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Pandya JD, Musyaju S, Modi HR, Okada-Rising SL, Bailey ZS, Scultetus AH, Shear DA. Intranasal delivery of mitochondria targeted neuroprotective compounds for traumatic brain injury: screening based on pharmacological and physiological properties. J Transl Med 2024; 22:167. [PMID: 38365798 PMCID: PMC10874030 DOI: 10.1186/s12967-024-04908-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 01/18/2024] [Indexed: 02/18/2024] Open
Abstract
Targeting drugs to the mitochondrial level shows great promise for acute and chronic treatment of traumatic brain injury (TBI) in both military and civilian sectors. Perhaps the greatest obstacle to the successful delivery of drug therapies is the blood brain barrier (BBB). Intracerebroventricular and intraparenchymal routes may provide effective delivery of small and large molecule therapies for preclinical neuroprotection studies. However, clinically these delivery methods are invasive, and risk inadequate exposure to injured brain regions due to the rapid turnover of cerebral spinal fluid. The direct intranasal drug delivery approach to therapeutics holds great promise for the treatment of central nervous system (CNS) disorders, as this route is non-invasive, bypasses the BBB, enhances the bioavailability, facilitates drug dose reduction, and reduces adverse systemic effects. Using the intranasal method in animal models, researchers have successfully reduced stroke damage, reversed Alzheimer's neurodegeneration, reduced anxiety, improved memory, and delivered neurotrophic factors and neural stem cells to the brain. Based on literature spanning the past several decades, this review aims to highlight the advantages of intranasal administration over conventional routes for TBI, and other CNS disorders. More specifically, we have identified and compiled a list of most relevant mitochondria-targeted neuroprotective compounds for intranasal administration based on their mechanisms of action and pharmacological properties. Further, this review also discusses key considerations when selecting and testing future mitochondria-targeted drugs given intranasally for TBI.
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Affiliation(s)
- Jignesh D Pandya
- TBI Bioenergetics, Metabolism and Neurotherapeutics Program, Brain Trauma Neuroprotection (BTN) Branch, Center for Military Psychiatry and Neuroscience (CMPN), Walter Reed Army Institute of Research (WRAIR), 503 Robert Grant Avenue, Silver Spring, MD, 20910, USA.
| | - Sudeep Musyaju
- TBI Bioenergetics, Metabolism and Neurotherapeutics Program, Brain Trauma Neuroprotection (BTN) Branch, Center for Military Psychiatry and Neuroscience (CMPN), Walter Reed Army Institute of Research (WRAIR), 503 Robert Grant Avenue, Silver Spring, MD, 20910, USA
| | - Hiren R Modi
- TBI Bioenergetics, Metabolism and Neurotherapeutics Program, Brain Trauma Neuroprotection (BTN) Branch, Center for Military Psychiatry and Neuroscience (CMPN), Walter Reed Army Institute of Research (WRAIR), 503 Robert Grant Avenue, Silver Spring, MD, 20910, USA
| | - Starlyn L Okada-Rising
- TBI Bioenergetics, Metabolism and Neurotherapeutics Program, Brain Trauma Neuroprotection (BTN) Branch, Center for Military Psychiatry and Neuroscience (CMPN), Walter Reed Army Institute of Research (WRAIR), 503 Robert Grant Avenue, Silver Spring, MD, 20910, USA
| | - Zachary S Bailey
- TBI Bioenergetics, Metabolism and Neurotherapeutics Program, Brain Trauma Neuroprotection (BTN) Branch, Center for Military Psychiatry and Neuroscience (CMPN), Walter Reed Army Institute of Research (WRAIR), 503 Robert Grant Avenue, Silver Spring, MD, 20910, USA
| | - Anke H Scultetus
- TBI Bioenergetics, Metabolism and Neurotherapeutics Program, Brain Trauma Neuroprotection (BTN) Branch, Center for Military Psychiatry and Neuroscience (CMPN), Walter Reed Army Institute of Research (WRAIR), 503 Robert Grant Avenue, Silver Spring, MD, 20910, USA
| | - Deborah A Shear
- TBI Bioenergetics, Metabolism and Neurotherapeutics Program, Brain Trauma Neuroprotection (BTN) Branch, Center for Military Psychiatry and Neuroscience (CMPN), Walter Reed Army Institute of Research (WRAIR), 503 Robert Grant Avenue, Silver Spring, MD, 20910, USA
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Hoegerl C. Organizational behavior among academic medical school faculty. J Osteopath Med 2021; 121:483-487. [PMID: 33694354 DOI: 10.1515/jom-2020-0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 09/02/2020] [Indexed: 11/15/2022]
Abstract
The study of organizational behavior in an academic medical school setting has many variables for consideration, including fragmentation, responsibilities, professionalism, burnout, and gender. In this Commentary, the author highlights some major factors affecting osteopathic physicians who practice in an academic setting, to bring to the attention of the medical community some of the inherent problems with modern academic medical education structure.
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Affiliation(s)
- Carl Hoegerl
- Liberty University College of Osteopathic Medicine, Lynchburg, VA, USA
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dos Santos MF, Schoueri JFL, Vidal CT, Hamamoto Filho PT, Fukushima FB, Vidal EIO. Missed opportunities in the way medical schools evaluate the ethical domain in clerkship rotations. PLoS One 2019; 14:e0217717. [PMID: 31141551 PMCID: PMC6541282 DOI: 10.1371/journal.pone.0217717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 05/16/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Several lines of evidence indicate that medical schools have been failing to adequately nurture empathy and the ethical dimension in their graduates, the lack of which may play a central role in the genesis of medical errors, itself a major source of avoidable deaths, incapacity and wasted resources. It has been widely proposed that medical schools should adopt evaluation strategies as a means to promote a culture of respectful relationships. However, it is not clear if evaluation strategies in medical schools have addressed key domains related to that aim, such as ethics, through the perspective of their students. Hence, we conducted a national survey of instruments used by Brazilian medical schools to assess clerkship rotations from the perspective of students, with a main focus on the ethical domain. METHODS The authors invited 121 randomly selected institutions to participate in the study. Key informants answered a questionnaire about clerkship rotations and sent copies of any instrument used to assess the quality of clerkship rotations according to the students' perspectives. RESULTS Twenty-six (53%) of 49 participating schools used an instrument to assess the quality of clerkship rotations according to the perspective of students. Just 13 (27%) schools had instruments containing at least one question encompassing the ethical domain. Only 2 (4%) schools asked students specifically about the occurrence of any negative experience concerning the ethical domain during rotations. Merely 1 (2%) school asked students about having witnessed patient mistreatment and none asked about mistreatment against students themselves. CONCLUSIONS There are several missed opportunities in the way medical schools assess the quality of clerkship rotations regarding the ethical domain. Closing the gap between usual institutional discourses regarding ethics and how that dimension is assessed within clerkship rotations might represent an important step towards the improvement of medical education and healthcare systems.
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Affiliation(s)
- Maria Fernanda dos Santos
- Public Health Department, Botucatu Medical School, Sao Paulo State University (UNESP), Botucatu, SP, Brazil
- Occupational Therapy Department, University of Sorocaba (UNISO), Sorocaba, SP, Brazil
| | - João F. L. Schoueri
- Internal Medicine Department, Botucatu Medical School, Sao Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Camila T. Vidal
- Internal Medicine Department, Botucatu Medical School, Sao Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Pedro T. Hamamoto Filho
- Neurology, Psychology and Psychiatry Department, Botucatu Medical School, Sao Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Fernanda B. Fukushima
- Anesthesiology Department, Botucatu Medical School, Sao Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Edison I. O. Vidal
- Internal Medicine Department, Botucatu Medical School, Sao Paulo State University (UNESP), Botucatu, SP, Brazil
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Diraviam SP, Sullivan PG, Sestito JA, Nepps ME, Clapp JT, Fleisher LA. Physician Engagement in Malpractice Risk Reduction: A UPHS Case Study. Jt Comm J Qual Patient Saf 2018; 44:605-612. [DOI: 10.1016/j.jcjq.2018.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 03/22/2018] [Indexed: 11/26/2022]
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Tiong JJL, Kho HL, Mai CW, Lau HL, Hasan SS. Academic dishonesty among academics in Malaysia: a comparison between healthcare and non-healthcare academics. BMC MEDICAL EDUCATION 2018; 18:168. [PMID: 30016945 PMCID: PMC6050687 DOI: 10.1186/s12909-018-1274-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 07/10/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND This study was carried out to gauge the prevalence of academic dishonesty among academics in Malaysian universities. A direct comparison was made between academics of healthcare and non-healthcare courses to note the difference in the level of academic integrity between the two groups. In addition, the predisposing factors and implications of academic dishonesty, as well as the different measures perceived to be effective at curbing this problem were also investigated. METHODS A cross-sectional study design with mixed qualitative and quantitative approaches was employed and data collection was carried out primarily using self-administered questionnaire. RESULTS Approximately half (52.5%, n = 74) of all respondents (n = 141) reported having personally encountered at least one case of academic dishonesty involving their peers. The results also revealed the significantly higher prevalence of various forms of academic misconduct among healthcare academics compared to their non-healthcare counterparts. Although respondents were generally conscious of the negative implications associated with academic dishonesty, more than half of all cases of misconduct were not reported due to the indifferent attitude among academics. Low levels of self-discipline and integrity were found to be the major factors leading to academic misdeeds and respondents opined that university managements should be more proactive in addressing this issue. CONCLUSIONS The outcome of this study should serve as a clarion call for all relevant stakeholders to start making immediate amends in order to improve the current state of affairs in academia.
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Affiliation(s)
- John Jeh Lung Tiong
- 0000 0004 0647 0003grid.452879.5School of Pharmacy, Taylor’s University, No. 1, Jalan Taylor’s, 47500 Subang Jaya, Selangor Malaysia
| | - Hui Ling Kho
- 0000 0004 0647 0003grid.452879.5School of Pharmacy, Taylor’s University, No. 1, Jalan Taylor’s, 47500 Subang Jaya, Selangor Malaysia
| | - Chun-Wai Mai
- 0000 0000 8946 5787grid.411729.8School of Pharmacy, International Medical University, 126, Jalan Jalil Perkasa 19, Bukit Jalil, Kuala Lumpur Malaysia
| | - Hui Ling Lau
- 0000 0004 0647 0003grid.452879.5School of Pharmacy, Taylor’s University, No. 1, Jalan Taylor’s, 47500 Subang Jaya, Selangor Malaysia
| | - Syed Shahzad Hasan
- 0000 0000 8946 5787grid.411729.8School of Pharmacy, International Medical University, 126, Jalan Jalil Perkasa 19, Bukit Jalil, Kuala Lumpur Malaysia
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Hill TE, Martelli PF, Kuo JH. A case for revisiting peer review: Implications for professional self-regulation and quality improvement. PLoS One 2018; 13:e0199961. [PMID: 29953510 PMCID: PMC6023173 DOI: 10.1371/journal.pone.0199961] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 06/18/2018] [Indexed: 12/04/2022] Open
Abstract
Background Quality improvement in healthcare has often been promoted as different from and more valuable than peer review and other professional self-regulation processes. In spite of attempts to harmonize these two approaches, the perception of dichotomous opposition has persisted. A sequence of events in the troubled California prison system fortuitously isolated workforce interventions from more typical quality improvement interventions. Our objectives were to (1) evaluate the relative contributions of professional accountability and quality improvement interventions to an observed decrease in population mortality and (2) explore the organizational dynamics that potentiated positive outcomes. Methods Our retrospective mixed-methods case study correlated time-series analysis of mortality with the timing of reform interventions. Quantitative and qualitative evidence was drawn from court documents, public use files, internal databases, and other archival documents. Results Change point analysis reveals with 98% confidence that a significant improvement in age-adjusted natural mortality occurred in 2007, decreasing from 138.7 per 100,000 in the 1998–2006 period to 106.4 in the 2007–2009 period. The improvement in mortality occurred after implementation of accountability processes, prior to implementation of quality improvement interventions. Archival evidence supports the positive impact of physician competency assessments, robust peer review, and replacement of problem physicians. Conclusions Our analysis suggests that workforce accountability provides a critical quality safeguard, and its neglect in scholarship and practice is unjustified. As with quality improvement, effective professional self-regulation requires systemic implementation of enabling policies, processes, and staff resources. The study adds to evidence that the distribution of physician performance contains a heterogeneous left skew of dyscompetence that is associated with significant harm and suggests that professional self-regulation processes such as peer review can reduce that harm. Beyond their responsibility for direct harm, dyscompetent professionals can have negative impacts on group performance. The optimal integration of professional accountability and quality improvement systems merits further investigation.
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Affiliation(s)
- Terry E. Hill
- Hill Physicians Medical Group, San Ramon, California, United States of America
- Center for Catastrophic Risk Management, University of California, Berkeley, California, United States of America
- * E-mail:
| | - Peter F. Martelli
- Center for Catastrophic Risk Management, University of California, Berkeley, California, United States of America
- Sawyer Business School, Suffolk University, Boston, Massachusetts, United States of America
| | - Julie H. Kuo
- Hill Physicians Medical Group, San Ramon, California, United States of America
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Martinez W, Lehmann LS, Thomas EJ, Etchegaray JM, Shelburne JT, Hickson GB, Brady DW, Schleyer AM, Best JA, May NB, Bell SK. Speaking up about traditional and professionalism-related patient safety threats: a national survey of interns and residents. BMJ Qual Saf 2017; 26:869-880. [DOI: 10.1136/bmjqs-2016-006284] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 04/03/2017] [Accepted: 04/04/2017] [Indexed: 11/04/2022]
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Webb LE, Dmochowski RR, Moore IN, Pichert JW, Catron TF, Troyer M, Martinez W, Cooper WO, Hickson GB. Using Coworker Observations to Promote Accountability for Disrespectful and Unsafe Behaviors by Physicians and Advanced Practice Professionals. Jt Comm J Qual Patient Saf 2016; 42:149-64. [PMID: 27025575 DOI: 10.1016/s1553-7250(16)42019-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Health care team members are well positioned to observe disrespectful and unsafe conduct-behaviors known to undermine team function. Based on experience in sharing patient complaints with physicians who subsequently achieved decreased complaints and malpractice risk, Vanderbilt University Medical Center developed and assessed the feasibility of the Co-Worker Observation Reporting System(SM) (CORS (SM)) for addressing coworkers' reported concerns. METHODS VUMC leaders used a "Project Bundle" readiness assessment, which entailed identification and development of key people, organizational supports, and systems. Methods involved gaining leadership buy-in, recruiting and training key individuals, aligning the project with organizational values and policies, promoting reporting, monitoring reports, and employing a tiered intervention process to address reported coworker concerns. RESULTS Peer messengers shared coworker reports with the physicians and advanced practice professionals associated with at least one report 84% of the time. Since CORS inception, 3% of the medical staff was associated with a pattern of CORS reports, and 71% of recipients of pattern-related interventions were not named in any subsequent reports in a one-year follow-up period. CONCLUSIONS Systematic monitoring of documented co-worker observations about unprofessional conduct and sharing that information with involved professionals are feasible. Feasibility requires organizationwide implementation; co-workers willing and able to share respectful, nonjudgmental, timely feedback designed initially to encourage self-reflection; and leadership committed to be more directive if needed. Follow-up surveillance indicates that the majority of professionals "self-regulate" after receiving CORS data.
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Affiliation(s)
- Lynn E Webb
- Vanderbilt University Medical Center (VUMC), Nashville, Tennessee, USA
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de Oliveira Vidal EI, Silva VDS, Santos MFD, Jacinto AF, Boas PJFV, Fukushima FB. Why medical schools are tolerant of unethical behavior. Ann Fam Med 2015; 13:176-80. [PMID: 25755040 PMCID: PMC4369591 DOI: 10.1370/afm.1763] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Revised: 10/16/2014] [Accepted: 01/05/2015] [Indexed: 12/30/2022] Open
Abstract
The exposure to unethical and unprofessional behavior is thought to play a major role in the declining empathy experienced by medical students during their training. We reflect on the reasons why medical schools are tolerant of unethical behavior of faculty. First, there are barriers to reporting unprofessional behavior within medical schools including fear of retaliation and lack of mechanisms to ensure anonymity. Second, deans and directors do not want to look for unethical behavior in their colleagues. Third, most of us have learned to take disrespectful circumstances in health care institutions for granted. Fourth, the accreditation of medical schools around the world does not usually cover the processes or outcomes associated with fostering ethical behavior in students. Several initiatives promise to change that picture.
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Affiliation(s)
| | - Vanessa Dos Santos Silva
- Internal Medicine Department, Universidade Estadual Paulista (UNESP), Botucatu, Sao Paulo, Brazil
| | | | | | | | - Fernanda Bono Fukushima
- Anesthesiology Department, Universidade Estadual Paulista (UNESP), Botucatu, Sao Paulo, Brazil
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Martinez W, Pichert JW, Hickson GB, Cooper WO. Editorial: Programs for Promoting Professionalism: Questions to Guide Next Steps. Jt Comm J Qual Patient Saf 2014; 40:159-60. [DOI: 10.1016/s1553-7250(14)40020-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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