This narrative review examines psychotherapeutic interventions for combat soldiers who deal with post-traumatic distress and face a complex therapeutic setting where the relationships between clients and therapy providers are often conflictual. Despite available emotional aid, gaps between traumatized soldiers’ emotional needs and institutional solutions are inevitable and are challenging for clients and therapists alike. These issues are discussed through Israeli soldiers’ experiences, a population at high risk for trauma-related distress, due to this country’s ongoing security threats. Following a narrative literature review, four key themes emerged: mutual difficulties in admitting mental injury, intergenerational trauma, preserving the soldier identity upon discharge, and choosing among therapeutic opportunities. The study highlights the need and rationale for diverse biopsychosocial interventions for veterans and proposes considerations for enhancing treatment success. Results emphasize the importance of tailored approaches that address both individual and systemic factors affecting veterans’ mental health. Guidance for psychosocial interventions is provided, considering the multifaceted nature of combat-related trauma.
: Background: More than half of patients with locally advanced esophageal cancer are unresponsive to first-line chemotherapy. To date, there is no standard second-line regimen; new agents, such as immune-checkpoint inhibitors or anti-Neurotrophic Tropomyosin-Related Kinas agents, have only been recently recommended. This study aimed to assess the benefits of classical second-line chemotherapy in terms of survival and tolerance. Materials and Methods: This retrospective analysis assessed the benefits and tolerance of different second-line regimens of chemotherapy in progressive, locally advanced or metastatic oesophageal cancer treated at the department of Radiotherapy-Oncology at the Institute of Oncology between January 2011 and January 2017. Results: The analysis found 87 patient files with a median age 59.5 years (ranging between 41 and 84), of which 40.2% (35 patients) failed the first-line platinum and 5- fluorouracil combination. Histology favoured adenocarcinomas (63.2%). The patients were in good clinical condition, with ECOG 0–1 in 86.1% (74 patients), and less than five percent had more than three metastatic sites (3.4%, 3 patients). The regimens were mostly two-drug cytotoxic (53.9%, 47 patients): FOLFIRI in 18 patients (20.7%), FOLFOX in 18 patients (20.7%), vinorelbine–platinum combination in 11 patients (12.6%), and docetaxel in 40 patients (38.7%). The median treatment duration was 7.74 weeks (range 1 to 12). The general response rate was 47.1% (41 patients), including stable disease. The median time to progression was 7.61 weeks, with a range between 1.6 and 8.6 weeks, with no differences in this respect among the fourth type of treatment received (p = 0.170). Grade 3–4 toxicities, including neutropenia, gastrointestinal problems, and metabolic disorders, were observed in 44 patients (50.6%). The median event-free survival was 2 months (range between 1 and 6.3), and 63.2% (55 patients) subsequently received a third line of chemotherapy. Conclusion: Second-line chemotherapy is still the first-choice recommendation in all fit patients with advanced oesophageal cancer. The new agents are efficacious only in cases with PD-L1 positive or high microsatellite instability.
During the late adolescence, it can be reached the highest level of mental operative functions and other intelligent human manifestations. Abstract mental operations can be done at this level: synthesis of syntheses, generalization of generalizations, abstraction of abstractions. Students go through many attempts to find which is their personal style of learning new materials, new contents. The study was conducted on a number of 31 participants. The group was divided into two subgroups: 16 students in the 5th year at Faculty of General Medicine and 15 master students in the second year at University of Sports, Sports Performance program. The used instrument consists of 21 questions (11 questions are about the individual studying process of the participants and 10 are about their beliefs about the teaching process of academics in courses), along with 4 more questions related to personal data. It is an opinion questionnaire. The teaching style of academics differs: those of Faculty of General Medicine are focusing on a lecture type style (75%), and University of Sports on an interactive style (67%). We discovered differences in the process of self-learning: between continuous and discontinuous style. For medical students, there was a longer distribution of the self-taught learning process; instead, University of Sports students organize their learning time in the last part of the semester. University of Sports students are more concerned with on the development and refinement of their personal practical skills, but also of the subjects they work with (kids or athletes), their goal being to accumulate their own experience as rich as possible from working with as many individuals and less to take from the experience of other colleagues. The coach-athlete/sports teacher-pupil relationship is more personalized and longer-lasting than the doctor-patient relationship.
Clinicians, professors of medicine in general, students, and professionals from the health sciences tend to focus their efforts on technical training related to their discipline in practice as well as activities that produce some benefit direct or personal satisfaction. It is unusual to devote time and effort to training in areas such as teaching or expand their skills in sociological and organizational aspects. Would you like to take a course on strategic planning if not a director or officer of the hospital? Manage time in your schedule for a workshop on communication and conflict management? Have room in your schedule for educational activities on leadership, organizational change, and diffusion of innovations, science or science complexity of implementation? Generally, doctors and teachers do not spend much time on these activities (at least voluntarily) because we feel that what we have learned from these topics on personal experience is enough [1]. Effective teamwork, not only in the operating room but also throughout the perioperative route is considered an important and critical component of the safety and effectiveness of surgical care and leads to good results and quick recovery of surgical patients. Therefore, considerable efforts have been made to understand how teams work within the route of surgical care and to improve teamwork [2]. The simple act of bringing together some experts does not guarantee that turned out an expert team. Given the evidence suggests that teamwork in the operating room sometimes is far from harmonious and effective, the importance of training the surgical team to work effectively is receiving international acceptance as a key strategy to maximize safety in surgery. This systematic literature review aims to present a review of literature that focuses on the importance and role of leadership skills in the surgeon and how these skills can play a significant role in increasing the quality of care and patients’ safety in operating room (OR) settings.
Introduction: One of the basic pillars of hemodialysis is its adequacy, which is achieved by stabilizing hemodynamic parameters. This is especially important in the hemodialysis adequacy of diabetic patients. The current study aims to determine the effect of lowering the dialysate temperature on hemodynamic indices and dialysis adequacy of diabetic patients. Materials and methods: This is a clinical trial that was performed on 32 diabetic patients admitted to the Dialysis Ward of Ali ibn Abi Talib Hospital affiliated with Zahedan University of Medical Sciences in 2017. The research subjects were selected using the convenience sampling method from eligible patients. Each patient underwent hemodialysis twice; i.e. routine dialysate temperature (37° C) and cold dialysate temperature (36 °C). Except for lowering the dialysate temperature to (36 °C), all other conditions were the same during the study. Blood pressure (BP) and pulse rate of patients were monitored before and after dialysis and during the first, second, and third hours after dialysis; however, the body temperature and weight of patients were monitored before and after each dialysis session. Patients' blood samples were collected at each stage before and after dialysis to evaluate urea and calculate dialysis adequacy. Data analysis was carried out using descriptive statistics, paired t-test, and one-way repeated measures ANOVA in SPSS Ver. 21. P-value <0.05 was considered as the significant level. Results: Systolic, diastolic, and mean arterial blood pressure among patients who underwent hemodialysis with normal dialysate temperature were significantly lower than those who underwent hemodialysis with cold dialysate temperature (p<0.05). There were no significant differences between cold and routine dialysis in terms of changes in body temperature before and after dialysis. The dialysis adequacy at 36 °C showed a significant increase as compared to 37° C. Conclusion: The results of the present study showed that hemodialysis with cold solution (36 °C) stabilized hemodynamic variables and improved dialysis adequacy among diabetic patients, therefore, this treatment is recommended in hemodialysis wards.
Backgrounds: Medication errors are one of the most common errors that are associated with adverse effects on patients and may even lead to mortality. One of the methods for determining patient safety in hospitals is assessing the prevalence of medication errors. In this regard, medication reconciliation is used to improve drug safety in the treatment process. The present study was conducted on 7564 patients in the emergency department of one of the hospitals in Tehran, Iran. Methods: In total, 256 adult patients with a mean of 45 years, who had been admitted to the emergency department of a hospital in the past six months and had used at least three drugs before admission, were entered into the study. In this study, the effect of medication reconciliation on admitted patients was assessed to prevent drug errors at the time of admission by pharmacists. The main outcome measure was Type and Frequency Percentage of Drug Differences Observed during Medication Reconciliation were measured. Results: According to the results, the presence of a trained pharmacist was significantly effective in medication reconciliation for enhancing patient safety and treatment process accuracy. In addition, it was concluded that age, the condition of hospitalization, and medical center personnel had a direct relationship with the frequency of medication discrepancies. Conclusion: The presence of a trained pharmacist to perform the medication reconciliation process significantly affected the improvement of patient safety and the accuracy of the treatment process.
Colorectal cancer is an important health problem, being the third most frequent cancer pathology both in men and women. Programmes have been developed to decrease CRC incidence and mortality, including primary prevention strategies focusing on population education regarding diet and physical activity and secondary prevention programmes such as screening. Modifiable risk factors are known to be diet, obesity, smoking, alcohol and read meat consumption. Non-modifiable risk factors are age, inflammatory bowel disease, genetic syndromes and family history of colorectal cancer.
HBOT has been used quite extensively in the last couple of decades. But there are not many centers that offer this treatment, even in civilian situations. This review has described the rationale and clinical evidence for equipping medical centers with HBO systems, especially in military areas. A narrative review of all the literature available on HBOT in combat-related injuries, studies were retrieved from systematic searches on Science Direct, PubMed, SCOPUS, ISC, Google Scholar, and by cross-referencing until 2020. First, the etiological mechanisms of action of HBOT were discussed. Furthermore, we have provided an overview of 117 studies that clinically investigated the effect of HBOT in the last couple of decades. Therefore, based on the number of studies showing a positive effect, to speed up the treatment process, especially in war-related injuries, it is better to provide its infrastructure and equip hospitals and centers with HBO.
Introduction. The primary tonsillar neoplasm is a common malignancy of the head and neck, alcohol and/or cigarette smoke and Human Papilloma Virus is the main etiological agent. This study offers a retrospective analysis of the tonsillar neoplasm cases in a tertiary medical center from Romania. Patients and methods. We present a 4-year (2015-2018) retrospective study on 72 patients diagnosed with tonsillar neoplasm in our clinic, previously untreated patients. The study was included only the patients diagnosed through histopathological evaluation with tonsillar neoplasm. We searched the cases in our clinic database, and we collected data about age, gender, symptoms on admission, findings of the objective physical examination, oro-pharyngoscopy, medical imaging examination results, histopathological results, stage of the disease, therapeutic management. Results. The group composition is: 75% men and 25% women, 62.5% of them are smokers. Dysphagia/swallowing discomfort was the most common symptom identified, and the non-keratinized squamous cell carcinoma was the most common histopathological form. Stage I tonsil carcinoma was diagnosed in 25% of the cases, stage II in 15.3%, while 47.2% of the cases had stage III or IV. None of the patients presented distant metastases. Lymphoma was diagnosed in 12.5% of the cases. We performed for all patients in stages I and II underwent total unilateral tonsillectomy. For the patients in stages III and IV, we performed surgery after radiotherapy-chemotherapy treatment or only radiotherapy-chemotherapy. Conclusions. In Romania, smoking is still the most important risk factor for tonsil cancer. The majority of patients have visited a doctor only when dysphagia and, above all, palpable cervical adenopathy, were present, and the tumor was in the advanced stage. In Romania, the ENT-oncology integrated medical services are few, in most cases patients are lost from otorhinolaryngological follow-up. 1 Department of Head-Neck Surgery and Otorhinolaryngology, University Clinical Hospital of Railway Company, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania 2 Department of Anatomy and Embryology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania 3 Department of Pathology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania 4 Department of Pathology, University Clinical Hospital of Railway Company, Cluj-Napoca, Romania 5 Department of Pathology, Ion Chiricuta Institute of Oncology, Cluj-Napoca, Romania 6 Department of Medical Oncology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania 7 Department of Head and Neck Surgery and Otorhinolaryngology, University Emergency Hospital, Bucharest, Romania 8 Department of Anatomy and Embryology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania 9 Department of Oral Health, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania 356
A symbiotic association between humans and microbes has been established over time. Disruptions in gut homeostasis have been linked to immune-mediated inflammatory diseases. Factors such as genetics, environment, diet, age, and medication play a major role in shaping the intestinal microbiome. An altered gut microbiome seems to modulate the progression and severity of inflammatory rheumatic diseases. Disruptions in the eubiotic state of the intestinal microbiome might promote intestinal and extraintestinal autoimmune and inflammatory disorders, although the mechanisms involved are not well understood. In this review, we provide a general overview of several studies concerning intestinal microbiome perturbations and their implications in rheumatoid arthritis, ankylosing spondylitis, and systemic lupus erythematosus. Furthermore, we discuss the relationship between diet, intestinal microbiota, and inflammation.
