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A Narrative Review of the Current Evidence of Fecal Microbiota Transplant as Curative Therapy for Recurrent Clostridioides difficile Infection 粪便菌群移植治疗复发性难辨梭菌感染的最新证据综述
Pub Date : 2021-01-01 DOI: 10.15404/msrj/08.2021.218
Divya Lakshmi Yerramsetty, D. Pandeya
Hypothesis: Compared to the flawed antimicrobial interventions, fecal microbiota transplantation (FMT) is more efficacious and safer in offering a significant clinical resolution of recurrent Clostridioides difficile (rCDI) – the world's leading hospital-acquired infection. Methods: An electronic search using Medscape, PubMed, and Google Scholar databases, limited only to articles published in academic journals with full-text access within the past ten years (2010-2020). Selection criteria consisted of quality research studies with relevant findings from patient follow-up post-FMT, considering both primary and secondary endpoints of the investigations. An evidence table was created to organize and evaluate the notable features of each source. Results: Three RCTs, two retrospective cohort studies, and two systematic reviews and meta-analyses have established that FMT is an effective alternative to standard care in treating rCDI. Multiple infusions of FMT as a monotherapy and rescue treatment demonstrated near-complete clinical resolution in patients with rCDI. Further management of rCDI with the recommended first-line agents (e.g., vancomycin and fidaxomicin) proved counterproductive to FMT in comparative studies. Conclusions: With its unappealing aesthetics and under-researched long-term implications, there is increased reluctance to FMT's regular use. Before declaring the novel procedure as the best form of medical practice, future studies should have a stronger emphasis on vancomycin and fidaxomicin to allow for the effective comparison of FMT to non-FMT treatments. Despite the existing limitations, including insufficient sample sizes, FMT has still shown overwhelming promise as a curative treatment for rCDI.
假设:与有缺陷的抗菌干预措施相比,粪便微生物群移植(FMT)在提供复发性艰难梭菌(rCDI)(世界领先的医院获得性感染)的显著临床解决方案方面更有效和更安全。方法:使用Medscape、PubMed和谷歌Scholar数据库进行电子检索,仅限在过去十年(2010-2020年)发表在可全文访问的学术期刊上的文章。选择标准包括高质量的研究和fmt后患者随访的相关发现,同时考虑研究的主要和次要终点。创建了一个证据表来组织和评估每个来源的显著特征。结果:3项随机对照试验、2项回顾性队列研究、2项系统评价和荟萃分析表明,FMT是治疗rCDI的有效替代标准治疗方法。多次输注FMT作为单药治疗和抢救治疗在rCDI患者中显示出近乎完全的临床解决。在比较研究中,使用推荐的一线药物(如万古霉素和非达霉素)进一步治疗rCDI被证明对FMT起反作用。结论:由于其不吸引人的美学和未充分研究的长期影响,人们越来越不愿意经常使用FMT。在宣布新方法为最佳医疗实践形式之前,未来的研究应该更加强调万古霉素和非达索霉素,以便对FMT和非FMT治疗进行有效比较。尽管存在局限性,包括样本量不足,FMT作为rCDI的治愈性治疗仍然显示出巨大的希望。
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引用次数: 2
The Crooked Tree: An Essay and Sculpture 弯曲的树:一篇散文和雕塑
Pub Date : 2021-01-01 DOI: 10.15404/msrj/08.2021.212
H.P.T.M. Jayawardana
The crooked tree has been adopted as the universal symbol for the field of orthopedics. Each part of this tree has hidden meanings closely related to orthopedic surgery. The purpose of this article is to generate thoughts among medical professionals and stimulate discussion among them on concepts behind the crooked tree and orthopedic surgery.
弯曲的树已被采纳为骨科领域的通用符号。这棵树的每一部分都隐藏着与整形外科密切相关的含义。本文的目的是在医疗专业人员中产生一些想法,并激发他们之间关于歪树和整形外科背后概念的讨论。
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引用次数: 0
Generational Giving: Japanese High School Students’ Motivation to Donate Blood 世代捐献:日本高中生献血的动机
Pub Date : 2021-01-01 DOI: 10.15404/msrj/08.2021.208
Luna Kinoshita, A. Goto, M. Kashimura, Norihiko Watanabe, K. Nollet
Background: As the number of young people in Japan decreases, the proportion of them who donate blood warrants urgent attention. The aims of this investigation were to test whether students’ motivation of “doing good for others” associated with their blood donation behavior and to explore factors associated with their motivation. Methods: Fukushima Red Cross Blood Donor Center conducted a questionnaire survey in 2018 at 10 high schools in Fukushima Prefecture (N=4506). From the database, we analyzed the factors associated with motivation as assessed by the perception of “doing good for others” using chi-square tests and binomial logistic regression. Results: The percentage of those answering “doing good for others” as “important” was 67.2%. Students who donated blood more often tended to cite “doing good for others” as important. The probability of regarding this perception as important was significantly higher among females, those with better subjective health, and those knowing their own blood type and donation eligibility criteria. Conclusion: Health promotion activities that improve subjective perceptions of one’s health may reinforce students’ awareness of blood donation as “doing good for others” that might promote frequent donation. Our results also support greater outreach to male students and improving students’ knowledge related to blood donation.
背景:随着日本年轻人数量的减少,他们献血的比例值得紧急关注。本研究旨在检验学生“为他人做好事”的动机是否与他们的献血行为有关,并探讨其动机的相关因素。方法:福岛县红十字会献血者中心于2018年对福岛县10所高中(N=4506)进行问卷调查。从数据库中,我们使用卡方检验和二项逻辑回归分析了与“为他人做好事”感知评估的动机相关因素。结果:回答“为他人做好事”“重要”的占67.2%。经常献血的学生往往认为“为他人做好事”很重要。在女性中,那些主观健康状况较好的人,以及那些知道自己的血型和捐赠资格标准的人,认为这种看法很重要的可能性要高得多。结论:通过健康促进活动,提高学生对自身健康的主观感知,可以增强学生献血“为他人做好事”的意识,从而促进学生频繁献血。我们的研究结果也支持更多的男性学生和提高学生献血相关的知识。
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引用次数: 0
Medical School is Killing My Personality 医学院在扼杀我的人格
Pub Date : 2021-01-01 DOI: 10.15404/msrj/08.2021.227
Haleigh Prather
This piece is a conversation and reflection of my ongoing relationship with toxic professionalism in medical school. Students are often at the whim of their evaluators to give them outstanding feedback in the name of having a strong residency application, but a great deal of the criteria we are evaluated on is subjective. One piece of feedback I’ve gotten more than once that I take issue with is the idea that being extroverted, enthusiastic, and cheery in medicine is seen as “unprofessional” and that I need to change myself. I am pushing back on this idea and advocating for medical students to feel more comfortable being themselves during patient encounters and asking those in evaluative positions of power to consider how feedback such as this contributing to phenomena like physician burn out.
这篇文章是我与医学院有毒专业主义之间持续关系的对话和反映。学生们常常会因评估人员的一时兴起,以出色的住院医师申请为名义,给他们提供出色的反馈,但我们评估的很多标准都是主观的。我不止一次得到的反馈是,在医学界,外向、热情和开朗被认为是“不专业的”,我需要改变自己。我反对这种观点,提倡医科学生在与病人接触时更自在地做自己,并要求那些处于评估地位的人考虑这样的反馈是如何导致医生倦怠等现象的。
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引用次数: 0
Comparing Student Satisfaction with Traditional and Modular Group Peer-Tutoring Session 学生满意度与传统和模块化小组同伴辅导课程的比较
Pub Date : 2019-08-24 DOI: 10.15404/MSRJ/07.2019.174
J. Cross, Rodney L. Nyland, Sarah Lerchenfeldt
Background: Our allopathic medical school has utilized a peer-tutoring program since inception in 2011, where second-year medical students teach first-year students in 2-h lecture-style review sessions. In 2015, an alternative format was implemented using four, repeating 30-min modules. This study was designed to compare student satisfaction with both approaches. Methods: An online survey was emailed to students graduating in 2018 (n = 97) and 2019 (n = 127). Results: A total of 72 (32.6%) responding students were included in the study, 35 from the class of 2018 (Co2018) and 37 from the class of 2019 (Co2019). Fewer Co2018 students, who received traditional instruction, were ‘very satisfied with the session timing’ compared with Co2019 students, who received the modular format (proportion difference: 0.42; P < 0.001, 95% confidence interval [CI] [0.21–0.63]). Co2018 students were more likely than Co2019 students to stop attending because their time was better utilized another way (proportion difference: 0.22; P = 0.054, 95% CI [-0.003 to 0.45]). Conclusions: Students preferred the session length and timing of the modular format. Future studies are warranted to evaluate the effectiveness of this approach.
背景:我们的对抗疗法医学院自2011年成立以来一直采用同伴辅导计划,由二年级的医学生以2小时的讲座式复习课程教一年级的学生。2015年,另一种形式采用了四个重复的30分钟模块。本研究旨在比较两种方法的学生满意度。方法:通过电子邮件对2018年(97名)和2019年(127名)毕业的学生进行在线调查。结果:共有72名(32.6%)学生参与了研究,其中35名来自2018级(Co2018), 37名来自2019级(Co2019)。与接受模块化教学的2019年学生相比,接受传统教学的2018年学生“对教学时间非常满意”(比例差:0.42;P < 0.001, 95%可信区间[CI][0.21-0.63])。Co2018的学生比Co2019的学生更有可能停止上学,因为他们的时间可以更好地利用在其他方面(比例差异:0.22;P = 0.054, 95% CI[-0.003 ~ 0.45])。结论:学生更喜欢模块格式的会话长度和时间。未来的研究有必要评估这种方法的有效性。
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引用次数: 0
Opioid Safety Education in Adolescent Students 青少年学生阿片类药物安全教育
Pub Date : 2019-07-26 DOI: 10.15404/02.2019.184
Alexandra K. Feiertag, Catherine A. Martin, Greg Guenthner
Purpose: Opioid overdoses profoundly impact thousands of families across the United States. Behind this issue lies the accessibility of opioid prescriptions right inside our medicine cabinets. Our goal was to educate adolescent students in Kentucky schools about this matter because they comprise a vulnerable population. Methods: Preand posttestings were used to analyze 26 adolescents’ knowledge, attitudes, and awareness regarding opioid overdoses preand post-intervention. Results: Adolescents displayed significantly improved results from pre-test to post-test. Overdose Knowledge scores improved by 16% from preto post-intervention (p = 0.01). Attitude to Act scores improved by 35% (p = 0.03). Drug Disposal Awareness scores improved by 54% (p < 0.01). Conclusions: This study demonstrates that education improves adolescents’ opioid overdose knowledge, attitudes, and awareness. The evidence shows that there are educational gaps that should be filled by teaching adolescents about the opioid epidemic and providing them with resources.
目的:阿片类药物过量严重影响了美国成千上万的家庭。这个问题的背后是我们药柜里的阿片类药物处方的可及性。我们的目标是教育肯塔基州学校的青少年学生关于这个问题,因为他们是弱势群体。方法:对26例青少年阿片类药物滥用干预前后的知识、态度和认知情况进行分析。结果:青少年在测试前和测试后表现出显著的改善。药物过量知识得分比干预前和干预后提高了16% (p = 0.01)。行为态度得分提高35% (p = 0.03)。药品处置意识评分提高54% (p < 0.01)。结论:本研究表明,教育提高了青少年阿片类药物过量的知识、态度和意识。有证据表明,应该通过向青少年讲授类阿片流行病并向他们提供资源来填补教育差距。
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引用次数: 0
Primary Intestinal Lymphangiectasia: A case report 原发性肠淋巴管扩张1例
Pub Date : 2019-05-16 DOI: 10.15404/05.2019.122
Ridwaan Albeiruti, P. Gleeson, T. Kelbel, T. Fausnight
Primary intestinal lymphangiectasia (Waldmann’s disease) is a rare protein-losing enteropathy which is mostly seen in young children. A 22-month-old male baby presented with a 1-week history of abdominal distension, chronic loose stools, recurrent ear infections, and failure to thrive. He had edematous eyelids and non-pitting edema of his hands and feet. The patient was diagnosed via endoscopic visualization and biopsy of the lymphangiectasia in the small bowel. He was managed through dietary restriction with a high-protein, low-fat diet. The patient subsequently had resolution of the diarrhea and an increase in albumin and total protein on labs. We describe a rare case of primary intestinal lymphangiectasia and highlight its clinical presentation, diagnosis, and treatment.
原发性肠淋巴管扩张症(瓦尔德曼病)是一种罕见的蛋白质丢失性肠病,多见于幼儿。一名22个月大的男婴有1周的腹胀、慢性稀便、反复耳朵感染和发育不良病史。他的眼睑水肿,手脚无点蚀水肿。该患者是通过小肠淋巴管扩张的内镜可视化和活检诊断的。他通过高蛋白、低脂肪的饮食来控制饮食。随后,患者腹泻得到缓解,实验室检查白蛋白和总蛋白含量增加。我们描述了一例罕见的原发性肠淋巴管扩张症,并强调其临床表现、诊断和治疗。
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引用次数: 0
Expert Opinions on Healthcare for Immigrants in Norway 挪威移民医疗专家意见
Pub Date : 2019-05-04 DOI: 10.15404/MSRJ/04.2019.0183
A. Kubicki, Haben Debessai, M. Masten, Reena Pullukat, Kirsten Salmela
Background: Documented immigrants eligible to stay in Norway for more than 6 months can enroll in the universal healthcare system for full healthcare services, such as acute, chronic, and preventative care.1 All other non-citizens only have access to emergency services. With an increasing influx of immigrants to Norway, it is advantageous to evaluate the Norwegian healthcare system, how documented and undocumented immigrants utilize the system, and any barriers they may face when doing so. The aim of this study is to identify barriers to healthcare for immigrants in Norway in order to better address them in the future. Methods: Sixteen subjects with knowledge of immigrant healthcare in Norway were interviewed. Participants were asked the same standardized four questions; answers were audio-recorded, transcribed, and analyzed. Results: Major themes that emerged included the following: (1) universal access is a benefit once accepted into the system, (2) timeliness is an issue, (3) chronic disease and mental health are common immigrant-specific health issues, and (4) language and lack of cultural competency are major barriers to care. Conclusion: There is a need for improved translation services and cultural competency as the immigrant population in Norway increases.
背景:有资格在挪威停留6个月以上的有证件的移民可以加入全民医疗系统,获得全面的医疗服务,如急性、慢性和预防性护理。1所有其他非公民只能获得紧急服务。随着越来越多的移民涌入挪威,评估挪威的医疗保健系统、有证件和无证移民如何使用该系统,以及他们在使用该系统时可能面临的任何障碍是有利的。本研究的目的是确定挪威移民在医疗保健方面的障碍,以便在未来更好地解决这些障碍。方法:对16名具有挪威移民医疗知识的受试者进行访谈。参与者被问到了同样标准化的四个问题;答案被录音、转录和分析。结果:出现的主要主题包括:(1)一旦被系统接受,普及是一项福利,(2)及时性是一个问题,(3)慢性病和心理健康是移民特有的常见健康问题,(4)语言和缺乏文化能力是护理的主要障碍。结论:随着挪威移民人口的增加,有必要改善翻译服务和文化能力。
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引用次数: 0
Malignant Chondroid Syringoma of the Foot – A Case Report 足部恶性软骨瘤1例报告
Pub Date : 2019-03-08 DOI: 10.15404/MSRJ/02.2019.0179
M. Masten
Background: This case report is about a very rare tumor – a malignant chondroid syringoma. The objective of this piece is to review both the case presented along with the current literature on cutaneous adnexal tumors. Case Presentation: The patient is a 73-year-old Caucasian female with a past medical history of treated colon and breast cancer who presented with a 2-year history of a slow-growing, painful cutaneous lesion on the medial aspect of her right foot. The patient presented to her primary care physician (PCP) for right foot pain, which was attributed to bunions. The PCP encouraged the patient to see a podiatrist for this issue. Upon presentation to the podiatrist, the patient had a right foot biopsy. The pathology report showed a mixed malignant chondroid syringoma with positive margins. A re-excision to ensure complete removal was recommended. The patient presented to surgical oncology and subsequently she underwent complete excision of the right foot mass. At the time of her last visit, 7 months postoperatively, the patient continued to have issues with wound healing and continuous drainage of her surgical wound. Discussion: This case differs from much of the current literature surrounding cutaneous adnexal tumors as it is a malignant chondroid syringoma of the foot, which is exceedingly rare. There are only three other published case reports of similar malignancies in similar places. This case study is important due to the uniqueness of the case. This case serves as a reminder of the importance of biopsy for diagnosis prior to management, as it is unlikely that such rare soft tissue tumors can be diagnosed without biopsy. Conclusion: The take away lesson of the case is that it is important to biopsy unknown masses, and to have follow up with specific specialists.
背景:本病例报告是关于一种非常罕见的肿瘤——恶性软骨样汗管瘤。这篇文章的目的是回顾该病例以及目前关于皮肤附件肿瘤的文献。病例介绍:患者是一名73岁的高加索女性,既往有结肠癌和乳腺癌癌症治疗史,右脚内侧有2年缓慢生长、疼痛的皮肤病变史。患者因右脚疼痛向初级保健医生(PCP)就诊,右脚疼痛可归因于拇囊炎。初级保健医生鼓励患者去看足科医生。在介绍给足科医生后,患者进行了右脚活检。病理报告显示混合性恶性软骨样脊髓瘤,边缘呈阳性。建议再次切除以确保完全切除。患者接受了肿瘤外科手术,随后接受了右脚肿块的完全切除。在术后7个月的最后一次就诊时,患者的伤口愈合和手术伤口的持续引流仍然存在问题。讨论:该病例与目前关于皮肤附件肿瘤的许多文献不同,因为它是一种极为罕见的足部恶性软骨样汗管瘤。在类似的地方,只有三个其他已发表的类似恶性肿瘤的病例报告。由于案例的独特性,本案例研究非常重要。这个病例提醒我们,活检在治疗前诊断的重要性,因为这种罕见的软组织肿瘤不太可能在没有活检的情况下被诊断出来。结论:该病例的教训是,对未知肿块进行活检,并与特定专家进行随访是很重要的。
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引用次数: 0
Systematic Review of the Role of Dietary Fiber in Weight Loss 膳食纤维在减肥中作用的系统评价
Pub Date : 2018-12-21 DOI: 10.15404/msrj/10/2018/0173
R. Roberts
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引用次数: 0
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