Very preterm birth is a risk factor for increased systolic blood pressure at a young adult age

Children born very prematurely who show intrauterine growth retardation (IUGR) are suggested to be at risk of developing high blood pressure as adults. Renal function may already be impaired by young adult age. To study whether very preterm birth affects blood pressure in young adults, we measured 24-h ambulatory blood pressure (Spacelabs™ 90207 device) and renin concentration in 50 very premature individuals (<32 weeks of gestation), either small (SGA) or appropriate (AGA) for gestational age (21 SGA, 29 AGA), and 30 full-term controls who all were aged 20 years at time of measurement. The mean (standard deviation) daytime systolic blood pressure in SGA and AGA prematurely born individuals, respectively, was 122.7 (8.7) and 123.1 (8.5) mmHg. These values were, respectively, 3.6 mmHg [95% confidence interval (CI) −0.9 to 8.0] and 4.2 mmHg (95% CI 0.4−8.0) higher than in controls [119.6 (7.6)]. Daytime diastolic blood pressure and nighttime blood pressure did not differ between groups. We conclude that individuals born very preterm have higher daytime systolic blood pressure and higher risk of hypertension at a young adult age

What basic clinical procedures should be mastered by junior clerkship students? Experience at a single medical school in Tanzania

Eveline T Konje,1,2 Rodrick Kabangila,2,3 Mange Manyama,2,4 Jacqueline M van Wyk2,5 1Department of Epidemiology and Biostatistics, School of Public Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania; 2Medical Education Fellowship, Southern Africa FAIMER Regional Institute &ndash; SAFRI, Cape Town, South Africa; 3Department of Internal Medicine, 4Department of Anatomy and Cell Biology, School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania; 5Department of Clinical and Professional Education, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa Background: Clinical training in most medical schools, including the Catholic University of Health and Allied Sciences (CUHAS), is offered in the form of junior and senior rotations. During these clinical rotations, students are expected to acquire and master the basic procedural skills. However, students&rsquo; learning process should be evaluated for quality improvement. Objectives: This study was conducted to identify the basic medical procedural skills that third-year medical students should acquire and master and determine the level of students&rsquo; exposure on these procedures at the end of junior rotation in internal medicine. Identification of the gap between clinicians&rsquo; opinions, skills practiced by students, and third-year students&rsquo; curriculum in the medical department at CUHAS was also done. Methods: The descriptive cross-sectional study was used to collect data through a self-administered, structured questionnaire from clinicians in medicine. A review of logbooks was considered to determine level of students&rsquo; exposure, and a document analysis was done using existing medical curriculum. Results: The response of 71% (n=22) was obtained. Clinicians agreed on basic procedures that students should perform independently (ie, Foley catheter insertion, venipuncture, and intravenous drip insertion). Clinicians thought that lumbar punctures, abdominal paracentesis, and nasogastric tube insertion should be done under minimal supervision. A considerable number of students (25%, n=75) did not practice any procedure throughout their rotation. The majority of the students performed venipuncture independently (82.14%, n=56) and lumbar punctures (73.21%, n=56) under supervision. Less than 25% (n=56) of the students met the required number of exposures on the basic procedures. The procedures to be performed and the level of competency in the procedures are not specified in the current curriculum. Conclusion: The study identified the procedures that should be taught and practiced by students. It also highlighted the discrepancies in the existing curriculum and the need to monitor and supervise students&rsquo; practice. Keywords: basic procedures, internal medicine rotation, Tanzania, medical education, logbooks, procedural skills, clinical clerkshi