Medicina Clinica Practica最新文献

Medical education should foster professionals with knowledge and skills, professional attitudes, and social responsibilities. Undergraduate and postgraduate education and continuing professional development as specialist each have unique possibilities and responsibilities.

The use of varied assessment formats assist progression towards the expected program outcomes. An analysis of the main methods for assessing clinical competence is done. This will support students, provide confidence, and document the competence acquired; needed for safe practise, professional life-long learning, being a member of the medical knowledge community and a catalyst for a health promoting society.

Spanish medical schools have partially incorporated the Bologna Process, including the introduction of outcome-based medical education. With some exceptions however, they continue with non-integrated curricula, structured on independent subjects.

Instead, integrated and progressive competence assessment programs in horizontally and vertically integrated curricula should be established based on the programmatic assessment paradigm. This supports feedback and summative decisions for each student, to help them progress and reach the expected outcomes.

Background and objective

Interprofessional education allows improving communication and acquiring interprofessional competencies for better patient care. The aim of the present study was to analyze such changes in the class group, and before-after participating in an undergraduate subject based on interprofessional simulation.

Methodology

Descriptive cross-sectional study in first year students of the nursing degree and second year students of the medical degree before participating in the interprofessional simulation elective subject in the subsequent academic year. A prospective before and after study was conducted with 12 students of the nursing degree and 12 medical students who received such training. The Interprofessional Socialization and Values Scale was used to assess attitudes and beliefs toward collaborative education and socialization in the professional group. Differences between grades were analyzed with the Mann-Whitney U test and between the two phases with the Friedman test for paired data.

Results

Overall, nursing students showed better pre-simulation role knowledge than medical students. In the pre-simulation cut-off, interprofessional simulation students scored low on the ISVS scale items related to the use of common language, role knowledge and shared decision making. In the post-simulation cut-off they scored significantly higher on all items of the scale (p < 0.001).

Conclusions

Interprofessional simulation-based education is optimal for developing interprofessional socialization between nursing and medical students in the context of an elective subject with students from both grades. It enables training of one's own role and knowledge of the role of the other members, improving communication and teamwork.

Dengue is a viral disease, with a wide clinical spectrum ranging from mild to severe forms, with involvement of multiple organs including the skin. Skin involvement is diverse from rash to rare forms of leukocytoclastic vasculitis. We present the case of a 44-year-old male patient who was admitted with fever, edema of the lower limbs and rash on the upper limbs that progressed to sloughing, confirming the diagnosis of dengue-associated vasculitis by biopsy. A review of the literature was carried out in order to understand the pathophysiological mechanisms involved, as well as its management.

Introduction

Malignancy-associated ascites (MAA) is the second cause of new-onset ascites after cirrhosis with portal hypertension (PHT), and is usually related to peritoneal carcinomatosis. Ascitic fluid is an exudate, with low serum-ascites albumin gradient (SAAG), ≥ 500 lymphocytes/mm³ and positive cytology. However, MAA may show atypical patterns. Signet ring cell carcinoma (SRCC) is a poor prognosis adenocarcinoma subtype with special clinical and endoscopic presentation.

Case summary

A 68-year-old female, without relevant medical history, with a ventriculoperitoneal shunt (VPS), presented a 1-week increase of abdominal perimeter, loose stools, hyporexia, and fever. In repeated paracentesis, ascites showed transudate properties, high SAAG, low cellularity, negative cultures, and cytologies. She didn’t have neurological impairments nor VPS dysfunctions. Significant PHT and other ascites etiologies were excluded. Ascites persisted despite evacuation paracentesis and diuretics. Further diagnostic workup finally revealed peritoneal carcinomatosis probably originated in a cecal SRCC.

Conclusions

We report an atypical presentation of MAA (transudative ascites, SAAG suggesting PHT, low cellularity, and initially negative cytology) due to a rare adenocarcinoma subtype, representing a challenge regarding its unusual characteristics and difficulties to reach a final diagnosis.

Background

Professionalism is a multidimensional and evolving structure with has socio-cultural information that affects patient satisfaction, and health care outcomes. An important part of nurses' professional behavior is formed during their student years and through education and learning. The aim of this study was assessing the professionalism in internship nursing student.

Methods

This cross-sectional study was conducted in Shiraz University of Medical Sciences. The data collection instrument was a nursing professionalism questionnaire that was completed by 2 instructors for 70 final-year nursing students in the internship. Method of sampling used non-probability convenience sampling. The data were analyzed using SPSS, version 16, for Windows (SPSS Inc., Chicago, IL, USA). Descriptive statistics (mean and percentage) were used to describe demographic characteristics and mean scores of professionalisms and its dimensions. Histograms and the bias-kurtosis and Shapiro–Wilk test were used to evaluate the normality. Comparisons between the two groups were made by independent samples t-test. To compare more groups, the Kruskal–Walli’s test was used.

Result

The findings of this study show that the mean score of professionalism was 75.26(± 10.5), the highest mean was related to the dimension of behavior based on professional values and norms (80.36 ± 9.93) and the lowest mean was related to the dimension of professional interactions (75.00 ± 13.72). Students with perfect regular participation in their internship had a significantly higher professionalism score than other students (P-value = .0001). There was no significant relationship between students' gender and score professionalism (P < .571).

Conclusion

Given the importance of familiarity of undergraduate students with the concepts of professionalism in theory, providing practical training of these concepts through experienced instructors and role models can be an effective step in developing professionalism in nurses after their graduation.