BENEFICENCE,TEMPERANCE AND MEDICAL SCIENCE

John Coakley Lettsom (1744–1815) founded the Medical Society of London and played a key role in the development of the Royal Humane Society. His Quaker background underpinned his interest in social reform. He established dispensaries and soup kitchens for the poor, recognized the need for public health measures in the control of disease, and advocated prison reform and education of the poor.     

Gender Differences in Nonprescribed Psychostimulant Use in Young Adults

Background: In order to better understand the recent rise in nonprescribed use of psychostimulants on college campuses, motives, outcomes, and acceptability of nonprescribed psychostimulants have been evaluated. Despite knowledge that students use nonprescribed medical stimulants for improved academic performance and recreational use, gender differences in these motives have not been examined, despite the fact that the social construction of gender may well affect motives for use. Objectives: The goal of the present study was to examine gender differences in motives, outcomes, and acceptability of nonprescribed psychostimulant use. Methods: 2716 undergraduates (1448 male) between the ages of 17 and 57 years (M = 19.43 years, SD = 1.7 years) completed an online survey examining subjective motives of nonprescribed psychostimulant use, as well as behaviors after use and moral views of nonprescribed use. Results: Consistent with hypotheses and known gender differences in social motivation, results suggested that while females are more likely to use nonprescribed psychostimulants for reasons related to schoolwork, males are typically more likely to use psychostimulants for reasons related to partying and socializing. Additional gender differences were that males are more likely to take part in other risky behaviors after use of psychostimulants, as well as view nonprescribed use as more moral and less physically dangerous than females. Conclusions/Importance: This work suggests that there are striking gender differences in motivation and outcomes of use of nonprescribed psychostimulants, which may have implications for personalized approaches for prevention of nonprescribed psychostimulant use on campuses based on gender.     

Paternal Roots of Female Character Development

Contemporary psychoanalysts maintain a widespread consensus on the interactive nature of the psychoanalytic process. Mitchell (1997) compares and contrasts the clinical work of three well-known contemporary analysts from three different analytic traditions: Theodore Jacobs, Darlene Ehrenberg, and Thomas Ogden. Mitchell uses this exercise to demonstrate that we each have our own idiosyncratic styles of engaging the world, and thus it follows that we each participate in distinct varieties of analytic interaction.

This article places Mitchell's own clinical approach squarely in line with the interpersonal tradition. The article argues that among all of the various schools of psychoanalysis, the interpersonal approach is unique in the freedom that it gives to analysts to behave flexibly and spontaneously with interventions other than interpretation. The article comments on Mitchell's unique qualities as a clinician and teacher.     

Living well with kidney disease by patient and care-partner empowerment: Kidney health for everyone everywhere

Living with chronic kidney disease (CKD) is associated with hardships for patients and their care-partners. Empowering patients and their care-partners, including family members or friends involved in their care, may help minimize the burden and consequences of CKD related symptoms to enable life participation. There is a need to broaden the focus on living well with kidney disease and re-engagement in life, including an emphasis on patients being in control. The World Kidney Day (WKD) Joint Steering Committee has declared 2021 the year of “Living Well with Kidney Disease” in an effort to increase education and awareness on the important goal of patient empowerment and life participation. This calls for the development and implementation of validated patient-reported outcome measures to assess and address areas of life participation in routine care. It could be supported by regulatory agencies as a metric for quality care or to support labelling claims for medicines and devices. Funding agencies could establish targeted calls for research that address the priorities of patients. Patients with kidney disease and their care-partners should feel supported to live well through concerted efforts by kidney care communities including during pandemics. In the overall wellness programme for kidney disease patients, the need for prevention should be reiterated. Early detection with a prolonged course of wellness despite kidney disease, after effective secondary and tertiary prevention programmes, should be promoted. WKD 2021 continues to call for increased awareness of the importance of preventive measures throughout populations, professionals, and policy makers, applicable to both developed and developing countries.     

High adherence to all-oral directly acting antiviral HCV therapy among an inner-city patient population in a phase 2a study

Background

As treatment for chronic hepatitis C (HCV) virus has evolved to all-oral, interferon-free directly acting antiviral (DAA) therapy, the impact of these improvements on patient adherence has not been described.

Methods

Medication adherence was measured in 60 HCV, genotype-1, treatment-naïve participants enrolled in a phase 2a clinical trial at the National Institutes of Health and community clinics. Participants received either ledipasvir/sofosbuvir (LDV/SOF) (90 mg/400 mg) (one pill) daily for 12 weeks, LDV/SOF + GS-9451 (80 mg/day) (two pills) daily for 6 weeks, or LDV/SOF + GS-9669 (500 mg twice daily; three pills, two in the morning, one in the evening) for 6 weeks. Adherence was measured using medication event monitoring system (MEMS) caps, pill counts and patient report.

Results

Overall adherence to DAAs was high. Adherence declined over the course of the 12-week treatment (p = 0.04). While controlled psychiatric disease or symptoms of depression did not influence adherence, recent drug use was a risk factor for non-adherence to 12-week (p = 0.01), but not 6-week regimens. Adherence as measured by MEMS was lower than by patient report.

Conclusions

Adherence to short courses of DAA therapy with 1–3 pills a day was excellent in an urban population with multiple risk factors for non-adherence.

     

Virtual Reality as a Clinical Tool for Pain Management

Purpose of Review

To evaluate the use of virtual reality (VR) therapies as a clinical tool for the management of acute and chronic pain.

Recent Findings

Recent articles support the hypothesis that VR therapies can effectively distract patients who suffer from chronic pain and from acute pain stimulated in trials. Clinical studies yield promising results in the application of VR therapies to a variety of acute and chronic pain conditions, including fibromyalgia, phantom limb pain, and regional specific pain from past injuries and illnesses.

Summary

Current management techniques for acute and chronic pain, such as opioids and physical therapy, are often incomplete or ineffective. VR trials demonstrate a potential to redefine the approach to treating acute and chronic pain in the clinical setting. Patient immersion in interactive virtual reality provides distraction from painful stimuli and can decrease an individual’s perception of the pain. In this review, we discuss the use of VR to provide patient distraction from acute pain induced from electrical, thermal, and pressure conditions. We also discuss the application of VR technologies to treat various chronic pain conditions in both outpatient and inpatient settings.

     

Mortality outcomes based on ED qSOFA score and HIV status in a developing low income country

Objective

To evaluate the utility of the quick Sepsis-related Organ Failure Assessment (qSOFA) score to predict risks for emergency department (ED) and hospital mortality among patients in a sub-Saharan Africa (SSA) setting.