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Acad Med ; 96(9): 1353-1365, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-33883396


PURPOSE: Performing a gynecological exam is an essential skill for physicians. While interventions have been implemented to optimize how this skill is taught in medical school, it remains an area of concern and anxiety for many medical students. To date, a comprehensive assessment of these interventions has not been done. The authors conducted a systematic review of the literature on interventions that aim to improve medical student education on gynecological exams. METHOD: The authors searched 6 databases (Ovid MEDLINE, Ovid EMBASE, EBSCO CINAHL Plus, Scopus, Web of Science Core Collection, and ERIC [Proquest]) from inception to August 4, 2020. Studies were included if they met the following criteria: focus on medical students, intervention with the purpose of teaching students to better perform gynecological exams, and reported outcomes/evaluation. Extracted data included study location, study design, sample size, details of the intervention and evaluation, and context of the pelvic exam. All outcomes were summarized descriptively; key outcomes were coded as subjective or objective assessments. RESULTS: The search identified 5,792 studies; 50 met the inclusion criteria. The interventions described were diverse, with many controlled studies evaluating multiple methods of instruction. Gynecological teaching associates (GTAs), or professional patients, were the most common method of education. GTA-led teaching resulted in improvements in student confidence, competence, and communication skills. Physical adjuncts, or anatomic models and simulators, were the second most common category of intervention. Less resource-intensive interventions, such as self-directed learning packages, online training modules, and video clips, also demonstrated positive results in student comfort and competence. All studies highlighted the need for improved education on gynecological exams. CONCLUSIONS: The literature included evaluations of numerous interventions for improving medical student comfort and competence in performing gynecological exams. GTA-led teaching may be the most impactful educational tool described, though less resource-intensive interventions can also be effective.

Competência Clínica , Exame Ginecológico/psicologia , Ginecologia/educação , Aprendizagem Baseada em Problemas/métodos , Estudantes de Medicina/psicologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Simulação de Paciente , Relações Médico-Paciente
J Obstet Gynaecol Can ; 43(4): 490-496, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33373695


OBJECTIVE: Obstetricians and gynaecologists are among the highest risk specialties for burnout. There is growing evidence that physician burnout can be both prevented and reduced. We sought to characterize the evidence base for interventions related to the prevention and treatment of burnout in obstetrics and gynaecology DATA SOURCES: We conducted a scoping review following PRISMA guidelines of 5 databases: (Medline-OVID, EMBASE, CINAHL,, and PsycInfo) from inception to March 17, 2020. Citations of relevant articles were hand-searched to maximize sensitivity. STUDY SELECTION: All interventional study designs were included. The target study population was obstetrics and gynaecology residents, learners, or staff. Published conference posters, papers, and abstracts were eligible for inclusion. DATA EXTRACTION AND SYNTHESIS: All extraction and descriptive analysis was completed by two independent reviewers. Outcomes were summarized descriptively. Appraisal was completed using the Cochrane Risk of Bias tool and Risk of Bias Assessment tool for Non-randomized Studies. RESULTS: Of the 1540 original database citations, 20 studies met our inclusion criteria. A total of 589 obstetrics/gynaecology participants were included. While there was an overall a lack of research in the field, there were several promising interventions that target residents. There were a combination of preventative interventions (e.g. yoga, nutritional programs, or narrative medicine initiatives) as well as treatments (e.g. counselling appointments or debrief sessions). The vast majority of these interventions focused on individual-specific interventions rather than structural changes. In addition, the majority of interventions appeared to be "proof of concept" and feasability-related studies, with many studies published as conference abstracts rather than peer-reviewed journal publications. CONCLUSIONS: Institutions should continue to implement interventions that address burnout in obstetrics and gynaecology. Further research is required on long-term outcomes of interventions as well as structural strategies.

Esgotamento Psicológico , Ginecologia , Obstetrícia , Estresse Ocupacional , Médicos/psicologia , Adaptação Psicológica , Feminino , Humanos , Saúde Mental , Gravidez , Resiliência Psicológica
BMJ Open ; 10(11): e040547, 2020 11 27.
Artigo em Inglês | MEDLINE | ID: mdl-33247019


OBJECTIVE: To characterise published evidence regarding preclinical and clinical interventions to overcome mask shortages during epidemics and pandemics. DESIGN: Systematic scoping review. SETTINGS: All healthcare settings relevant to epidemics and pandemics. SEARCH STRATEGY: English peer-reviewed studies published from January 1995 to June 2020 were included. Literature was identified using four databases (Medline-OVID, EMBASE, CINAHL, Cochrane Library), forwards-and-backwards searching through Scopus and an extensive grey literature search. Assessment of study eligibility, data extraction and evidence appraisal were performed in duplicate by two independent reviewers. RESULTS: Of the 11 220 database citations, a total of 47 articles were included. These studies encompassed six broad categories of conservation strategies: decontamination, reusability of disposable masks and/or extended wear, layering, reusable respirators, non-traditional replacements or modifications and stockpiled masks. Promising strategies for mask conservation in the context of pandemics and epidemics include use of stockpiled masks, extended wear of disposable masks and decontamination. CONCLUSION: There are promising strategies for overcoming face mask shortages during epidemics and pandemics. Further research specific to practical considerations is required before implementation during the COVID-19 pandemic.

COVID-19 , Pessoal de Saúde , Controle de Infecções/métodos , Máscaras/provisão & distribuição , Respiradores N95/provisão & distribuição , Pandemias , SARS-CoV-2 , COVID-19/prevenção & controle , COVID-19/transmissão , COVID-19/virologia , Atenção à Saúde , Reutilização de Equipamento , Humanos , Dispositivos de Proteção Respiratória
Top Stroke Rehabil ; : 1-6, 2020 Oct 17.
Artigo em Inglês | MEDLINE | ID: mdl-33073739


BACKGROUND: Persistent and intractable hiccups have a major impact on quality of life and can be a barrier to stroke rehabilitation. The first-line treatment for intractable hiccups, chlorpromazine, can have sedating effects, which may negatively affect rehabilitation participation. Gabapentin has been reported in several cases to be effective in hiccup treatment in both the general and post-stroke populations. OBJECTIVE: To describe the use of gabapentin for treatment of persistent or intractable hiccups in post-stroke patients. METHODS: Four cases were identified by clinicians for a retrospective review. A literature review was concurrently conducted. RESULTS: This case series presents four patients with improvement or resolution of intractable hiccups on gabapentin in a stroke rehabilitation setting. Therapeutic dose ranged from 100 mg TID to 400 mg BID. Treatment duration ranged from 2 days to 5.5 weeks. Adjuncts were used in three of the cases. A potential side effect was worsened confusion in one case. CONCLUSION: Evidence on the use of gabapentin for persistent or intractable hiccups is limited. This case series expands on the current literature by examining and comparing the current literature to our cases and exploring issues related to dosing, titration, side effects, and adjuncts to gabapentin.

J Clin Med ; 9(4)2020 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-32252255


BACKGROUND: Obstructive sleep apnea (OSA) is associated with long-term cardiovascular morbidity and is highly prevalent in patients with cardiovascular disease (CVD). The objectives of this scoping review were to determine the prevalence of OSA inpatients hospitalized for CVD and to map the range of in-hospital outcomes associated with OSA. METHODS: We searched MEDLINE(R), Embase, and Cochrane Databases for articles published from 1946-2018. We included studies involving non-surgical adults with OSA or at high risk of OSA who were hospitalized for CVD. The outcomes were considered as in-hospital if they were collected from admission up to 30 days post-discharge from hospital. RESULTS: After the screening of 4642 articles, 26 studies were included for qualitative synthesis. Eligible studies included patients presenting with acute coronary syndromes (n = 19), congestive heart failure (n = 6), or any cardiovascular disease (n = 1). The pooled prevalence of OSA in cardiac inpatients was 48% (95% CI: 42-53). The in-hospital outcomes reported were mortality (n = 4), length of stay (n = 8), left ventricular ejection fraction (n = 8), peak troponin (n = 7), peak B-type natriuretic peptide (n = 4), and composite cardiovascular complications (n = 2). CONCLUSIONS: OSA is highly prevalent in the cardiac inpatient population. The outcomes reported included mortality, cardiac function, cardiac biomarkers, and resource utilization. There are significant knowledge gaps regarding the effect of treatment and OSA severity on these outcomes. The findings from this review serve to inform further areas of research on the management of OSA among patients with CVD.

Hemoglobin ; 39(5): 368-70, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26154945


We report a case of δß-thalassemia (δß-thal) trait in an adult male originally from Sudan. Multiplex ligation-dependent probe amplification (MLPA) was used to localize the approximate boundaries of the deletion, followed by polymerase chain reaction (PCR) amplification and sequence analysis of the junction fragment to determine the precise deletion endpoints. The deletion spans 9594 bp, with the 5' deletion endpoint located 1560 bp upstream of the δ-globin gene and the 3' endpoint within the second intervening sequence (IVS-II) of the ß-globin gene.

Mutação , Globinas beta/genética , Talassemia beta/diagnóstico , Talassemia beta/genética , Globinas delta/genética , Talassemia delta/diagnóstico , Talassemia delta/genética , Adulto , Sequência de Bases , Análise Mutacional de DNA , Genótipo , Humanos , Íntrons , Masculino , Fenótipo , Deleção de Sequência , Sudão , Globinas beta/química , Globinas delta/química