Professionalism beyond medical school: An educational continuum?

Given the changes in society we are experiencing, the increasing focus on patient centred care and acknowledgment that medical education needs to continue not only in the residency programmes but throughout the doctors career, is not surprising. This article describes the attention currently paid to professionalism in the residency programmes, differences in perception of professionalism between patients, faculty, students and residents, differences in professionalism issues in the different educational phases, as well as their consequences for training and assessment regarding professionalism. Continuous medical education in professionalism is thereafter briefly discussed.     

Obesity Diagnosis and Care Practices in the Veterans Health Administration

BACKGROUND  

In response to dramatic increases in obesity prevalence, clinical guidelines urge health care providers to prevent and treat obesity more aggressively.     

Supportive counseling for postpartum depression in Asian mothers

Introduction: The aim of the present study was to describe the role of supportive counseling for postpartum depression (PPD) in an Asian population and explore the treatment outcomes of supportive counseling with and without antidepressants. Oral antidepressants remain the mainstay treatment in depression. However in postpartum depression, mothers are often concerned about breastfeeding and the effects of medication on the developing child. For mothers willing to take antidepressants, the class of antidepressant more efficacious for postpartum depression still remains unclear. Non‐pharmacological treatments appear to have an important role in recent studies. Methods: In this naturalistic prospective cohort study, patients were identified from a postpartum depression screening program in a maternity hospital. Patients diagnosed with PPD were treated with antidepressant and counseling, or counseling alone. Outcomes were assessed using the Edinburgh Postnatal Depression Scale (EPDS) and Global Assessment of Functioning Scale (GAF). Statistical Package for the Social Sciences (SPSS) was used for statistical analyses (SPSS Inc., Chicago, IL, USA). Results: Between April 2008 and December 2009, 87 patients were recruited in this study. Sixty‐nine percent of all patients achieved remission at 6 months. Combining antidepressants and counseling did not appear to significantly improve outcome compared to counseling alone. Discussion: The majority of all depressed mothers with supportive counseling had remission of symptoms by 6 months. The benefit of combining antidepressants and counseling needs to be further studied.     

Audit of short term outcomes of surgical and medical second trimester termination of pregnancy

Background  

As comparisons of modern medical and surgical second trimester termination of pregnancy (TOP) are limited, and the optimum method of termination is still debated, an audit of second trimester TOP was undertaken, with the objective of comparing the outcomes of modern medical and surgical methods.     

Effect of carbohydrate ingestion on exercise performance and carbohydrate metabolism in persons with spinal cord injury

Carbohydrate ingestion during exercise and as a pre-exercise bolus improves exercise performance in able-bodied athletes. Little is known about the potential for carbohydrate ingestion to improve exercise performance in athletes with spinal cord injury (SCI), nor the potential physiological limitations of such a practice resulting from an SCI. Therefore, this study investigated the effects of carbohydrate ingestion on exercise performance in physically active and athletic persons with SCI. Six participants with complete SCI (neurological level of lesion ranging from C₆ to T₇) and normal glucose tolerance were studied twice during 60 min of arm cranking at 65% of peak oxygen consumption followed by a 20-min time trial with the ingestion of either a carbohydrate drink (CHO trial: 0.5 g CHO kg^?1 body weight in 500 ml) or placebo (PLA trial) applied in a double-blind counter-balanced manner. The participants with tetraplegia had sufficient neurological function to permit voluntary arm-cranking exercise. There was no difference in time-trial performance between CHO and PLA trials (P > 0.05). The results suggest that carbohydrate ingestion in persons with SCI does not improve exercise performance.     

Parental reaction to disability

How the diagnosis of neurodevelopmental disability is communicated to the family has long-lasting effects. When clarification of the diagnosis takes a long time, this is particularly hard for child health professionals to manage well, and a joint understanding of the process with the family is important. Guidelines for the conduct of the diagnostic consultation are presented.The impact of the child's disability on the family depends on many factors, including the child's behaviours, available resources and the family's coping strategies. By understanding families' individual differences, professionals can provide excellent health care but also help families to promote the child's quality of life and social participation.     

The effect of diet on total antioxidant status,ceruloplasmin, transferrin and ferritin serum levels in phenylketonuric children

Objectives: To investigate the effect of diet on total antioxidative status (TAS), transferrin, ferritin and ceruloplasmin serum levels in phenylketonuric (PKU) children. Patients and methods: Seventeen poorly controlled PKU children underwent clinical and laboratory examinations before, ‘off diet’, and 60 days after adhering to their special diet ‘on diet’, whereas controls (N = 24) were examined once. Blood chemistry was performed with the appropriate methodologies. Results: Phenylalanine levels differed significantly among the examined groups. Lipids and lipoproteins were higher in ‘off diet’ than in ‘on diet’ group, except of high density lipoprotein and apolipoprotein AI that remained unaffected. Total antioxidative status (386 ± 30 vs 204 ± 23 μmol/L, p < 0.001), ferritin (48.2 ± 2.3 vs 33.0 ± 2.8 μg/L, p < 0.001) and ceruloplasmin (40.02 ± 2.5 vs 25.5 ± 2.8 mg/dL, p < 0.001) levels were significantly higher in ‘on diet’ patients’ group compared to ‘off diet’ one. The low lipoprotein and the high TAS and ferritin levels in patients with PKU ‘on diet’ may be related to the vegetarian diet and the rich in iron formula supplementation. Conclusions: The low ferritin levels found in ‘off diet’ patients with PKU may be attributed to a decreased liver production of ceruloplasmin, which evaluation may be a useful tool for the follow‐up of patients with PKU.     

Bench-to-bedside review: Targeting antioxidants to mitochondria in sepsis

Development of organ dysfunction associated with sepsis is now accepted to be due at least in part to oxidative damage to mitochondria. Under normal circumstances, complex interacting antioxidant defense systems control oxidative stress within mitochondria. However, no studies have yet provided conclusive evidence of the beneficial effect of antioxidant supplementation in patients with sepsis. This may be because the antioxidants are not accumulating in the mitochondria, where they are most needed. Antioxidants can be targeted selectively to mitochondria by several means. This review describes the in vitro studies and animal models of several diseases involving oxidative stress, including sepsis, in which antioxidants targeted at mitochondria have shown promise, and the future implications for such approaches in patients.     

Bradycardia without associated hypertension: a common sign of ventriculo-peritoneal shunt malfunction

Introduction  

Delayed diagnosis of ventriculo-peritoneal (VP) shunt malfunction results in avoidable morbidity and mortality. One reason is that most of the signs of shunt malfunction have low specificity.