Acta medica portuguesa最新文献

Myasthenia gravis is an autoimmune disease that affects the neuromuscular junction, mainly through the action of pathogenic antibodies such as those directed against the nicotinic acetylcholine receptor or, more infrequently, against the muscle specific kinase. Other important components of the autoimmune process include the complement pathway and B and T cell populations. Diagnosis is based on the finding of fatigable muscle weakness, which can affect several muscle groups, either in isolation or in variable combinations. Neurophysiological techniques and/or the detection of pathogenic antibodies in serum are also essential for the diagnosis of myasthenia gravis. Maintenance treatment was traditionally based on corticosteroids and non-steroidal immunosuppressants. Recently approved drugs, such as the terminal complement pathway inhibitors and the neonatal Fc receptor antagonists, are reshaping the treatment landscape, supported by robust evidence of an excellent combination of efficacy and safety. Although several international guidelines have been published in the last decade, some key questions remain without precise guidance. Hence, a group of nine experts from the Portuguese Neuromuscular Society has elaborated consensus guidelines that aim to provide detailed guidance on diagnostic workup and treatment, grounded both in published evidence and in clinical experience. Key novel aspects include step-by-step instructions for diagnostic workup, a set of diagnostic criteria, guidance on the use of complement inhibitors and neonatal Fc receptor antagonists, and tailored treatment algorithms according to antibody subgroup and clinical severity.

Introduction: Even though ethical decision-making is a cornerstone of medical practice there is a lack of validated tools to assess ethical sensitivity among medical students, junior, and senior doctors. The aim of this study was to adapt and validate the Ethics in Health Care Questionnaire - Version 2 (EHCQ-2) for use in Portugal, ensuring its relevance in evaluating ethical sensitivity within the Portuguese healthcare context.

Methods: The EHCQ-2 was translated into European Portuguese and culturally adapted through a rigorous process involving forward and back-translation, expert review, cognitive interviews with medical professionals, and pilot testing. A validation study was conducted with a sample of 156 participants, including medical students, junior, and senior doctors, to evaluate the questionnaire's reliability and validity.

Results: The adapted EHCQ-2 demonstrated good internal consistency (Cronbach's alpha = 0.74) and variable inter-rater reliability (ranging from 0.12 to 0.67 across tasks), reflecting the complexity of ethical dilemmas. Content validity was established through expert evaluation, while construct validity was supported by significant correlations between individual scenarios and overall scores (e.g., r = 0.683 for Scenario 7). Regression analysis revealed that sub-scales measuring issue identification, explanation sophistication, and value recognition collectively explained 99.6% of the variance in total scores, underscoring the questionnaire's robust predictive validity.

Conclusion: The European Portuguese version of the EHCQ-2 is a reliable and valid tool for assessing ethical sensitivity among medical students, junior and senior doctors. Its application can enhance ethics training programs, inform curriculum development, and support efforts to improve ethical decision-making skills in future healthcare professionals. Further research should explore its longitudinal utility and applicability in diverse cultural contexts.

Introduction: Even though mastery of suturing is a core technical skill in surgical education, existing tools for its assessment often lack psychometric validation or are not specifically designed for undergraduate training. The aim of this study was to develop and validate the Minho Suture Assessment Scale (Minho-SAS), a structured instrument to evaluate fundamental suturing competencies in medical students. The research question was whether the Minho-SAS demonstrates validity and reliability as a psychometric tool.

Methods: The development process involved collaboration with multidisciplinary surgical teams and experienced practitioners to ensure content validity. Data from a cohort of medical students were utilized for psychometric evaluation. Dimensionality was assessed using parallel analysis, Bayesian information criterion, unidimensional congruence, item unidimensional congruence, explained common variance, item explained common variance and mean of item residual absolute loadings. Validity based on internal structure was assessed with Rasch model analysis and factor analysis from the tetrachoric correlation matrix. Reliability was assessed using Rasch model standard errors of measurement to obtain a conditional reliability curve and Cronbach's alpha and McDonald's omega internal consistency coefficients.

Results: Analyses supported a unidimensional structure for the Minho-SAS. The single-factor solution explained 39.96% of variance, and Rasch measures accounted for 29.15% (16.43% by persons, 12.72% by items). Residual correlations, factor loadings, and item fit statistics were within acceptable ranges. Reliability indices were satisfactory: Rasch reliability = 0.706; McDonald's omega = 0.889; Cronbach's alpha = 0.883.

Conclusion: The Minho-SAS is a robust instrument specifically tailored for assessing fundamental suturing skills among medical students. Rasch model analysis yielded less favorable results than factor analysis, yet still acceptable. While demonstrating considerable potential, further exploration of Minho-SAS across diverse populations and educational settings is crucial to affirm its broader applicability and impact in medical education and clinical practice.