Open Access Study Protocol

Effect of Group Cognitive Behavioural Therapy with Compassion Training on Depression: A Study Protocol

Kenichi Asano, Haruna Koike, Hiromi Isoda, Toshihiro Inoue, Kimiko Sato, Akiko Asanuma, Michiko Nakazato, Akiko Nakagawa, Eiji Shimizu, Masaomi Iyo

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/BJMMR/2015/19206

Aims: Cognitive behavioural therapy (CBT) is one of the evidence-based treatments for depression. However, some patients high in self-criticism do not respond to CBT. Compassion-focused therapy (CFT) is featured in treating self-criticism and shame, and some trials have reported its effectiveness on depression in individual and group settings. The aim of this study is to adapt an established combined manual of group CBT and CFT, evaluate its efficacy as a pilot study, and discuss the advantages of group CBT (GCBT) program using compassion as a depression therapy in a Japanese community setting.

Design and Methods: In this single group study, participants will receive 10 sessions of GCBT with compassion training that was provided through the CFT. All sessions will last for 1 hour and be provided weekly. The outcome measure is the Beck Depression Inventory II, and the secondary outcome is the Self-Compassion Scale in Japanese. Both outcomes will be measured pre- and post-program. The sample size will be 15 participants due to the limited capacity for intervention within the community.

Discussion: It is expected that the program will show a larger effect size than that of GCBT reported in previous studies on depression and self-compassion. The results will show an effect size that justifies the introduction of a randomized controlled study to improve the program.

Trial Registration: UMIN Clinical Trials Registry 000015007

Conclusion: CFT or compassion training can augment the treatment of major depression using CBT. Despite several limitations, this clinical trial may help estimate the effectiveness of CFT, which will aid in the design of a further controlled study.

Open Access Minireview Article

Integrins and Reorganization of Osteoclast Cytoskeleton under Orthodontic Force

Jie Feng, Yang Xu, Li Xu, Qiuyue Guan, Zheng Wang, Ding Bai, Xianglong Han

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2015/19544

Integrins are mechanoreceptors and mediate mechanotransduction by transferring forces into focal adhesions. Osteoclastogenesis starts with adhesion to the bone matrix, leading to cytoskeleton reorganization that is important for osteoclast polarization and migration. However, there are several signaling pathways mediating this process, and integrins have been shown to be important signaling molecules participating osteoclastogenesis. Particularly, integrins have played an important role in both force transduction and osteoclastogenesis. This paper reviewed the findings on the relationship between integrins and reorganization of osteoclast cytoskeleton under orthodontic force.

Open Access Original Research Article

Frequency of Parent-reported Indicators of Sleep Disordered Breathing in Children with Clinical Diagnosis of Adenotonsillar Hypertrophy in Benin City, Nigeria

N. C. Onyeagwara, A. L. Okhakhu, L. O. Onotai

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2015/19026

Background: Sleep disordered breathing (SDB) comprises a wide spectrum of sleep-associated breathing abnormalities; those related to increase upper airway resistance include snoring, upper airway resistance syndrome (UARS) and obstructive sleep apnea syndrome (OSAS). This concept suggests that a person who snores may be exhibiting the first manifestation of SDB and that snoring should not be viewed as normal. Obstructive sleep disordered breathing is common in children. Snoring, mouth breathing, and obstructive sleep apnea (OSA) often prompt parents to seek medical attention.

Aim: This study aims to determine the frequency of parent-reported indicators of SDB among children clinically diagnosed with adenotonsilar hypertrophy (ATH) in the Otorhinolaryngology department of the University of Benin Teaching Hospital (UBTH), Benin City.

Methods: This was a cross-sectional study of children aged 12 years and below who were sent to the Ear Nose and Throat clinics of UBTH, Benin-city with symptoms of obstructive adenotonsilar hypertrophy (ATH) between May 2012 and April 2014. All consecutive parent/caregiver who presented their child/ward to the ENT clinic with symptoms of obstructive adenotonsilar hypertrophy (ATH) were interviewed using structured questionnaire/proforma after verbal consent was obtained.

Results:  A total of 104 children were studied. The children were 73 males and 31 females with a male/ female ratio of 2.4:1. The children were aged 1-12yrs with average age of 4.98 ± 2.68 years. The parents/caregivers were 92 females and 12 males giving a ratio of 7.6:1.The frequency of sleep apnea was reported by 50 children/care givers (48.1%). There was a high prevalence of reporting for patients between the ages of 1 and 4years 62 (59.6%) which was followed by those between 5 and 9 years 34 (32.7%). Symptoms lasted more than 3 years in 43(41.3%), 1-2 years in 31(29.9%) and less than 1 year in 30 (28.8%) of the patients. Symptoms reported were snoring 104 (100%), nasal obstruction 97(93%), nasal discharge 96 (92%), mouth breathing 92 (88%), sleep apnea 50 (48.1%), restless night sleep 72 (69.2%), sore throat 69(66.3%), failure to thrive 2(1.9%). Cervical (jugulo-digastric) lymph node was enlarged in 70 (67.3%). Tonsillar grades were as follows; grade 3 was 59 (56.7%), 4 was 27 (26%) while 1 and 2 accounted for 17 (16.3%).

Conclusion: Snoring was the commonest symptom reported in children with SDB.  Parents and caregivers should monitor their children closely during sleep as this may reveal early symptoms of adenotonsilar hypertrophy causing SDB.

Open Access Original Research Article

Transferring High Quality Care of the Elderly into the Clinical Workplace: Barriers and Facilitating Factors

S. Peters, J. De Lepeleire, S. Cortvriendt, C. De Keyser, K. Hoet, B. Janssens, A. Roex

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2015/19601

Introduction: Medical students experience difficulty transferring what they have learned in the classroom into the clinical workplace. Learning environments based upon whole-task learning can help medical students to apply knowledge, skills and attitudes into their clinical practice. However, little is known about how students experience the transfer from such a whole-task learning environment into the workplace.

Aim: This study aims to identify the factors that students perceive to be facilitating and hindering the transfer of learning.

Methodology: Semi-structured interviews were conducted. The principle of data saturation was applied. The interviews were coded by two independent researchers and analysed using thematic analysis. The inductive coding process (both descriptive and interpretive) identified recurring themes.

Results: The barriers and facilitating factors that were identified as influencing the transfer of learning were linked to elements within the classroom (e.g. lack of practical protocols), the clinical workplace (e.g. supervisor not aware of what student learned in classroom) and students’ motivation (e.g. interest in the topic).

Conclusion: Despite the focus on whole-task learning environments, students did not find the application of knowledge, skills and attitudes in the clinical workplace easy. Future research needs to investigate how the perceived barriers can be avoided.

Open Access Original Research Article

Improving Cognitive Evaluation and the Diagnosis of Delirium among Elderly Patients Visiting the Emergency Room

Boris Punchik, Yan Press, Yakov Grinshpun, A. Mark Clarfield

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2015/19443

Introduction: Delirium is a common problem among elderly patients seen in the emergency department (ED). Under-diagnosis of delirium by the ED team is common and can have serious implications.  In a previous study we found poor quality of cognitive assessment and no mention of delirium in the ED of a large teaching hospital in southern Israel in 2003.

Aim: To evaluate cognitive assessment and delirium diagnosis two years after adding of a consultant geriatrician to the ED team. 

Methods: We examined the rate of mental status assessment and the prevalence of delirium in the ED among patients older than 65 years via a retrospective chart review.

Results: In a random sample utilizing medical records of 317 older people examined in the ED during 2007-2008, cognitive assessment (full or partial) was performed for 192 of 317 (60.6%) of patients (compared with only 12.5% in 2003), and 12 cases of delirium were specifically diagnosed in the ED (3.8%) compared to none in 2003. The rate of cognitive evaluation for subsequently hospitalized patients was 45% (compared with 59% in 2003).

Conclusions: This study indicates a moderate improvement in the rate of cognitive evaluation and the diagnosis of delirium among elderly patients seen in an ED compared with a similar study which was published 5 years ago.

Open Access Original Research Article

Estimation of the Risk of Cancer Associated with Pediatric Cranial Computed Tomography

O. M. Atalabi, B. I. Akinlade, A. J. Adekanmi

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2015/18079

Background: The role of Computed Tomography (CT) in the medical diagnosis of diseases has greatly expanded, despite the potential risk of cancer following exposures to ionising radiation (X-Ray) from this modality. This risk is particularly of great concern in children, who are more radiosensitive and have many years to manifest radiation effect than adults.

Aims: To estimate risk of cancer induction from Pediatric cranial CT.

Materials and Methods: A total of 203 patients, who were referred from various pediatric clinics and wards for cranial CT in a teaching hospital in the South Western Nigeria between the year 2011 and 2013 were considered. All patients were grouped into four age (year) groups: less than 1, 1-5, 5-10 and 10-15. A mathematical method was used to estimate the risk of cancer from the effective dose(ED) calculated from volume computed tomography dose index (CTDIvol), dose length product (DLP) and standard conversion factor.

Results: The range of CTDIvol (mGy) received by all patients was 10–250 mGy while majority of the patients received 50–100. The range of DLP ( received by all patients and majority of patients was 500–5000 and 2001–2500 respectively. The range of ED (mSv) received by all patients and majority of the patients was 1–25 and 5–10 respectively. The risk estimated with respect to patients’ age showed that patient in the age group 1–5 years have the highest risk of cancer induction while the risk based on gender showed no significant difference.

Conclusion: Over 60% of pediatric patients received more than the recommended values of CTDIvol, DLP and ED from cranial CT. Urgent steps must be taken to ensure compliant with international recommended precautions for dose reduction in pediatric medical imaging.

Open Access Original Research Article

Scorpion Sting and Acute Kidney Injury: Case Series from Pakistan

Rubina Naqvi

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2015/19611

Objectives: We aim to report here a series of cases developing AKI after scorpion stings.

Patients and Methods: During a period of 25 years that is; from January 1990- December 2014 all the patients coming to Sindh Institute of Urology and Transplantation, with AKI after scorpion sting are included in study. AKI was defined according to RIFLE criteria and Scorpion sting was labeled on history of person stung by scorpion.

Results: During studied period 18 patients were brought with scorpion sting. Mean age of patients was 29.22±18.48 years, 7 were male and 11 females. Mean duration of insult was 8.94±4.12 days. Sixteen out of 18 patients were either oliguric or anuric on presentation. Uremia was advanced on arrival with mean urea of 324.38±116.82 and creatinine of 11.8±4.30 mg/dl. Hyponatremia was a common finding with mean sodium of 129.16±8.76 meq/l. Extensive tissue damage at site of sting observed in many patients and mean values for LDH and CK were 2349.71±3499.15 and 3116.23±5468.22 U/L respectively. Hemodialysis required in all patients. Complete renal recovery seen in 13 patients, 2 expired and 3 discharged from hospital in partial state of recovery and never turned for follow up.

Conclusion: Scorpion sting is major health problem in many parts of our country, in majority it takes a benign course but in some may affect multiple organs and result in death, especially if initial treatment is delayed.

Open Access Original Research Article

Doctor-Nurse Conflict in Nigerian Hospitals: Causes and Modes of Expression

Ademola T. Olajide, Michael C. Asuzu, Taiwo A. Obembe

Journal of Advances in Medicine and Medical Research, Page 1-12
DOI: 10.9734/BJMMR/2015/15839

Background: Conflict within the health team is a recognized problem known to hinder quality health care service delivery. In order to achieve the objective for which a hospital is set up, interactions between all members within a medical team must be conducted in such a way that conflicts are minimized as much as possible.

Aims: To examine conflict issues between doctors and nurses and to determine the causes and modes of expression of such conflicts in Nigerian hospitals.

Methods: A cross-sectional study with quantitative and qualitative approaches was carried out in 2 tertiary hospitals in Ekiti State, Nigeria. Data was collected over 4 weeks in April 2005.

Pre-tested semi-structured questionnaires were self-administered to 323 participants (Response rate=96.4%) recruited. Focused group discussions (FGDs) were conducted with three groups each of doctors and nurses in the selected hospitals. Data were analyzed using frequencies, percentages and logistic regression.

Results: Majority of our respondents were females (81.7%); below 40 years (53.0%); married (75.9%); nurses (84.5%) and with less than 15 years of professional experience (50.3%). Odds of conflicts were significantly higher with limited opportunities for staff interaction (OR=1.8, CI=1.1-2.9); desire for power (autonomy) by doctors (OR=3.2, CI=1.9-5.2) and desire for more influence by nurses (OR=12.5, CI=4.8-41.3). Chances of expressing conflicts were significantly higher as strikes (OR=2.1; 1.3-3.5) but less with physical assaults (OR=0.1, CI=0.03-0.41).

Conclusion: Doctor-nurse conflict is associated with a combination of socio-economic and interpersonal-intergroup factors. Hospital management must understand the interplay of these factors and recognize its role in the handling of such conflicts. Doctors and nurses must also acquire the understanding of team building and group dynamics through training.

Open Access Original Research Article

How Physician Age Affects Surveillance Intensity after Primary Ovarian Cancer Treatment

Akshar Y. Patel, Anit K. Behera, Feng Gao, David G. Mutch, Katherine S. Virgo, Randall K. Gibb, Frank E. Johnson

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2015/16127

Objective: We aimed to determine whether the variability in surveillance strategies after curative-intent primary treatment of ovarian cancer is related to practitioner age.

Materials and Methods: The 943 members of The Society of Gynecologic Oncology (SGO) were surveyed by conventional mail to quantify their surveillance strategies for patients with ovarian carcinoma after potentially curative initial treatment. We requested data regarding the recommended frequency of 10 commonly employed surveillance modalities. Age was used as a proxy for time since formal residency training.

Results: There were 283 responders: 58 were aged 30-39, 114 were aged 40-49, 70 were aged 50-59, and 41 were aged ≥ 60. Older gynecologic oncologists (60+) ordered office visits and pelvic examinations more frequently than younger gynecologic oncologists in year 1 (p<0.05). They ordered comprehensive metabolic panels more frequently during years 2-4 (p<0.05). They ordered CBCs more frequently during years 1-5 and year 10.

Conclusions: Although we had predicted that younger physicians would order surveillance tests more frequently than older physicians, we found the opposite. However, the differences attributable to age were clinically small. The results suggest that physician age does not account for a large portion of the known overall variation in the clinical practice of ovarian cancer patient surveillance after initial treatment. We propose that continuing medical education is a factor that can most plausibly explain this.

Open Access Original Research Article

Effect of High Normal Thyroid Stimulating Hormone Levels on Lipid Parameters in Non-diabetic Subjects

T. Jaseem, Anupama Hegde, Poornima A. Manjrekar, Chakrapani Mahabala, Sathish Rao, M. S. Rukmini

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2015/18858

Aim: To investigate relationship between serum TSH and lipid parameters in subjects with different levels of TSH.

Study Design: Cross-sectional study.

Place and Duration of Study: Clinical Biochemistry Department of Kasturba Medical College, Hospital Mangalore, between January 2014 to June 2014.

Methodology: 348 subjects were screened of which 194 were selected. Lipid parameters, TSH, T3, T4 and glycemic status were determined. Association between TSH and serum lipids were studied by categorizing subjects into three groups based on their thyroid status. Group 1 [TSH= 0.27-2.5 mIU/L], Group 2 [TSH= 2.6-4.12 mIU/L] and Group 3 [TSH= 4.13-9.9mIU/L].Statistical analysis was performed by ANOVA followed by Tukey’s multiple comparison test. The relationships between TSH and different parameters were evaluated by Pearson’s correlation analysis.

Results: TSH showed a significant positive linear correlation with total cholesterol (r=0.288; P = 0.001), Triglycerides (r=0.129; P=0.016), LDL cholesterol (r=0.305; P =0.001) and negative correlation with HDL (r = - 0.129; P=0.750). Increasing TSH showed a consistent linear association with altered lipids quite evident from the uppermost part of the reference range that is considered clinically normal and there on.

Conclusion: A subtle variations of TSH alone in clinically normal thyroid state can alter serum lipids and hence asserts the role of TSH in maintaining lipid homeostasis.