Workshops med patient videocases Balslev, Thomas; Leegaard, Anne
Læring og medier,
10/2014, Letnik:
7, Številka:
12
Journal Article
Odprti dostop
Når medicinstuderende begynder at møde patienter, starter de en langvarig proces med dannelse af kognitive mønstre kaldet illness scripts. Hvert enkelt nyt møde med en patient bidrager med nye ...detaljer. Imidlertid mindsker ændringer i arbejdstilrettelæggelse eller naturlige årstidsvariationer de studerendes chance for at møde virkelige patienter. Patient videocases er en værdifuld hjælp til at skabe interaktive, autentiske, virtuelle læringsmiljøer som kan fremme nødvendig script dannelse.Vi ville identificere en række vigtige tilstande, som de medicinstuderende ofte ikke møder dem under deres 16 dage i klinikophold på en børneafdeling. Vi fremstillede 8 digitale patient videocases med passende hyppighed, relevans og teknisk kvalitet. De studerende beskrev og fortolkede dem før de blev gennemgået med en underviser. Efterfølgende udfyldte de studerende et spørgeskema.Alle 65 medicin studerende deltog i de to workshops. Andelen, som udelukkende har mødt patienter med de 8 tilstande via patient videocases var 36,8-87,5 %, afhængigt af tilstanden.
OBJECTIVE
To examine the association between diabetes, glycemic control, and risk of tuberculosis (TB).
RESEARCH DESIGN AND METHODS
We conducted a population-based case-control study in Northern ...Denmark. Cases of active TB were all individuals with a first-time principal hospital diagnosis of TB between 1980 and 2008. Each case subject was matched with up to five population control subjects with similar age, sex, place and length of residence in Denmark, and country of emigration. We computed odds ratios (ORs) for a first-time TB diagnosis among people with and without diabetes using regression to control for other comorbidities, alcoholism, immunosuppressive medications, and socioeconomic markers.
RESULTS
We identified 2,950 patients, including 156 diabetic individuals (5.3%), with active TB, and 14,274 population control subjects, of which 539 had diabetes (3.8%). The adjusted OR for active TB among subjects with diabetes was 1.18 (95% CI 0.96–1.45) compared with nondiabetic individuals. We found a similar risk increase from diabetes in the 843 (29%) TB case subjects who were immigrants; adjusted OR = 1.23 (95% CI 0.78–1.93). In a subset with laboratory data, diabetic individuals with an HbA1c <7.0, 7–7.9, and ≥8.0% had ORs of 0.91 (0.51–1.63), 1.05 (0.41–2.66), and 1.19 (CI 0.61–2.30), respectively, compared with individuals without diabetes.
CONCLUSIONS
In the low TB–burden country of Denmark, the TB risk increase associated with diabetes is substantially lower than previously suggested. We found no evidence for any association between TB and dysglycemia.
To examine the pain threshold in children with juvenile idiopathic arthritis (JIA) compared with healthy children by using a digital pressure algometer.
Fifty-eight children with JIA born between ...1995 and 2000 and 91 age-related healthy children participated in the study. We used a digital pressure algometer to measure the pain threshold on 17 symmetric, anatomically predefined joint-related or bone-related areas. All children were asked to rate their current pain on a Faces Pain Scale, and parents of children with JIA were asked to complete a parental revised version of the Child Health Assessment Questionnaire (CHAQ-R). Clinical data were registered on children with JIA.
The pain threshold was significantly lower among children with JIA (total mean PT = 1.33 ± 0.69 kg/cm(2)) when compared with the healthy control group (total mean PT = 1.77 ± 0.67 kg/cm(2)). The same pattern was found in all areas measured, including negative control areas that are normally unaffected in JIA (p = 0.0001 to 0.005). Overall, the pain threshold was 34% lower in females than in males in both groups (p < 0.0001). We found no correlation between pain threshold and age, current pain experience, disease duration, or disease activity.
Children with JIA had a substantially lower pain threshold even in areas usually unaffected by arthritis. Our findings suggest that JIA alters the pain perception and causes decreased pain threshold.
Infants with Noonan Syndrome and hypertrophic cardiomyopathy have a poor prognosis and a high mortality especially when diagnosed before six months of age. As for the majority of the RASopathies, no ...medical treatment has been approved for Noonan Syndrome. Meanwhile, several approved agents targeting the same RAS/MAPK signaling pathway are used in cancer treatment. In this case report we describe a child with Noonan Syndrome caused by a pathogenic RIT1 variant, who developed severe early-onset hypertrophic cardiomyopathy and pulmonary valve stenosis. She received off-label treatment with the MEK-inhibitor trametinib which resulted in complete remission of the cardiac hypertrophy and a significant improvement of the pulmonary valve stenosis. Our case emphasizes the potential of existing cancer agents targeting the RAS/MAPK signaling pathway as successful treatment for RASopathy manifestations.
Når medicinstuderende begynder at møde patienter, starter de en langvarig proces med dannelse af kognitive mønstre kaldet illness scripts. Hvert enkelt nyt møde med en patient bidrager med nye ...detaljer. Imidlertid mindsker ændringer i arbejdstilrettelæggelse eller naturlige årstidsvariationer de studerendes chance for at møde virkelige patienter. Patient videocases er en værdifuld hjælp til at skabe interaktive, autentiske, virtuelle læringsmiljøer som kan fremme nødvendig script dannelse.Vi ville identificere en række vigtige tilstande, som de medicinstuderende ofte ikke møder dem under deres 16 dage i klinikophold på en børneafdeling. Vi fremstillede 8 digitale patient videocases med passende hyppighed, relevans og teknisk kvalitet. De studerende beskrev og fortolkede dem før de blev gennemgået med en underviser. Efterfølgende udfyldte de studerende et spørgeskema.Alle 65 medicin studerende deltog i de to workshops. Andelen, som udelukkende har mødt patienter med de 8 tilstande via patient videocases var 36,8-87,5 %, afhængigt af tilstanden.
Workshops med patient videocases Thomas Balslev; Anne Leegaard
Læring og medier,
10/2014, Letnik:
7, Številka:
12
Journal Article
Odprti dostop
Når medicinstuderende begynder at møde patienter, starter de en langvarig proces med dannelse af kognitive mønstre kaldet illness scripts. Hvert enkelt nyt møde med en patient bidrager med nye ...detaljer. Imidlertid mindsker ændringer i arbejdstilrettelæggelse eller naturlige årstidsvariationer de studerendes chance for at møde virkelige patienter. Patient videocases er en værdifuld hjælp til at skabe interaktive, autentiske, virtuelle læringsmiljøer som kan fremme nødvendig script dannelse. Vi ville identificere en række vigtige tilstande, som de medicinstuderende ofte ikke møder dem under deres 16 dage i klinikophold på en børneafdeling. Vi fremstillede 8 digitale patient videocases med passende hyppighed, relevans og teknisk kvalitet. De studerende beskrev og fortolkede dem før de blev gennemgået med en underviser. Efterfølgende udfyldte de studerende et spørgeskema. Alle 65 medicin studerende deltog i de to workshops. Andelen, som udelukkende har mødt patienter med de 8 tilstande via patient videocases var 36,8-87,5 %, afhængigt af tilstanden.
OBJECTIVE: To examine the association between diabetes, glycemic control, and risk of tuberculosis (TB). RESEARCH DESIGN AND METHODS: We conducted a population-based case-control study in Northern ...Denmark. Cases of active TB were all individuals with a first-time principal hospital diagnosis of TB between 1980 and 2008. Each case subject was matched with up to five population control subjects with similar age, sex, place and length of residence in Denmark, and country of emigration. We computed odds ratios (ORs) for a first-time TB diagnosis among people with and without diabetes using regression to control for other comorbidities, alcoholism, immunosuppressive medications, and socioeconomic markers. RESULTS: We identified 2,950 patients, including 156 diabetic individuals (5.3%), with active TB, and 14,274 population control subjects, of which 539 had diabetes (3.8%). The adjusted OR for active TB among subjects with diabetes was 1.18 (95% CI 0.96–1.45) compared with nondiabetic individuals. We found a similar risk increase from diabetes in the 843 (29%) TB case subjects who were immigrants; adjusted OR = 1.23 (95% CI 0.78–1.93). In a subset with laboratory data, diabetic individuals with an HbA1c <7.0, 7–7.9, and ≥8.0% had ORs of 0.91 (0.51–1.63), 1.05 (0.41–2.66), and 1.19 (CI 0.61–2.30), respectively, compared with individuals without diabetes. CONCLUSIONS: In the low TB–burden country of Denmark, the TB risk increase associated with diabetes is substantially lower than previously suggested. We found no evidence for any association between TB and dysglycemia.
Pain is still a part of everyday living for several children with juvenile idiopathic arthritis (JIA) despite improvement in treatment. Psychological interventions may contribute to diminish pain ...complaints and improve well-being in children with JIA. Only few studies have investigated the efficacy of psychological therapy in children with arthritis and with mixed results. The aim of the study was to evaluate the feasibility and preliminary efficacy of a cognitive behavioral therapy group intervention for children with JIA and their parents.
Nineteen children with JIA and their parents were allocated to six sessions' group cognitive-behavioral therapy (n = 9) or a waitlist control condition (n = 10). Results were measured from self-reported scales and one-week pain diaries. Clinical data was collected by a rheumatologist.
The participation rate was low; 33 % of the invited families participated. However, the participants rated the intervention's credibility and satisfaction with the intervention as high. The dropout rate was low and attendance rate high. Increased quality of life and improvements in adaptive pain cognitions was reported in the intervention condition compared to the waitlist condition, whereas no differences were found for pain and functional disability. The disease activity increased in the treatment condition but not in the control condition.
The feasibility of this study seemed high with regards to the acceptability of the families participating in the intervention. However, the feasibility in general was challenged by implementation problems with a low participation rate. A reduction in pain after the intervention was not found even though pain management was the main target in the intervention. Preliminary analysis showed that although the severity of the disease status increased, an increase in quality of life, reduction in pain catastrophizing, and an improvement in adaptive pain cognitions (the beliefs in controlling pain and self-efficacy) were seen in the intervention condition. The study highlights the importance of considering the disease status when evaluating the efficacy of a psychological intervention in children with arthritis. Conclusions on the strength of the efficacy require further research in a large, randomized controlled trial.
Automated testing of antimicrobial susceptibility is common in clinical microbiology laboratories but their ability to detect low‐level resistance has been questioned. This Nordic multicentre study ...aimed to evaluate the performance of commercially available automated AST systems. A phenotypically well‐characterised collection of gram‐negative bacilli (Escherichia coli (n = 7), Klebsiella pneumoniae (n = 6) and Pseudomonas aeruginosa (n = 7)) with and without resistance mechanisms was examined by Danish (n = 1), Finnish (n = 6), Norwegian (n = 16) and Swedish (n = 5) laboratories. Minimum inhibitory concentrations (MICs) were determined for 12 antimicrobials with automated systems and compared with MICs obtained with gold standard broth microdilution. The automated systems used were VITEK 2 (n = 23), Phoenix (n = 4), MicroScan (n = 1), and ARIS (n = 1). Very major errors were identified for six antimicrobials; cefotaxime (6.9%), meropenem (0.4%), ciprofloxacin (0.7%), ertapenem (4.3%), amikacin (3.4%) and colistin (6.4%). Categorical agreement of MIC for the automated systems compared to broth microdilution ranged from 83% for imipenem to 100% for ampicillin and trimethoprim‐sulfamethoxazole. The analysis revealed several important antimicrobials where resistance was underestimated, potentially with significant consequences in patient treatment. The results cast doubt on the use of automated AST in the management of patients with serious infections and suggests that more work is needed to define their limitations.
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