Section 2.7. Sensory evaluation of the fermented dairy beverage incorporating the correction is as follows:“The sensory evaluation used in the present study was approved by the Ethics Committee of the State University of Paraíba (UEPB), Paraíba, Brazil, Certificate of Presentation for Ethical Assessment (CAAE) no. 71428417.5.0000.5187, decision no. 2.229.941, and was performed in the Laboratory of Sensory Analysis at the Federal University of Campina Grande (UFCG), Paraíba State, Brazil.”The Royal Society of Chemistry apologises for these errors and any consequent inconvenience to authors and readers.