Tackling differential attainment in specialist GP training in England and Scotland.

In this article NHS England and NHS Education for Scotland describe practical ways we are tackling differences in the attainment of people training as general practitioners (GPs).Trainees from minority ethnic groups and international medical graduates are less likely than others to qualify as GPs. It is difficult to change systemic inequalities, but over the past five years we have made practical changes to GP speciality training. Educators recognise there is an issue and are trying to tackle it.For example, people who had not successfully qualified had an opportunity to return to GP training. When we provided individualised targeted support, the proportion who completed training significantly increased (76%).This was a catalyst for reviewing unconscious bias in GP training. We implemented a national programme to tackle differential attainment and system-level bias. Educators now work with all GP trainees to identify their individual needs. Supervisors are trained to recognise bias and provide targeted support. There is mental health support and regular reviews to see whether trainees are ready to sit exams. Trainee representatives are championing the learner voice in national committees. Exams are being altered to reduce unconscious bias. We are monitoring attainment over time.The key message is that differential attainment should not be in the 'too hard basket'. The narrative is changing from 'can't do' to 'must do', supported by appropriate leadership, promotion and resourcing. There is much more to do, but we are making changes, evaluating and applying our learning. We have moved from talking to taking action.

[Systematic analysis of evaluations of Objective Structured Clinical Exam (OSCE) multiple circuits: Explanatory variables and inter-rater correlations]. / Analyse systématique des évaluations de circuits multiples d'examen clinique objectif structuré (ECOS) : variables explicatives et corrélations inter-évaluateurs.

INTRODUCTION: Objective Structured Clinical Examinations (OSCEs) assess professional performance in a simulated environment. Following their integration into the reform of the 2nd cycle of medical studies (R2C), this pedagogical modality was implemented in France. This study investigates the variability of students' OSCE scores, as well as their inter-rater reproducibility. METHODS: This single-center retrospective study covered several sessions of evaluative OSCE circuits conducted between January 2022 and June 2023. Variables collected were: baseline situation family, competency domain, presence of a standardized participant for stations; gender and professional status for evaluators; scores (global, clinical and communication skills), number of previously completed OSCE circuits and faculty scores for students. RESULTS: The variability of the overall score was explained mainly (79.7%, CI95% [77.4; 82.0]) by the station factor. The student factor and the circuit factor explained 7.5% [12.9; 20.2] and<0.01% [2.10-13; 2.10-9] respectively. The inter-rater intra-class correlation coefficient was 87.2% [86.4; 87.9] for the global score. Station characteristics (starting situation, domain) and evaluator characteristics (gender, status) were significantly associated with score variations. CONCLUSION: This first study on the variability of OSCE circuit scores in France shows good reproducibility with influence of station characteristics. In order to standardize circuits, variability linked to the domain competency should be considered as well.

Impact of the Covid-19 Pandemic on the Prevalence of MTP Cases and Their Clinicodemographic Profile in India: A Retrospective Multicentric Study.

Background: During the Covid-19 pandemic, reproductive health of women was disproportionately affected due to difficult access to safe abortion and contraceptive services. This study aims to assess the impact of the Covid-19 pandemic on the prevalence of MTP cases and to find out the clinicodemographic profiles of women undergoing MTP during three Covid-waves in different hospitals-Government and private sectors in India. Methods: This retrospective multicentric cohort study was conducted during three Covid-19 pandemic waves. The records were retrieved from the centers' medical record section and the MTP register from the Department of Obstetrics and Gynaecology. Results: On an average, 1.1 women/day underwent MTP during covid waves compared to 1.9 women/day during the pre-covid 2019. The first Covid wave's average MTP/day was very low (0.71) compared to the third (2.88) and second wave (1.12), respectively. These differences were statistically significant (p<0.0001). The most common indication for MTP was contraceptive failure 245(50.9%), followed by eugenic/congenital anomalies 88(18.9%). A total of 244 cases (50.6%) reported for MTP ≤ seven weeks and 114(23.6%) presented between 7 and 12 weeks. More than half (54%) of the women underwent surgical methods for abortion as the unavailability of medical abortion (MA) drugs. IUCD and sterilization were severely affected during the first and second Covid waves. Conclusion: Safe abortions are essential services for reproductive-age women. With the uncertainty of future Covid-like an emergency, we should strengthen our telemedicine network so that women can reach out early and MMA can be initiated to reduce the number of surgical abortions and unwanted pregnancies.

Educating Future Physicians in Artificial Intelligence (AI): An Integrative Review and Proposed Changes.

BACKGROUND: As medicine and the delivery of healthcare enters the age of Artificial Intelligence (AI), the need for competent human-machine interaction to aid clinical decisions will rise. Medical students need to be sufficiently proficient in AI, its advantages to improve healthcare's expenses, quality, and access. Similarly, students must be educated about the shortfalls of AI such as bias, transparency, and liability. Overlooking a technology that will be transformative for the foreseeable future would place medical students at a disadvantage. However, there has been little interest in researching a proper method to implement AI in the medical education curriculum. This study aims to review the current literature that covers the attitudes of medical students towards AI, implementation of AI in the medical curriculum, and describe the need for more research in this area. METHODS: An integrative review was performed to combine data from various research designs and literature. Pubmed, Medline (Ovid), GoogleScholar, and Web of Science articles between 2010 and 2020 were all searched with particular inclusion and exclusion criteria. Full text of the selected articles was analyzed using the Extension of Technology Acceptance Model and the Diffusions of Innovations theory. Data were successively pooled together, recorded, and analyzed quantitatively using a modified Hawkings evaluation form. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses was utilized to help improve reporting. RESULTS: A total of 39 articles meeting inclusion criteria were identified. Primary assessments of medical students attitudes were identified (n = 5). Plans to implement AI in the curriculum for the purpose of teaching students about AI (n = 6) and articles reporting actual implemented changes (n = 2) were assessed. Finally, 26 articles described the need for more research on this topic or calling for the need of change in medical curriculum to anticipate AI in healthcare. CONCLUSIONS: There are few plans or implementations reported on how to incorporate AI in the medical curriculum. Medical schools must work together to create a longitudinal study and initiative on how to successfully equip medical students with knowledge in AI.

Fifteen Years of Experience from a Medical School' Clinical Skills Laboratory.

INTRODUCTION: Medical Education has evolved being defined as a continuum of the medical training from the pre- to the post-graduate period and through a lifetime of medical practice that is mirrored in the competencies framework that several international institutions have established. This creates a challenge to educational institutions (pre- and post-graduate) that traditionally take separate pathways. MATERIAL AND METHODS: The present report is a description of the efforts carried by the School of Medicine of the University of Minho to implement a strategy of teaching/learning methods that follows modern standards towards constructive alignment of the medical curriculum, from the pre- to the post-graduate. The faculty members responsible for these activities make a narrative self-report of the activities developed and where available quantitative data from participant surveys are presented. RESULTS: In order to achieve a constructive alignment of educational/assessment strategies several steps were taken that focused on the revision of the learning goals, teaching methodologies and assessment strategies. This implicated the investment in the training/certification of faculty, acquisition of simulation tools and a dedicated infrastructure. Alumni were a fundamental cornerstone as voluntary faculty contributing to pre-graduate training, but also training their own scholar skills. Overall, courses are rate with a high rate of satisfaction among course participants. DISCUSSION: Setting up the present teaching/learning environment of the School of Medicine of the University of Minho required a collective effort of the faculty, as well a progressive investment in both acquisition of equipment and training of staff. These human and material efforts, however, lead to an excellent return in learning outcomes. CONCLUSION: The main conclusion is that the constructive alignment of educational and assessment strategies towards the medical education continuum needs reflective thinking on the learners' needs. The secondary gain of these initiatives is to provide opportunities for junior doctors to practice teaching.

Introdução: O conceito de Educação Médica tem evoluído sendo definido como um continuum do treino médico desde o pré- ao pós-graduado, prolongando-se por uma vida de prática médica que é espelhada na estrutura de competências que várias instituições internacionais estabeleceram. Isto cria um desafio às instituições de ensino (pre- e pós-graduado) que tradicionalmente funcionam separadamente. Material e Métodos: O presente trabalho reporta os esforços executados pela Escola de Medicina da Universidade do Minho para implementar uma estratégia de métodos de ensino/aprendizagem que seguem os níveis de exigência modernos por forma a se atingir o alinhamento construtivo do currículo médico, desde o pré- ao pós-graduado. Os docentes responsáveis por estas atividades fazem uma narrativa auto reportada das atividades desenvolvidas e quando disponíveis dados quantitativos de inquéritos de avaliação. Resultados: Por forma a atingir o alinhamento construtivo de estratégias educacionais/avaliação vários passos foram dados, que se focaram na revisão dos objetivos de aprendizagem, metodologias de ensino e estratégias de avaliação. Isto implicou o investimento no treino/cerificação dos docentes, aquisição de simuladores e estabelecimento de uma infraestrutura dedicada. Os alumni foram um pilar fundamental trabalhando como docentes voluntários e contribuindo para o treino dos alunos do pré-graduado, e adicionalmente treinando as suas próprias capacidades de ensino. Em geral, os cursos são avaliados com um elevado grau de satisfação entre os participantes dos cursos. Discussão: Montar o atual ambiente de ensino/aprendizagem presente na Escola de Medicina da Universidade do Minho requereu um esforço coletivo dos docentes bem como o investimento progressivo em equipamento e treino da equipa. Estes esforços humanos e materiais, contudo, produziram excelente retorno em termos de resultados de aprendizagem. Conclusão: A principal conclusão é que o alinhamento construtivo das estratégias educativas e de avaliação por forma a atingir as necessidades do continuum da educação médica exige um pensamento reflexivo nas necessidades dos estudantes. Um ganho secundário é que estas iniciativas providenciam oportunidades para médicos juniores praticarem o ensino.

Group Self-Reflection to Address Burnout: A Facilitator's Guide.

Introduction: Inadequately supported clinicians risk burnout, which is prevalent among them. Balint-like groups can be utilized to address clinician stressors and augment interpersonal skills by exploring the clinician-patient relationship. Methods: In January 2012, we initiated the Clinical Case Discussion Group (CCDG), based on Michael Balint's Balint group, at the Boston University School of Medicine Section of General Internal Medicine. The CCDG is an interprofessional group discussion founded on self-reflection of patient cases designed to tease out ethical, psychosocial, and medical issues that impact the clinician-patient relationship. The format consists of a facilitator-led small group session including 5-10 minutes of case discussion followed by open group discussion. In April 2014, we conducted a cross-sectional survey of clinicians who participated in the CCDG to evaluate the group's ability to foster skills in self-reflection, empathy, response to patient challenges, personal awareness, and tolerance of uncertainty, and to address clinicians' personal and professional stressors. Results: More than 75% of clinicians surveyed agreed that participation fostered skills in tolerating uncertainty, increasing empathy, and navigating difficult patient relationships. All respondents agreed the group developed skills in self-reflection. At least 40% of clinicians reported some degree of isolation, professional stress, and personal stress; group participation addressed these issues at least 70% of the time. Discussion: This self-reflection case discussion group, incorporated into academic clinical practice, supports the professional development of a broad cadre of clinicians and addresses both personal and professional stressors. Clinical departments should consider systematically implementing similar groups in practice.

Biomedical Simulation: Evolution, Concepts, Challenges and Future Trends.

Biomedical simulation is an effective educational complement for healthcare training, both at undergraduate and postgraduate level. It enables knowledge, skills and attitudes to be acquired in a safe, educationally orientated and efficient manner. In this context, simulation provides skills and experience that facilitate the transfer of cognitive, psychomotor and proper communication competences, thus changing behavior and attitudes, and ultimately improving patient safety. Beyond the impact on individual and team performance, simulation provides an opportunity to study organizational failures and improve system performance. Over the last decades, simulation in healthcare had a slow but steady growth, with a visible maturation in the last ten years. The simulation community must continue to provide the core leadership in developing standards. There is a need for strategies and policy development to ensure its coordinated and cost-effective implementation, applied to patient safety. This paper reviews the evolutionary movements of biomedical simulation, including a review of the Portuguese initiatives and nationwide programs. For leveling knowledge and standardize terminology, basic but essential concepts in clinical simulation, together with some considerations on assessment, validation and reliability are presented. The final sections discuss the current challenges and future initiatives and strategies, crucial for the integration of simulation programs in the greater movement toward patient safety.

A simulação biomédica é uma ferramenta educativa para a formação nas ciências da saúde, com aplicação nos vários níveis de ensino. Proporciona experiências ativas e sistemáticas de aprendizagem com o treino de conhecimentos, habilidades e atitudes, de forma segura, pedagogicamente orientada e eficiente. Neste contexto, a simulação biomédica proporciona habilidades e experiência que facilitam a transferência de competências cognitivas, psicomotoras e de comunicação, mudando assim o comportamento e atitudes, aumentando, em última instância, a segurança do doente. Para além do impacto sobre o desempenho individual e de equipa, a simulação proporciona o ambiente ideal para o estudo de falhas organizacionais e teste de melhorias nos desempenhos dos sistemas. Nas últimas décadas, a simulação na área da saúde cresceu lentamente, mas de forma constante, com um amadurecimento significativo nos últimos 10 anos. A comunidade de simulação deve continuar a liderar o estabelecimento de standards nesta área, assim como o desenvolvimento de estratégicas e políticas para assegurar a sua implementação coordenada e custo-efetiva, no aumento da segurança do doente. Este artigo apresenta os movimentos evolutivos da simulação biomédica, incluindo uma revisão das iniciativas portuguesas e programas nacionais. Para nivelar o conhecimento e padronizar a terminologia, são apresentados conceitos básicos, mas essenciais, da simulação clínica, juntamente com algumas considerações sobre avaliação, validação e fiabilidade. As seções finais discutem os desafios atuais e as iniciativas e estratégias futuras, cruciais para a integração de programas de simulação no movimento global de promoção da segurança do paciente.

Medical methods for cervical ripening before the removal of intrauterine devices in postmenopausal women: a systematic review.

In China, most women with intrauterine devices (IUDs) ask to have them removed following the menopause. As the cervix is stenotic after the menopause and most IUDs do not have a thread attached, various medical methods are used for cervical ripening prior to IUD removal. A systematic review of the relevant literature was conducted to compare different medical methods for cervical priming with no treatment, or with other methods, prior to IUD removal in postmenopausal women. Multiple electronic databases including the Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, the WHO Reproductive Health Library (2011) and the Chinese Biomedical Literature Database were searched systematically. Reference lists of articles published in English or Chinese between 1980 and 2011 were searched. All randomized controlled trials (RCTs) on IUD removal following the menopause using medical agents compared with no treatment, or with other treatments, were included. Outcomes were the ease of IUD removal, need for forced cervical dilatation, cervical width, procedure time, severe pain and any side-effects. Data were processed using RevMan 5 software. Thirty original RCTs were eligible for inclusion. Most medical agents such as oestrogens, mifepristone, misoprostol and methyl carboprost were highly effective for facilitating IUD removal, and reduced the need for further dilatation during the procedure. In particular, treatment with mifepristone or misoprostol prior to IUD removal was found to increase the width of the cervical canal and reduce the procedure time. Mifepristone was more effective than vaginal misoprostol for cervical dilatation, but it showed similar effectiveness to misoprostol and nilestriol in terms of the ease of IUD removal. Sublingual misoprostol was superior to oral misoprostol for facilitating IUD removal. A dose of misoprostol as low as 200µg was effective for cervical priming. For vaginal and oral misoprostol, the optimum times of application were 2-3h and 1 day prior to the procedure, respectively. All the prophylactic medical methods were able to alleviate pain during IUD removal, and vaginal misoprostol was more effective than nilestriol. Uterine injury was more common with no treatment and with nilestriol. Gastrointestinal side-effects such as nausea and diarrhoea were common with oral misoprostol and vaginal misoprostol, respectively. Therefore, mifepristone or sublingual misoprostol should be the medical treatments of choice. Oestrogen regimens might be alternatives when mifepristone or misoprostol are contraindicated, and there is a need for further study on combined regimens for cervical priming.

Three dimensional anatomy of the anterior cruciate ligament: a new approach in anatomical orthopedic studies and a literature review.

BACKGROUND: The anterior cruciate ligament (ACL) is an important structure in the knee. The ACL does not heal following lesions, and surgical reconstruction is the standard treatment among athletes. Some steps of ACL reconstruction remain controversial. It is important to fully understand the anatomy of the ACL to accurately reproduce its anatomy during surgical reconstructions. The purpose of this study was to evaluate the use of anaglyphic images that produce 3D images to better visualize the anatomy of the ACL, and to highlight the anatomical features of this ligament as reported in the literature. METHODS: We included ten knees in this study. After dissection of the knee structures, pictures were acquired using a camera with Nikon D40, AF-S Nikkor 18-55 mm (1:3.5-5.6 G2 ED), and Micro Nikkor 105 mm (1:2.8) lenses. The pair of images was processed using Callipyan 3D Anabuilder software, which transforms the two images into one anaglyphic image. RESULTS: During the dissection of the knees, nine pictures were acquired and transformed into anaglyphic images. CONCLUSION: This study, demonstrated that the use of 3D images is a useful tool that can improve the knowledge of the anatomy of the knee, while also facilitating knee reconstruction surgery.

A three-dimensional anatomy of the posterolateral compartment of the knee: the use of a new technology in the study of musculoskeletal anatomy.

BACKGROUND: Recently, an interest has developed in understanding the anatomy of the posterior and posterolateral knee. The posterolateral compartment of the knee corresponds to a complex arrangement of ligaments and myotendinous structures. Undiagnosed lesions in this compartment are the main reason for failure of the anterior and posterior cruciate ligament reconstructions. Understanding the anatomy of these structures is essential to assist in the diagnosis and treatment of these lesions. The aim of this study was to better understand the relationship between these structures of the knee using three-dimensional technology. METHODS: Ten knees were included from cadaver lower limbs of adult patients. The skin and subcutaneous tissue were removed leaving only the muscle groups and ligaments. The neurovascular bundles and their ramifications were preserved. Images were acquired from the dissections using a Nikon D40 camera with AF-S Nikkor 18-55 mm (1:3.5 5.6 GII ED) and Micro Nikkor 105 mm (1:2.8) lenses. The pair of images were processed using Callipyan 3D and AnaBuilder software, which transforms the two images into one anaglyphic image. RESULTS: During the dissection of the knees, twelve pictures were acquired and transformed into anaglyphic images. CONCLUSION: The use of three-dimensional images in this study demonstrates that this technique is useful to improve the knowledge in anatomy of the knee as well as for knee reconstruction surgery.

International Tale on Gene Patents - between Medical and Legal Uncertainties / Cuento internacional sobre patentes genéticas: entre la incertidumbre médica y jurídica

This work is inspired by the international litigation chronicle of Myriad Genetics that remains of topical importance in the judicial and academic discourse regardless of the time that passed since. It discusses approaches of various jurisdictions to the problem of gene patenting as well as patenting of geneticdiagnostic testing. The article takes under scrutiny the judgments rendered in the U.S., Australia as well as the decisions by the European Patent Office and placesthem into interdisciplinary background of genetic science. The issue is significant, both theoretically and practically. Notwithstanding the expiration of patents that constituted the subject matter of the Myriad’s various lawsuits, the problem still remains currently relevant. Firstly, because the judgments in individual cases did not answer all the questions, but – in some way – only prepared a path for future decisions. Secondly, it is on account of new scientific breakthroughs in the area of human genetics. Consequently, the domain of genetic diagnostics is under continuous development and in the future may continue to reveal new scientific discoveries and (possibly) inventions. The lack of uniform and transparent rules in this field, and well-defined boundaries for potential monopolies constantly brings not only uncertainty for medical practitioners and scientists, but also real disadvantagesfor the patients. (AU)

Esta obra se inspira en la crónica del litigio internacional de Myriad Genetics, que sigue siendo de actualidad en el discurso judicial y académico a pesar del tiempotranscurrido desde entonces. En él se examinan los enfoques de diversas jurisdicciones sobre el problema de las patentes de genes, así como de las patentes de pruebas de diagnóstico genético. El artículo examina las sentencias dictadas en Estados Unidos y Australia, así como las decisiones de la Oficina Europea de Patentes, y las sitúa en el contexto interdisciplinario de la ciencia genética. La cuestión es importante, tanto desde el punto de vista teórico como práctico. A pesar de la expiración de las patentes que constituyeron el objeto de los diversos pleitos de Myriad, el problema siguesiendo de actualidad. En primer lugar, porque las sentencias dictadas en los casos individuales no respondieron a todas las preguntas, sino que –en cierto modo– sólo prepararon el camino para futuras decisiones. En segundo lugar, debido a los nuevosavances científicos en el ámbito de la genética humana. En consecuencia, el ámbito del diagnóstico genético está en continuo desarrollo y en el futuro puede seguirrevelando nuevos descubrimientos científicos y (posiblemente) invenciones. La falta de normas uniformes y transparentes en este ámbito y de límites bien definidos para los monopolios potenciales no sólo genera constantemente incertidumbre para losmédicos y científicos, sino también desventajas reales para los pacientes. (AU)

Habilidades investigativas en estudiantes de medicina. Universidad de Ciencias Médicas de Sancti Spíritus. Curso 2013-2014 / Investigative abilities in medicine students. University of Medical Sciences of Sancti Spiritus. Academical year 2013-2014

Fundamento: La pertinencia y calidad de la educación superior es posible con actividad investigativa evidente e implícita, por ser consustancial con el proceso docente educativo. Objetivo: Identificar el nivel de desarrollo de las habilidades investigativas en estudiantes de Medicina de segundo año de la Universidad de Ciencias Médicas de Sancti Spiritus, durante el curso 2013-2014. Metodología: Se revisaron y analizaron 73 informes de trabajos científicos estudiantiles mediante una guía estructurada según el Estilo de Presentación de Investigaciones Científicas o indicaciones de comités organizadores de otros eventos, se observaron concurrentemente exposiciones y defensas de trabajos en la Jornada Científico estudiantil, Fórum de Historia y Jornada de Infecciones de Trasmision Sexual. El procesamiento de datos obtenidos incluyó distribución de frecuencia absoluta y relativa, con triangulación de métodos técnica y fuentes. Resultados: Predominó un escaso desarrollo de habilidades investigativas relacionadas con diseño teórico, fundamentalmente en problema científico y formulación de objetivos, errores ortográficos, de transcripción, redacción, en el apoyo digital de la exposición, expresión oral y argumentación en la defensa. Conclusiones: Existen necesidades de preparación científica estudiantil, desde asignaturas y disciplinas, rol de tutores, y protagonismo de organizaciones laborales y estudiantiles, con intencionalidad en el trabajo, que propicie la motivación y participación efectiva, lo que tributa a mejores modos de actuación y formación integral del futuro egresado.

Background: The relevancy and quality of the superior education is possible with evident and implicit investigative activity, to be consubstantial with the educational educational process. Objective: To identify the level of development of the investigative abilities in Medicine students of second year at the University of Medical Sciences of Sancti Spiritus, during the academical year 2013-2014. Methodology: 73 reports of student scientific works were checked and analyzed by means of a guide structured according to the Style of Presentation of Scientific Investigations or indications of organizing committees of other events, exhibitions and defenses of concurrently works in the Scientist student´s Day, Forum of History and Day of Sexual Transmission Infections were observed. The prosecution of obtained data included distribution of absolute and relative frequency, with technical triangulation of methods and sources. Results: A scarce development of investigative abilities related with theoretical design prevailed, fundamentally in scientific problem and formulation of objectives, spelling mistakes, of transcription, writing, in the digital support of the exhibition, oral expression and argument in the defense. Conclusions: Necessities of scientific student preparation exist, from subjects and disciplines, tutors' list, and protagonist of labor and student organizations, with premeditation in the work that propitiates the motivation and effective participation, what pays to better performance ways and integral formation of the future graduated.

Simulation models applied to practical learning and skill enhancement in direct and indirect ophthalmoscopy: a review / Modelos de simulação aplicados ao ensino prático e aprimoramento de habilidades em oftalmoscopia direta e indireta: uma revisão

The purpose of this review was to analyze and describe simulation methods for practical learning and training of the ophthalmoscopy exam and to organize them into specific topics relative to each principle of operation, while evaluating their preliminary results. A critical review of articles that described and evaluated simulated models for ophthalmoscopy published in the last ten years (2004-2014) was performed. One hundred articles about ophthalmology and simulation were found in national and international periodicals, but only a few discussed the examination of the posterior pole of the eye. For this study, 25 articles were considered; those articles described simulation methods, general concepts, and its actual use in ophthalmoscopy. There were many different simulation methods described, but only few articles proved their efficacy or performed a comparison between models. Review of this topic may give information for the critical analysis of the simulation devices and ideas for the development of new ones.

O objetivo desta revisão foi analisar e descrever os métodos de simulação, apresentados em um conjunto de artigos, sobre o ensino prático e treinamento no exame de oftalmoscopia e organizá-los em tópicos específicos, referentes aos seus princípios de funcionamento, avaliando resultados preliminares. Uma revisão crítica de artigos que tratam sobre modelos de simulação para oftalmoscopia que foram criados nos últimos dez anos (2004-2014) foi realizada. Após a análise de 100 artigos, encontrados em periódicos nacionais e internacionais, sobre oftalmologia e simulação, percebemos o pouco material existente em relação ao exame de fundo de olho. Para este estudo, apenas 25 foram considerados, os quais descrevem métodos de simulação, conceitos gerais e seu uso atual na oftalmoscopia. Vários métodos de simulação já foram descritos, mas poucos artigos provam sua eficácia ou realiza uma comparação entre diferentes modelos. Uma revisão deste tópico pode contribuir para possíveis análises críticas de dispositivos de simulação já existentes e ideias para criação de outros.

Acupunctural Treatment for Hypertension / 全日本鍼灸学会雑誌

We have twice previously reported the results of our preliminary investigation regarding patients with hypertension. Recently, the focus of our interest has been on the blood pressure levels at the time of the third sound of korotkoff. We reported our findings regarding this topic in an oral presentation titled “Evaluation of acupunctural treatment in hypertensive patients” at the 9th Annual Central Japan Block Meeting of the Japanese Society of Acupuncture and Moxibustion Therapy.<br>Since then, we have accumulated further clinical experience regarding hypertensive patients. In this study, we investigated the third sound of korotkoff in patients diagnosed as borderline hypertension according to the WHO criteria for hypertension. The blood pressure during the third sound of korotkoff ranged from 100mmHg to 110mmHg in our patients. This difference in blood pressure noted during the decreasing phase of the blood pressure cycle may serve as a useful prognostic indicator in hypertensive patients.