The development of a novel, multilingual IBD knowledge questionnaire for Asian patients with inflammatory bowel disease.

BACKGROUND: Inflammatory bowel disease is an uncommon disease in developing nations whereby patient's knowledge on the disease may be limited. The CCKNOW questionnaire, a widely known questionnaire to assess patient's knowledge on the disease, may be too complex to comprehend for patients in developing countries. The aim of this study is to develop a new tool known as AIBDKQ questionnaire to evaluate the local inflammatory bowel disease patient's knowledge. METHODS: This was a prospective study carried out in four phases. In phase 1, three gastroenterologists with expertise in IBD generated a total of 21 questions related to the general knowledge of the disease in the English language. Phase 2 involved content and face validity whereby the questions were further validated by other gastroenterologists. In phase 3, the validated questions were translated into three languages namely Malay, Mandarin and Tamil which are commonly used in Malaysia. In phase 4 (statistical validity), administration of the questionnaires to patients and hospital staff were conducted to assess the construct validity, discriminative ability, predictive validity and reliability of the questionnaires. RESULTS: A total of 21 questions were generated initially. Further evaluation indicated that 20 items had adequate kappa and content validity index for relevance (CVI: 0.714 to 1, Kapp: 0.645 to 1) and clarity (CVI: 0.714 to 1, Kapp: 0.645 to 1). The questionnaires in four languages were administered to 213 patients to assess the construct validity. Six items were removed (three for low communality, one for small loading factors, two for cross loading), resulting in 16 final questions. Assessment with 34 hospital staff involving nurses, doctors and clerks showed significant differences in knowledge between the groups (F = 14.007, p < 0.001) and were able to discriminate doctors from nurses and clerks. Another group of 18 hospital staff administered with AIBDKQ and CCKNOW questionnaires showed a Pearson's correlation coefficient of 0.8 indicating strong correlation and concurrent predictive validity between the two questionnaires. Final assessment with 38 patients for reliability assessment revealed high intraclass correlation of the questionnaire among the four languages. CONCLUSIONS: The AIBDKQ has an excellent discriminant ability and internal consistency with a strong correlation when compared to the standard CCKNOW questionnaire.

Improving Vertical Jump Profiles Through Prescribed Movement Plans.

Mayberry, JK, Patterson, B, and Wagner, P. Improving vertical jump profiles through prescribed movement plans. J Strength Cond Res 32(6): 1619-1626, 2018-Developing practical, reliable, and valid methods for monitoring athlete wellness and injury risk is an important goal for trainers, athletes, and coaches. Previous studies have shown that the countermovement vertical jump (CMJ) test is both a reliable and valid metric for evaluating an athlete's condition. This study examines the effectiveness of prescribed workouts on improving the quality of movement during CMJ. The data set consists of 2,425 pairs of CMJ scans for high school, college, and professional athletes training at a privately owned facility. During each scan, a force plate recorded 3 ground reaction force (GRF) measurements known to impact CMJ performance: eccentric rate of force development (ERFD), average vertical concentric force (AVCF), and concentric vertical impulse (CVI). After an initial scan, coaches either assigned the athlete a specific 1- or 2-strength movement plan (treatment group) or instructed the athlete to choose their own workouts (control group) before returning for a follow-up scan. A multivariate analysis of covariance (MANCOVA) revealed significant differences in changes to GRF measurements between athletes in the 2 groups after adjusting for the covariates sex, sport, time between scans, and rounds of workout completed. A principal component analysis of GRF measurements further identified 4 primary groups of athlete needs and the results provide recommendations for effective workout plans targeting each group. In particular, split squats increase CVI and decrease ERFD/AVCF; deadlifts increase AVCF and decrease CVI; alternating squats/split squats increase ERFD/CVI and decrease AVCF; and alternating squats/deadlifts increase ERFD/AVCF and decrease CVI.

The Need to Develop a Regulatory Body for the Practice of Al-Hijama.

Al-Hijama is a traditional therapy which has been extensively used in the Middle East. It has an Islamic basis but is used in many cultures in the form of wet cupping. There has been a significant growth in its availability in most Western countries during the last decade. In none is it subject to statutory regulation and the training and quality of practitioners is variable. It has both a preventive and therapeutic element and so there are appropriate concerns about the potential for incorrect diagnoses and delays in other effective treatments. In the past, the apprenticeship model in which a trainee worked for some years with an experienced ijazah ensured such problems did not arise. However, there is now an urgent need to recognise the widespread practice of this therapy and ensure that it has the benefits of statutory regulation, be this through specific regulatory bodies or a negative licensing model.

The brick kiln child workers of Pakistan.

Pakistani law recognises that no young person under the age of 18 years can enter into a valid and binding contract. In hazardous industries, such as brick kilns, none of the children working in them have any formal contract, so limiting any rights they may have. Any contract that does exist is with the child's father and will be linked to everlasting debts and constitutes a form of bondage. This paper reviews the adverse medical effects on children of such employment.

The legal and medical consequences of child marriage.

The Marriage and Civil Partnership (Minimum Age) Act 2022 came into force in England on 27 February 2023 and made both registered and unregistered marriages involving people under 18 illegal in England and Wales. This means that such marriages which take place outside England and Wales will not be recognised and those who organised them, including parents, will have committed a criminal offence.This review considers issues related to families where such marriages have happened, including their impact on the health of the victim and any resulting children. It touches on religious and societal issues and the need for targeted and appropriate education.

English Language Medical Schools in China: An Analysis of International Medical Graduates Practicing in the UK.

OBJECTIVES: From 2006, the Ministry of Education in China has approved universities to provide undergraduate medical training in English, targeting fee-paying international students. Students on these courses can face challenges in their clinical training, particularly in the domains of communication and professionalism. This study examines the proportion of doctors qualified from such medical schools who are currently listed on the UK medical register. METHODS: The UK General Medical Council register of medical practitioners was searched to identify doctors qualified from 33 Chinese medical schools who provide education in the English language. RESULTS: As of February 2022, 502 doctors whose primary medical qualification is from a university offering English language education in China were registered on the UK medical register. Four hundred twenty-five (84.7%) of these doctors were aged 39 and under, approximately double the proportion of doctors in this age bracket overall. Three hundred forty nine (69.5%) were staff grade and associate specialist doctors, 109 (21.7%) were doctors in training, 36 (7.2%) were on the General Practitioner (GP) register, and 20 (4.0%) were on the specialist register. Among doctors in training, the most common specialty areas were in general practice and psychiatry that are both facing recruitment shortages in the UK at present. CONCLUSION: A small but significant number of graduates whose medical training was in the English language in China are practicing medicine in the UK. These doctors are in younger age groups than the overall medical workforce, and are less likely to be in training, and specialist or GP posts. Among those in training, a high proportion are in GP and psychiatry training and could contribute to alleviating UK medical workforce shortages. Policymakers and educators should be mindful of the growing numbers of doctors qualified from these schools, and the additional support they may require considering the unique training environments they have encountered.

Training pharmacy students to deliver bad news using the SPIKES model.

BACKGROUND AND PURPOSE: Delivery of bad news or negative health information is a complex skill critical to the provision of patient care. While counseling models with this focus exist within other health care professions, their use in pharmacy education is lacking. The purpose of this study is to assess pharmacy students' ability to deliver bad news with the implementation of a counseling model titled SPIKES (Setting, Perception, Invitation, Knowledge, Emotions with Empathy, and Strategy/Summary). EDUCATIONAL ACTIVITY AND SETTING: First-year pharmacy students attended a one-hour training on the SPIKES model and completed three simulations with its application. Pre- and post-training surveys were administered to assess confidence, attitudes, and perceptions. Student performance during the simulations was evaluated by teaching assistants (TAs) as well as a self-assessment using the same grading rubric. A paired t-test was used to test for significant mean improvement in competency scores, confidence, attitudes, and perceptions from Week 1 to Week 3. FINDINGS: One hundred and sixty-seven students were included in the analysis. There was a significant improvement in the student's self-assessment of their performance for each of the SPIKES components and summative scores. For the TA assessment, there was a significant mean improvement in the summative SPIKES score; however, within each component of SPIKES, only the knowledge component showed significant mean improvement. There was also a significant improvement in student confidence in the post-training surveys. SUMMARY: Implementation of the SPIKES protocol in the pharmacy curriculum showed an overall improvement in students' self-assessed performance in delivering bad news.

"Islamic Medicine": A true discipline for the 21st century or quackery?

The purpose of this review is to consider the position of "Islamic Medicine" and whether it is a legitimate form of clinical care or quackery. The analysis is based on published work together with an identification of themes derived from testimonials on practitioners' websites, as well as a consideration of how such therapies are considered in medical search engines. "Islamic Medicine" covers Traditional or Yunani practice, Prophetic Medicine, Hijama and Ruqya. Their origins are discussed and, subsequently, current-day practice and its relationship to allopathic medicine. Reasons for antagonism to modern medicine are considered and the absence of a rational basis for many of the views expressed. In the case of Yunani medicine, its pre-Islamic origins are identified together with the impact of anti-colonialism and the potential role of clerics in wishing to distance medical care from Galenic concepts. In the case of Hijama, the absence of effective training and regulation and its promotion as a "lost sunna" are discussed alongside claims for miraculous cures. The movement of Ruqyah away from Qur'anic recitation in support of the sick towards a popularised approach to dealing with magic and possession is considered, together with consequential adverse publicity in the media. The consequences of a failure to adopt training practices for Yunani medicine, as recommended by the WHO, are identified. Accredited detailed courses monitored by external statutory regulatory agencies, based in institutions committed to providing the best healthcare, and supporting research would allow "Islamic Medicine" to become a significant role player in contemporary clinical practice and stop present-day quackery.

Surgery for Ulcerative Colitis in the White British and South Asian Populations in Selected Trusts in England 2001-2020: An Absence of Disparate Care and a Need for Specialist Centres.

Over the last decade, there has been extensive evidence that patients with inflammatory bowel disease from minority communities in the UK receive less than optimal care. In none of the studies has the role of surgery in the management of acute and severe ulcerative colitis been considered in any detail. A freedom of information (FOI) request was sent to 14 NHS Trusts in England, which serve significant South Asian populations. Details of the type of surgery patients from the South Asian and White British communities received between 2021 and 2020 were requested. Detailed responses were obtained from eight Trusts. Four hundred and ten White British patients underwent surgery for ulcerative colitis over this period at these eight Trusts, together with 67 South Asian patients. There was no statistically significant difference in the distribution across the types of surgery undergone by the two communities overall (χ2 = 1.3, ns) and the proportions who underwent an ileo-anal anastomosis with pouch (z = -1.2, ns). However, within individual trusts, at the University Hospital Southampton NHS Foundation Trust, a significantly greater proportion of South Asian patients had an ileo-anal anastomosis with pouch compared to White British patients. At Cambridge University Hospitals NHS Foundation Trust, all 72 patients who underwent surgery for ulcerative colitis were White British. This study has shown that, in general, for patients with a severe flare of ulcerative colitis where medical treatment has failed and surgery is warranted, the nature of the procedures offered is the same in the White British and South Asian communities. However, of concern is the number of units with low volume procedures. For most Trusts reported in this study, the overall number of Ileo-anal pouch anastomosis or anastomosis of ileum to anus procedures performed over a number of years was substantially below that required for a single surgeon to achieve competence. These findings reinforce the argument that inflammatory bowel disease surgery should be performed in a limited number of high-volume centres rather than across a wide range of hospitals so as to ensure procedures are carried out by surgeons with sufficient and on-going experience.

Ancient surgeons: A characterization of Mesopotamian surgical practices.

BACKGROUND: The Ancient Mesopotamian civilization, the earliest known, emerged in the fourth millennium BCE.1 While the advent of medicine is established, there is little understanding of surgery's origins. We sought to describe the characteristics and medical acumen of the surgeons of the first civilization. METHODS: Source documents and commentary on Mesopotamian medicine were systematically analyzed for evidence of surgery and physician descriptions. RESULTS: Early tablets reveal evidence of the incisional drainage of a scalp abscess and empyema, advanced wound care, fracture alignment, and possible caesarians without evidence of wound suturing, emergency procedures, trephination, or circumcision.2 While the asû and asipu understood disease processes, strong evidence of an inextricable connection between spiritual and diagnostic/curative roles exists. CONCLUSIONS: Mesopotamian physicians were diagnosticians and healers, approaching surgery as part of their holistic practice rather than a separate entity. Surgery was utilized as an endpoint to a careful process aided by objective evaluation and spiritual incantation.

Thoracic trauma: Clinical and paleopathological perspectives.

OBJECTIVES: Although trauma is one of the most significant areas of study in paleopathology, most studies focus on fractures of single anatomical elements. Paleopathological research on regional trauma, such as of the thorax, is rare. This paper explores the causes, complications, and consequences of adult thoracic trauma using clinical data in order to inform paleopathological research. MATERIALS AND METHODS: Trends in paleopathological thoracic trauma literature were assessed by evaluating publications from Bioarchaeology International, International Journal of Osteoarchaeology, International Journal of Paleopathology, and American Journal of Biological Anthropology. Clinical publications on thoracic trauma throughout time were also assessed through a PubMed search, and modern prevalence data was found through trauma databases such as the National Trauma Databank. RESULTS: Consideration of thoracic trauma involving concomitant injuries is a recent trend in clinical literature and patient care, but paleopathological research on thoracic trauma has been limited. Since thoracic fractures tend to occur in conjunction with other injuries, assessing them together is critical to the interpretation of trauma in the past. CONCLUSIONS: Clinical research into thoracic fractures and concomitant injuries provides valuable data for paleopathological research. Evaluating the likelihood and consequences of concomitant injury in skeletal remains provides a more robust understanding of trauma in the past and its impact on past lifeways. SIGNIFICANCE: This paper provides a review of current clinical and paleopathological literature on thoracic trauma and demonstrates the importance of moving beyond the analysis of fractures or trauma of single anatomical elements. LIMITATIONS: Thoracic bones are often taphonomically altered and differentially preserved leading to difficulty in identifying and interpreting fractures. SUGGESTIONS FOR FURTHER RESEARCH: Practical application of the data presented here to archaeological samples will help to advance paleopathological understandings of thoracic trauma.

Evolution of ligand specificity in vertebrate corticosteroid receptors.

BACKGROUND: Corticosteroid receptors include mineralocorticoid (MR) and glucocorticoid (GR) receptors. Teleost fishes have a single MR and duplicate GRs that show variable sensitivities to mineralocorticoids and glucocorticoids. How these receptors compare functionally to tetrapod MR and GR, and the evolutionary significance of maintaining two GRs, remains unclear. RESULTS: We used up to seven steroids (including aldosterone, cortisol and 11-deoxycorticosterone [DOC]) to compare the ligand specificity of the ligand binding domains of corticosteroid receptors between a mammal (Mus musculus) and the midshipman fish (Porichthys notatus), a teleost model for steroid regulation of neural and behavioral plasticity. Variation in mineralocorticoid sensitivity was considered in a broader phylogenetic context by examining the aldosterone sensitivity of MR and GRs from the distantly related daffodil cichlid (Neolamprologus pulcher), another teleost model for neurobehavioral plasticity. Both teleost species had a single MR and duplicate GRs. All MRs were sensitive to DOC, consistent with the hypothesis that DOC was the initial ligand of the ancestral MR. Variation in GR steroid-specificity corresponds to nine identified amino acid residue substitutions rather than phylogenetic relationships based on receptor sequences. CONCLUSION: The mineralocorticoid sensitivity of duplicate GRs in teleosts is highly labile in the context of their evolutionary phylogeny, a property that likely led to neo-functionalization and maintenance of two GRs.

Fructose malabsorption: true condition or a variance from normality.

Fructose exists in food naturally or as a sweetening additive. It has been thought that fructose malabsorption may cause the gastrointestinal symptoms seen in patients with irritable bowel syndrome. However, fructose malabsorption is still poorly understood, and clinicians are still uncertain of its role. This review attempts to clarify the relation between fructose malabsorption and symptoms in normal individuals and patients with irritable bowel syndrome. The main problem lies in the diagnosis. First, there is no definite cut off value for the breath tests. Second, we are unsure of the normal absorptive capacity of fructose in normal individuals. Normal individuals will have a degree of fructose malabsorption with or without symptoms depending on the dose of fructose used. From earlier studies, 25 g of fructose seems to be the cut-off dose to investigate fructose malabsorption, with a positive breath test at this dose suggesting abnormally low capacity to absorb fructose. This low level may be difficult to exclude from the daily diet, resulting in symptoms of fructose malabsorption.

Telephone clinic improves gluten-free dietary adherence in adults with coeliac disease: sustained at 6 months.

BACKGROUND: A gluten-free (GF) diet is the only treatment for coeliac disease (CD), non-adherence to the diet is associated with greater morbidity. The study aimed to examine the effect of a telephone clinic, designed to increase GF dietary knowledge and adherence, in adults with CD. METHODS: A prospective study of 125 patients with histologically confirmed CD. Patients, not adhering to a GF diet (n=30), engaged in a personalised telephone clinic. Validated questionnaires were used to assess GF dietary adherence (Coeliac Disease Adherence Test; CDAT), knowledge of GF foods and CD-related quality of life (QoL). GF dietary adherence was assessed up to 12 months post telephone clinic. The control group completed the questionnaires only. RESULTS: GF dietary adherence (CDAT) median scores significantly improved at 3 and 6 months after the telephone clinic compared with baseline (16, 13 and 13, respectively, p<0.01). Reassuringly, the dietary burden QoL score remained similar to baseline values. No change in CDAT scores were observed in the control group. Change in GF dietary knowledge score was associated with improved GF dietary adherence CDAT score (r=-0.22; p=0.039). At 9 and 12 months, CDAT scores were similar to baseline values. CONCLUSIONS: Telephone clinics have a positive impact on dietary knowledge and GF dietary adherence in adults with CD, promoting health-benefitting behaviours in those previously not adhering to a GF diet. The study highlights the need for patients to have regular follow-up, with targeted reviews for those not adhering to a GF diet.

Traumatic thoracic rib cage and chest wall hernias: A review and discussion of management principles.

Traumatic thoracic or chest wall hernias are relatively uncommon but highly challenging injuries that can be seen after a variety of injury mechanisms. Despite their description throughout history there remains scant literature on this topic that is primarily limited to case reports or series. Until recently, there also has been no effort to create a reliable grading system that can assess severity, predict outcomes, and guide the choice of surgical repair. The purpose of this article is to review the reported literature on this topic and to analyze the history, common injury mechanisms, likely presentations, and optimal management strategies to guide clinicians who are faced with these challenging cases. We also report a modified and updated version of our previously developed grading system for traumatic chest wall hernias that can be utilized to guide surgical management techniques and approaches.

Evolutionary dynamics of tumor progression with random fitness values.

Most human tumors result from the accumulation of multiple genetic and epigenetic alterations in a single cell. Mutations that confer a fitness advantage to the cell are known as driver mutations and are causally related to tumorigenesis. Other mutations, however, do not change the phenotype of the cell or even decrease cellular fitness. While much experimental effort is being devoted to the identification of the functional effects of individual mutations, mathematical modeling of tumor progression generally considers constant fitness increments as mutations are accumulated. In this paper we study a mathematical model of tumor progression with random fitness increments. We analyze a multi-type branching process in which cells accumulate mutations whose fitness effects are chosen from a distribution. We determine the effect of the fitness distribution on the growth kinetics of the tumor. This work contributes to a quantitative understanding of the accumulation of mutations leading to cancer.

Rib fracture fixation: controversies and technical challenges.

Rib fractures are a common injury affecting more than 350,000 people each year in the United States and are associated with respiratory complications, prolonged hospitalization, prolonged pain, long-term disability, and mortality. The social and economic costs that rib fractures contribute to the health care burden of the United States are therefore significant. But despite this measurable impact on patients' quality of life, current treatment of the majority of patients in the United States with rib fracture syndromes is supportive only. Even the most severe of chest wall injuries have historically been treated non-operatively. Recently, however, several reports from American centers support an increased application of operative fixation. With this resurgent interest of American surgeons in mind, we review the clinical presentations, potential indications, controversies, and technical challenges unique to rib fracture fixation.

Bicycle commuter injury prevention: it is time to focus on the environment.

BACKGROUND: Few data exist on the risk of injury while commuting to work or school by bicycle. The proportion of commuters choosing to travel by bike is increasing in the United States, and information on injury incidence and the influences of rider characteristics and environmental factors may suggest opportunities for prevention actions. METHODS: Bicycle commuters in the Portland, OR, metropolitan area were recruited via the websites and community advertising to participate in a 1-year study. Riders completed an initial online survey along with 12 monthly surveys describing their commutes and injury events from September 2007 to August 2008. A traumatic event was considered a serious traumatic event if medical attention was sought. RESULTS: Nine hundred sixty-two adult bicyclists (52% men and 48% women) with a mean age of 36.7 ± 0.4 years (range, 22-70 years) commuted an average of 135 miles (range, 7-617) per month. There were 225 (23%) beginner, 256 (27%) intermediate, and 481 (50%) advanced riders. Four hundred twenty (44%) had a prior traumatic event. Over the 1-year period, 164 (18%) riders reported 192 traumatic events and 49 (5%) reported 50 serious traumatic events. The incidence rates of traumatic events and serious traumatic events were 15.0 (95% CI, 13.2-17.5) and 3.9 (95% CI, 2.9-5.1) per 100,000 miles commuted. There were no differences in age, gender, safety practices, and experience levels between commuters who experienced a traumatic event and those who did not. CONCLUSIONS: Approximately 20% of bicycle commuters experienced a traumatic event and 5% required medical attention during 1 year of commuting. Traumatic events were not related to rider demographics, safety practices, or experience levels. These results imply that injury prevention should focus on improving the safety of the bicycle commuting environment.

What Can a Jump Tell Us About Elbow Injuries in Professional Baseball Pitchers?

BACKGROUND: The incidence rate of elbow injuries has been rising in recent years among professional baseball pitchers. Determining valid screening procedures that allow practitioners to identify pitchers at an increased risk of such injuries is therefore of critical importance. PURPOSE: To validate the use of countermovement jump (CMJ) tests as a diagnostic tool for pitcher conditioning. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: More than 500 pitchers at a single professional baseball organization performed preseason CMJ assessments on a force plate before the 2013 to 2018 seasons. Three measurements were extracted from ground-reaction force data during the test: eccentric rate of force development (ERFD), average vertical concentric force (AVCF), and concentric vertical impulse (CVI). Athletic trainers at the organization collected detailed information on elbow and shoulder injury rates as well as workload (pitch count) throughout the rest of the season. Poisson regression models were fit to investigate the dependency of injury rates on CMJ test performance. RESULTS: ERFD, CVI, and AVCF were all significant predictors of elbow injury risk after accounting for pitcher age, weight, and workload. The analysis identified 3 specific indicators of heightened risk based on the results of a CMJ scan: low ERFD, a combination of low AVCF and high CVI, and a combination of high AVCF and low CVI. In contrast, shoulder injury risk was roughly independent of all 3 CMJ test measurements. CONCLUSION: This study supports the hypothesis of the entire kinetic chain's involvement in pitching by establishing a link between CMJ test performance and elbow injury risk in professional baseball pitchers. CMJ assessment may be a powerful addition to injury risk alert and prevention protocols. Pitchers in high-risk groups can be prescribed specific exercise plans to improve movement imbalances.