Joselina Barbosa

Soft tissue injuries after direct laryngoscopy.

STUDY OBJECTIVE The study objective is to determine the incidence of oral soft tissue trauma during classic direct laryngoscopy for tracheal intubation and the risk factors associated with it. DESIGN This is a prospective observational study. SETTING The setting is at a ward. PATIENTS The patients are adults submitted to elective interventions in general surgery requiring tracheal intubation by classic direct laryngoscopy. INTERVENTIONS During 6 months, all patients were interviewed 12-24 hours before anesthesia and after surgery and underwent a detailed oral examination performed by an anesthesiology blind to anesthetic management details and preoperative patient care. MEASUREMENTS Evaluation of oral soft tissue injuries includes oral mucosa including the gums; the alveolar mucosa in the edentulous patient, palate, and the buccal mucosa; lips (mucosa and skin); and the tongue. Injury severity was assessed using the severity scale presented routinely in Portuguese legal medicine research: grade 0, no injuries had; grade 1, mild severity injuries; grade 2, medium severity injuries; and grade 3, major severity injuries. MAIN RESULTS Soft tissue trauma was observed in 278 (52.1%) patients. Soft tissue injury occurred once in 204 (38.2%) patients, 2 in 64 (38.2%) patients, and 3 times in 10 (1.9%) patients. Tongue injury was the most common type of soft tissue trauma (36.3%) followed by lower lip injury (22.3%), upper lip injury (7.1%), and oral mucosa injury (2.1%). All the lesions were grade 1 or 2. Only oral mucosa injury was found to be associated with age group (P = .021). CONCLUSIONS Our study reveals a high incidence of lesions grade 1 or 2 in soft tissue.

How students perceive medical competences: a cross-cultural study between the Medical Course in Portugal and African Portuguese Speaking Countries

BackgroundA global effort has been made in the last years to establish a set of core competences that define the essential professional competence of a physician. Regardless of the environment, culture or medical education conditions, a set of core competences is required for medical practice worldwide. Evaluation of educational program is always needed to assure the best training for medical students and ultimately best care for patients. The aim of this study was to determine in what extent medical students in Portugal and Portuguese speaking African countries, felt they have acquired the core competences to start their clinical practice. For this reason, it was created a measurement tool to evaluate self-perceived competences, in different domains, across Portuguese and Portuguese-speaking African medical schools.MethodsThe information was collected through a questionnaire that defines the knowledge, attitudes and skills that future doctors should acquire. The Cronbachs Alpha and Principal Components Analysis (PCA) were used to evaluate the reliability of the questionnaire. In order to remove possible confounding effect, individual scores were standardized by country.ResultsThe order of the domains scores was similar between countries. After standardization, Personal Attitudes and Professional Behavior showed median scores above the country global median and Knowledge alone showed median score below the country global median. In Portugal, Clinical Skills showed score below the global median. In Angola, Clinical Skills and General Skills showed a similar result. There were only significant differences between countries in Personal Attitudes (p < 0.001) and Professional Behavior (p = 0.043).ConclusionsThe reliability of the instrument in Portuguese and Portuguese-speaking African medical schools was confirmed. Students have perceived their level of competence in personal attitudes in a high level and in opposite, knowledge and clinical skills with some weaknesses.

Pediatric Facial Fractures: A Review of 2071 Fractures.

BackgroundFacial fractures are infrequent in children and adolescents, and there are only few reports that review a significant number of patients. The objective of this study was to analyze the pattern of maxillofacial fractures in pediatric patients of Portugal. Study DesignWe reviewed the clinical records of a series of 1416 patients 18 years or younger with facial fractures, treated by the Department of Plastic Reconstructive, Aesthetic and of Maxillofacial Surgery of São João Hospital, Porto, Portugal, between 1993 and 2012. The following parameters were evaluated: age; sex; cause of the accident; hour, day, and month of hospital admission; location and type of fractures; presence and location of associated injuries; treatment methods; length of in-hospital stay; and complications. ResultsA total of 2071 fractures were treated. The ratio of boys to girls was 3.1:1. Patients between 16 and 18 years old were the major group (43.9%). Motor vehicle accident was the most common cause of injuries (48.7% of patients). Mandibular fractures were the most common (44.4%). Associated injuries occurred in 1015 patients (71.7%). ConclusionsPediatric facial fractures are usually associated with severe trauma. There has been a highly significant decrease (P < 0.001) in pediatric facial fractures in Portugal for the past 20 years.

Predictors of Subclinical Inflammatory Obesity: Plasma Levels of Leptin, Very Low-Density Lipoprotein Cholesterol and CD14 Expression of CD16+ Monocytes

Objective: Predictors of subclinical inflammatory obesity (SIO) can be important tools for early therapeutic interventions in obesity-related comorbidities. Waist circumference (WC) and BMI have different SIO sensitivity. We aimed to i) identify SIO predictors and ii) investigate whether CD16+ monocytes are associated with BMI- (generally) or WC-defined (centrally) obesity. Methods: Anthropometric and metabolic/endocrine (namely catecholamines, adrenaline and noradrenaline) parameters were evaluated, and CD16+ monocytes were studied by flow cytometry in the peripheral blood from 63 blood donors, and compared and correlated to each other. Multiple linear regression analysis was performed to identify variables that best predict SIO. Results: CD16+ monocyte counts were similar in BMI and WC groups. CD16+ monocytes from centrally obese (CO) showed a more inflammatory pattern, as compared to non-CO subjects. WC was sensitive to lipidemia and, in CO subjects, lipidemia was associated with a more inflammatory phenotype of CD16+ monocytes. These differences were not noticed between BMI groups. Adrenaline was correlated with CD16+ monocyte expansion with a lower inflammatory pattern. Leptin, very low-density lipoprotein cholesterol (VLDL-C), and CD14 expression of CD16+ monocytes were found to be CO predictors. Conclusions: WC-, but not BMI-defined obesity, was associated with a more inflammatory pattern of CD16+ monocytes, without monocyte expansion, suggesting that a monocyte maturation process rather than an independent arise of CD16+ monocytes occurs in CO. Thus, in a population with low cardiovascular risk, leptin, VLDL-C, and CD14 expression of CD16+ monocytes predict CO, constituting a putative tool for screening of SIO.

The impact of students and curriculum on self-study during clinical training in medical school: a multilevel approach

BackgroundIn higher education, the focus has shifted from the acquisition of knowledge to learning objectives and skills. This means that, the majority of student learning time is spent independently working outside the classroom. Students take an active role in setting goals, deciding how to achieve them, and planning individual study time. Although extensive research has recognized the importance of curriculum and students’ characteristics in time devoted to self-study, it is still unclear to what extent these variables affect time to study. Due to the growing reliance on self-directed learning in medical education, and in an attempt to elucidate this issue, this research aims to evaluate self-study time during clinical training and assess whether this is more influenced by the student or the curriculum.MethodsA questionnaire was given to 1220 medical students (43.3% of the enrolled students). The students were asked to indicate the average number of study hours per week beyond the time allocated to classes for each clerkship (rotation) attended. Variation and generalizability of students’ self-study were estimated using linear mixed models.ResultsFindings showed that the intrinsic differences within students were a greater source of variation in self-study time than differences within clerkships (56.0% vs. 6.9%). If the amount of self-study dedicated to an individual clerkship is to be determined, at least 32 students are needed to achieve acceptable reliability. However, this data with two clerkships per student can used to retrospectively measure the self-study reported by students in clinical training.ConclusionsThe findings suggest that, both, curriculum and student characteristics influence self-study in undergraduate clinical training. Indeed, students’ characteristics play a significant role in time devoted to study. Further research should be undertaken to investigate students’ characteristics that may predict self-study during undergraduate medical training.

Neuroanatomy Education: The Impact on Perceptions, Attitudes, and Knowledge of an Intensive Course on General Practice Residents.

General practitioners are responsible for the management of an increasing number of patients with neurological illness, and thus a solid education in neurosciences is a necessary component of their training. This study examines the effects of an intensive clinical neuroanatomy course on twenty general practice residents’ perceptions, attitudes, and knowledge. A knowledge test was completed by the participants and by a control group at four different time points. The participants were asked to answer a questionnaire about their reasons for signing up for the course and their attitudes and perceptions toward the course experience. Experimental and control groups demonstrated identical mean baseline test scores. The experimental group significantly increased its test scores (plus 49.0% correct answers, a mean improvement of 120%) relative to controls after the educational intervention. There were no differences among scores from the evaluated time points after the educational intervention in the experimental group. In the control group, there were likewise no significant differences between the four evaluated time points. Most participants indicated that they signed up for the course to update/acquire knowledge and skills in the field of neurosciences, and also because they had difficulty in diagnosing and managing patients with neurological diseases. Participants’ attitudes and perceptions toward the course experience were very positive. Most of the participants (n = 17; 85%) rated the course as “extremely useful,” and 3 (15%) rated it as “very useful.” This study provides evidence demonstrating the potential positive effect of neurosciences education to general practice residents. Anat Sci Educ 10: 465–474.

Haematological malignancies and acute kidney injury requiring nephrology consultation: challenging the worst of the worst

Background Acute kidney injury (AKI) often complicates the course of haematological malignancies (HMs) and confers a worse prognosis. The majority of these patients are managed by the attending physician, yet, a small group, mostly coincident with the worst presentation and outcomes, requires nephrology consultation, challenging the clinician with ethical issues regarding the decision to initiate or forgo renal support therapy. The purpose of this work is to identify the prognostic determinants for in-hospital mortality in this population. Methods A retrospective, observational chart review was undertaken at a single tertiary referral oncological centre. We reviewed the medical records of in-hospital patients with AKI and HM between 1 January 1995 and 31 December 2014 who met the criteria for RIFLE (Risk, Injury, and Failure; and Loss; and End-stage kidney disease) classification of I or higher and were followed by a nephrologist. Results Three hundred and forty-five patients were included in the study. Predictors of in-hospital death in patients with HM and AKI were septic shock [odds ratio (OR) 4.290 (95% CI 2.058–8.943)], invasive mechanical ventilation (IMV) [OR 4.305 (95% CI 2.075–8.928)] and allogeneic stem cell transplantation (SCT) [OR 2.232 (95% CI 1.260–3.953)]. The combination of each risk factor was used to estimate the probability of dying. Patients with all three risk factors had a risk of death of 86%. Conclusions Septic shock, IMV and allogeneic SCT were identified as independent predictors of death in patients with HM and AKI, with only a small chance of survival if all three were present. Depending on the combination of risk factors, the indication for aggressive life support therapies, such as RST, might be questionable.

Changes in the characteristics of facial fractures in children and adolescents in Portugal 1993–2012

We investigated the changes in the characteristics of facial fractures in children and adolescents during a 20-year period in Portugal to try to find out how to prevent such fractures in future. We reviewed the clinical records of patients aged 0-18 years old who had facial fractures treated at the Department of Plastic Surgery, São João Hospital, Porto, during the 20-year period 1993-2012. The patients were divided into two 10-year periods: January 1993 to December 2002, and January 2003 to December 2012, and these were compared and analysed. A total of 1416 patients with 2071 fractures were diagnosed. There was a significant reduction (p<0.001) in the number of patients treated during the two decades. In both groups the number of patients increased with increasing age (p<0.001), and there was a male preponderance in all age groups. Motor vehicle collisions were the main cause of the fractures, and the mandible was the most common site (49.7%). Other injuries were recorded in 1015 patients (71.7%), and the head and neck was the most common site in both decades. Facial fractures in children are usually associated with severe trauma, and their characteristics can be influenced by social and economic factors. Although the number of children injured has decreased significantly during the last decade, facial fractures remain common in Portugal.

Do reciprocal relationships between academic workload and self-regulated learning predict medical freshmen’s achievement? A longitudinal study on the educational transition from secondary school to medical school

One of the most important factors that makes the transition from secondary school to medical school challenging is the inability to put in the study time that a medical school curriculum demands. The implementation of regulated learning is essential for students to cope with medical course environment and succeed. This study aimed to investigate the reciprocal relationships between self-regulated learning skills (SRLS) and academic workload (AW) across secondary school to medical school transition. Freshmen enrolled in medical school (N = 102) completed questionnaires at the beginning and at the end of their academic year, assessing AW (measured as study time hours and perceived workload), SRLS (planning and strategies for learning assessment, motivation and action to learning and self-directedness) and academic achievement. An exploratory factor analysis (EFA) and a longitudinal path analysis were performed. According to the EFA, study time and perceived workload revealed two factors of AW: students who had a high perceived workload also demonstrated increased study time (tandem AW); and those who had a low perceived workload also demonstrated increased study time (inverse AW). Only a longitudinal relationship between SRLS and AW was found in the path analysis: prior self-directedness was related to later tandem AW. Moreover, success during the first year of medical school is dependent on exposure to motivation, self-directedness and high study time without overload during secondary school and medical school, and prior academic achievement. By better understanding these relationships, teachers can create conditions that support academic success during the first year medical school.

Graduate Students in Medicine Course: Motivation, Socialization and Academic Recognition

INTRODUCTION Students with a previous degree have personal and professional experiences that can contribute to a different academic path during the medical course. This study aims to: 1) analyze both satisfaction and impact of academic recognition; 2) investigate whether motivations and expectations at entrance are maintained along the course; 3) to evaluate socialization after regress to higher education. MATERIAL AND METHODS To accomplish the first objective a questionnaire was administered to 82 students who entered the medical school from 2011/2012 to 2013/2014. For the second and third goals a focus group was run (three groups with five students each, representing the three academic years). RESULTS AND DISCUSSION Students felt satisfied with the recognition, and 50% of them believe that accreditations replace knowledge acquired with the curricular units, and 47% preferred to obtain accreditation. Academic achievement was negatively associated with the satisfaction of recognition and positively with age, background and registration cycle. Socialization of these students is distinct from the younger ones, their motivations at entrance are intrinsic and, contrary to expectations, are maintained along the course. CONCLUSION Students prefer recognition instead of attending the curricular units. The most satisfied with the recognition accomplish less credits and the younger ones, from health area and enrolled in the clinical cycle, accomplish more. Along the course, motivations become more solid, expectations change and socialization is carried out with greater responsibility.