Accomplishments and challenges in picornavirology as observed by a medical doctor

Background: The family of picornaviridae has been studied extensively: the structure of the virion and its replication strategy are known in molecular detail. Nevertheless, infections with the multitude of enteroviruses still cause widespread epidemics, serious disease and a diversity of clinical syndromes ranging from central nervous system involvement to light febrile illness. Infections with more than 100 human rhinovirus types are an important economic factor.Objective: In order to treat and control picornavirus infections with their great diversity of manifestations the pathogenesis of diseases must be better understood, e.g. concerning virus spread in the organism or molecular detail of the disease processes, such as cell tropism of the virus or cytokine and immunologic actions. Elucidation of mechanisms of virus transmission in the population is also needed.Study design: This review discusses aspects of our present knowledge of the pathogenesis, transmission, prophylaxis and treatment of picornavirus infections.Conclusions: The need for further development of selective antiviral substances, safe vaccines and basic research in picornavirology is stressed.     

The medical student as behavioural psychotherapist.

A group of medical students were randomly selected from a larger group to carry out behaviour therapy under supervision. Ten patients with phobic disorders and two with obsessive-compulsive neurosis were treated, and the results, assessed by ratings of proved reliability, compared favourably with other studies in which psychiatrists or nurses acted as therapists. A questionnaire survey showed that students involved in therapy had a more favourable opinion about this kind of treatment than those receiving only theoretical instruction. The results suggested not only that medical students make good behavioural psychotherapists but also that the subject is a worthwhile training experience which warrants inclusion in the curriculum.     

'Well doctor, it is all about how life is lived': cues as a tool in the medical consultation

Introduction During consultations, the perspective of the patient and the family physician come together. In order to reach a shared view about the symptoms it is important to know the agenda of the patient. Cues (i.e. non-explicit remarks that can enclose a special meaning) can serve as a tool to clarify the agenda.Case report In this article, we describe a patient with unexplained palpitations during vacuuming. During one of the following consultations she provided an important psychosocial cue which changed my perspective on her palpitations, resulting in a deeper understanding of her symptoms.Discussion Recognition and exploration of cues is important for reaching mutual understanding of doctors and patients about the symptoms. Moreover, it enhances the therapeutic relationship and improves illness outcomes and patient satisfaction.Conclusion Noticing cues in the medical consultation helps the doctor to understand the patient's real worries. It gives us, as doctors, a better understanding of the patient's perspective.