One-minute preceptor and SNAPPS for clinical reasoning: a systematic review and meta-analysis.

Clinical reasoning teaching strategies could be important models to teach healthcare trainees. This study aims to assess the effectiveness of clinical reasoning teaching strategies (one-minute preceptor (OMP) and SNAPPS) for developing clinical reasoning skills, attitudes and satisfaction of medical/healthcare students and post-graduate trainees as compared to controls. A systematic review and meta-analysis of randomised controlled studies, with no restriction on language or publication date, were carried out by searching the PubMed, SCOPUS, ERIC, Web of Science, Embase and Cochrane Library databases. The risk of bias of the studies selected was determined using Cochrane's risk-of-bias tool (RoB 2) and the quality of evidence used the Grading of Recommendations Assessment, Development and Evaluation system. Of the 1066 articles retrieved, 12 were included in the systematic review and 10 in the meta-analysis. The results showed a growing body of literature on the use of strategies for teaching clinical reasoning that consisted predominantly of low-quality quasi-experimental studies. When only randomised controlled trials were included, analyses showed effectiveness among both healthcare students and post-graduate trainees for a series of outcomes, including total presentation length, duration of discussion, number of basic attributes, number of justified diagnoses in differential diagnoses and number of uncertainties expressed. Lastly, results for SNAPPS were better than for OMP relative to the control group. The strategies for teaching clinical reasoning improved the performance of healthcare students and professionals on this skill, promoting deeper discussion of clinical cases and a higher number of differential diagnoses. Further good-quality trials are needed to corroborate these findings. PROSPERO Registration: CRD42020175992.

Mental health interventions following COVID-19 and other coronavirus infections: a systematic review of current recommendations and meta-analysis of randomized controlled trials.

OBJECTIVE: To review the most common mental health strategies aimed at alleviating and/or preventing mental health problems in individuals during the coronavirus disease 2019 (COVID-19) and other coronavirus pandemics. METHODS: We conducted a systematic review of the literature assessing three databases (PubMed, SCOPUS, and PsycINFO). A meta-analysis was performed with data from randomized controlled trials (RCTs). For non-RCT studies, a critical description of recommendations was performed. RESULTS: From a total of 2,825 articles, 125 were included. Of those, three RCTs were included in the meta-analysis. The meta-analysis revealed that the interventions promoted better overall mental health outcomes as compared to control groups (standardized mean difference [SMD] = 0.87 [95%CI 0.33-1.41], p < 0.001, I2 = 69.2%), but did not specifically improve anxiety (SMD = 0.98 [95%CI -0.17 to 2.13], p > 0.05; I2 = 36.8%). Concerning the systematic review, we found a large body of scientific literature proposing recommendations involving psychological/psychiatric interventions, self-care, education, governmental programs, and the use of technology and media. CONCLUSIONS: We found a large body of expert recommendations that may help health practitioners, institutional and governmental leaders, and the general population cope with mental health issues during a pandemic or a crisis period. However, most articles had a low level of evidence, stressing the need for more studies with better design (especially RCTs) investigating potential mental health interventions during COVID-19. PROSPERO REGISTRATION: CRD42020190212.

The root of the problem: identifying major sources of stress in Brazilian medical students and developing the Medical Student Stress Factor Scale

Objectives: To investigate the most common sources of stress faced by medical students and the degree to which different stressors impact their lives. As a secondary objective, a new instrument, Medical Student Stress Factor Scale (MSSF), was developed based on these stressors. Methods: The MSSF was applied to 431 medical students. The Depression, Anxiety and Stress Scale was administered to investigate the relationship between these stressors and the students' mental health. Results: The five greatest stressors were the extensive content, lack of time to study, sleep deprivation, excessive self-pressure for good grades, and lack of leisure time. The MSSF showed good psychometric characteristics, resulting in a 28-item scale with five subscales. The Relationships and Health subscales were associated with depressive symptoms; Relationships, Health, and Learning Environment/Academic Performance were associated with anxiety symptoms, while Health, and Learning Environment/Academic Performance were associated with stress symptoms. Conclusions: Our study presents important data about the most important stressors that affect medical students' lives and cause mental health issues. The factors are generally related to academic performance and the learning environment and should be targeted in future interventions.

The root of the problem: identifying major sources of stress in Brazilian medical students and developing the Medical Student Stress Factor Scale.

OBJECTIVES: To investigate the most common sources of stress faced by medical students and the degree to which different stressors impact their lives. As a secondary objective, a new instrument, Medical Student Stress Factor Scale (MSSF), was developed based on these stressors. METHODS: The MSSF was applied to 431 medical students. The Depression, Anxiety and Stress Scale was administered to investigate the relationship between these stressors and the students' mental health. RESULTS: The five greatest stressors were the extensive content, lack of time to study, sleep deprivation, excessive self-pressure for good grades, and lack of leisure time. The MSSF showed good psychometric characteristics, resulting in a 28-item scale with five subscales. The Relationships and Health subscales were associated with depressive symptoms; Relationships, Health, and Learning Environment/Academic Performance were associated with anxiety symptoms, while Health, and Learning Environment/Academic Performance were associated with stress symptoms. CONCLUSIONS: Our study presents important data about the most important stressors that affect medical students' lives and cause mental health issues. The factors are generally related to academic performance and the learning environment and should be targeted in future interventions.

Comparison of Team-Based Learning versus Traditional Lectures in Neuroanatomy: Medical Student Knowledge and Satisfaction.

Neuroanatomy is often considered a difficult subject to teach, due to its broad scope, multitude of terms, and high degree of complexity. Thus, newer educational strategies that facilitate learning while also stimulating students by allowing increased student autonomy and group discussions should be carefully considered. This study aimed to evaluate the impact of introducing team-based learning (TBL) in the traditional discipline of neuroanatomy and to measure student knowledge acquisition and perception relative to traditional lectures (TL). A quasi-experimental, nonrandomized study was performed using two consecutive TBL classes (intervention group, n = 157 students, 25% content using TBL) with a TL class (control group, n = 76). Team-based learning sessions included all stages according to the classic description of the method. Student knowledge acquisition was assessed in regularly scheduled tests during the discipline, and their perception regarding TBL was evaluated using a questionnaire (developed by the authors). The groups presented a similar sociodemographic profile (sex and age) and the same performance in another anatomy discipline before the study. Team-based learning was significantly associated with greater acceptance, higher motivation, better student perception, and feelings that the methodology was able to integrate clinical and basic sciences. Nevertheless, according to tests, knowledge acquisition was similar between the TBL and lectures. In conclusion, since TBL is comparable to TL for knowledge acquisition, TBL seems to be a promising strategy to improve the teaching of neuroanatomy in medical schools. It fosters group discussions and increases satisfaction and the perception of integration between clinical and basic sciences.

Is it possible to teach Geriatric Medicine in a stimulating way? Measuring the effect of active learning activities in Brazilian medical students.

OBJECTIVE: To describe the experience of a Brazilian medical school in implementing different active methods to teach Geriatric Medicine, reporting the students' opinions and satisfaction with the classes and comparing pre- and postcourse measurements of knowledge, attitudes and skills. METHODS: A total of 166 third-year medical students received different active theoretical-practical activities for teaching Geriatric Medicine and their knowledge, attitudes, clinical skills and satisfaction were investigated. RESULTS: All activities had good acceptance among students ranging from 8.54 in the activity "Walking aids" to 9.81 in the activity "Nursing Home visit" (ranging 0-10). After the course, students had better attitudes towards older persons (r = 0.55-0.81, P < 0.001), better knowledge (r = 0.84, P < 0.001), greater empathy (r = 0.51, P < 0.001) and better clinical skills (r = 0.86, P < 0.001). Finally, the course was evaluated positively by the students. CONCLUSION: New active Geriatric Medicine learning activities resulted in improvement in medical students knowledge, attitudes and skills.

Altruistic behaviour, but not volunteering, has been associated with cognitive performance in community-dwelling older persons.

AIM: Studies have indicated that altruistic behaviour may be associated with better health. Nevertheless, it has not been determined if volunteering acts as a protective factor against cognitive decline or if a person's altruistic character does so. This study aims to evaluate whether altruistic behaviour and volunteering are associated with better cognitive function in active community-dwelling older persons. METHODS: This was a cross-sectional study in healthy older persons. Sociodemographics, altruistic behaviour (self-report altruism scale), volunteering (days volunteered), cognitive state (cognitive assessment battery), and factors associated with cognition (e.g. depression, social support, functional status, and religiosity) were evaluated. Adjusted and non-adjusted models were created in order to understand the relationship of altruistic behaviour and volunteering with cognitive performance. RESULTS: A total of 312 older adults were evaluated; 89.4% were women, and the mean age was 69.6 years. In the linear regression models, greater altruistic behaviour was associated with higher scores on the Mini-Mental State Examination (ß = 0.148, P < 0.05) and the verbal fluency test (ß = 0.219, P < 0.001), even after adjustments. In contrast, volunteering was not associated with any of the cognitive tests used. CONCLUSION: Altruistic behaviour seems to have a role in older persons' cognition, with more altruistic people tending to have greater cognitive performance. These findings can assist in developing mechanisms that can help keep older people more cognitively active and serve as the foundation for future interventions and studies in this area.

Association of spiritual/religious coping with depressive symptoms in high- and low-risk pregnant women.

AIMS AND OBJECTIVES: To investigate the role of spiritual/religious coping (SRC) on depressive symptoms in high- and low-risk pregnant women. BACKGROUND: Spiritual/religious coping is associated with physical and mental health outcomes. However, only few studies investigated the role of these strategies during pregnancy and whether low- and high-risk pregnant women have different coping mechanisms. DESIGN: This study is a cross-sectional comparative study. METHODS: This study included a total of 160 pregnant women, 80 with low-risk pregnancy and 80 with high-risk pregnancy. The Beck Depression Inventory, the brief SRC scale and a structured questionnaire on sociodemographic and obstetric aspects were used. General linear model regression analysis was used to identify the factors associated with positive and negative SRC strategies in both groups of pregnant women. RESULTS: Positive SRC use was high, whereas negative SRC use was low in both groups. Although we found no difference in SRC strategies between the two groups, negative SRC was associated with depression in women with high-risk pregnancy, but not in those with low-risk pregnancy. Furthermore, positive SRC was not associated with depressive symptoms in both groups. CONCLUSIONS: Results showed that only the negative SRC strategies of Brazilian women with high-risk pregnancies were associated with worsened mental health outcomes. RELEVANCE TO CLINICAL PRACTICE: Healthcare professionals, obstetricians and nurse midwives should focus on the use of negative SRC strategies in their pregnant patients.

Motor Imagery Training After Stroke: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

BACKGROUND AND PURPOSE: A number of studies have suggested that imagery training (motor imagery [MI]) has value for improving motor function in persons with neurologic conditions. We performed a systematic review and meta-analysis to assess the available literature related to efficacy of MI in the recovery of individuals after stroke. METHODS: We searched the following databases: PubMed, Web of Knowledge, Scopus, Cochrane, and PEDro. Two reviewers independently selected clinical trials that investigated the effect of MI on outcomes commonly investigated in studies of stroke recovery. Quality and risk of bias of each study were assessed. RESULTS: Of the 1156 articles found, 32 articles were included. There was a high heterogeneity of protocols among studies. Most studies showed benefits of MI, albeit with a large proportion of low-quality studies. The meta-analysis of all studies, regardless of quality, revealed significant differences on overall analysis for outcomes related to balance, lower limb/gait, and upper limb. However, when only high-quality studies were included, no significant difference was found. On subgroup analyses, MI was associated with balance gains on the Functional Reach Test and improved performance on the Timed Up and Go, gait speed, Action Research Arm Test, and the Fugl-Meyer Upper Limb subscale. DISCUSSION AND CONCLUSIONS: Our review reported a high heterogeneity in methodological quality of the studies and conflicting results. More high-quality studies and greater standardization of interventions are needed to determine the value of MI for persons with stroke.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A188).

Effect of an educational intervention in "spirituality and health" on knowledge, attitudes, and skills of students in health-related areas: A controlled randomized trial.

BACKGROUND: To date there have been no randomized studies that assess whether "Spirituality and Health" (S/H) programs are, indeed, effective, or not. We sought to evaluate if an intervention in teaching S/H fosters competence changes in healthcare students. METHODS: A randomized controlled trial was carried out. Students were randomized into two groups: an Intervention Group (a theoretical-practical course in S/H) and a control group (waiting list). Students' S/H knowledge, attitudes, and skills (through a simulated patient) were assessed. RESULTS: A total of 49 students were evaluated. Students in the intervention group received higher scores on knowledge tests, felt more comfortable and prepared to talk about religious/spiritual beliefs with patients, more readily recognized importance of hospital chaplains, and more frequently held the opinion that addressing spirituality is important. Furthermore, a breaking down of S/H barriers was identified. Students also demonstrated more ability in obtaining a patient's spiritual history when compared to the control group. CONCLUSIONS: There were some differences on knowledge, attitudes, and spiritual history skills between students who participated in the S/H teaching strategy and students who have not been exposed to the theme. These results might foster discussion for the development of new educational strategies about the subject.

Inappropriate prescribing in older persons: A systematic review of medications available in different criteria.

OBJECTIVE: The present study aims to systematically review all potentially inappropriate medications for older persons included in prescribing criteria published in the last decade. METHODS: A systematic review of published studies was performed. Articles describing the development of criteria for PIM Use in Older Adults published in the last decade and which provided a list of medications that should be considered inappropriate were included. The searches were conducted on Pubmed/Medline for articles published from 1st of January 2006 to 31st of December 2015. We analyzed the medications/classes reported in all criteria, most common classes and how many indications each medication made. RESULTS: From 778 articles, 14 articles were included in our analysis (containing 14 different criteria). Europe was responsible for 8 criteria (57.2% of total) followed by Asia (3 criteria) and USA (2 criteria). More than 85% used a Delphi method. There were 729 different medications/classes reported in all criteria. Diazepam was included in all 14 criteria followed by amitriptyline (13 criteria) and doxepin (12 criteria). We found benzodiazepines, NSAIDs, antihistamines and antipsychotics were the most common drugs reported as potentially inappropriate for older persons. CONCLUSION: The present study systematically compiled all medications included in 14 different criteria published last decade. Benzodiazepines, NSAIDs, antihistamines and antipsychotics were the most common drugs reported as potentially inappropriate for older persons. These results could help health professionals and panel experts to plan future criteria.

Brazilian scientific articles on "Spirituality, Religion and Health"

Abstract Background Studies on "Spirituality, religion and health"(R/S) have been increasing worldwide, including in Brazil. Mapping this production can help researchers to understand this field and also to identify gaps in the Brazilian R/S studies. Objective To analyze the Brazilian scientific articles on "Religion, Spirituality and Health&" available on the main electronic databases using a bibliometric approach. Methods A comprehensive review of four major databases (PubMed, Scopus, BVS and Web of Science) was conducted. Three reviewers performed the data analysis. Off-topic articles, articles from Portugal, books and thesis were excluded. Articles were then classified by: Publication year, journal, Central focus in R/S, Academic Area, Main topic and Study Type. Results From 3,963 articles found, 686 studies were included in the final analysis (320 had central focus on R/S). There was an increase of articles in the last decade (most observational), with predominance of mental health issues, and from journals in the field of psychiatry, public health and nursing. Discussion This study enabled us to widen our understanding about how the field of "spirituality, religion and health" has been established and how this field is increasing in Brazil. These findings can help in the development of future Brazilian studies.

Spiritual Religious Coping is Associated with Quality of Life in Institutionalized Older Adults.

The purpose of this study was to investigate the relationship between spiritual/religious coping (SRCOPE) strategies and quality of life (QoL) in institutionalized older adults. This is a cross-sectional, correlational study, with a sample of 77 older adults in Brazil. The present study found long-term care patients use religious and spiritual coping strategies to deal with their chronic health conditions. Positive SRCOPE and Total SRCOPE have positive correlations with most QoL domains from the WHOQOL-OLD and WHOQOL-BREF. On the other hand, Negative SRCOPE strategies correlated negatively with the facets of "death and dying" from the WHOQOL-OLD. These results suggest the need for an integrative approach for long-term care patients, considering the positive and negative aspects of coping.

Spirituality, Religiosity, and Health: a Comparison of Physicians' Attitudes in Brazil, India, and Indonesia.

BACKGROUND: One of the biggest challenges in the spirituality, religiosity, and health field is to understand how patients and physicians from different cultures deal with spiritual and religious issues in clinical practice. PURPOSE: The present study aims to compare physicians' perspectives on the influence of spirituality and religion (S/R) on health between Brazil, India, and Indonesia. METHOD: This is a cross-sectional, cross-cultural, multi-center study carried out from 2010 to 2012, examining physicians' attitudes from two continents. Participants completed a self-rated questionnaire that collected information on sociodemographic characteristics, S/R involvement, and perspectives concerning religion, spirituality, and health. Differences between physicians' responses in each country were examined using chi-squared, ANOVA, and MANCOVA. RESULTS: A total of 611 physicians (194 from Brazil, 295 from India, and 122 from Indonesia) completed the survey. Indonesian physicians were more religious and more likely to address S/R when caring for patients. Brazilian physicians were more likely to believe that S/R influenced patients' health. Brazilian and Indonesians were as likely as to believe that it is appropriate to talk and discuss S/R with patients, and more likely than Indians. No differences were found concerning attitudes toward spiritual issues. CONCLUSION: Physicians from these different three countries had very different attitudes on spirituality, religiosity, and health. Ethnicity and culture can have an important influence on how spirituality is approached in medical practice. S/R curricula that train physicians how to address spirituality in clinical practice must take these differences into account.

Peripheral Facial Palsy: Does Patients' Religiousness Matter for the Otorhinolaryngologist?

In order to deal with the suffering, a frequent strategy employed by patients is the use of religious beliefs and behaviors. Nevertheless, few studies in otorhinolaryngology have investigated this dimension. Therefore, the present study aims to investigate the role of religiousness on quality of life, mental health, self-esteem and appearance in 116 patients with peripheral facial palsy (PFP). A cross-sectional, single-center study was carried out between 2010 and 2012 in PFP outpatients. We assessed socio-demographic data, PFP characteristics, depression, anxiety, quality of life, self-esteem, appearance and religiosity. A linear regression (adjusted for confounders) was performed to investigate whether religiosity was associated with any outcomes. The present study found that religious attendance, but not other types of religiousness, was related to quality of life and mental health on PFP patients. In addition, ENT patients would like their doctors to ask them about their faith and religion as part of their medical care. These findings give further support to the importance of religious and spiritual beliefs on ENT patients. Otorhinolaryngologists should be aware of the positive and negative aspects of religion and be prepared to address these issues in clinical practice.

Spiritual Treatment for Depression in Brazil: An Experience From Spiritism.

BACKGROUND: Spiritism has been strongly connected with mental health in Brazil. However, there is a lack of descriptions of spiritual treatment provided by thousands of Brazilian Spiritist centers. The present study aims to describe the spiritual care for depression provided by one large Spiritist center in São Paulo, Brazil. METHODS: This is a descriptive study carried out in 2012 at "São Paulo Spiritist Federation." Authors visited the "spiritual intervention sections," observed the therapies provided, listened to the "spirits' communication," and interviewed two patients. RESULTS: The assistance consists on a 90-min "Spiritual healing" session which includes educational lectures, "disobsession" (spirit release therapy), "passe" (laying on of hands) and person advice. Both patients had remitted depression when they were interviewed. CONCLUSIONS: Further studies would be necessary to report other religious/spiritual treatments in order to improve our understanding of the available practices used by patients and optimize the integration of conventional care with spiritual treatments.

Religiousness and headache: is there a relation? Results from a representative sample of adults living in a low-income community.

BACKGROUND: The use of religious behaviors to alleviate the consequences of stressful life circumstances is a frequent strategy employed by pain sufferers. Specifically in the field of headache research, to date, few studies have assessed spiritual and religious beliefs. OBJECTIVE: The objective of this article is to investigate the relation between religiousness (organizational, non-organizational and intrinsic) and headache disorders in a representative sample of adults living in a low-income community. METHODS: This was a cross-sectional, population-based study. In 2005, we conducted door-to-door interviews with 439 people, aged more than 18 years, randomly selected from a low-income community in Brazil. Four regression models were created to explain the relationships between religious involvement and headache, controlling for demographics, depression/anxiety and alcohol use and smoking. RESULTS: Of the 439 households contacted, at least one member from 383 (87.2%) households participated. We interviewed more women (74.4%) and more subjects aged 18-39 years. The mean age was 41.7 (SD 8.5) years. Bivariate analysis shows that high religious attendance, non-organizational religiousness and intrinsic religiousness were associated with presence of headache and presence of migraine. After the logistic regression models, only high non-organizational religiousness remained associated with presence of headache (odds ratio (OR): 1.22 (1.01-1.49)). All other religious variables were unrelated to the presence of headache and its types. CONCLUSION: There is a modest relationship between high non-organizational religiousness and presence of headache. Headache sufferers may use coping strategies such as private religious behaviors to try to overcome suffering.

Religious beliefs or physicians' behavior: what makes a patient more prone to accept a physician to address his/her spiritual issues?

The present study aims to understand the relation between religious beliefs, physicians' behavior and patients' opinions regarding "Spirituality, religiosity and health (S/R)" issues, and what makes a patient more prone to accept a physician to address his/her spiritual issues. A cross-sectional study was carried out in outpatients from a tertiary hospital, and a path analysis was used to examine the direct and indirect relationships between the variables. For the final analysis, 300 outpatients were evaluated. Most patients would like their doctors to address S/R issues but did not feel comfortable to ask them. In contrast, they reported most doctors have never addressed S/R issues, and they believe doctors are not prepared to address these issues. The path analysis revealed that patients' previous experiences with their doctors may be as important as their religious/spiritual beliefs in proneness to accept a physician to address his/her spiritual issues.