Simon Diaz, G. Cossu, Mihailo Obrenović, J. Barges-Coll
Background: Spinal cord tumors represent 2-4% of all CNS tumors. Ependymomas are the most frequent lesions of the spinal cord1. Gross total resection remains the gold standard2. Method: We describe the mini-invasive surgical technique using a fixed tubular retractor performed for the resection of an ependymoma of the filum terminale, along with its advantages and limits. Conclusion: This mini-invasive technique has shown to be safe and effective for the resection of filum terminale ependymoma, with a good impact on postoperative pain and less risks of CSF leak, which is probably secondary to a limited dead space.
{"title":"Ependymoma of the Filum Terminale, Technical Operative Note","authors":"Simon Diaz, G. Cossu, Mihailo Obrenović, J. Barges-Coll","doi":"10.18103/mra.v11i4.3591","DOIUrl":"https://doi.org/10.18103/mra.v11i4.3591","url":null,"abstract":"Background: Spinal cord tumors represent 2-4% of all CNS tumors. Ependymomas are the most frequent lesions of the spinal cord1. Gross total resection remains the gold standard2. Method: We describe the mini-invasive surgical technique using a fixed tubular retractor performed for the resection of an ependymoma of the filum terminale, along with its advantages and limits. Conclusion: This mini-invasive technique has shown to be safe and effective for the resection of filum terminale ependymoma, with a good impact on postoperative pain and less risks of CSF leak, which is probably secondary to a limited dead space.","PeriodicalId":94137,"journal":{"name":"Medical research archives","volume":"50 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78362455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.18103/mra.v11i7.2.4176
Kiersten R. Baughman
As the COVID-19 pandemic struck in early 2020, states in the United States (U.S.) varied widely in the arrival of the first case of the virus, the official response of government officials and citizens, and the overall impact of the virus. The Culture of Honor, a reputation-based system more prevalent in the U.S. South and West, is linked with lawlessness or mistrust of the law where it exists, fierce independence, and condones aggressive behaviors, particularly in response to threat. The current project explored the influence of the Culture of Honor on perceptions of the legitimacy of COVID-19 messaging, government actions and citizens responses, and overall impact of the pandemic at the state level. It was predicted that the overall numbers of citizens infected by COVID-19 would be higher in culture of honor states, that any actions taken by government officials would be strict and perceived negatively by citizens residing in culture of honor states, and that citizens would be unlikely to follow any imposed government restrictions. Publicly available data were compiled for each of the U.S. states including total number of COVID-19 cases, total deaths, how the elected officials managed any coordinated response (such as issuing executive orders, any stay-at-home or lockdown orders), and coded evidence of citizens violating any of these orders such as by protesting or showing up at public locations that were currently closed. I am deeply indebted to Luke Conway for providing access to an individual-level dataset collected via Amazon Mechanical Turk (MTurk) that included 978 people from across the U.S. who had responded to items related to these variables of interest. Analyses indicated that individuals in US states identified as Culture of Honor had seen greater impact to their states of the COVID-19 pandemic as of 2020 in several ways, including higher total number of citizens who tested positive and also died from COVID-19, less support for government action to mitigate the spread, and stronger distrust of information shared by their state authorities about the pandemic. These findings indicate that cultural values including the Culture of Honor could impede state-level attempts to thwart the spread of contagious diseases and other measures intended to protect individuals.
随着2019冠状病毒病(COVID-19)大流行于2020年初爆发，美国各州在第一例病毒病例的到来、政府官员和公民的官方反应以及病毒的整体影响方面存在很大差异。荣誉文化是一种以名誉为基础的体系，在美国南部和西部更为普遍，它与法律存在的地方的无法无天或不信任法律、激烈的独立、容忍攻击性行为，特别是在面对威胁时的行为联系在一起。当前的项目探讨了荣誉文化对认知COVID-19信息合法性、政府行动和公民反应以及州一级疫情总体影响的影响。有分析认为，在荣誉文化国家，感染新冠病毒的全体国民人数会更多，而在荣誉文化国家，政府官员采取的任何行动都会受到严格的限制，因此会受到市民的负面评价，而且很难遵守政府的限制措施。对美国每个州的公开数据进行了汇编，包括COVID-19病例总数、死亡总数、当选官员如何管理任何协调应对(例如发布行政命令、任何居家或封锁命令)，以及公民违反任何这些命令的编码证据，例如抗议或出现在目前关闭的公共场所。我非常感谢Luke Conway提供了通过Amazon Mechanical Turk (MTurk)收集的个人数据集，其中包括来自美国各地的978人，他们对与这些感兴趣的变量相关的项目做出了回应。分析表明，截至2020年，被认定为“荣誉文化”的美国各州的个人在几个方面对其所在州的COVID-19大流行产生了更大的影响，包括检测呈阳性并死于COVID-19的公民总数增加，对政府采取行动减轻传播的支持减少，以及对州当局分享的关于大流行的信息更加不信任。这些发现表明，包括荣誉文化在内的文化价值观可能会阻碍国家层面阻止传染病传播的努力和旨在保护个人的其他措施。
{"title":"Culture of Honor and COVID-19: Regional Mitigation Efforts in the United States During the Pandemic","authors":"Kiersten R. Baughman","doi":"10.18103/mra.v11i7.2.4176","DOIUrl":"https://doi.org/10.18103/mra.v11i7.2.4176","url":null,"abstract":"As the COVID-19 pandemic struck in early 2020, states in the United States (U.S.) varied widely in the arrival of the first case of the virus, the official response of government officials and citizens, and the overall impact of the virus. The Culture of Honor, a reputation-based system more prevalent in the U.S. South and West, is linked with lawlessness or mistrust of the law where it exists, fierce independence, and condones aggressive behaviors, particularly in response to threat. The current project explored the influence of the Culture of Honor on perceptions of the legitimacy of COVID-19 messaging, government actions and citizens responses, and overall impact of the pandemic at the state level. It was predicted that the overall numbers of citizens infected by COVID-19 would be higher in culture of honor states, that any actions taken by government officials would be strict and perceived negatively by citizens residing in culture of honor states, and that citizens would be unlikely to follow any imposed government restrictions. Publicly available data were compiled for each of the U.S. states including total number of COVID-19 cases, total deaths, how the elected officials managed any coordinated response (such as issuing executive orders, any stay-at-home or lockdown orders), and coded evidence of citizens violating any of these orders such as by protesting or showing up at public locations that were currently closed. I am deeply indebted to Luke Conway for providing access to an individual-level dataset collected via Amazon Mechanical Turk (MTurk) that included 978 people from across the U.S. who had responded to items related to these variables of interest. Analyses indicated that individuals in US states identified as Culture of Honor had seen greater impact to their states of the COVID-19 pandemic as of 2020 in several ways, including higher total number of citizens who tested positive and also died from COVID-19, less support for government action to mitigate the spread, and stronger distrust of information shared by their state authorities about the pandemic. These findings indicate that cultural values including the Culture of Honor could impede state-level attempts to thwart the spread of contagious diseases and other measures intended to protect individuals.","PeriodicalId":94137,"journal":{"name":"Medical research archives","volume":"74 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78332309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Airway management is both a fundamental skill and resuscitative treatment that has taken a prominent role in emergency medicine. In the past few decades there have been many advancements in airway management particularly in critically ill patients. Technology has been developed and adapted to provide improved visualization for endotracheal intubation as well as supportive strategies for oxygenation and optimization of medications. In this review we will discuss the current practices and literature in airway management of critically ill patients including medication optimization and airway visualization techniques for first pass success.
{"title":"Airway Management for the Critically Ill Patient in the Emergency Department","authors":"Jennifer L. Stahl, J. O'Donnell","doi":"10.18103/mra.v11i4.3720","DOIUrl":"https://doi.org/10.18103/mra.v11i4.3720","url":null,"abstract":"Airway management is both a fundamental skill and resuscitative treatment that has taken a prominent role in emergency medicine. In the past few decades there have been many advancements in airway management particularly in critically ill patients. Technology has been developed and adapted to provide improved visualization for endotracheal intubation as well as supportive strategies for oxygenation and optimization of medications. In this review we will discuss the current practices and literature in airway management of critically ill patients including medication optimization and airway visualization techniques for first pass success.","PeriodicalId":94137,"journal":{"name":"Medical research archives","volume":"45 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74988586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Elke Smeers, H. Désiron, A. Rijk, E. Hoof, J. Mebis, L. Godderis
Background: International research indicates that patients’ needs for return-to-work (RTW) support should be addressed and integrated within the curative healthcare process and as early as possible in the treatment process. Using intervention mapping, a hospital based RTW intervention, named BRIDGE (Bridging health care and workspace), was developed with an emphasis on bridging the gap between healthcare and the workplace. The aims of this evaluation were (a) to determine whether BRIDGE contributes to restoring participation and increasing quality of life for BC patients during their RTW process; and (b) to identify the needs and experiences of patients and healthcare professionals during this transmural intervention process. This paper describes the quantitative and qualitative evaluation of the intervention. Method: The mixed-method design of this study assessed quantitative outcome measures on patient level (perceived Quality of life), number of days on sick leave, relapse and experience with RTW support; and on healthcare worker level (days of duration of the RTW guided process, perception of satisfaction with RTW support and time spent by the occupational therapist and the multidisciplinary team). Semi structured interviews were used to evaluate qualitative measures on patient level, focus-group discussion was used to collect healthcare providers’ perceptions. Results: Of all eligible patients (n =179), 79 accepted to participate. Randomisation attributed 43 participants to the intervention group (IG) and 36 to the control group (CG). The outcomes showed that patients felt respected and empowered in their choices and actions regarding their professional career and that health care providers perceive the intervention as valuable support for their patients. Conclusions: The BRIDGE intervention is highly appreciated both by HCPs and BC patients. Improvements can be made by elaborating the thoughtful follow-up which enables the BCM to stay in touch, to enable indication of the right moment for each patient to engage in the RTW process. It also would reinforce insights for the BCM to provide the type of service that fits patients’ and all other stakeholders’ needs. On the other hand, HCPs are not comfortable with the content as well as the potential impact. More emphasis on the thoughtful follow-up is needed to motivate HCPs to align with the idea of the BRIDGE intervention.
{"title":"Evaluation of a Hospital-Based Return to Work intervention for Breast Cancer Patients","authors":"Elke Smeers, H. Désiron, A. Rijk, E. Hoof, J. Mebis, L. Godderis","doi":"10.18103/mra.v11i1.3448","DOIUrl":"https://doi.org/10.18103/mra.v11i1.3448","url":null,"abstract":"Background: International research indicates that patients’ needs for return-to-work (RTW) support should be addressed and integrated within the curative healthcare process and as early as possible in the treatment process. Using intervention mapping, a hospital based RTW intervention, named BRIDGE (Bridging health care and workspace), was developed with an emphasis on bridging the gap between healthcare and the workplace. The aims of this evaluation were (a) to determine whether BRIDGE contributes to restoring participation and increasing quality of life for BC patients during their RTW process; and (b) to identify the needs and experiences of patients and healthcare professionals during this transmural intervention process. This paper describes the quantitative and qualitative evaluation of the intervention. Method: The mixed-method design of this study assessed quantitative outcome measures on patient level (perceived Quality of life), number of days on sick leave, relapse and experience with RTW support; and on healthcare worker level (days of duration of the RTW guided process, perception of satisfaction with RTW support and time spent by the occupational therapist and the multidisciplinary team). Semi structured interviews were used to evaluate qualitative measures on patient level, focus-group discussion was used to collect healthcare providers’ perceptions. Results: Of all eligible patients (n =179), 79 accepted to participate. Randomisation attributed 43 participants to the intervention group (IG) and 36 to the control group (CG). The outcomes showed that patients felt respected and empowered in their choices and actions regarding their professional career and that health care providers perceive the intervention as valuable support for their patients. Conclusions: The BRIDGE intervention is highly appreciated both by HCPs and BC patients. Improvements can be made by elaborating the thoughtful follow-up which enables the BCM to stay in touch, to enable indication of the right moment for each patient to engage in the RTW process. It also would reinforce insights for the BCM to provide the type of service that fits patients’ and all other stakeholders’ needs. On the other hand, HCPs are not comfortable with the content as well as the potential impact. More emphasis on the thoughtful follow-up is needed to motivate HCPs to align with the idea of the BRIDGE intervention.","PeriodicalId":94137,"journal":{"name":"Medical research archives","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75230867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Adriano Lubanga, Alfred Lipenga, V. Mwapasa, Gift Kanyinji, Darlington Ndlovu, Tuntufye Sichinga, George Mwenye-Phiri, Louis Ng’oma, Elled Mwenyekonde, Donghyun Jeon, Seok Han, Kaylin Choe, J. Seung, Justin Kong, T. Nyirenda
Background: The COVID-19 pandemic has caused devastating effects on the world since its discovery in the city of Wuhan in 2019. It has claimed millions of lives and has significantly affected the economies of the world. However, the characteristics of affected populations in poorest settings in Africa are not clearly known. Aims and Objectives: The study was undertaken to evaluate common clinical presentations of patients diagnosed with COVID-19, asses the socio-economic and demographic profiles and analyze the clinical course, and comorbidities of COVID-19 positive patients at Likuni mission hospital, central region of Malawi. Methods: This was a cross sectional study, however we looked at retrospective data from for all patients diagnosed from January 2021 to January 2022. Results: Patients were predominantly female (65%), less than 40 years, without any known comorbidity and had at least 3 symptoms before being diagnosed. The most common symptoms were fever, cough, chest pains, headache, shortness of breath, and general body weakness. A significantly higher population were from low social economic status (p<0.05). Over 95% of the population suffered minor ailment and did not need hospitalization and advanced life support. All patients that required hospitalization were above the age of 60 and the results were statistically significant (p<0.05). More than 90% of the cases were locally spread and did not have traceable positive contact. Conclusion: The diversity of clinical and epidemiological characteristic of patients diagnosed with COVID-19 across gender, socio-economic status, age group and occupation is extremely important. Our results provides an understanding of the characteristics of patients in a poor setting like Malawi and will inform policy makers at local hospitals and district levels including researchers and the ministry of health.
{"title":"The Clinical and Social Economic Profile of Patients Diagnosed with COVID-19 at Likuni Mission Hospital, Malawi.","authors":"Adriano Lubanga, Alfred Lipenga, V. Mwapasa, Gift Kanyinji, Darlington Ndlovu, Tuntufye Sichinga, George Mwenye-Phiri, Louis Ng’oma, Elled Mwenyekonde, Donghyun Jeon, Seok Han, Kaylin Choe, J. Seung, Justin Kong, T. Nyirenda","doi":"10.18103/mra.v11i5.3696","DOIUrl":"https://doi.org/10.18103/mra.v11i5.3696","url":null,"abstract":"Background: The COVID-19 pandemic has caused devastating effects on the world since its discovery in the city of Wuhan in 2019. It has claimed millions of lives and has significantly affected the economies of the world. However, the characteristics of affected populations in poorest settings in Africa are not clearly known. Aims and Objectives: The study was undertaken to evaluate common clinical presentations of patients diagnosed with COVID-19, asses the socio-economic and demographic profiles and analyze the clinical course, and comorbidities of COVID-19 positive patients at Likuni mission hospital, central region of Malawi. Methods: This was a cross sectional study, however we looked at retrospective data from for all patients diagnosed from January 2021 to January 2022. Results: Patients were predominantly female (65%), less than 40 years, without any known comorbidity and had at least 3 symptoms before being diagnosed. The most common symptoms were fever, cough, chest pains, headache, shortness of breath, and general body weakness. A significantly higher population were from low social economic status (p<0.05). Over 95% of the population suffered minor ailment and did not need hospitalization and advanced life support. All patients that required hospitalization were above the age of 60 and the results were statistically significant (p<0.05). More than 90% of the cases were locally spread and did not have traceable positive contact. Conclusion: The diversity of clinical and epidemiological characteristic of patients diagnosed with COVID-19 across gender, socio-economic status, age group and occupation is extremely important. Our results provides an understanding of the characteristics of patients in a poor setting like Malawi and will inform policy makers at local hospitals and district levels including researchers and the ministry of health.","PeriodicalId":94137,"journal":{"name":"Medical research archives","volume":"324 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76302273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Reeder, Tyler B. Anderson, Brent Alumbaugh, Steven Murray
Sauna bathing is a time-efficient, cost-effective health modality that has the potential to mimic the heat thermogenesis and cardiovascular effects of exercise. In recent years, researchers have been able to measure the benefits of sauna on human performance, endurance, and cardiovascular health. While many studies have investigated sauna use and its effect on athletic performance, fewer studies have investigated the use of sauna as a medical treatment for chronic health conditions. This review compiles the proven effects of sauna on human physiology and investigates its applications in the treatment of patients with chronic disease. Sauna use appears to be safe in most patient populations and is shown to be both tolerable and effective in patient populations with cardiovascular disease and late stages of congestive heart failure. Multiple cardiovascular benefits were demonstrated in the review including improved perfusion in peripheral arterial disease, decreased ventricular arrhythmias, 51% reduced annual cardiovascular mortality and 47% reduced annual risk of developing hypertension in men using the sauna 4-7 times per week. Finnish cohort studies have additionally exhibited reductions in lifetime annual risk of dementia by 66% in men using the sauna 4-7 times per week. It is suggested that increased heat shock protein expression through heat exposure may be responsible for the neuroprotective benefits of lifetime sauna use. Sauna has also displayed benefits in metabolic disease by reducing hemoglobin A1C and aiding heat acclimation in diabetics through improved thermoregulation. In mental health research, sauna use has shown potential in the treatment of depression by improving objective depression scores. Another study exhibited that sauna use was able to increase appetite in patients with severe depression and coexisting appetite suppression. Additionally, in cohort studies sauna is shown to be correlated to reduced annual risk of developing psychosis across the lifespan. By compiling and reviewing the current research on sauna bathing, education and guidance are provided to medical providers regarding the potential use of sauna as a treatment adjunct for patients with various conditions including cardiovascular disease, neurodegenerative disease, metabolic disease, and mental health disorders.
{"title":"Sauna Bathing as an Alternative Adjunct Therapy in the Prevention and Treatment of Chronic Health Conditions Including Cardiovascular Disease, Neurodegenerative Disease, Metabolic Disease, and Mental Health Disorders","authors":"M. Reeder, Tyler B. Anderson, Brent Alumbaugh, Steven Murray","doi":"10.18103/mra.v11i6.3965","DOIUrl":"https://doi.org/10.18103/mra.v11i6.3965","url":null,"abstract":"Sauna bathing is a time-efficient, cost-effective health modality that has the potential to mimic the heat thermogenesis and cardiovascular effects of exercise. In recent years, researchers have been able to measure the benefits of sauna on human performance, endurance, and cardiovascular health. While many studies have investigated sauna use and its effect on athletic performance, fewer studies have investigated the use of sauna as a medical treatment for chronic health conditions. This review compiles the proven effects of sauna on human physiology and investigates its applications in the treatment of patients with chronic disease. Sauna use appears to be safe in most patient populations and is shown to be both tolerable and effective in patient populations with cardiovascular disease and late stages of congestive heart failure. Multiple cardiovascular benefits were demonstrated in the review including improved perfusion in peripheral arterial disease, decreased ventricular arrhythmias, 51% reduced annual cardiovascular mortality and 47% reduced annual risk of developing hypertension in men using the sauna 4-7 times per week. Finnish cohort studies have additionally exhibited reductions in lifetime annual risk of dementia by 66% in men using the sauna 4-7 times per week. It is suggested that increased heat shock protein expression through heat exposure may be responsible for the neuroprotective benefits of lifetime sauna use. Sauna has also displayed benefits in metabolic disease by reducing hemoglobin A1C and aiding heat acclimation in diabetics through improved thermoregulation. In mental health research, sauna use has shown potential in the treatment of depression by improving objective depression scores. Another study exhibited that sauna use was able to increase appetite in patients with severe depression and coexisting appetite suppression. Additionally, in cohort studies sauna is shown to be correlated to reduced annual risk of developing psychosis across the lifespan. By compiling and reviewing the current research on sauna bathing, education and guidance are provided to medical providers regarding the potential use of sauna as a treatment adjunct for patients with various conditions including cardiovascular disease, neurodegenerative disease, metabolic disease, and mental health disorders.","PeriodicalId":94137,"journal":{"name":"Medical research archives","volume":"71 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75689581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.18103/mra.v11i7.2.4118
Akbar Khan, M. Ghen
Despite Otto Warburg’s discovery of aerobic glycolysis in cancer cells in the 1920’s, the potential for developing therapeutics that targeted cancer cell metabolism was essentially ignored until 2007 when a groundbreaking publication was released from a group of Canadian researchers. Bonnet et al. (who paradoxically were not specialized in oncology) discovered that the generic drug dichloroacetate sodium (“DCA”) could reverse the Warburg phenotype in cancer cells in vitro and in vivo resulting in natural cancer cell suicide and tumour shrinkage in rats. This phenomenon was previously thought to be impossible as it was believed that mitochondria in malignant cells were permanently altered and unable to trigger apoptosis. Despite the fact that no large clinical trial of DCA as a cancer therapy was ever completed, a small number of doctors in North America and Europe rapidly translated this new knowledge into clinical cancer protocols through independent observational research and creative thinking. Since off-label drug use is permitted in most jurisdictions, clinicians initially began to use DCA in patients who had failed all conventional therapies. Over the years, further novel anti-cancer mechanisms of DCA were discovered such as angiogenesis inhibition, immune activation and cancer stem cell targeting. Around 2011, the work of Seyfried (USA) began to illuminate the importance of glutamine inhibition and suggested that a multi-energetic targeted approach was superior to glycolysis inhibition alone. A collaborative effort of the authors incorporating Seyfried’s concepts resulted in the creation of a new metabolic protocol named “MOMENTUM” (Metabolic, Oncologic, Multi-ENergetic Targeted, Universal, Modified). In this protocol, glucose and glutamine metabolism were targeted simultaneously with a combination of multiple natural and pharmacologic agents administered intravenously. Surprising preliminary clinical results in several difficult cancer cases confirmed that metabolic multi-targeted methods are extremely promising, and more so than metabolic monotherapy. Life threatening side effects of this approach to cancer management are virtually non-existent and therapy costs are manageable. A disappointing absence of industry funding for large clinical trials has not curtailed the development of the metabolic approach as a clinically viable methodology, proving that unadulterated medical science can conquer the ongoing push for multibillion-dollar economic reward.
{"title":"A 15 Year Evolution of Dichloroacetate-Based Metabolic Cancer Therapy: A Review with Case Reports","authors":"Akbar Khan, M. Ghen","doi":"10.18103/mra.v11i7.2.4118","DOIUrl":"https://doi.org/10.18103/mra.v11i7.2.4118","url":null,"abstract":"Despite Otto Warburg’s discovery of aerobic glycolysis in cancer cells in the 1920’s, the potential for developing therapeutics that targeted cancer cell metabolism was essentially ignored until 2007 when a groundbreaking publication was released from a group of Canadian researchers. Bonnet et al. (who paradoxically were not specialized in oncology) discovered that the generic drug dichloroacetate sodium (“DCA”) could reverse the Warburg phenotype in cancer cells in vitro and in vivo resulting in natural cancer cell suicide and tumour shrinkage in rats. This phenomenon was previously thought to be impossible as it was believed that mitochondria in malignant cells were permanently altered and unable to trigger apoptosis. Despite the fact that no large clinical trial of DCA as a cancer therapy was ever completed, a small number of doctors in North America and Europe rapidly translated this new knowledge into clinical cancer protocols through independent observational research and creative thinking. Since off-label drug use is permitted in most jurisdictions, clinicians initially began to use DCA in patients who had failed all conventional therapies. Over the years, further novel anti-cancer mechanisms of DCA were discovered such as angiogenesis inhibition, immune activation and cancer stem cell targeting. Around 2011, the work of Seyfried (USA) began to illuminate the importance of glutamine inhibition and suggested that a multi-energetic targeted approach was superior to glycolysis inhibition alone. A collaborative effort of the authors incorporating Seyfried’s concepts resulted in the creation of a new metabolic protocol named “MOMENTUM” (Metabolic, Oncologic, Multi-ENergetic Targeted, Universal, Modified). In this protocol, glucose and glutamine metabolism were targeted simultaneously with a combination of multiple natural and pharmacologic agents administered intravenously. Surprising preliminary clinical results in several difficult cancer cases confirmed that metabolic multi-targeted methods are extremely promising, and more so than metabolic monotherapy. Life threatening side effects of this approach to cancer management are virtually non-existent and therapy costs are manageable. A disappointing absence of industry funding for large clinical trials has not curtailed the development of the metabolic approach as a clinically viable methodology, proving that unadulterated medical science can conquer the ongoing push for multibillion-dollar economic reward.","PeriodicalId":94137,"journal":{"name":"Medical research archives","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74729877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.18103/mra.v11i7.2.4085
J. Perlmutter, S. Brain, T. Brown, D. Collyar, Amy Delson, D. Heditsian, B. Lestage, Bev Parker, Susan Samson, Joan Venticinque, Jeff Matthews
The innovative I-SPY Breast Trial is presented as an example of an unusually patient-centric clinical trial that has been significantly impacted by extensive advocate involvement. In the introduction we briefly define what we mean by patient-centric trials and describe the overall structure, goals, and evolution of I-SPY. We then describe: 1) the roles and philosophy of advocate involvement; 2) attributes of the trial design that make it especially patient-centric; and 3) educational material and communications approaches aimed at empowering and supporting trial participants. For each section, in addition to describing I-SPY practices, we provide aspirational suggestions that could enhance I-SPY and/or other clinical trials. Embedding advocates into every aspect of clinical trial design and operations, empowering trial participants with excellent patient educational material and incorporating and learning from patient-reported outcomes serves as a model approach to achieve more patient-centric clinical trials.
{"title":"Advocate involvement in Clinical Trials: Lessons from the Patient-centric I-SPY2 Breast Cancer Trial","authors":"J. Perlmutter, S. Brain, T. Brown, D. Collyar, Amy Delson, D. Heditsian, B. Lestage, Bev Parker, Susan Samson, Joan Venticinque, Jeff Matthews","doi":"10.18103/mra.v11i7.2.4085","DOIUrl":"https://doi.org/10.18103/mra.v11i7.2.4085","url":null,"abstract":"The innovative I-SPY Breast Trial is presented as an example of an unusually patient-centric clinical trial that has been significantly impacted by extensive advocate involvement. In the introduction we briefly define what we mean by patient-centric trials and describe the overall structure, goals, and evolution of I-SPY. We then describe: 1) the roles and philosophy of advocate involvement; 2) attributes of the trial design that make it especially patient-centric; and 3) educational material and communications approaches aimed at empowering and supporting trial participants. For each section, in addition to describing I-SPY practices, we provide aspirational suggestions that could enhance I-SPY and/or other clinical trials. Embedding advocates into every aspect of clinical trial design and operations, empowering trial participants with excellent patient educational material and incorporating and learning from patient-reported outcomes serves as a model approach to achieve more patient-centric clinical trials.","PeriodicalId":94137,"journal":{"name":"Medical research archives","volume":"62 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74354552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: The Entrustable Professional Activity (EPA) framework was introduced to operationalise and translate competency-based medical education into daily practice. Adoption of EPAs is recommended and supported in guidelines by educational research on trust and entrustment decision-making. However, systematic field studies evaluating the experiences of medical professionals (residents and supervisors) working with an EPA framework in daily practice are lacking. Still these evaluations are necessary to support the design and implementation of new EPA-based residency training programmes. This study provides an in-depth insight and a more comprehensive understanding of the experiences of professionals working in an EPA-based residency training programme. Methods: We conducted a qualitative study using a constructivist approach. Focus groups were used for separate interviews with residents and supervisors assessing their experiences with the first national EPA-based residency training programme in the Netherlands. Thematic analysis was used to analyse the results of the focus groups and to define relevant themes. Results: The EPA framework enabled residents to enhance and individualise their training programme. Personal leadership proved to be essential for finding a balance between the requirements of the national training programme and exploration of residents’ individual talents, experience and learning curve. Supervisors’ supportive and guiding role is crucial throughout the process of EPA acquirement. Independent from each other, supervisors and residents indicated that trust (and not exhaustive testing) is essential in the summative assessment by a Clinical Competence Committee (CCC). Supervisors see added value in the mandatory portfolio that residents compile to help them prepare for the CCC meeting. Starting to work without supervision is an important but challenging goal once an EPA has been acquired. The ability to further individualise the training programme after an EPA has been acquired, varies among residents. Discussion: We found that residents and supervisors see added value in working and learning in an EPA-based residency training programme. Awareness and encouragement of self-regulated learning skills could potentially help create a balance between programme requirements and individualisation. When discussing a portfolio, trust and gut-feelings during CCC meetings is fundamental and helpful for supervisors to get a comprehensive view of the resident’s performance. An autonomy-supportive supervision strategy could encourage and improve residents’ autonomy and practice of working without direct supervision after acquiring an EPA.
{"title":"Summative Entrustment Decision-Making in a National Entrustable Professional Activity-Based Residency Training Programme: Where theory meets practice","authors":"Maaike Smit, Reinoud J.B.J. Gemke, Karsten Loon, Marieke Visser, M. Hoog, Janiëlle Velden","doi":"10.18103/mra.v11i6.3863","DOIUrl":"https://doi.org/10.18103/mra.v11i6.3863","url":null,"abstract":"Introduction: The Entrustable Professional Activity (EPA) framework was introduced to operationalise and translate competency-based medical education into daily practice. Adoption of EPAs is recommended and supported in guidelines by educational research on trust and entrustment decision-making. However, systematic field studies evaluating the experiences of medical professionals (residents and supervisors) working with an EPA framework in daily practice are lacking. Still these evaluations are necessary to support the design and implementation of new EPA-based residency training programmes. This study provides an in-depth insight and a more comprehensive understanding of the experiences of professionals working in an EPA-based residency training programme. Methods: We conducted a qualitative study using a constructivist approach. Focus groups were used for separate interviews with residents and supervisors assessing their experiences with the first national EPA-based residency training programme in the Netherlands. Thematic analysis was used to analyse the results of the focus groups and to define relevant themes. Results: The EPA framework enabled residents to enhance and individualise their training programme. Personal leadership proved to be essential for finding a balance between the requirements of the national training programme and exploration of residents’ individual talents, experience and learning curve. Supervisors’ supportive and guiding role is crucial throughout the process of EPA acquirement. Independent from each other, supervisors and residents indicated that trust (and not exhaustive testing) is essential in the summative assessment by a Clinical Competence Committee (CCC). Supervisors see added value in the mandatory portfolio that residents compile to help them prepare for the CCC meeting. Starting to work without supervision is an important but challenging goal once an EPA has been acquired. The ability to further individualise the training programme after an EPA has been acquired, varies among residents. Discussion: We found that residents and supervisors see added value in working and learning in an EPA-based residency training programme. Awareness and encouragement of self-regulated learning skills could potentially help create a balance between programme requirements and individualisation. When discussing a portfolio, trust and gut-feelings during CCC meetings is fundamental and helpful for supervisors to get a comprehensive view of the resident’s performance. An autonomy-supportive supervision strategy could encourage and improve residents’ autonomy and practice of working without direct supervision after acquiring an EPA.","PeriodicalId":94137,"journal":{"name":"Medical research archives","volume":"48 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74636316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Increasingly, medical care targets conditions, like hypertension and hypercholesterolemia, which are defined as ranges of some clinical variable, not by any concrete physical pathology. These ranges are usually chosen from data on modifiable risk, as well as by other empirical consequences. Such purported disease categories face three main criticisms, one practical and two conceptual. The practical issue is overdiagnosis: the fear that more people suffer harm than benefit from such diagnoses. The second issue is Schwartz’s and Accad’s complaint that disease and risk of disease must not be confused. The third issue is that most of the literature on risk-based diseases wrongly assumes a conceptual connection between disease and medical treatment. In this essay I analyze these issues about risk-based diseases from the viewpoint of my biostatistical analysis of health and disease. I reach no conclusion on the first, the overdiagnosis of specific conditions. But I conclude that the two conceptual criticisms are wholly valid: in traditional medical thought, neither risk nor treatability implies pathologicity. So Pickering was right: current categories of hypertension, high cholesterol, and the like are not true diseases, nor even diagnostic criteria for true diseases. They are, at best, only categories of justified medical treatment.
{"title":"Boundaries of Disease: Disease and Risk","authors":"Christopher Boorse","doi":"10.18103/mra.v11i4.3599","DOIUrl":"https://doi.org/10.18103/mra.v11i4.3599","url":null,"abstract":"Abstract Increasingly, medical care targets conditions, like hypertension and hypercholesterolemia, which are defined as ranges of some clinical variable, not by any concrete physical pathology. These ranges are usually chosen from data on modifiable risk, as well as by other empirical consequences. Such purported disease categories face three main criticisms, one practical and two conceptual. The practical issue is overdiagnosis: the fear that more people suffer harm than benefit from such diagnoses. The second issue is Schwartz’s and Accad’s complaint that disease and risk of disease must not be confused. The third issue is that most of the literature on risk-based diseases wrongly assumes a conceptual connection between disease and medical treatment. In this essay I analyze these issues about risk-based diseases from the viewpoint of my biostatistical analysis of health and disease. I reach no conclusion on the first, the overdiagnosis of specific conditions. But I conclude that the two conceptual criticisms are wholly valid: in traditional medical thought, neither risk nor treatability implies pathologicity. So Pickering was right: current categories of hypertension, high cholesterol, and the like are not true diseases, nor even diagnostic criteria for true diseases. They are, at best, only categories of justified medical treatment.","PeriodicalId":94137,"journal":{"name":"Medical research archives","volume":"175 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73958829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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