Background Many systematic reviews and meta-analyses have assessed the efficacy of dietary patterns on blood pressure (BP) lowering but their findings are largely conflicting. Objective This umbrella review aims to provide an update on the available evidence for the efficacy of different dietary patterns on BP lowering. Methods PubMed and Scopus databases were searched to identify relevant studies through to June 2020. Systematic reviews with meta-analyses of randomized controlled trials (RCTs) were eligible if they measured the effect of dietary patterns on systolic (SBP) and/or diastolic blood pressure (DBP) levels. The methodological quality of included systematic reviews was assessed by A Measurement Tool to Assess Systematic Review version 2. The efficacy of each dietary pattern was summarized qualitatively. The confidence of the effect estimates for each dietary pattern was graded using the NutriGrade scoring system. Results Fifty systematic reviews and meta-analyses of RCTs were eligible for review. Twelve dietary patterns namely the Dietary Approaches to Stop Hypertension (DASH), Mediterranean, Nordic, vegetarian, low-salt, low-carbohydrate, low-fat, high-protein, low glycemic index, portfolio, pulse, and Paleolithic diets were included in this umbrella review. Among these dietary patterns, the DASH diet was associated with the greatest overall reduction in BP with unstandardized mean differences ranging from −3.20 to −7.62 mmHg for SBP and from −2.50 to −4.22 mmHg for DBP. Adherence to Nordic, portfolio, and low-salt diets also significantly decreased SBP and DBP levels. In contrast, evidence for the efficacy of BP lowering using the Mediterranean, vegetarian, Paleolithic, low-carbohydrate, low glycemic index, high-protein, and low-fat diets was inconsistent. Conclusion Adherence to the DASH, Nordic, and portfolio diets effectively reduced BP. Low-salt diets significantly decreased BP levels in normotensive Afro-Caribbean people and in hypertensive patients of all ethnic origins. This review was registered at PROSPERO as CRD42018104733.

BackgroundIntroducing reflective writing to a medical curriculum requires the acceptance and participation of teachers. The purpose of this study was to explore medical teachers’ views on the benefits of introducing a reflective writing exercise into an undergraduate medical curriculum, including their levels of satisfaction and their concerns. We also investigated effects on the teachers’ personal and professional development arising from their roles as novice facilitators.MethodsA qualitative approach was employed using semi-structured interviews. During an attachment to Primary Care Medicine course, fourth-year medical students (n = 180) in the Faculty of Medicine, Ramathibodi Hospital, Bangkok, Thailand were assigned to write a reflective essay titled, “A Significant Event in My First Clinical Year”. After reading the essays and facilitating between one to three small group discussions based on these, each of the 18 teachers enrolled in our study completed an in-depth face to face interview. Transcripts of these were studied, using thematic content analysis to identify emerging themes.ResultsThe novice facilitators felt that facilitated reflection was both valuable and appropriate for students. They also perceived that it had a positive impact on their own personal and professional lives. In the early phase of implementing this activity, teachers expressed concerns about 1) their ability and confidence as facilitators in small group discussion 2) their ability to deal with emotions raised within their groups 3) the effectiveness of the activity 4) poor presentation and possible fabrication of student work.ConclusionsMost teachers regarded this activity as being beneficial to them, to student learning, and to the curriculum. Their insights, including concerns about the level of skill needed for facilitation, provide valuable material for planning a comprehensive faculty development programme.

Background: Recent national healthcare reforms in Thailand aim to transfer primary care to family physicians, away from more expensive specialists. As Family Medicine has yet to be established as a separate discipline in Thailand, newly trained family physicians work alongside untrained general doctors in primary care. While it has been shown that Family Medicine training programs in Thailand can increase the quality of referrals from primary care doctors to specialists, information is lacking about whether such training affects the quality of patient care. In the Department of Family Medicine at Ramathibodi Hospital, trained family physicians work with residents and general doctors. Although this situation is not typical within Thailand, it offers us the opportunity to look for variations in the levels of satisfaction reported by patients treated by different types of primary care doctor.

Objective: The objective of this study is to compare the effectiveness of a "cartoon-style" handout with a "traditional-style" handout in a self-study assignment for preclinical medical students. Methods: Third-year medical students (n ¼ 93) at the Faculty of Medicine Ramathibodi Hospital, Mahidol University, took a pre-learning assessment of their knowledge of intercostal chest drainage. They were then randomly allocated to receive either a "cartoon-style" or a "traditional-style" handout on the same topic. After studying these over a 2-week period, students completed a post-learning assessment and estimated their levels of reading completion. Results: Of the 79 participants completing the post-learning test, those in the cartoon-style group achieved a score 13.8% higher than the traditional-style group (p ¼ 0.018). A higher proportion of students in the cartoon-style group reported reading 75% of the handout content (70.7% versus 42.1%). In post-hoc analyses, students whose cumulative grade point averages (GPA) from previous academic assessments were in the middle and lower range achieved higher scores with the cartoon-style handout than with the traditional one. In the lower-GPA group, the use of a cartoon-style handout was independently associated with a higher score. Conclusions: Students given a cartoon-style handout reported reading more of the material and achieved higher postlearning test scores than students given a traditional handout.

ObjectivesTo systematically review and compare the efficacy of all available home-based non-pharmacological treatments of depression.DesignSystematic review and network meta-analysis of randomised controlled trials.Data sourcesMedline, Scopus and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were searched since inceptions to 7 August 2016.Eligibility criteriaRandomised controlled trials comparing the efficacy of home-based non-pharmacological interventions with usual care of patients with depression were included in the review.Main outcomesDepression symptom scores and disease remission rates at the end of treatment.ResultsSeventeen studies were included in the review. Home-based non-pharmacological interventions were categorised as (1) home-based psychological intervention, (2) home-based exercise intervention, (3) combined home-based psychological intervention with exercise intervention and (4) complementary medicine. Complementary medicine approaches were excluded from the meta-analysis due to heterogeneity. The standardised mean differences of post-treatment depression symptom scores between usual care groups and home-based psychological intervention, home-based exercise intervention and combined home-based psychological intervention with exercise intervention were −0.57 (95% CI −0.84 to −0.31), −1.03 (95% CI −2.89 to 0.82) and −0.78 (95% CI −1.09 to −0.47), respectively. These results suggest that only home-based psychological intervention and combined home-based psychological intervention with exercise intervention could significantly decrease depression scores. Compared with usual care groups, the disease remission rate was also significantly higher for home-based psychological intervention (pooled risk ratio=1.53; 95% CI 1.19 to 1.98) and combined home-based psychological intervention with exercise intervention (pooled risk ratio=3.47; 95% CI 2.11 to 5.70). Of all the studied interventions, combined home-based psychological intervention with exercise intervention had the highest probability of resulting in disease remission.ConclusionOur study confirms the efficacy of home-based psychological intervention and combined home-based psychological intervention with exercise intervention in the treatment of depression. Combined home-based psychological intervention and exercise intervention was the best treatment and should be considered for inclusion in clinical guidelines for managing depression.

This systematic review aimed to assess the efficacy of psychosocial interventions in reducing risk of low birth weight (LBW) and preterm birth (PTB) in teenage pregnancy. Relevant studies were identified from Medline, Scopus, CINAHL, and CENTRAL databases. Randomized controlled trials investigating effect of psychosocial interventions on risk of LBW and PTB, compared to routine antenatal care (ANC) were eligible. Relative risks (RR) of LBW and PTB were pooled using inverse variance method. Mean differences of birth weight (BW) between intervention and control groups were pooled using unstandardized mean difference (USMD). Five studies were included in the review. Compared with routine ANC, psychosocial interventions significantly reduced risk of LBW by 40% (95%CI: 8%,62%) but not for PTB (pooled RR ¼ 0.67, 95%CI: 0.42,1.05). Mean BW of the intervention group was significantly higher than that of the control group with USMD of 200.63 g (95% CI: 21.02, 380.25). Results of our study suggest that psychosocial interventions significantly reduced risk of LBW in teenage pregnancy.

What problem was addressed? Cartoons, or comics, are being used increasingly in medical education. Publishing these on the internet can reduced publication costs and give access to an extremely wide audience. As the popularity of social media increases, these could also be effective platforms for cartoon-based medical learning. One study using cartoons on a website demonstrated an improvement in post-learning test scores of healthcare professionals 1 but, to our knowledge, there are no reports of using graphic-novel cartoons on Facebook to teach a medical topic. What was tried? To evaluate the opinions of readers about this approach, a prospective trial was conducted; "Medical Academic Facilitation using Anthropomorphic Cartoon Illustrations (MAFAI): a pilot study". This was approved by the Ethics Committee of Ramathibodi Hospital, Mahidol University. We created a new non-animated comic-style cartoon aimed at teaching the physiology of breath sounds and their clinical examination. The story line used an anthropomorphic figure depicting a medical student questioning a resident about the physical examination of the lungs. The physiology was described using metaphors, diagrams and speech balloons, with the occasional use of humour for entertainment. The original version consisted of 3-4 panels (boxes) of cartoons per page with 29 pages in total. These were later rearranged into 49 pages to make them more readable. The cartoon was posted on a Facebook webpage in March 2016. (Link: http://tiny.cc/MAFAI_study) The final page encouraged readers to participate in an online survey during a 7-week period. Their personal characteristics, occupation and workplace were collected and a 5-point Likert-scale used to gather qualitative opinions of the cartoons. What lessons were learned? To date the cartoon has reached about 30,000 views, with 161 readers completed the questionnaire. Their mean age was 27.2 (±7.4) years and 60% were female. Most were doctors or medical students (62.7%), followed by nurses and nursing students (19.3%). All respondents were satisfied with our cartoon approach. More than 90% reported that the cartoons attracted their attention as well as helping them to memorize the content, understand the physiology, and improve their approach to conducting a thorough physical examination. The anthropomorphic characters were liked by 78% of the participants, only 10% suggesting that the cartoons would be improved by using human characters. Our cartoon stayed "active" for a short period. A peak of about 10,000 views was reached on the day of publication, falling to 3,000 the following day and fewer than 100 views per day after a week. The prior popularity of the webpage probably played a role in determining these numbers, having 2,856 fans at baseline. The number of participants who thought that cartoon density per page was just right increased from 43% to 67% when the original 29-page cartoon was replaced with the rearranged 49-page version, implying that less content density per page might be better. Our study sh...

Background Compulsory 3-year public service was implemented in 1967 as a measure to tackle the maldistribution of doctors in Thailand. Currently, therefore, most medical graduates work in rural community hospitals for their first jobs. This research explored doctors’ perceptions of preparedness for practice using a critical incident technique. Methods A self-administered critical incident questionnaire was developed. Convenient samples were used, i.e. Family Medicine residents at Ramathibodi Hospital who had worked in a community hospital after graduation before returning to residency training. Participants were asked to write about two incidents that had occurred while working in a community hospital, one in which they felt the knowledge and skills obtained in medical school had prepared them for managing the situation effectively and the other in which they felt ill-prepared. Data were thematically analysed. Results Fifty-six critical incidents were reported from 28 participants. There were representatives from both normal and rural tracks of undergraduate training and community hospitals of all sizes and all regions. Doctors felt well-prepared to provide care for patients in emergency situations and as in-patients, but under-prepared for obstetric and paediatric emergencies, out-patient care, and palliative care. Moreover, they felt poorly prepared to deal with difficult patients, hospital administration and quality assurance. Conclusions Long-term solutions are needed to solve the rural doctor shortage. Medical graduates from both normal and rural tracks felt poorly prepared for working effectively in community hospitals. Medical training should prepare doctors for rural work, and they should be supported while in post. Keywords Preparedness for practice, Community hospital, Critical incident, Rural doctor, Rural practice, Undergraduate medical training