Anafilaxia por Azul Patente: um raro relato de caso

A anafilaxia perioperatória é uma condição sistêmica e imprevisível. O diagnóstico independe do agente causal, podendo citar como substâncias desencadeadoras: antibióticos, bloqueadores neuromusculares, látex e corantes artificiais, como o azul patente, que é utilizado para identificação do linfonodo sentinela para o manejo do câncer de mama, podendo evitar uma linfadenectomia total. Apresentar um caso de uma paciente que seria submetida a quadrantectomia, em que se empregou o corante Azul Patente V, causando uma séria reação anafilática. Paciente feminina, 42 anos, diagnosticada com câncer de mama à direita, submetida a quimioterapia neoadjuvante, e posteriormente encaminhada para realização de uma quadrantectomia de mama direita com biópsia de linfonodo sentinela. Para a preparação cirúrgica, foi injetado o corante azul patente periareolar e a paciente evoluiu com grave instabilidade hemodinâmica, dificuldade respiratória e taquicardia importante, levantando hipótese de choque anafilático. A anafilaxia perioperatória é uma condição pouco frequente, porém, quando ocorre pode ser fatal. Apresenta reações mediadas por imunoglobulinas, com ativação disseminada de mastócitos, podendo envolver diversos sistemas do corpo humano, sendo seus principais sintomas a dispneia e a hipotensão. Qualquer substância utilizada durante a indução anestésica ou no procedimento cirúrgico pode desencadear uma reação anafilática, sendo as mais frequentes: bloqueador neuromuscular (50 a 70%), látex (12 a 16,7%) e antibióticos (15%). Outros agentes responsáveis por anafilaxia perioperatória são os colóides, corantes, anti-inflamatórios não esteroidais e a protamina. A paciente já havia sido submetida a outros procedimentos cirúrgicos, sem apresentar nenhum tipo de reação, sendo o corante azul patente a única substância diferente utilizada. Portanto, devido sua baixa prevalência (0,6 a 2,7%), a anafilaxia relacionada ao azul patente configura a importância do presente relato

Implementing a medical student interpreter training program as a strategy to developing humanism

Abstract Background Humanistic care in medicine has shown to improve healthcare outcomes. Language barriers are a significant obstacle to humanistic care, and trained medical interpreters have demonstrated to effectively bridge the gap for the vulnerable limited English proficiency (LEP) patient population. One way in which medical schools can train more humanistic physicians and provide language access is through the implementation of programs to train bilingual medical students as medical interpreters. The purpose of this prospective study was to evaluate whether such training had an impact on bilingual medical student’s interpretation skills and humanistic traits. Methods Between 2015 and 2017, whole-day (~ 8 h) workshops on medical interpretation were offered periodically to 80 bilingual medical students at the Penn State College of Medicine. Students completed a series of questionnaires before and after the training that assessed the program’s effectiveness and its overall impact on interpretation skills and humanistic traits. Students also had the opportunity to become certified medical interpreters. Results The 80 student participants were first- to third- year medical students representing 21 languages. Following training, most students felt more confident interpreting (98%) and more empathetic towards LEP patients (87.5%). Students’ scores in the multiple-choice questions about medical interpretation/role of the interpreter were also significantly improved (Chi-Square test, p < 0.05). All students who decided to take the exam were able to successfully become certified interpreters. Ninety-two percent of participants reported they would recommend the program and would be willing to serve as a future “coaches” for interpreter training workshops delivered to peer students. Conclusions Our program was successful in increasing self-reported measures of empathy and humanism in medical students. Our data suggests that implementation of medical interpreter training programs can be a successful strategy to develop of humanism in medical students, and aid in the development of sustainable language access for LEP patients

Additional file 2: of Implementing a medical student interpreter training program as a strategy to developing humanism

Anonymous survey (“Part 2 post”) administered to workshop participants to obtain post-workshop feedback about the program and their self-rated confidence about their interpretation abilities. (PDF 38 kb

Additional file 1: of Implementing a medical student interpreter training program as a strategy to developing humanism

Anonymous pre-workshop surveys (“Part 1”, “Part 2 pre”, and “Part 3”), and post-workshop surveys (“Part 1” and “Part 3”) administered to participants to obtain information about the interpreation process knowledge, cultural competencies, language skills and cultural background . (PDF 55 kb