The experiences of autistic medical students: A phenomenological study.

BACKGROUND: Increasing recognition of autism is reflected in the growing awareness of autistic health care providers. Regulatory bodies including the UK General Medical Council and the UK Medical Schools Council have published guidance fostering inclusion. Whilst many autistic doctors and students are thriving, many may not disclose their diagnosis unless difficulties arise, which perpetuates stereotypes. No studies have explored the experiences of autistic medical students. We aimed to do this. METHODS: This was an interpretive phenomenological study. Autistic medical students were recruited using Facebook announcements. Participants underwent audio-recorded, loosely structured interviews. Recordings were transcribed verbatim and underwent an interpretive phenomenological analysis. RESULTS: Five participated from five different UK medical schools. Constructed themes included: Autistic profiles and stereotypes-'I'm a lot better with patients than I am with my peers, with staff, which is hard for a lot of people to understand'; sensory processing and the learning environment-'noises really hurt my ears … It actually hurts'; me, myself and masking-'so, medicine's hard. But I'm also studying myself and I'm figuring myself out and that degree is harder'; the social world-'I always feel like I'm watching my back'; and navigating the system-'[they say] "but you're going to be a doctor one day, so you need to get used to it"'. CONCLUSION: Participants longed for understanding and support from their medical schools. They reported experiences of isolation, bullying and anxiety. Most felt themselves to be victims of the system, whereby they were expected to adapt themselves in order to appear non-autistic. When participants reported not coping due to being autistic, most were advised to 'take time out'. None were offered personalised adjustments to their learning environment. All reported strengths associated with being autistic. This supports the assertion that autistic people can be safe, effective and skilled doctors.

The learning experiences of dyslexic medical students during the COVID-19 pandemic: a phenomenological study.

Dyslexia is a Specific Learning Difficulty that impacts on reading and writing abilities. During the COVID-19 pandemic, medical schools have been forced to undertake distance learning and assessment. The wider literature suggested that e-learning might pose additional challenges for dyslexic students. Here we explore their overall experiences of learning/studying during this time in a phenomenological study. Five medical students were interviewed in depth and the audio-recordings were transcribed verbatim. Transcripts then underwent an interpretive phenomenological analysis. Our results highlighted a largely positive experience, with an improved culture of togetherness, freedom and sense of control. They also revealed issues with a lack of clinical exposure, potential negative impacts on ranking positions for those with dyslexia, and possible cheating in exams. There are some surprising results-in particular the positive responses to how remote learning was delivered. These seemed to put our participants more on a par with their non-dyslexic colleagues-except in some examinations. It is our hope that medical educators may resist a return to 'the way things have always been done' when the pandemic has resolved, and by doing so, continue to foster this new, positive culture and paradigm shift.

The experiences of foundation doctors with dyspraxia: a phenomenological study.

Dyspraxia, otherwise known as Developmental Coordination Disorder (DCD), is a specific learning difficulty (SpLD). Its main difficulties manifest as problems with motor coordination, organisation, academic and social difficulties. There are now more students arriving at university with SpLDs, and, therefore, a similar rise may be expected within medical education. There has been no previous research focusing on dyspraxia in doctors. An interpretive phenomenological approach was used. Six UK foundation schools disseminated the announcements. Three participants took part in loosely structured telephone interviews regarding their experiences of undertaking medical school and foundation school with dyspraxia. These were transcribed verbatim and then thematically analysed. The themes could be split into two main categories: "Weakness and Coping Strategies" and "Perspectives of Dyspraxia". "Weakness" included: clumsiness, organisation and needing extra time. The participants focused on their "Coping Strategies" that included: Ensuring safety, adapted learning preferences and external support. "Perspectives of Dyspraxia" included: diagnosis, career choice, stigma, "normalisation" and the "difference view" or "medical deficit" view of dyspraxia. Doctors with dyspraxia often mask their difficulties through sophisticated coping strategies. These were determined and hardworking individuals who believe that their dyspraxia was a positive aspect of their identity, adopting a "difference view". They felt further education is needed about dyspraxia to change the perceived stigma. There is now a need for further research in this area.

Adjustable Loop Femoral Cortical Suspension Devices for Anterior Cruciate Ligament Reconstruction: A Systematic Review.

BACKGROUND: Anterior cruciate ligament (ACL) injury is a common sports injury. Symptomatic knee instability after this injury is usually treated operatively through ACL reconstruction. The surgery involves a tendon graft being fixed in bony tunnels drilled through femur and tibia. The fixation of the graft is of critical importance to achieving good results. One of the commonest devices used to fix the graft in the femoral bony tunnel is a fixed loop cortical suspensory device. More recently, adjustable loop cortical suspension devices have been introduced, and have gained popularity for ACL reconstruction. These allow for adjusting the length of the suspension loop after insertion. There is currently much debate concerning whether the adjustable loop devices are superior or inferior to the fixed loop devices. PURPOSE: To critique and review the current biomechanical and clinical evidence on the use of adjustable loop devices in hamstring ACL reconstruction. To our knowledge, there have been no previous reviews of this topic. STUDY DESIGN: Systematic review. METHODS: This systematic review was conducted in accordance with PRISMA. Five databases were searched using multiple search terms and MeSH terms where possible. The following limits were applied: papers published in English and papers published in the last 21 years. RESULTS: Eleven laboratory and six clinical studies were reviewed. The laboratory-based studies have frequently shown elongation of adjustable loop devices to more than 3 mm under loading protocols, whereas the clinical studies have not shown any significant differences between the patients with fixed loop and the ones with adjustable loop devices. CLINICAL SIGNIFICANCE: This review shows a discrepancy between laboratory-based and clinical studies. The review of clinical studies in our paper would give future researchers confidence and act as a prompt to construct randomised clinical trials to investigate these devices further. CONCLUSION: We feel that more robust clinical randomised studies and trials are needed to evaluate these new devices.

Safe and effective prescribing with dyslexia.

BACKGROUND: The term 'dyslexia' refers to a condition that impacts upon reading and writing abilities whilst not altering intelligence. Individuals with dyslexia may have difficulties with the speed and accuracy and their reading and writing, amongst other issues. Dyslexia is not automatically considered a disability but is a protected characteristic under the UK Equality Act (2010), and therefore employers and educational institutions are required to provide 'reasonable adjustments' in order to allow individuals to reach their full potential. There is a lack of research on this issue, but what little there is suggests that doctors feel as though any support they received ended when they graduated from medical school. MAIN BODY: A core distinction between medical school and medical practice is the requirement to prescribe medicines as registered medical practitioners. Junior doctors have to master this complex and potentially hazardous skill "on the job", with a perceived lack of support. Here, we open up a debate about the potential impact of dyslexia on prescribing, and the need to find supports that may be effective in enabling doctors with dyslexia prescribe medicines safely and effectively - and thus reach their full potential as medical practitioners and promote patient safety. CONCLUSION: We argue that medical schools and hospitals could immediately provide dyslexia awareness training in both undergraduate and postgraduate settings. We discuss electronic prescribing systems, and conclude that research is required to identify effective supports for junior doctors with dyslexia.

Vitamin and mineral supplementation for maintaining cognitive function in cognitively healthy people in mid and late life.

BACKGROUND: Vitamins and minerals play multiple functions within the central nervous system which may help to maintain brain health and optimal cognitive functioning. Supplementation of the diet with various vitamins and minerals has been suggested as a means of maintaining cognitive function, or even of preventing dementia, in later life. OBJECTIVES: To evaluate the effects of vitamin and mineral supplementation on cognitive function in cognitively healthy people aged 40 years or more. SEARCH METHODS: We searched ALOIS, the Cochrane Dementia and Cognitive Improvement Group's (CDCIG) specialised register, as well as MEDLINE, Embase, PsycINFO, CINAHL, ClinicalTrials.gov and the WHO Portal/ICTRP from inception to 26th January 2018. SELECTION CRITERIA: We included randomised controlled trials that evaluated the cognitive effects on people aged 40 years or more of any vitamin or mineral supplements taken by mouth for at least three months. DATA COLLECTION AND ANALYSIS: Study selection, data extraction, and quality assessments were done in duplicate. Vitamins were considered broadly in the categories of B vitamins, antioxidant vitamins, and combinations of both. Minerals were considered separately, where possible. If interventions and outcomes were considered sufficiently similar, then data were pooled. In order to separate short-term cognitive effects from possible longer-term effects on the trajectory of cognitive decline, data were pooled for various treatment durations from 3 months to 12 months and up to 10 years or more. MAIN RESULTS: In total, we included 28 studies with more than 83,000 participants. There were some general limitations of the evidence. Most participants were enrolled in studies which were not designed primarily to assess cognition. These studies often had no baseline cognitive assessment and used only brief cognitive assessments at follow-up. Very few studies assessed the incidence of dementia. Most study reports did not mention adverse events or made only very general statements about them. Only 10 studies had a mean follow-up > 5 years. Only two studies had participants whose mean age was < 60 years at baseline. The risk of bias in the included studies was generally low, other than a risk of attrition bias for longer-term outcomes. We considered the certainty of the evidence behind almost all results to be moderate or low.We included 14 studies with 27,882 participants which compared folic acid, vitamin B12, vitamin B6, or a combination of these to placebo. The majority of participants were aged over 60 years and had a history of cardio- or cerebrovascular disease. We found that giving B vitamin supplements to cognitively healthy adults, mainly in their 60s and 70s, probably has little or no effect on global cognitive function at any time point up to 5 years (SMD values from -0.03 to 0.06) and may also have no effect at 5-10 years (SMD -0.01). There were very sparse data on adverse effects or on incidence of cognitive impairment or dementia.We included 8 studies with 47,840 participants in which the active intervention was one or more of the antioxidant vitamins: ß-carotene, vitamin C or vitamin E. Results were mixed. For overall cognitive function, there was low-certainty evidence of benefit associated with ß-carotene after a mean of 18 years of treatment (MD 0.18 TICS points, 95% CI 0.01 to 0.35) and of vitamin C after 5 years to 10 years (MD 0.46 TICS points, 95% CI 0.14 to 0.78), but not at earlier time points. From two studies which reported on dementia incidence, there was low-certainty evidence of no effect of an antioxidant vitamin combination or of vitamin E, either alone or combined with selenium. One of the included studies had been designed to look for effects on the incidence of prostate cancer; it found a statistically significant increase in prostate cancer diagnoses among men taking vitamin E.One trial with 4143 participants compared vitamin D3 (400 IU/day) and calcium supplements to placebo. We found low- to moderate-certainty evidence of no effect of vitamin D3 and calcium supplements at any time-point up to 10 years on overall cognitive function (MD after a mean of 7.8 years -0.1 MMSE points, 95% CI -0.81 to 0.61) or the incidence of dementia (HR 0.94, 95% CI 0.72 to 1.24). A pilot study with 60 participants used a higher dose of vitamin D3 (4000 IU on alternate days) and found preliminary evidence that this dose probably has no effect on cognitive function over six months.We included data from one trial of zinc and copper supplementation with 1072 participants. There was moderate-certainty evidence of little or no effect on overall cognitive function (MD 0.6 MMSE points, 95% CI -0.19 to 1.39) or on the incidence of cognitive impairment after 5 years to 10 years. A second smaller trial provided no usable data, but reported no cognitive effects of six months of supplementation with zinc gluconate.From one study with 3711 participants, there was low-certainty evidence of no effect of approximately five years of selenium supplementation on the incidence of dementia (HR 0.83, 95% CI 0.61 to 1.13).Finally, we included three trials of complex supplements (combinations of B vitamins, antioxidant vitamins, and minerals) with 6306 participants. From the one trial which assessed overall cognitive function, there was low-certainty evidence of little or no effect on the TICS (MD after a mean of 8.5 years 0.12, 95% CI -0.14 to 0.38). AUTHORS' CONCLUSIONS: We did not find evidence that any vitamin or mineral supplementation strategy for cognitively healthy adults in mid or late life has a meaningful effect on cognitive decline or dementia, although the evidence does not permit definitive conclusions. There were very few data on supplementation starting in midlife (< 60 years); studies designed to assess cognitive outcomes tended to be too short to assess maintenance of cognitive function; longer studies often had other primary outcomes and used cognitive measures which may have lacked sensitivity. The only positive signals of effect came from studies of long-term supplementation with antioxidant vitamins. These may be the most promising for further research.

The experiences of medical students with dyslexia: An interpretive phenomenological study.

This article explores the experiences of U.K. medical students with dyslexia, using an interpretive phenomenological approach. This project began with a review of the literature, highlighting a void of qualitative research. We then conducted a collaborative autoethnography. This paper forms the next stage in this series of research. We aimed to elicit meaning and understanding from the lived experiences of our participants. Eight U.K. junior doctors with dyslexia were interviewed over the telephone in an in-depth, unstructured manner. Audio recordings were transcribed verbatim and thematically analysed with the aid of a template analysis. Experiences of helplessness and hopelessness were common. These may be a result of a fear of stigmatization and personal feelings of inadequacy. They may also be fuelled by the incidents of bullying and belittling from other medical students that were reported. An important meta-theme was of fear and lack of understanding. A lack of pastoral support was also reported. Their experiences of medical school assessments are also reported. More may need to be done to educate teachers and clinical supervisors on dyslexia.

The exam performance of medical students with dyslexia: a review of the literature.

This article was migrated. The article was marked as recommended. INTRODUCTION: Dyslexia is a common condition. Estimates suggest it effects approximately 10% of the worldwide population, and 1.7% of UK medical students. This review aimed to explore the existing literature concerning the exam performance of medical students with dyslexia. METHODS: A Review of Medline, ERIC, PsychInfo, The Cochrane Library, and Google Scholar was conducted in accordance with the PRISMA checklist. Papers were accepted if they concerned the exam performance of medical students with dyslexia. RESULTS: Three papers were selected for review. These were all cross-sectional studies comparing exam results in students with dyslexia and without dyslexia - and the impacts of extra time in exams. A risk of bias assessment determined that all three were appropriate to include in this review. A meta-analysis was planned but could not be performed because the number of studies was low and heterogeneity between the studies too high. There was consensus that Multiple Choice Question exams were fair for students with dyslexia, when extra time was allowed. Essay type exams were found to be particularly challenging for students with dyslexia. Students with dyslexia were also found to be at a disadvantage in their first year. DISCUSSION: Overall, the evidence suggests that medical students with dyslexia are slower to adapt to medical school and under-perform early in the course. However, with appropriate supports, they appear to perform on a par with their non-dyslexic peers as they progress through their course. Our review highlights the need for more research in the medical student population.

International Leaders Summit: using dialogue to Center the Conversation on the Education of Deaf Children and Youth in the 21st century.

Om July 18, 2010, the eve of the 21st International Congress on the Education of the Deaf (ICED 2010), the International Leaders Summit was held at the Center for Dialogue at Simon Fraser University, Vancouver, Canada. A total of 120 world leaders from 32 countries participated. Presenters, including students, led the conversation on current perspectives, teacher preparation, worldwide resources, and major issues affecting the education of d/Deaf and hard of hearing infants, children, and youth. Summit participants recognized that advances in detection, early intervention, and technology present challenges in meeting the needs of a student population more diverse than at any other stage in history. While it was acknowledged that needs differ in various parts of the world, there was a consensus that change is required to prepare students to handle challenges in the 21st century.

Patients' and staff's experiences of multidisciplinary follow-up for high-grade glioma after radical radiotherapy.

Meeting the complex needs of patients with high-grade glioma requires multidisciplinary input. How best to provide care after initial treatment ends is contentious. This study explored the experiences of patients and staff at one UK centre where regular multidisciplinary clinics and brain scanning is provided. In-depth interviews conducted with 10 patients and six staff were transcribed and analysed qualitatively. Patients reported: supportive, individualised care with familiar staff; good communication; that regular scanning was reassuring. Staff believed that team follow-up facilitated immediate decision-making and referral, and reduced visits. They felt that patients value seeing their scans. Patients and staff described positive and negative experiences of multidisciplinary follow-up. There is need to investigate the impact of different approaches to ongoing care.

A UK-wide survey of follow-up practices for patients with high-grade glioma treated with radical intent.

RATIONALE AND OBJECTIVE: High-grade glioma profoundly affects patients and their families. The best ongoing care for patients completing radical treatment is uncertain. To address this issue a UK-wide audit surveying the follow-up practices of multidisciplinary cancer teams was conducted. METHOD: An online survey package was used with a paper version available. RESULTS: Of 102 clinicians approached 86 replied, a response rate of 84%. Three-monthly outpatient department appointments led by an oncologist and a specialist nurse were the norm, but more controversially, some centres conduct joint clinics with the whole neurosurgical/oncology team present or available. Nurse-led telephone follow-up in place of hospital visits is uncommon. Regular scanning is conducted despite the clinical benefits being contentious. Access to a range of allied services providing supportive care is considered, but the actual levels of need and the efficiency with which they are delivered require further investigation. CONCLUSIONS: The picture of UK follow-up practices revealed by this survey demonstrates that research is now needed to determine what preferences patients and families have for follow-up and their satisfaction with these.

Communication and informed consent in phase 1 trials: a review of the literature from January 2005 to July 2009.

OBJECTIVE AND METHODS: A review conducted in 2005 identified many of the communication difficulties experienced by patients and doctors when discussing phase 1 (P1) oncology trials. The current paper is an update of the area and focuses on studies that measure patient comprehension of information given during the P1 trial discussion and ways to enhance understanding. A literature search was performed for relevant articles published between January 2005 and July 1st 2009. RESULTS: Only 12/109 studies met the criteria for inclusion in the review. One study recorded the actual trial discussion and compared patients' understanding with what the clinician had communicated. The others used interview techniques and surveys to elicit patients' understanding of P1 trials, motivations for considering trials and expectations of benefit. Two examined interventions to aid patient understanding. CONCLUSION: Explaining potential participation in a P1 trial with a patient with cancer is not an easy task: the doctor must ensure that the patient has an accurate understanding of their condition and that standard treatments have now been exhausted. This must be followed by admission of the probable lack of any therapeutic benefit from the P1 drug together with the possibility that there might be unwanted side effects, many of which are unknown. These are all challenging subjects. New educational initiatives informed through research conducted with patients and health care professionals are currently being developed and clearly much needed.

Diffusion of insulin-like growth factor-I and ribonuclease through fibrin gels.

A fluorescence-based method for simultaneously determining the diffusion coefficients of two proteins is described, and the diffusion coefficient of insulin-like growth factor (IGF-I) and ribonuclease (RNase) in a 0.27% fibrin hydrogel is reported. The method is based on two-color imaging of the relaxation of the protein concentration field with time and comparing the results with a transport model. The gel is confined in a thin (200 microm) capillary and the protein is labeled with a fluorescent dye. The experimentally determined diffusion coefficient of RNase (D = 1.21 x 10(-6) cm(2)/s) agrees with literature values for dilute gels and bulk aqueous solutions, thus indicating the gel and the dye had a negligible effect on diffusion. The experimental diffusion coefficient of IGF-I (D = 1.59 x 10(-6) cm(2)/s), in the absence of binding to the fibrin matrix, is consistent with the dimensions of the molecule known from x-ray crystallography and a correlation between D and molecular weight based on 14 other proteins. The experimental method developed here holds promise for determining molecular transport properties of biomolecules under a variety of conditions, for example, when the molecule adsorbs to the gel or is convected through the gel by fluid transport.

Repair of recurrent visceral aortic patch aneurysm after thoracoabdominal aortic aneurysm repair with a branched endovascular stent graft.

Aneurysmal degeneration of the visceral aortic patch is an uncommon late complication of surgical replacement of the thoracoabdominal aorta. We report on a 70-year-old woman who had undergone previous open thoracoabdominal aortic aneurysm repair and subsequent revision surgery for a visceral aortic patch aneurysm. The patient presented with a recurrent asymptomatic 60-mm-diameter visceral aortic patch aneurysm involving the celiac axis and superior mesenteric artery. The lesion was successfully treated with a custom-designed Zenith branched endovascular stent graft. The patient remains well at 12 months.

Salvage of failed prior endovascular abdominal aortic aneurysm repair with fenestrated endovascular stent grafts.

Three patients with type I proximal endoleak after previous endovascular abdominal aortic aneurysm (AAA) repair were treated with fenestrated endovascular stent grafts. Six renal arteries, three superior mesenteric arteries, and one coeliac axis were targeted for incorporation by graft fenestration. The fenestration-renal ostium interface was secured with balloon-expandable stents and completion angiography demonstrated no endoleaks and antegrade perfusion in all target vessels. All patients made an uncomplicated recovery. Fenestrated endovascular stent grafts can be used to salvage failed prior endovascular AAA repair in patients who are considered unsuitable for other endovascular or open surgical interventions.

Repair of juxtarenal para-anastomotic aortic aneurysms after previous open repair with fenestrated and branched endovascular stent grafts.

Three patients with juxtarenal para-anastomotic aortic aneurysms after previous open abdominal aortic aneurysm repair were treated with custom-designed fenestrated and branched Zenith endovascular stent grafts. Six renal arteries and two superior mesenteric arteries were targeted for incorporation by graft fenestrations and branches. The fenestration/renal ostium interface was secured with balloon-expandable Genesis stents (n = 5) or Jostent stent grafts (n = 1). Completion angiography demonstrated no endoleaks and antegrade perfusion in all target vessels. During follow-up, one patient developed asymptomatic renal artery occlusion and underwent further endovascular intervention for type I distal endoleak. Computed tomography at 12 months demonstrated complete aneurysm exclusion in all patients with antegrade perfusion in the remaining target vessels. Fenestrated and branched endovascular stent grafts may be an acceptable alternative to conventional open repair in this group of patients.

Movement of colloidal particles in two-dimensional electric fields.

We characterize the movement of carbon black particles in inhomogeneous, two-dimensional dc electric fields. Motivated by display applications, the particles are suspended in a nonpolar solvent doped with a charge control agent. The two-dimensional fields are generated between strip electrodes on a glass slide spaced 120 microm apart with field strengths up to 10(4) V/m. Such fields are insufficient to drive either electrohydrodynamic instabilities or natural convection due to ohmic heating, but they move the particles between the electrodes in about 30 s. In the center region between the strip electrodes, the particles move by electrophoresis; that is, the particle velocity is proportional to the electric field. However, when imposing a constant-potential or constant-current boundary condition at the electrodes to derive the electrical field, the electrophoretic mobility calculated from the measured particle velocities is outside the range of mobilities predicted from the theory of O'Brien and White. Near the electrodes the particles either speed up or slow down, depending on the polarity of the electrode, and these changes in velocity cannot be explained simply by electrophoresis in a spatially varying electric field. We suggest that this anomalous motion arises from electrohydrodynamic flows originating from the interaction between the space charge of the polarized layers above the electrodes and the electric field. Approximate calculations indicate such flows could be sufficiently strong to explain the anomalous trajectories near the edges of the electrodes.

Repair of thoracoabdominal aortic aneurysms with fenestrated and branched endovascular stent grafts.

OBJECTIVE: To report the repair of thoracoabdominal aortic aneurysms (TAAAs) with fenestrated and branched endovascular stent grafts (EVSGs). METHODS: Four patients with asymptomatic TAAAs were treated with custom-designed Zenith fenestrated and branched EVSGs. Three patients had undergone previous open aortic aneurysm repair. Thirteen visceral vessels in four patients were targeted for incorporation by graft fenestrations and branches. RESULTS: The fenestration/orifice interface was secured with balloon-expandable Genesis stents or Jostent stent grafts in 9 of 13 target vessels. Completion angiography demonstrated antegrade perfusion in 12 of 13 target vessels. One renal artery occluded because of graft rotation during deployment. There were no endoleaks. Three patients required additional surgical procedures related to access vessels. One patient required reoperation for bleeding from an extra-anatomic bypass graft and subsequently died from multisystem organ failure. Three patients made an uncomplicated recovery. No patient developed spinal cord ischemia. Computed tomography at 12 months in the 3 survivors demonstrated complete aneurysm exclusion with antegrade perfusion in all 10 target vessels. CONCLUSIONS: TAAA repair with fenestrated and branched EVSGs is feasible and provides an acceptable and promising alternative to conventional surgical repair in selected patients.