RESUMO
BACKGROUND: In 2020, final year medical students applying for the United Kingdom's competitive academic training posts face an additional challenge because interviews are conducted online rather than in-person. We assessed how this new format influences anxiety and the impact of a targeted course on candidates' confidence levels. METHODS: A mixed-methods national teaching programme including online bespoke mock interviews was delivered to prospective Academic Foundation Programme applicants. Pre- and post-interview questionnaires assessed anxiety levels subjectively and using a Measure of Anxiety in Selection Interviews (MASI) scores. RESULTS: Individuals self-reported greater confidence, experience and preference for interviews delivered in-person as compared to online interviews. Post-course, there was an increase in self-reported confidence specific to online interviews (p = 0.009) and lower MASI scores in three of five domains, indicating reduced anxiety (social anxiety: p = 0.004, performance anxiety: p <0.001, behavioral anxiety: p = 0.003). CONCLUSION: A structured course can increase confidence and reduce anxiety for online academic medicine interviews.
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Depression is a common psychiatric disorder affecting more than 300 million people worldwide. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the diagnosis of depression requires at least two weeks of either low mood or anhedonia as well as four or more other symptoms such as appetite or weight changes, insomnia or hypersomnia, psychomotor agitation or retardation, loss of energy, inability to concentrate, feelings of worthlessness or excessive guilt, and suicidality. Selective serotonin reuptake inhibitors (SSRIs) target the monoaminergic system and are the commonest drugs used for treating depression, but have certain limitations, such as their delayed onset of action. Ketamine, a non-competitive NMDA receptor antagonist, has shown in several randomized controlled trials (RCTs) promising results with rapid antidepressant effects, especially in patients with severe treatment-resistant depression (TRD), which is depression that has not responded to more than two antidepressants. In this review, the clinical efficacy of ketamine in TRD has been discussed, with emphasis placed on the evidence from RCTs.
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Direct oral anticoagulants (DOACs) have predictable pharmacokinetics and pharmacodynamics, limited potential for drug to drug interactions, and can be given at fixed doses without the need for routine coagulation monitoring, which makes them a very attractive alternative to vitamin K antagonists. DOACs act by specifically targeting a single coagulation factor, such as Factor Xa or thrombin. Rivaroxaban is a direct Factor Xa inhibitor and has been approved for use in several thromboembolic disorders, such as the prevention of stroke and systemic embolism in adults with non-valvular atrial fibrillation and the prevention of recurrent deep vein thrombosis and pulmonary embolism in adult patients. This review aimed to provide an overview of the mechanism of action of rivaroxaban and outline its pharmacokinetic properties (absorption, distribution, metabolism, and excretion) in healthy adult subjects.
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Heart failure (HF) is a multi-faceted clinical condition affecting up to 2% of the population in the developed world and is linked to significant morbidity and mortality, therefore posing a major public health concern. To this date, pharmacotherapy for HF has mainly focused on chronic HF with reduced ejection fraction (HFrEF), with angiotensin converting enzyme inhibitors (ACEi) being at the centre of the management plan, alongside angiotensin-receptor-blockers (ARBs), ß-blockers (BB) and mineralocorticoid receptor antagonists (MRAs). A novel and recently approved therapy, however, involving angiotensin receptor-neprilysin inhibitors (ARNI), has shown very promising results and comparable to those of ACEi, which raises the question of whether ACEi should remain the first-line treatment option for HFrEF. In this review, the evidence regarding the clinical efficacy of ACEi and ARNI in the treatment of HFrEF is discussed, with emphasis placed on the major landmark trials.
RESUMO
Deep brain stimulation (DBS) is a neurosurgical procedure indicated for patients with advanced Parkinson's disease (PD). Whether similar benefits may be realized by patients with early PD, however, is currently unclear, especially given the potential risks of the procedure. This systematic review and meta-analysis aimed to investigate the relative efficacy and safety of DBS in comparison to best medical therapy (BMT) in the treatment of PD. It also aimed to compare the efficacy of DBS between patients with early and advanced PD. A systematic search was performed in Medline, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL). Randomized controlled trials (RCTs) comparing DBS to BMT in PD patients were included. Outcome measures were impairment/disability using the Unified Parkinson's Disease Rating Scale (UPDRS), quality of life (QoL) using the Parkinson's Disease Questionnaire (PDQ-39), levodopa equivalent dose (LED) reduction, and rates of serious adverse events (SAE). Eight eligible RCTs (n = 1,189) were included in the meta-analysis, two of which recruited early PD patients. Regarding efficacy outcomes, there were significant improvements in UPDRS, PDQ-39, and LED scores in favour of DBS (P < 0.00001). There was a significantly greater reduction of LED in patients with early PD (P < 0.00001), but no other differences between early and advanced PD patients were found. The risk of a patient experiencing an SAE was significantly higher in the DBS group (P = 0.005), as was the total number of SAEs (P < 0.00188). Overall, DBS was superior to BMT at improving impairment/disability, QoL, and reducing medication doses, but these benefits need to be weighed against the higher risk of SAEs. There was insufficient evidence to determine the impact of the PD stage on the efficacy of DBS.
