A systematic scoping review of approaches to teaching and assessing empathy in medicine.

BACKGROUND: Empathy is pivotal to effective clinical care. Yet, the art of nurturing and assessing empathy in medical schools is rarely consistent and poorly studied. To inform future design of programs aimed at nurturing empathy in medical students and doctors, a review is proposed. METHODS: This systematic scoping review (SSR) employs a novel approach called the Systematic Evidence Based Approach (SEBA) to enhance the reproducibility and transparency of the process. This 6-stage SSR in SEBA involved three teams of independent researchers who reviewed eight bibliographic and grey literature databases and performed concurrent thematic and content analysis to evaluate the data. RESULTS: In total, 24429 abstracts were identified, 1188 reviewed, and 136 included for analysis. Thematic and content analysis revealed five similar themes/categories. These comprised the 1) definition of empathy, 2) approaches to nurturing empathy, 3) methods to assessing empathy, 4) outcome measures, and 5) enablers/barriers to a successful curriculum. CONCLUSIONS: Nurturing empathy in medicine occurs in stages, thus underlining the need for it to be integrated into a formal program built around a spiralled curriculum. We forward a framework built upon these stages and focus attention on effective assessments at each stage of the program. Tellingly, there is also a clear need to consider the link between nurturing empathy and one's professional identity formation. This foregrounds the need for more effective tools to assess empathy and to better understand their role in longitudinal and portfolio based learning programs.

Rational design of secondary operation for penetrating head injury: A case report.

Penetrating head injury is rare, and thus management of such injuries is non-standard. Early diagnosis and intraoperative comprehensive exploration are necessary considering the complexity and severity of the trauma. However, because of the lack of microsurgical techniques in local hospitals, the possible retained foreign bodies and other postoperative complications such as cerebrospinal fluid (CSF) leak usually require a rational design for a secondary operation to deal with. We present a case of a 15-year-old boy who was stabbed with a bamboo stick in his left eye. The chopsticks passed through the orbit roof and penetrated the skull base. In subsequent days, the patient sustained CSF leak and intracranial infection after an unsatisfied primary treatment in the local hospital and had to request a secondary operation in our department. Computed tomography including plain scan, three dimension reconstruction and computed tomographic angiography are used to determine the course and extent of head injury. A frontal craniotomy was performed. Three pieces of stick were found residual and removed with the comminuted orbit bone fragments. A pedicled temporalis muscle fascia graft was applied to repair the frontier skull base and a free temporalis muscle flap to seal the frontal sinus defect. Aggressive broad-spectrum antibiotics of vancomycin and meropenem were administrated for persistent fever after operation. CSF external drainage system continued for 12 days, and was removed 10 days after temperature returned to normal. The Glasgow coma scale score was improved to 15 at postoperative day 7 and the patient was discharged at day 22 uneventfully. We believe that appropriate preoperative surgical plan and thorough surgical exploration by microsurgery is essential for attaining a favorable outcome, especially in secondary operation. Good postoperative recovery depends on successfully management before and after operation for possible complications as well.

[An fMRI study on brain activation patterns of males and females during video sexual stimulation].

OBJECTIVE: To investigate the difference in the brain activation patterns of males and females during video sexual stimulation by functional magnetic resonance imaging (fMRI). METHODS: The participants were 20 adult males and 20 adult females, all healthy, right-handed, and with no history of sexual function disorder and physical, psychiatric or neurological diseases. Blood-oxygen-level-dependent fMRI was performed using a 1.5 T MR scanner. Three-dimensional anatomical image of the entire brain were obtained by using a T1-weighted three-dimensional anatomical image spoiled gradient echo pulse sequence. Each person was shown neutral and erotic video sequences for 60 s each in a block-study fashion, i.e. neutral scenes--erotic scenes--neutral scenes, and so on. The total scanning time was approximately 7 minutes, with a 12 s interval between two subsequent video sequences in order to avoid any overlapping between erotic and neutral information. RESULTS: The video sexual stimulation produced different results in the men and women. The females showed activation both in the left and the right amygdala, greater in the former than in the latter ([220.52 +/- 17.09] mm3 vs. [155.45 +/- 18.34] mm3, P < 0.05), but in the males only the left amygdala was activated. The males showed greater brain activation than the females in the left anterior cingulate gyrus ([420.75 +/- 19.37] mm3 vs. [310.67 +/- 10.53] mm3, P < 0.05), but less than the females in the splenium of the corpus callosum ([363.32 +/- 13.30] mm3 vs. [473.45 +/- 14.92] mm3, P < 0.01). CONCLUSION: Brain activation patterns of males and females during video sexual stimulation are different, underlying which is presumably the difference in both the structure and function of the brain between men and women.

Chlorogenic Acid Prevents Osteoporosis by Shp2/PI3K/Akt Pathway in Ovariectomized Rats.

Cortex Eucommiae is used worldwide in traditional medicine, various constituents of Cortex Eucommiae, such as chlorogenic acid (CGA), has been reported to exert anti-osteoporosis activity in China, but the mechanism about their contribution to the overall activity is limited. The aims of this study were to determine whether chlorogenic acid can prevent estrogen deficiency-induced osteoporosis and to analyze the mechanism of CGA bioactivity. The effect of CGA on estrogen deficiency-induced osteoporosis was performed in vivo. Sixty female Sprague-Dawley rats were divided randomly among a sham-operated group and five ovariectomy (OVX) plus treatment subgroups: saline vehicle, 17α-ethinylestradiol (E2), or CGA at 9, 27, or 45 mg/kg/d. The rats' femoral metaphyses were evaluated by micro-computed tomography (µCT). The mechanism of CGA bioactivity was investigated in vitro. Bone mesenchymal stem cells (BMSCs) were treated with CGA, with or without phosphoinositide 3-kinase (PI3K) inhibitor LY294002. BMSCs proliferation and osteoblast differentiation were assessed with 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2-H-tetrazolium bromide (MTT) and alkaline phosphatase, with or without Shp2 interfering RNA (RNAi). The results display that CGA at 27 and 45 mg/kg/day inhibited the decrease of bone mineral density (BMD) that induced by OVX in femur (p< 0.01), significantly promoted the levels of bone turnover markers, and prevented bone volume fraction (BV/TV), connectivity density (CoonD), trabecular number (Tb.N), trabecular thickness (Tb.Th) (all p< 0.01) to decrease and prevented the trabecular separation (Tb.Sp), structure model index (SMI)(both p< 0.01) to increase. CGA at 1 or 10 µM enhanced BMSC proliferation in a dose-dependent manner. CGA at 0.1 to 10 µM increased phosphorylated Akt (p-Akt) and cyclin D1. These effects were reversed by LY294002. CGA at 1 or 10 µM increased BMSC differentiation to osteoblasts (p< 0.01), Shp2 RNAi suppressed CGA-induced osteoblast differentiation by decreasing Shp2, p-Akt, and cyclin D1. This study found that CGA improved the BMD and trabecular micro-architecture for the OVX-induced osteoporosis. Therefore, CGA might be an effective alternative treatment for postmenopausal osteoporosis. CGA promoted proliferation of osteoblast precursors and osteoblastic differentiation of BMSCs via the Shp2/PI3K/Akt/cyclin D1 pathway.

[Correlation between magnetic resonance diffusion weighted imaging and cell density in astrocytoma].

OBJECTIVE: To evaluate the apparent diffusion coefficients (ADC) in magnetic resonance diffusion weighted imaging with echo-planar technique in depicting the tumor cellularity and grading of astrocytoma. METHODS: Thirty-four astrocytoma patients including 18 male and 16 female with age from 10 to 73 years (mean 38.4 years) were examined by MRI and eventually proved by surgical resection and pathological examination. Of them, 26 had low-grade (grade I, II) astrocytoma and 8 high-grade (grade III, IV) astrocytoma. ADC value of astrocytoma was determined on magnetic resonance diffusion weighted images. Cellularity of the astrocytoma was analyzed using Adobe Photoshop 7.0.1 software. RESULTS: The mean ADC value (in units of 10(-4) mm(2)/s) of the high-grade astrocytomas (7.34 +/- 2.95) was significantly lower than that of the low-grade astrocytomas (13.76 +/- 3.31) (t = 4.91, P < 0.001). The mean cellularity of the high-grade astrocytomas (19.81 +/- 9.73)% was significantly higher than that of the low-grade astrocytomas (4.74 +/- 2.96)% (t = 4.32, P = 0.003). ADC value of the astrocytoma was significantly and negatively correlated with its cellularity (r = -0.535, P = 0.001). CONCLUSION: ADC value of astrocytoma is significantly and negatively correlated with its cellularity. Magnetic resonance diffusion weighted imaging may well be highly potential in predicting the degree of astrocytoma.

[1H-MRS of the hippocampus of psychogenic erectile dysfunction].

OBJECTIVE: To study the changes of the hippocampus metabolites with MRS to provide some clues for exploring the possible underlying unrecognised factors and pathophysiological mechanisms of psychogenic erectile dysfunction (ED). METHODS: Fifteen cases of psychogenic erectile dysfunction and 15 normal volunteers (the control) were studied by a clinical 1. 5T MRI/MRS system. Proton multi-voxel spectroscopy imaging (1H-MRSI) was obtained from both sides of the hippocampus region. N-acetylaspartate (NAA), creatine and phosphocreatine (Cr) and choline-containing compounds (Cho) were determined and the ratios of NAA/Cr and Cho/Cr were calculated respectively. RESULTS: The NAA/Cr ratio was significantly lower in the ED patients than in the control (P < 0.05). There was no significant difference in the Cho/Cr ratio between the two groups (P > 0.05). CONCLUSION: Psychogenic erectile dysfunction may not be simply a functional disease. The hippocampus may be involved in the pathophysiology of psychogenic ED. The disease may have some previously unrecognised underlying aetiological factors and pathophysiological mechanisms.