Healing at the Periphery

India has long occupied an important place in Tibetan medicine's history and development. However, Indian Himalayan practitioners of Tibetan medicine, or amchi, have largely remained overlooked at the Tibetan medical periphery, despite playing a central social and medical role in their communities. Power and legitimacy, religion and economic development, biomedical encounters and Indian geopolitics all intersect in the work and identities of contemporary Himalayan amchi. This volume examines the crucial moment of crisis and transformation that occurred in the early 2000s to offer insights into the beginnings of Tibetan medicine's professionalization, industrialization, and official recognition in India and elsewhere. Based on fine-grained ethnographic studies in Ladakh, Zangskar, Sikkim, and the Darjeeling Hills, Healing at the Periphery asks how the dynamics of capitalism, social change, and the encounter with biomedicine affect small communities on the fringes of modern India, and, conversely, what local transformations of Tibetan medicine tell us about contemporary society and health care in the Himalayas and the Tibetan world. Contributors. Florian Besch, Calum Blaikie, Sienna R. Craig, Barbara Gerke, Isabelle Guérin, Kim Gutschow, Pascale Hancart Petitet, Stephan Kloos, Fernanda Pirie, Laurent Pordié

Directed Medical Role Play for Children: Review of the Teddy Bear Hospital Implementations, Objectives, and Reported Experiences

Background: Role-playing is often used as a pedagogical method for learning communication in medical education. Therefore, medical play using the Teddy Bear Hospital (TBH) is a concept that can quickly familiarize children with health care and help them develop positive experiences in these areas. This review aims to assess the strengths of TBH, as a form of directed medical role play, in improving health outcomes and well-being in children, along with implanting an awareness of preventive health care in young children.Methods: For this scoping review, we examined the list of recommendations, including 11 studies from two databases, PubMed and Google Scholar. We incorporated pre/post quasi-experimental studies, ANOVA, qualitative research studies, systematic reviews, and control group studies that deliberately utilize the teddy bear hospital as an intervention.Results: The results of individual studies were further categorized into three sections. The first being upon the analysis of 11 studies, the Teddy Bear Hospital was mainly conducted in Europe and Asia. It is evident that regardless of the different approaches and strategies used to implement the Teddy Bear Hospital, they all ultimately share the same intent: to raise health care awareness and alleviate young children's anxiety over medical treatment while focusing on the promotion of positive healthy lifestyle. All studies portray the teddy bear hospital as an intervention of medical roleplay which analyzed the children's feelings, behaviors, and health awareness after visiting the Teddy Bear Hospital.Conclusion: The application of the teddy bear hospital has overwhelmingly positive results, with lower levels of anxiety and improved health knowledge. Its reported efficacy calls for future studies on aspects that lead to its efficacy and potential effectiveness.

Active Learning: Basic Science Workshops, Clinical Science Cases, and Medical Role-Playing in an Undergraduate Biology Course

Effective undergraduate courses increasingly blend elements of active learning with a more traditional lecture format. Designing and implementing active learning sessions that engage, educate, and are challenging and workable in a group setting are essential for student learners. In addition, active learning sessions take concepts of fundamental knowledge and apply them to a more relevant and real-world environment. Thus, effective active learning lesson plans enable students to thrive in their educational experience, and this potentially enhances material retention. Presented here are examples of the critical components of active learning engagement in an undergraduate biology course. First, basic science workshops let students apply basic scientific principles to biomedical science scenarios. Second, clinical science case studies help students understand the interplay between basic and clinical sciences in a patient-based medical case format. Finally, medical role-playing allows student teams to understand the complexity of medical care, moving from the patient’s presenting symptoms to formulating a diagnosis and treatment plan. These exercises strengthen several aspects of active learning, especially those related to student-team-based collaboration, conversation, coordination, and compilation.

The efficiency of the medical role within a Single Point of Access (SPA) Service in reducing the number of clinic appointments required

AimsThe SPA service takes referrals from general practitioners (GPs), medical professionals, the London Ambulance service, the London Police, psychology and social services, and from patients themselves and their family members or support groups. Some of these referrals require input from secondary care, but others can be solved within primary care if given specialist advice, this minimizing the time spent by patients in the healthcare system and minimizing also the NHS costs.Our aim was to evaluate the implementation of the Advice from Medics Service in a 1-year period.MethodWe examined a random sample of 200 referrals between 1st of April 2019 and 31st of March 2020 out of all referrals that were considered, after the triage, to be appropriate for an advice on treatment provided by the medics as an alternative to a clinic appointment in secondary care. We collected information from the electronic patient records regarding the dates of referrals, the senders of referrals, the type of referrals, the age and gender of patients and the reasons to be referred, and finally we analysed the outcome of the referrals and compared it with the action requested.ResultOf the 200 referrals, 113 were for female patients and 87 for male patients. The age of patients was between 18 and 91 years old, with a median of 43 years old.The person/authority making the referral was the GP in 179 cases, and others in 21 cases.The referrers asked for review in 74 cases, urgent review in 2 cases, review and advice in 31 cases, only advice in 46 cases, and did not state the type of referral in 47 cases.The primary pathology implied was affective in most of the cases (122), followed by psychotic (31) and neurotic (22), organic (8), of personality (5), hyperkinetic disorders (5), due to substance misuse (4), of psychological development (2) and learning disability (1).The outcome of the referrals was as follows: 19 patients (9.5%) were seen by the Crisis Team, 11 (5.5%) were referred to other teams, 4 (2%) did not engage with SPA, and the rest of 166 (83%) referrals were solved with advice.ConclusionThe outcome was extremely favourable as the majority of referrals requested medical review but most of them (83%) were solved with specialist advice to GPs or other professionals, highlighting that the implementation of the Advice from Medics Service has been an improvement to the SPA.

Recent changes in COVID-19 Vaccine Hesitancy among Healthcare Workers

IntroductionEarly COVID-19 vaccine acceptance rates suggest that up to one-third of HCWs may be vaccine-hesitant. However, it is unclear whether hesitancy among HCWs has improved with time and if there are temporal changes whether these differ by healthcare worker role.MethodsIn October 2020, a brief survey was sent to all participants in the Healthcare Worker Exposure Response and Outcomes (HERO) Registry with a yes/no question regarding vaccination under emergency use authorization (EUA): “If an FDA emergency use-approved vaccine to prevent coronavirus/COVID-19 was available right now at no cost, would you agree to be vaccinated?” The poll was repeated in December 2020, with the same question sent to all registry participants. Willingness was defined as a “Yes” response, and hesitancy was defined as a “No” response. Participants were stratified into clinical care roles. Baseline demographics of survey respondents at each timepoint were compared using appropriate univariate statistics (chi-squared and t-tests). Analyses were descriptive, with frequencies and percentages reported for each category.ResultsOf 4882 HERO active registry participants during September 1 – October 31, 2020, 2070 (42.4%) completed the October survey, and n=1541 (31.6%) completed the December survey. 70.2% and 67.7% who were in clinical care roles, respectively. In October, 54.2% of HCWs in clinical roles said they would take an EUA-approved vaccine, which increased to 76.2% in December. The largest gain in vaccine willingness was observed among physicians, 64.0% of whom said they would take a vaccine in October, compared with 90.5% in December. Nurses were the least likely to report that they would take a vaccine in both October (46.6%) and December (66.9%). We saw no statistically significant differences in age, race/ethnicity, gender, or medical role between time points. When restricting to the 998 participants who participated at both time points, 69% were vaccine-willing at both time points; 15% were hesitant at both time points, 13% who were hesitant in October were willing in December; and 2.9% who were willing in October were hesitant in December.ConclusionsIn a set of cross-sectional surveys of vaccine acceptance among healthcare workers, willingness improved substantially over 2 calendar months during which the US had a presidential election and two vaccine manufacturers released top-line Phase 3 trial results. While improved willingness was observed in all role categories, nurses reported the most vaccine hesitancy at both time points.

Study on the Optimization for the Extraction Process of Andrographolide by Ultrasonic Assisted Extraction

Because andrographis has a long history of folk medicine in Southeast Asian countries with antibacterial, antipyretic, antineoplastic, anti-inflammatory, cardioprotective effect and so on, the areas where andrographolia is introduced and cultivated are mainly concentrated. Espically andrographolide, neoandrographolide, andrographiside, homoandrographolide, andrographane, andrographanin, andrographone and andrographosterol that is concentrated in the leaves of the plant play the main medical role of andrographis. Of the above chemicals, andrographolide is the major bioactive constituent responsible for variety of activities. Leaves and stems of plant are used for extracting active phytochemicals; roots are used rarely. In this study, improved the extractability of andrographolide from the A. paniculata by ultrasonic assisted extraction, the optimum condition for extracted the andrographolide is determined by response surface experiment and detected the extractability of andrographolide under the optimum condition. By single factor analysis and response surface experiments, the optimum conditions for extracted the andrographolide were the extraction solution concentration 62.8%, the ultrasonic extraction time 59min, the ratio of solid to liquid 1:10.5 and the extraction temperature 62?. Investigate the andrographolide extractability in the optimun extraction condition by HPLC were increased from 2.27% to 3.28%.

Passing the Abortion Act 1967

This chapter looks at the debates surrounding the passage of the Abortion Act 1967 and how it operated to extend medical power over abortion. It argues that in order for medicalisation to take place, it was necessary to convince doctors that they had a legitimate ‘social’ as well as ‘medical’ role. This was achieved in particular through a series of revisions to the controversial ‘social clause’ of the Act, which provided for abortions for non-medical reasons. Constructions of women seeking abortion as victims or essentially vulnerable – and therefore in need of the authority and paternalistic guidance of the doctor – were central to this process.