Improving communication skill training in patient centered medical practice for enhancing rational use of laboratory tests: The core of bioinformation for leveraging stakeholder engagement in regulatory science.

Requests for laboratory tests are among the most relevant additional tools used by physicians as part of patient's health problemsolving. However, the overestimation of complementary investigation may be linked to less reflective medical practice as a consequence of a poor physician-patient communication, and may impair patient-centered care. This scenario is likely to result from reduced consultation time, and a clinical model focused on the disease. We propose a new medical intervention program that specifically targets improving the patient-centered communication of laboratory tests results, the core of bioinformation in health care. Expectations are that medical students training in communication skills significantly improve physicians-patient relationship, reduce inappropriate use of laboratorial tests, and raise stakeholder engagement

Impacto do Treinamento de Habilidades de Comunicação e do Registro Médico na Prática do Método Clínico de Atendimento Integral à Pessoa

RESUMO Introdução A prática do atendimento clínico integral à pessoa é um desafio enfrentado pelo educador médico, por instituições de ensino e por pesquisadores que tentam contribuir para que os estudantes desenvolvam competências educacionais que sintetizem conhecimentos, habilidades e atitudes para esse modelo. Objetivo O objetivo deste estudo foi avaliar o impacto do treinamento de habilidades de comunicação na prática do método clínico de atendimento integral à pessoa, com ou sem o uso de registro específico para o atendimento. Métodos Participaram do estudo 46 estudantes do sétimo período do curso de Medicina da Universidade Federal de Minas Gerais (UFMG). Uma combinação de atividades educacionais foi utilizada para propiciar a aquisição de habilidades de comunicação para o atendimento clínico integral à pessoa, como modeling example, seguido de reflexão individual e discussão, aula expositiva interativa e uso de formulário de registro específico para o atendimento clínico integral à pessoa (RACIP). O estudo foi dividido em quatro fases: (1) pré-treinamento: filmagem de atendimento clínico em ambiente simulado, realizado pelos 46 estudantes, com a utilização do modelo de registro de consulta vigente no HC-UFMG; (2) treinamento: os estudantes foram divididos em três grupos: G1 – submetidos à atividade educacional não relacionada ao atendimento clínico; G2 e G3 – submetidos a treinamento de habilidades de comunicação; (3) avaliação: filmagem de consulta em ambiente simulado, realizada por todos os grupos, sendo que G1 e G3 utilizaram o RACIP, e G2, o modelo de registro vigente; (4) feedback e oportunidade de mesma aprendizagem para todos os grupos. Os vídeos dos atendimentos clínicos realizados pelos estudantes, pré e pós-treinamento, foram avaliados por uma banca constituída por três avaliadores, utilizando-se o instrumento AVACIP (avaliação de atendimento clínico integral à pessoa), levando-se em consideração cinco domínios: início da consulta; expectativas do paciente sobre a consulta; perspectiva do paciente sobre sua doença; comportamento e hábitos de vida; uso de propedêutica complementar e aliança terapêutica. Resultado O escore total de atitudes positivas de cada grupo foi maior na Fase 3 em relação à 1 (p = 0,001), mostrando que todas as estratégias promoveram a melhora das habilidades de comunicação, mas não houve diferença entre os grupos em cada fase (p > 0,310). Quando os escores foram analisados por domínio, observou-se que o G3 apresentou melhor desempenho do que os outros. Conclusão O treinamento de habilidades em comunicação e o uso de modelo de registro específico para o atendimento melhoram o desempenho dos estudantes em relação ao atendimento clínico integral à pessoa

Improving communication skill training in patient centered medical practice for enhancing rational use of laboratory tests: The core of bioinformation for leveraging stakeholder engagement in regulatory science

Requests for laboratory tests are among the most relevant additional tools used by physicians as part of patient's health problemsolving. However, the overestimation of complementary investigation may be linked to less reflective medical practice as a consequence of a poor physician-patient communication, and may impair patient-centered care. This scenario is likely to result from reduced consultation time, and a clinical model focused on the disease. We propose a new medical intervention program that specifically targets improving the patient-centered communication of laboratory tests results, the core of bioinformation in health care. Expectations are that medical students training in communication skills significantly improve physicians-patient relationship, reduce inappropriate use of laboratorial tests, and raise stakeholder engagement

Improving communication skill training in patient centered medical practice for enhancing rational use of laboratory tests: The core of bioinformation for leveraging stakeholder engagement in regulatory science.

Requests for laboratory tests are among the most relevant additional tools used by physicians as part of patient's health problemsolving. However, the overestimation of complementary investigation may be linked to less reflective medical practice as a consequence of a poor physician-patient communication, and may impair patient-centered care. This scenario is likely to result from reduced consultation time, and a clinical model focused on the disease. We propose a new medical intervention program that specifically targets improving the patient-centered communication of laboratory tests results, the core of bioinformation in health care. Expectations are that medical students training in communication skills significantly improve physicians-patient relationship, reduce inappropriate use of laboratorial tests, and raise stakeholder engagement

Histopathological and parasitological investigations of ear healthy skin of dogs naturally and experimentally infected with Leishmania (Leishmania) chagasi

Although 90% of clinical cases of American visceral leishmaniasis (AVL) occur in the northeastern region of Brazil, the incidence of cases in recent years has increased in southeastern states such as Minas Gerais (MG), where the disease has been reported in several cities, including Belo Horizonte, the state capital. Some studies have shown a strong correlation between the incidence of AVL and canine visceral leishmaniasis (CVL) in Belo Horizonte. A study of 108 dogs with parasite Leishmania chagasi detected by immunohistochemistry in healthy ear skin was obtained from two distinct geographical areas: 55 from a metropolitan area of the municipality (Santa Luzia, MG) and 53 dogs from a central area of Belo Horizonte. In parallel, a group of 10 beagles were experimentally infected with L. chagasi. Considering the clinical aspects of all naturally infected dogs, symptomatic dogs were more frequent than asymptomatic ones, especially animals from the metropolitan area compared with the central area (79.6% and 20.3%, respectively). A chronic exudate was observed in the ear of 51 out of 55 dogs naturally infected from the metropolitan area (92.7%) and 45 out of 53 dogs naturally infected from the central area (84.9%). Importantly, asymptomatic dogs from the central area harbor more parasites in the skin than the asymptomatic ones from the metropolitan area. In addition, a profound difference was noted in the intensity of the inflammatory reaction and parasite load in the skin of experimental infected dogs

Toll receptors type-2 and CR3 expression of canine monocytes and its correlation with immunohistochemistry and xenodiagnosis in visceral leishmaniasis.

The aim of the present study was to investigate TLR2 expression in peripheral blood monocytes from dogs naturally infected with Leishmania (Leishmania) infantum to determine whether it correlates with CD11b/CD18 (CR3) expression, and to evaluate the potential of dogs as sources of infection using phlebotomine xenodiagnosis. Forty eight dogs were serologically diagnosed with L. infantum infection by indirect immunofluorescence antibody test (IFAT) and enzyme linked immunosorbent assay (ELISA). Parasitological exams from bone-marrow aspirates were positive by PCR analysis. All dogs were clinical defined as symptomatic. Ear skin tissue samples were obtained for immunohistochemistry (IHQ) analysis. The potential of these dogs as a source of infection using phlebotomine xenodiagnosis (XENO) was evaluated. Flow cytometry was carried out on peripheral blood mononuclear cells using superficial receptors including CD14, CD11b, TLR2 and MHCII. IHQ ear skin tissue parasite load and XENO where done where we found a strict correlation (r = 0.5373). Dogs with higher expression of MFI of CD11b inside CD14 monocytes were represented by dogs without parasite ear tissue load that were unable to infect phlebotomines (IHQ⁻/XENO⁻). Dogs with lower expression of MFI of CD11b inside CD14 monocytes were represented by dogs with parasite ear tissue load and able to infect phlebotomines (IHQ⁺/XENO⁺) (p = 0,0032). Comparable results were obtained for MFI of MHCII (p = 0.0054). In addition, considering the population frequency of CD11b⁺TLR2⁺ and CD11b⁺MHCII⁺, higher values were obtained from dogs with IHQ⁻/XENO⁻ than dogs with IHQ⁺/XENO⁺ (p = 0.01; p = 0.0048, respectively). These data, together with the TLR2 and NO assays results (CD11b⁺TLR2⁺ and NO with higher values for dogs with IHQ⁻/XENO⁻ than dogs with IHQ⁺/XENO⁺, led to the conclusion that IHQ⁻/XENO⁻ dogs are more resistant or could modulate the cellular immune response essential for Leishmania tissue clearance

Identification of monocytes subpopulation of the peripheral blood mononuclear cells (PBMC) in naturally infected dogs with <i>Leishmania (L.) infantum.</i>

<p>Panel A has depicted the gate of monocytes based on SSC <i>versus</i> CD14/FL3 expression dot plot (SSC^intermediateCD14^hight+) subpopulation; Panel B, geometric mean fluorescent intensity (MFI) of CD11b <i>versus</i> cells number (previous subpopulation selection). Panel C (representative dotplot) showing gates that were set, based on negative controls (cell and isotype)</p

Nitric Oxide (NO) plasma levels of non-infected dogs (NID) and naturally infected dogs with <i>Leishmania (L.) infantum</i>, Belo Horizonte, Minas Gerais, Brazil.

<p>As an indirect measurement of NO production, the Griess reaction was used to determine the nitrite levels. These results are expressed in micromolar (µM). A comparison inside groups NID (mean = 21.93 µM) and dogs IHQ and XENO double positive (IHQ⁺/XENO⁺) (mean = 24.11 µM) or negative IHQ⁻/XENO⁻ (mean = 39.19 µM) was carried out. Significant differences, at a level of 5% of probability (p<0.05), between cohorts are identified by the lower case letter (a) through Kruskal-Wallis Test (p = 0.0358)</p

Flow cytometry analysis considering distinct phenotypical kinetics of monocytes (SSC^intermediateCD14^hight+) taking into account the non-infected dogs (NID), immunohistochemistry (IHQ) and xenodiagnosis (XENO) results.

<p>Panel A and B represent geometric mean fluorescent intensity (MFI) of CD11b and MHC II, inside previously select monocyte subpopulation, taking into consideration NID (n = 5) <i>versus</i> double positive XENO⁺/IHQ⁺ (n = 21) <i>versus</i> double negative XENO⁻/IHQ⁻ (n = 16) results. Panel C and D represent the percentage of fluorescent cells within the population CD11bFITC⁺.TLR2PE⁺ and CD11bFITC⁺.MHCIIPE⁺ considering NID (n = 5) <i>versus</i> double positive IHQ⁺/XENO⁺ (n = 21) <i>versus</i> double negative IHQ⁻/XENO⁻ (n = 16) results. MFI and Parent frequencies of constituent groups: CD11b - NID (mean =  24.016, 50^th percentile = 22.350), Xeno⁺/IHQ⁺ (mean = 10.83, 50^th percentile = 9.700), Xeno⁻/IHQ⁻ (mean = 19.23, 50^th percentile = 15.320); MHC class II - NID (mean = 14.32, 50^th percentile = 14.04), Xeno⁺/IHQ⁺ (mean = 30.35, 50^th percentile = 29.03), Xeno⁻/IHQ⁻ (mean = 61.64, 50^th percentile = 68.23); CD11b⁺.TLR2⁺ - NID (mean = 0.3276, 50^th percentile = 0.2500), Xeno⁺/IHQ⁺ (mean = 0.2687, 50^th percentile = 0.1410), Xeno⁻/IHQ⁻ (mean = 0.4806, 50^th percentile = 0.4620); CD11b⁺.MHCII⁺ - NID (mean = 0.4492, 50^th percentile = 0.4600), Xeno⁺/IHQ⁺ (mean = 0.3851, 50^th percentile = 0.4200), Xeno⁻/IHQ⁻ (mean = 0.5765, 50^th percentile = 0.5755). Significant differences, at a level of 5% of probability (p<0.05), between cohorts are identified by the lower case letter (a, b and c) through Kruskal-Wallis and One-way ANOVA</p