Background Simulation via Instant Messaging - Birmingham Advance (SIMBA) aimed to improve clinicians’ confidence in managing various clinical scenarios during the COVID-19 pandemic. Methods Five SIMBA sessions were conducted between May and August 2020. Each session included simulation of scenarios and interactive discussion. Participants’ self-reported confidence, acceptance, and relevance of the simulated cases were measured. Results Significant improvement was observed in participants’ self-reported confidence (overall n = 204, p<0.001; adrenal n = 33, p<0.001; thyroid n = 37, p<0.001; pituitary n = 79, p<0.001; inflammatory bowel disease n = 17, p<0.001; acute medicine n = 38, p<0.001). Participants reported improvements in clinical competencies: patient care 52.0% (n = 106/204), professionalism 30.9% (n = 63/204), knowledge on patient management 84.8% (n = 173/204), systems-based practice 48.0% (n = 98/204), practice-based learning 69.6% (n = 142/204) and communication skills 25.5% (n = 52/204). Conclusion SIMBA is a novel pedagogical virtual simulation-based learning model that improves clinicians’ confidence in managing conditions across various specialties.
Introduction: Medical cannabinoids have received significant mainstream media attention in recent times due to an evolving political and clinical landscape. Whilst the efficacy of cannabinoids in the treatment of some childhood epilepsy syndromes is increasingly recognized, medical cannabinoids may also have potential clinical roles in the treatment of older adults. Prescribing restrictions for medical cannabinoids in certain jurisdictions (including the UK) has recently been relaxed. However, few geriatricians have the detailed knowledge or awareness of the potential risks or rewards of utilizing cannabinoids in the older person; even fewer geriatricians have direct experience of using these drugs in their own clinical practice. Older persons are more likely to suffer from medical illness representing potential indications for medical cannabinoids (e.g., pain); equally they may be more vulnerable to any adverse effects. Aim: This narrative literature review aims to provide a brief introduction for the geriatrician to the potential indications, evidence-base, contra-indications and side effects of medical cannabinoids in older people. Methods: A search was conducted of CENTRAL, Medline, Embase, CINAHL and psycINFO, Cochrane and Web of Science databases. Reference lists were hand searched. Abstracts and titles were screened, followed by a full text reading of relevant articles. Results: 35 studies were identified as relevant for this narrative review. Conclusions: Cannabinoids demonstrate some efficacy in the treatment of pain and chemotherapy-related nausea; limited data suggest potential benefits in the treatment of spasticity and anxiety. Risks of cannabinoids in older patients appear to be moderate, and their frequency comparable to other analgesic drug classes. However, the quality of research is weak, and few older patients have been enrolled in cannabinoid studies. Dedicated research is needed to determine the efficiency and safety of cannabinoids in older patients.
Objectives/aimsElevated levels of pro-inflammatory cytokines are associated with a range of mental illnesses, and also with childhood trauma.1–4 Evidence suggests that inflammation occurring as a result of childhood trauma could play a role in the pathogenesis of psychiatric disorders.5 6 However, previous research does not account for confounders, including psychotropic medication and illness duration, that may affect inflammation levels.7 The aim of this study was to investigate the relationship between childhood trauma exposure and levels of inflammation in young people with emerging mental health disorders with confounding factors removed.Methods10 patients, aged 16–25, with a range of psychiatric disorders and no history of psychotropic medication were recruited from Birmingham mental health services, along with 16 healthy controls. Childhood trauma exposure was assessed with the Childhood Trauma Questionnaire (CTQ), and blood samples were analysed for serum concentrations of pro- inflammatory cytokines IL-6 and IL-1β.ResultsThere was no significant difference in serum cytokines between patients and healthy controls, or those with and without childhood trauma (p>0.05). Post-hoc sample size calculations estimated 197 patients with and 197 without childhood trauma would be needed to detect a significant 2 pg/ml difference in cytokine levels (80% power, 5% significance). There was a weak positive, but non-significant, correlation between both cytokines and CTQ score in the patient group (rS=0.1–0.3, p>0.05). Multiple linear regression of CTQ score, sex and BMI found that none of these variables significantly predicted cytokine concentration in our population.ConclusionsThere is preliminary evidence of an association between childhood trauma and inflammation in patients with mental illness, but due to small sample size no definitive conclusions can be drawn from this data. Future research with a larger sample size and longitudinal approach would be beneficial in establishing whether a relationship exists independent of confounders.ReferencesGoldsmith DR, Rapaport MH, Miller BJ. A meta-analysis of blood cytokine network alterations in psychiatric patients: comparisons between schizophrenia, bipolar disorder and depression. Mol Psychiatr. 2016; 21: 1696–1709.Upthegrove R, Manzanares-Teson N, Barnes NM. Cytokine function in medication-naive first episode psychosis: a systematic review and meta-analysis. Schizophr. Res 2014; 155: 101–108.Baumeister D, Akhtar R, Ciufolini S, Pariante CM, Mondelli V. Childhood trauma and adulthood inflammation: a meta-analysis of peripheral C-reactive protein, interleukin-6 and tumour necrosis factor-α. Mol Psychiatr 2016; 21: 642–649.Danese A, Baldwin JR. Hidden wounds? Inflammatory links between childhood trauma and psychopathology. Annu Rev of Psychol 2017; 68: 517–544.Upthegrove R, Barnes NM. The immune system and schizophrenia: an update for clinicians. BJPsych Adv 2014; 20: 83–91.Miller AH, Maletic V, Raison CL. Inflammation and its discontents: the role of cytokines in the pathophysiology of major depression. Biol Psychiat 2009: 65; 732–741.Danese A, Pariante CM, Caspi A, Taylor A, Poulton R. Childhood maltreatment predicts adult inflammation in a life-course study. P Natl Acad Sci USA 2007;104:1319–1324.
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