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Right brain injury causes visual neglect - lost awareness of left space. During prism adaptation therapy, patients adapt to a rightward optical shift by recalibrating right arm movements leftward. This can improve left neglect, but the benefit of a single session is transient (~1 day). Here we show that tonic disinhibition of left motor cortex during prism adaptation enhances consolidation, stabilizing both sensorimotor and cognitive prism after-effects. In three longitudinal patient case series, just 20 min of combined stimulation/adaptation caused persistent cognitive after-effects (neglect improvement) that lasted throughout follow-up (18–46 days). Moreover, adaptation without stimulation was ineffective. Thus stimulation reversed treatment resistance in chronic visual neglect. These findings challenge consensus that because the left hemisphere in neglect is pathologically over-excited it ought to be suppressed. Excitation of left sensorimotor circuits, during an adaptive cognitive state, can unmask latent plastic potential that durably improves resistant visual attention deficits after brain injury.

Background Experts in the field of medical education emphasized the need for curricula that improve students’ attitudes toward the underserved. However, some studies have shown that medical education tends to worsen these attitudes in students. We aimed at systematically reviewing the literature assessing the change in medical students’ attitudes toward the underserved and intention to work with the underserved throughout medical education, the sociodemographic and educational factors associated with favorable medical student attitudes toward and/or intention to work with the underserved and the effectiveness of educational interventions to improve medical student attitudes toward and/or intention to work with the underserved. Method We conducted a systematic review on MEDLINE, Scopus, and Web of Science databases. Three investigators independently conducted the electronic search. We assessed the change in medical students attitudes toward the underserved by computing a weighted mean effect size of studies reporting scores from validated scales. The research team performed a meta-analysis for the sociodemographic and educational factors associated with medical students attitudes toward and/or intention to work with the underserved. Results Fifty-five articles met the inclusion criteria, including a total of 109,647 medical students. The average response rate was 73.2%. Most of the studies were performed in the USA ( n  = 45). We observed a significant decline of medical students attitudes toward the underserved throughout medical education, in both US and non-US studies. A moderate effect size was observed between the first and fourth years (d = 0.51). Higher favorable medical students attitudes toward or intention to work with the underserved were significantly associated with female gender, being from an underserved community or ethnic minority, exposure to the underserved during medical education and intent to practice in primary care. Regarding educational interventions, the effectiveness of experiential community-based learning and curricula dedicated to social accountability showed the most positive outcome. Conclusions Medical students attitudes toward the underserved decline throughout medical education. Educational interventions dedicated to improving the attitudes or intentions of medical students show encouraging but mixed results. The generalizability of our results is impeded by the high number of studies from the global-North included in the review.

Objective structured clinical examination (OSCE) is a valid method to evaluate medical students’ competencies. The present cross-sectional study aimed at determining how students’ coping and health-related behaviors are associated with their psychological well-being and performance on the day of the OSCE. Fourth-year medical students answered a set of standardized questionnaires assessing their coping (BCI) and health-related behaviors before the examination (sleep PSQI, physical activity GPAQ). Immediately before the OSCE, they reported their level of instant psychological well-being on multi-dimensional visual analogue scales. OSCE performance was assessed by examiners blinded to the study. Associations were explored using multivariable linear regression models. A total of 482 students were included. Instant psychological well-being was positively associated with the level of positive thinking and of physical activity. It was negatively associated with the level of avoidance and of sleep disturbance. Furthermore, performance was negatively associated with the level of avoidance. Positive thinking, good sleep quality, and higher level of physical activity were all associated with improved well-being before the OSCE. Conversely, avoidance coping behaviors seem to be detrimental to both well-being and OSCE performance. The recommendation is to pay special attention to students who engage in avoidance and to consider implementing stress management programs. Clinical trial : The study protocol was registered on clinicaltrial.gov NCT05393206, date of registration: 11 June 2022.

Stroke results in balance disorders and these directly affect autonomy and quality of life. The purpose of this systematic review and meta-analysis was to determine the efficacy of physical therapy (PT) on balance and postural control after stroke. We included all randomized controlled trials assessing the efficacy of PT on balance and postural control in adult patients after stroke without language restriction. Medline, Embase/Scopus, Cochrane Central Register of Controlled Trials, PEDro, Pascal, and Francis databases were searched until January 2019. Primary outcomes were balance (Berg Balance scale and Postural Assessment Scale for Stroke) and postural control with postural deviation or stability measurement in sitting or standing static evaluation. A pair of independent reviewers selected studies, extracted data, and assessed risk of bias. Meta-analyses with subgroups (categories of PT, time post-stroke, and lesion location) and meta-regression (duration of PT) were conducted. A total of 145 studies (n = 5912) were selected from the 13,123 records identified. For balance, evidence was found in favor of the efficacy of functional task-training alone (standardized mean difference 0.39, 95% confidence interval [0.09; 0.68], heterogeneity I2 = 63%) or associated with musculoskeletal intervention and/or cardiopulmonary intervention (0.37, [0.19; 0.55], I2 = 48%), electrostimulation (0.91, [0.49; 1.34], I2 = 52%) immediately after intervention, compared to sham treatment or usual care (ST/UC). For postural deviation eyes open, assistive devices were more effective than no treatment (-0.21, [-0.37; -0.05], I2 = 0%) immediately after intervention; for postural stability eyes open, functional task-training and sensory interventions were more effective than ST/UC (0.97, [0.35; 1.59], I2 = 65% and 0.80, [0.46; 1.13], I2 = 37% respectively) immediately after intervention. Functional task-training associated with musculoskeletal intervention and/or cardiopulmonary intervention and sensory interventions seem to be immediately effective in improving balance and postural stability, respectively. The heterogeneity of PT and the weak methodological quality of studies limited the interpretation and the confidence in findings.

Background The French government has set up a community-based learning programme on health promotion for undergraduate health students to involve them in key public health objectives. At the University of Lyon, students first underwent formal instruction, including e-learning, lectures, and interactive seminars, and then became health educators for school pupils. The main objective of the present study was to assess the process of implementing this programme during the 2018–2019 academic year. Methods The satisfaction and perception of medical and midwife students with community-based learning experiences were assessed by a questionnaire, semi-directive interviews, and observations. Replies to the questionnaire were described by median and interquartile range or by proportion. A paired Wilcoxon-Mann–Whitney test was used to compare self-evaluated students’ competence scores before and after the seminars (alpha risk of 5%). Thematic analyses using grounded theory were performed on recorded and transcribed interviews, and on transcribed notes taken during the observations. Results Over time the students have evolved from a negative perception of the community-based learning to a positive one. The students were mostly satisfied by interactive seminars that allowed them to gain confidence and competencies in health education. Their involvement in the programme increased their self-esteem. They became more aware of their educative responsibilities regarding public health issues as future professionals. Conclusions The students had a positive perception of the implementation of a community-based learning programme in our University, as it appeared a pertinent strategy to raise their awareness of prevention and health education issues.

Background Medical students often encounter challenges in maintaining healthy habits. The Preventive Remediation for Optimal MEdical StudentS (PROMESS) project seeks to support students to adopt healthier lifestyles throughout their curriculum by implementing a program focused on three modules (stress, sleep, and physical activity). Prior to implementation, it was essential to gain insights into students' needs. For this purpose, a comprehensive approach was adopted to ensure that the proposed program aligns with students’ needs, to identify barriers and facilitators for implementation, to propose adjustments, and to test the program. Methods A three-step study was conducted. First, two focus groups sessions, one involving students and the other involving university staff members were conducted to identify medical students' needs and obstacles to change regarding their health. After verbatim transcription, a framework thematic analysis was performed with the use of MAXQDA. Second, a co-construction workshop was conducted with participants from both groups to develop the PROMESS program. Third, some of the medical students who participated in the prior steps tested the co-constructed program. The study was conducted at the Lyon-Est Faculty of Medicine (France, IRB2023070404). Results (i) The medical students cited a heavy academic workload and demanding internships as the main factors that contribute to their limited selfcare, heightened stress levels and sleep disruptions, and reduced physical activity. The university staff members noted that students struggled to acknowledge their needs, accept limitations, and seek assistance. (ii) The participants provided advice for adapting PROMESS program to the students’ specific needs (e.g., individualized advice, one-on-one meetings, peer coaching, and signing a commitment contract). (iii) The students who tested the program reported being more aware of their health behaviors and reported improvement in stress levels, sleep, and physical activity. They believed that the changes could be long-lasting. Conclusion This study identified barriers to changes in medical students’ behaviors that affect their health. The co-construction workshop and the pilot study facilitated program development and enhanced its feasibility and acceptability for broader implementation. This three-step approach highlights the importance of engaging various stakeholders to craft complex health interventions for medical students.

Background Medical students face highly competitive stressful situations throughout their curriculum, which can lead to elevated stress levels and a major decline in quality of life, well-being, learning abilities, and health. It is crucial to assist medical students in coping with these stressful situations during their curriculum. Methods The PROMESS-Stress clinical trial aims to support future healthcare professionals by enhancing their abilities to manage stressful situations. The support will be provided through a 3-session stress management program. Each session will include an individual meeting between a PROMESS-Stress expert and a medical student. To reduce stress levels and enhance coping mechanisms, these sessions will focus on establishing personalized advice and goals. The present protocol is designed to assess the influence of this program on forty-five undergraduate medical students (4th and 5th-year) of the Lyon-Est Faculty of Medicine (Claude Bernard University Lyon 1, France). Assessments of psychological and physiological stress variables will be conducted before and during the intervention. At the end of the 3rd session the student’s levels of satisfaction will be assessed. The primary outcome will be changes in scores on the Perceived Stress Scale (PSS), while secondary outcomes will provide a detailed characterization of the intervention’s effects on stress coping behaviors, psychological and physiological stress variables. Exploratory outcomes will provide information regarding the student’s level of satisfaction and will determine the moderators of the program’s efficacy. Data will be analyzed according to the intention-to-treat principle and presented in accordance with the CONSORT Guidelines. Ethical approval has been obtained by the Institutional Review Board (IRB: 2023–07-04–02) and all the procedures will be performed in adherence to the Helsinki declaration. Results from this study will be presented at scientific conferences and in peer-reviewed scientific journals. Discussion Results will provide valuable insights into the program's efficacy in reducing stress and improving coping abilities. If its efficacy is proven, PROMESS-Stress could become an integral and sustainable part of medical education, fostering a healthier and more resilient future for healthcare professionals. This manuscript follows the SPIRIT guidelines (Additional files 1 & 6). Trial registration ClinicalTrials.gov: NCT06295133; retrospectively registered.

Findings regarding the impact of language bias on treatment effect estimates (TEE) are conflicting, and very few studies have assessed these impacts in rehabilitation. The purpose was to compare TEE between studies published in non-English language (SPNEL) and those published in English language (SPEL) included in a previously published meta-analysis assessing the effects of physical therapy on balance and postural control after stroke. Six databases were searched until January 2019. Two independent reviewers selected randomised trials, extracted data, and assessed risk of bias. We conducted subgroup meta-analyses according to the language of study publication, then compared TEE between SPEL and SPNEL subgroups by using a random-effects meta-regression model. From 13,123 records, 132 SPEL (n = 5219) and 13 SPNEL (n = 693) were included. SPNEL had a weight in the pooled estimate (8.2%) significantly lower than SPEL (91.8%; p<0.001). Compared to SPEL, SPNEL had both significantly worse methodological quality (p = 0.002) and quality of reporting for blinding of outcome assessment (p<0.001); and a significantly worse quality of reporting for incomplete outcome data (p<0.001). SPNEL had a significantly worse precision (i.e. inverse of variance) of TEE than SPEL (p = 0.005). Overall, the TEE was not significantly different between SPNEL and SPEL (standardised mean difference -0.16, 95% confidence interval [-0.53; 0.22], heterogeneity I2 = 78%). However, when PT was compared to sham treatment or usual care, SPNEL significantly over-estimated treatment effects (SMD -0.68, 95%CI [-1.03; -0.33], I2 = 39%) compared to SPEL. Restriction of the search to SPEL only did not change the direction of TEE for 8 out of 9 comparisons. SPNEL had a worse methodological quality than SPEL and were likely to over-estimate treatment effect. If inclusion of SPNEL in a systematic review is considered to be relevant, the impact of such studies on TEE should be explored by sensitivity analyses to ensure the findings validity.

Background Medical students face a demanding workload, stressful situations, and irregular sleep patterns, which can lead to elevated sleep disturbances and high fatigue levels. These difficulties may be further associated with a major decline in well-being, quality of life, performance, and health. Thus, these struggles must be addressed to reduce these students’ sleep disturbances and fatigue during their curriculum. Methods The PROMESS-Sleep clinical trial aims to support future healthcare professionals by enhancing their abilities to manage their sleep. The support will be provided through a three-session sleep management program. Each session will include an individual meeting between a PROMESS-Sleep expert and a medical student, during which self-care education, advice, and personalized goals will be established. The present protocol is designed to assess the influence of this program on 45 undergraduate medical students (fourth- and fifth-year) of the Lyon-Est Faculty of Medicine (Claude Bernard University Lyon 1, France). Assessments of sleep and fatigue will be conducted before and during the intervention using self-reported questionnaires and actigraphy. At the end of the third session, the student’s satisfaction levels regarding the program will be assessed. The primary outcome will be changes in scores on the Pittsburgh Sleep Quality Index (PSQI) during the program. Secondary outcomes will provide a detailed characterization of changes in various aspects of sleep disturbances, fatigue, sleep habits, and sleep-wake rhythms. Exploratory outcomes will provide information regarding the students’ satisfaction levels and will determine the moderators of the program’s efficacy. Data will be analyzed according to the intention-to-treat principle and presented in accordance with the CONSORT Guidelines. Ethical approval has been obtained by the Institutional Review Board (IRB: 2023-07-04-03), and all procedures will be performed in adherence to the Helsinki Declaration. The results from this study will be presented at scientific conferences and in peer-reviewed scientific journals. Discussion The results will provide valuable insights into the program’s efficacy in reducing sleep disturbances and fatigue. If its efficacy is proven, PROMESS-Sleep could become an integral and sustainable part of medical education due to fostering a healthier and more resilient future for healthcare professionals. This manuscript follows the SPIRIT guidelines (Additional files 1 & 8). Trial registration ClinicalTrials.gov: NCT06297330; retrospectively registered.

IntroductionTetraplegia causes extensive sensorimotor deficits affecting activity, participation and quality of life. People with C6-C7 tetraplegia can learn to grasp objects by performing wrist extension movement (ie, tenodesis grasp), and motor imagery (MI) added to rehabilitation significantly improved tenodesis grasp. We hypothesise that this improvement can be further boosted by adding neurofeedback during MI. Thus, we design a randomised controlled trial investigating the effect of MI training on grasping ability in people with C6-C7 tetraplegia.Methods and analysisWe will perform a bicentric, assessor-blinded, randomised controlled study. During rehabilitation, 21 inpatients with C6-C7 tetraplegia will be allocated to MI with neurofeedback (MI training with graphical display on a computer screen based on mu (8–13 Hz) and beta (18–25 Hz) frequency rhythms measured with 32-channel electroencephalography), MI alone (only MI training) and control (watching movies and visualisation of geometric shapes). All participants will receive three 45-min training sessions per week for 5 weeks.The primary outcome measure will be wrist extension angle immediately after the intervention during tenodesis grasp measured with a 3D motion analysis system (VICON). Secondary outcomes will include a range of measures: kinematic, grip strength, upper limb range of motion, upper limb strength (manual muscle test and hand-held dynamometer measure), dexterity (box and block test, 9-hole peg test, Jebsen test, capabilities of upper extremity questionnaire), quality of life (WHOQOL-Bref), daily life autonomy (Quadriplegic Index of Function), MI capacity and brain reorganisation (magnetoencephalography only available in Lyon, n=15). We will measure all outcomes five times: during weeks 1, 3 and 5 (baseline), week 11 (immediately after the intervention end) and week 18 (8 weeks after the intervention end).Ethics and disseminationEthical approval was granted on 29 September 2017 (CPP Nord-Ouest-IV 17/25, N°2017-A00990-53). Dissemination will occur via presentation of results in scientific meetings and publication in peer-reviewed academic journals.Trial registration numberNCT03190863 (ClinicalTrials.gov).