A letter about Jean Fernel by Charles Sherrington and the mind–brain connection

In 1940 during the early phase of the Nazi aerial assault on Britain, the English neurophysiologist, C.S. Sherrington, age 83 years, had just published a philosophical work, Man on His Nature, and was researching the writings of Jean Fernel, a 16th century French physician . Sherrington’s study of Fernel stemmed from a common interest they shared in the association between the mind and the brain. This essay was prompted by a short letter penned by Sherrington in December 1940 and bound years later in his biography, The Endeavour of Jean Fernel, published in 1946. The letter requested information about a particular medical work by Fernel but also mentioned in passing Sherrington’s recent forced evacuation from his home in Ipswich, threatened by German bombing and invasion. The letter in the book invited a reprise of his remarkable career and a study of his last neurological concern – the mind–brain mystery.

The Action Chrétienne en Orient: From Missionary Society to Fellowship of Churches

The Action Chrétienne en Orient was founded in 1922 in order to bring relief among displaced Christians, especially Armenians, in Syria. It also supported the displaced Protestant communities in their ecclesiastical, educational and medical work. In structure the ACO resembled other Protestant missionary societies, but it had some unique features such as its trans-European character. At the time of the decolonization, the work of the ACO changed as the local Protestant churches took charge and the ACO devolved its responsibilities. In the postcolonial period the ACO gradually embraced a missiology that was focused on partnership. This led to the formation of the ACO Fellowship, a communion of churches and mission agencies.

The COVID-19 pandemic: an analysis of the epidemic situation and the restructuring of medical education (according to the Republic оf Mordovia)

Возникновение нового варианта вируса и эпидемический потенциал, проявленный возбудителем COVID-19, поставили перед специалистами здравоохранения задачи, связанные с быстрой разработкой диагностики и профилактики новой инфекции, а также тактики оказания медицинской помощи больным. Активное распространение коронавирусной инфекции заставило активно вносить изменения в систему медицинского образования. Целью данной работы был анализ эпидемиологической ситуации по COVID-19 в Республике Мордовия для понимания особенностей развития эпидемического процесса и составления его прогноза, а также рассмотрения перестройки образовательного процесса в условиях пандемии. Проведен ретроспективный анализ эпидемиологической ситуации по заболеваемости COVID-19 в Республике Мордовия, проанализирована эффективность реализации профилактических и противоэпидемических мероприятий, приведены данные по динамике заболеваемости, выздоровлению и летальности пациентов. Изучены элементы перестройки образовательного процесса. Проанализирована эпидемиологическая ситуация в сравнении с некоторыми регионами РФ, изучены данные по проведению вакцинации, по динамике коечного фонда за период пандемии. Вероятность смерти от коронавируса COVID-19 в Республике Мордовия аналогична мировым показателям. Можно предположить, что дистанционное обучение займет одну из лидирующих позиций в высшей школе. Благополучная ситуация в Республике Мордовия с заболеваемостью и летальностью от новой коронавирусной инфекции складывалась благодаря реализации научно обоснованной стратегии опережающего реагирования – на основе постоянной оценки масштабов распространения новой коронавирусной инфекции, анализа тенденций эпидемического процесса, моделирования развития эпидемической ситуации и проводимых превентивных мероприятий. Непосредственное участие преподавателей университета в лечебной работе, использование их опыта и знаний в решении практических задач будут способствовать повышению качества медицинской помощи и развитию системы здравоохранения Республики Мордовия не только в условиях пандемии COVID-19, но и в дальнейшем. The emergence of a new variant of the virus and the epidemic potential manifested by the causative agent of COVID-19 have set health professionals tasks related to the rapid development of diagnostics and prevention of a new infection, as well as tactics for providing medical care to patients. The active spread of coronavirus infection has forced active changes to the system of medical education. The goal is to analyze the epidemiological situation of COVID-19 in the Republic of Mordovia in order to understand the development of the epidemic process and make a forecast, consideration of the restructuring of the educational process in the context of a pandemic. In this article, a retrospective analysis of the epidemiological situation on the incidence of COVID-19 in the Republic of Mordovia is carried out, the effectiveness of the implementation of preventive and anti-epidemic measures is analyzed, data on the dynamics of morbidity, recovery and mortality of patients are presented. The elements of the restructuring of the educational process are studied. The epidemiological situation was analyzed in comparison with some regions of the Russian Federation, data on vaccination, on the dynamics of the bed fund during the pandemic period were studied. The probability of death from the COVID-19 coronavirus in the Republic of Mordovia is similar to the indicators around the world. It can be assumed that distance learning will take one of the leading positions in the process of studying in higher education. A favorable situation in the Republic of Mordovia with morbidity and mortality from a new coronavirus infection was formed positive to the implementation of a scientifically grounded strategy of proactive response – based on a constant assessment of the scale of the spread of a new coronavirus infection, analysis of trends in the epidemic process, modeling the development of the epidemic situation and ongoing preventive measures. The direct participation of university teachers in medical work, the use of their experience and knowledge in solving practical problems will contribute to improving the quality of medical care and the development of the healthcare system of the Republic of Mordovia not only in the conditions of the COVID-19 pandemic, but also in the future.

Correlation of Renal Profiles with Choroidal Vascularity Index in Eyes with Diabetic Retinopathy

The vascular system is affected by systemic conditions, including diabetes, hypertension, and cardiovascular disease. The choroid is an important vascular tissue surrounding the sensory retina. However, the relationship between the choroid and systemic factors in patients with diabetes has rarely been investigated. Here, we assessed the correlation of renal profiles with choroidal vasculature in eyes with diabetic retinopathy (DR) using a retrospective study design. The study included 131 patients with diabetes who underwent swept-source optical coherence tomography and routine medical work-up within a 4-week period between 1 February 2016 and 30 October 2018. Consecutive patients with treatment-naïve DR who did not receive any subsequent treatment were included. The distribution of patients according to the DR stage was as follows: no DR, 32 patients; mild-to-moderate non-proliferative DR (NPDR), 33 patients; severe NPDR, 34 patients; and treatment-naïve proliferative DR, 32 patients. Multivariate regression analyses showed that the choroidal vascularity index (CVI) of naïve eyes with DR was negatively correlated with age (p = 0.013) and the serum levels of phosphorus (p = 0.002) and positively correlated with subfoveal choroidal thickness (p < 0.001). Taken together, our findings suggest that a lower CVI is associated with phosphorus retention in patients with chronic kidney disease.

Clinical guidelines and clinical autonomy: exploring the missing link

PurposeThis paper aims at understanding how clinical guidelines' use in the labour process relates to clinical autonomy, that is, the self-control medical professionals exercise over medical practice.Design/methodology/approachDrawing on a qualitative case study research strategy, this paper explores how medical professionals use clinical guidelines in the labour process in one public general hospital of the Greek National Health System. Supplemented by an extensive study of documents, semi-structured interviews were conducted with 33 doctors of several specialties.FindingsThe analysis shows (1) how clinical autonomy, as a self-control structure, mediates the use of clinical guidelines as a knowledge tool in the labour process, and (2) how employing clinical guidelines as a means towards coordinating medical work, but also towards regulating and standardising medical practice, is exercising pressure on the individualistic character of clinical autonomy.Originality/valueAdvancing the analytic value of workplace control structures, this paper contributes novel theoretical understanding of emerging tendencies characterising medical work organisation and clinical autonomy, and explains how medical professionals' non-adherence to clinical practice guidelines (CPGs) relates to CPGs' role as a resource to medical practice. Finally, this research proposes a more critical approach to health policy towards addressing the challenges associated with centrally introducing clinical guidelines in healthcare organisations.

The Comparative Study of Social Organizations and Hospital

Hospital is a social organization and logical combination of the activities of a number of persons with different level of knowledge and skill for achieving a common goal of patient care through a hierarchy of authority and responsibility. Public and professional interest in health services has increased dramatically over the last two decades. Medical sociologists have been interested in the structure, organization, dynamics, and impact of health services for well over 50 years. Sociologists have been instrumental in highlighting the challenges associated with integrating care, as well as the inter‐ and intra‐organizational dynamics that are occurring within increasingly complex healthcare systems (Flood and Fennel 1995; Light 2004; Scott et al. 2000). Understanding these organizational changes is critical because they reflect fundamental shifts in the nature of medical work and the delivery of health services. Today’s complex health systems represent fundamentally new configurations of an increasingly broad array of professional expertise that is altering the long standing system of professional. In this, the health care system has been elaborately discussed focusing mainly on hospital system. Following are some of the points focusing on hospital as a social organization. Goffman described hospitals as “total institutions” (referring in particular to asylums for those with mental health problems, but also to hospitals more generally), in which people were isolated from society over a period of time and led life an in enclosed and formally administered way (Goffman, 1968). He argued that, as a result of this experience, people often formed new relationships and attachments dependent on these institutions (i.e. underwent a process of “institutionalization”) that could make re-integration into the community on discharge very difficult. Keywords: Social organization, Hospital, Medical sociologists, Goffman, system of professional, “institutionalization

Changes in the organ of vision in children and adults with confirmed COVID-19 and anti-epidemic measures

The COVID-19 pandemic revealed several aspects of the problems directly related to the Ophthalmologists: damage to the eyes of patients with the SARS-CoV-2 virus; organization of medical work in a pandemic, including in a medical department redesigned to treat patients infected with SARS-CoV-2; side effects of personal protective equipment usage and anti-epidemic measures aimed to protect the organ of vision. Ocular manifestations were noted in 15–23% of children and 4–31% of adults with COVID-19. They were usually limited to acute conjunctivitis with «clear» discharge, hyperemia, edema and folliculosis of the conjunctiva, which reduced in 7–14 days without any treatment or on symptomatic therapy. The presence of SARS-CoV-2 in the tear and epithelium of the conjunctiva does not always correlated with the presence and severity of conjunctivitis and therefore had no clinical significance. There were also other problems associated with anti-epidemic measures (dry eye syndrome when wearing personal protective equipment, computer visual syndrome, etc.), which also requires attention of Ophthalmologists. Key words: COVID-19, SARS-CoV-2, ocular manifestations in children and adults.