Knowledge, skills and beetles: respecting the privacy of private experiences in medical education

In medical education, we assess knowledge, skills, and a third category usually called values or attitudes. While knowledge and skills can be assessed, this third category consists of ‘beetles’, after the philosopher Wittgenstein’s beetle-in-a-box analogy. The analogy demonstrates that private experiences such as pain and hunger are inaccessible to the public, and that we cannot know whether we all experience them in the same way. In this paper, we claim that unlike knowledge and skills, private experiences of medical learners cannot be objectively measured, assessed, or directly accessed in any way. If we try to do this anyway, we risk reducing them to knowledge and skills—thereby making curriculum design choices based on what can be measured rather than what is valuable education, and rewarding zombie-like student behaviour rather than authentic development. We conclude that we should no longer use the model of representation to assess attitudes, emotions, empathy, and other beetles. This amounts to, first of all, shutting the

Turkish imams and their role in decision-making in palliative care: A Directed Content and Narrative analysis

Background: Muslims are the largest religious minority in Europe. When confronted with life-threatening illness, they turn to their local imams for religious guidance. Aim: To gain knowledge about how imams shape their roles in decision-making in palliative care. Design: Direct Content Analysis through a typology of imam roles. To explore motives, this was complemented by Narrative Analysis. Setting/Participants: Ten Turkish imams working in the Netherlands, with experience in guiding congregants in palliative care. Results: The roles of Jurist, Exegete, Missionary, Advisor and Ritual Guide were identified. Three narratives emerged: Hope can work miracles, Responsibility needs to be shared, and Mask your grief. Participants urged patients not to consent to withholding or terminating treatment but to search for a cure, since this might be rewarded with miraculous healing. When giving consent seemed unavoidable, the fear of being held responsible by God for wrongful death was often managed by requesting fatwa from committees of religious experts. Relatives were urged to hide their grief from dying patients so they would not lose hope in God. Conclusion: Imams urge patients’ relatives to show faith in God by seeking maximum treatment. This attitude is motivated by the fear that all Muslims involved will be held accountable by God for questioning His omnipotence to heal. Therefore, doctors may be urged to offer treatment that contradicts medical standards for good palliative care. To bridge this gap, tailor-made palliative care should be developed in collaboration with imams. Future research might include imams of other Muslim organizations

The use of C-reactive protein in case of preterm labor with intact membranes

Background: Preterm labor, defined as delivery between 22 and 37WA, is the leading cause of perinatal morbidity and mortality. Through this study, we wanted to know if the high CRP rate in preterm labor with intact membranes could be a risk factor for poor prognosis on pregnancy and the newborn.Methods: We conducted a prospective cohort study from November 1, 2018 to April 31, 2019 at Befelatanana University Hospital of Gynecology-Obstetrics on singleton pregnancies with preterm labor and intact membranes. The population is divided in two groups according to the rate of CRP and we have chosen as a pathological threshold a CRP ≥7 mg/l.Results: We included 71 cases of MAP over 1735 births, or 4.09%, of which 47% had a CRP≥7mg / l (group I) and 51% a CRP <7mg / l (group II). There was a significant difference in the persistence of uterine contraction after 48h of tocolysis in group I and II [p = 0.0013, RR 5.20 (1.63-16.55)] as well as within of delivery (7.68±5.33 versus 21.36±11.30 days, p <0.05). There was no difference in the occurrence of neonatal asphyxia and neonatal infection between the 2 groups. However, the risk of prematurity is high in the group with a high CRP level [RR 1.34 (1.06-1.70)] (p = 0.02).Conclusions: In the case of preterm labor with intact membrane, CRP is a determinant of delivery delay, failure of tocolysis, and occurrence of preterm delivery

Epidemiology of maternal mortality in Befelatanana maternity during 2016-2017

Background: Maternal mortality remains a permanent obsession for the pregnant woman and her entourage, and is still one of the topical issues faced by a developing country, such as Madagascar. Our study aims to determine the epidemiological and etiological profile.Methods: We conducted a descriptive retrospective study over a 2-year period from January 1st, 2016 to December 31st, 2017 at the Befelatanana Gynecology-Obstetrics Hospital on maternal deaths.Results: We had 76 maternal deaths out of 5430 births, or 1.39%. The average age was 31.18±8.38 years with extremes of 14 and 49 years. The average parity was 2.67±1.85. The majority of pregnancies were poorly followed with a mean ANC of 2.18±1.85. The referred patients predominated at 68.42%. Women living in the urban area had a 57.89% majority. Among the etiology, hypertensive complications predominated at 42.11% followed by hemorrhagic (38.16%) and infectious (19.14%) complications. The patients who underwent surgery predominated at 78.94% and 59.21% were transfused.Conclusions: Maternal mortality remains a major concern at the Befelatanana Obstetrics Gynecology Hospital. During our study, hypertensive complications were found to be the most common causes requiring adequate management. For this, an awareness of pregnant women for the standardization of ANC, as well as regular training of health actor are necessary

Designing Efficient Taxi Pickup Operations at Airports

This paper provides a practical procedure for designing efficient taxi pickup operations at airports. How to do this effectively is an open question. Solutions are not available, and practices vary. They reflect different approaches to and lack of research on the subject. The solutions are often unsatisfactory. At many airports, passengers routinely suffer long waits outdoors, exposed to the elements, after a tiring journey. Such disagreeable experiences are avoidable. Designing efficient taxi pickup operations at airports is problematic. The peculiarities of the process preclude easy solutions. First, the process involves queuing, so system performance is a nonlinear function of the loads. Second, it features unstable transient situations, since travelers typically arrive in bulk over short periods. Third, traffic is significantly differentiated and consists of a wide variety of groups implying different service characteristics. Standard results from queuing theory thus do not have a useful application to this problem. The design process uses simulation that is based on detailed observation of local practices. It involves four steps: (a) detailed local measurements of the arrival of both travelers and taxis, and the service rates provided by taxis in different queuing positions; (b) creation and validation of a simulation model sufficiently detailed to account for these realities; (c) exploration of design alternatives to estimate the characteristics of the service they would provide; and (d) selection of a preferred design that properly balances efforts to minimize average and extreme wait times. The paper demonstrates the procedure through application to Lisbon International Airport, Portugal.SIMUL8 Corporatio