Drama as a pedagogical tool for practicing death notification-experiences from Swedish medical students

<p>Abstract</p> <p>Background</p> <p>One of the toughest tasks in any profession is the deliverance of death notification. Marathon Death is an exercise conducted during the fourth year of medical school in northern Sweden to prepare students for this responsibility. The exercise is designed to enable students to gain insight into the emotional and formal procedure of delivering death notifications. The exercise is inspired by Augusto Boal's work around Forum Theatre and is analyzed using video playback. The aim of the study was to explore reflections, attitudes and ideas toward training in delivering death notifications among medical students who participate in the Marathon Death exercise based on forum play.</p> <p>Methods</p> <p>After participation in the Marathon Death exercise, students completed semi-structured interviews. The transcribed interviews were analyzed using the principles of qualitative content analysis including a deductive content analysis approach with a structured matrix based on Bloom's taxonomy domains.</p> <p>Results</p> <p>The Marathon Death exercise was perceived as emotionally loaded, realistic and valuable for the future professional role as a physician. The deliverance of a death notification to the next of kin that a loved one has died was perceived as difficult. The exercise conjured emotions such as positive expectations and sheer anxiety. Students perceived participation in the exercise as an important learning experience, discovering that they had the capacity to manage such a difficult situation. The feedback from the video playback of the exercise and the feedback from fellow students and teachers enhanced the learning experience.</p> <p>Conclusions</p> <p>The exercise, Marathon Death, based on forum play with video playback is a useful pedagogical tool that enables students to practice delivering death notification. The ability to practice under realistic conditions contributes to reinforce students in preparation for their future professional role.</p

Maternal Serologic Screening to Prevent Congenital Toxoplasmosis: A Decision-Analytic Economic Model

We constructed a decision-analytic and cost-minimization model to compare monthly maternal serological screening for congenital toxoplasmosis, prenatal treatment, and post-natal follow-up and treatment according to the current French protocol, versus no systematic screening or perinatal treatment. Costs are based on published estimates of lifetime societal costs of developmental disabilities and current diagnostic and treatment costs. Probabilities are based on published results and clinical practice in the United States and France. We use sensitivity analysis to evaluate robustness of results. We find that universal monthly maternal screening for congenital toxoplasmosis with follow-up and treatment, following the French (Paris) protocol, leads to savings of $620 per child screened. Results are robust to changes in test costs, value of statistical life, seroprevalence in women of childbearing age, fetal loss due to amniocentesis, incidence of primary T. gondii infection during pregnancy, and to bivariate analysis of test costs and incidence of primary T. gondii infection. Given the parameters in this model and a maternal screening test cost of$12, screening is cost-saving for rates of congenital infection above 1 per 10,000 live births. Universal screening according to the French protocol is cost saving for the US population within broad parameters for costs and probabilities

TÉTANO NA POPULAÇÃO GERIÁTRICA: PROBLEMÁTICA DA SAÚDE COLETIVA? TÉTANO EN LA POBLACIÓN GERIÁTRICA: PROBLEMÁTICA DE LA SALUD COLECTIVA? TETANUS IN THE GERIATRIC POPULATION: IS THIS A COLLECTIVE HEALTH PROBLEM?

O tétano é uma doença infecciosa, não contagiosa, causada pelo bacilo Clostridium tetani que penetra no organismo através de ferimento. A disfunção psicomotora facilita acidentes entre os idoso e a cobertura vacinal é baixa nesta população contribuindo para letalidade alta. Este estudo tem como objetivo refletir sobre a situação do homem idoso, com relação ao tétano, dentro da perspectiva da Saúde Coletiva. Trata-se de Estudo de Caso realizado com dois pacientes idosos, do sexo masculino, portadores de tétano acidental, internados num hospital do município de Fortaleza. A coleta de dados se deu entre março e abril de 1998. A análise mostra a ausência de cobertura vacinal e da implantação da profilaxia de emergência. Os dois pacientes evoluíram para óbito confirmando alta mortalidade por tétano entre este grupo etário. A reflexão crítica aponta para urgência de abordagem de saúde coletiva.<br>El tétano es una enfermedad infecciosa, no contagiosa, causada por el bacilo Clostridium Tetani que penetra en el organismo a través de una herida. El disturbio psicomotor facilita accidentes entre las personas mayores y la protección por vacunas en esta población es baja, lo que contribuye para un alto índice de mortalidad. Este estudio tiene como objetivo la reflexión sobre la situación del adulto mayor, con relación al tétano, dentro de la perspectiva de la Salud Colectiva. Se trata de un estudio de caso con dos pacientes ancianos, del sexo masculino, portadores del tétano accidental, internados en un hospital del municipio de Fortaleza. La recolección de datos de hizo entre marzo y abril de 1998. El análisis muestra la ausencia de cobertura de la vacuna y de una implementación de profilaxis de emergencia. Los dos pacientes fallecieron, lo que confirma la alta mortalidad por el tétano en este grupo de edad. La reflexión crítica, denota la urgencia de un abordaje desde la salud colectiva.<br>Tetanus is an infectious non-contagious disease caused by the bacillus Clostridium tetani, which penetrates in the organism through wounds. Psychomotor dysfunction facilitates accidents among elderly people and vaccinal coverage is low in this population, thus contributing to high lethality. This study aimed at reflecting on the situation faced by elderly people in relation to tetanus in the perspective of Collective Health. It is a Case Study conducted with two elderly males who had accidental tetanus and were hospitalized in a hospital in the municipality of Fortaleza. Data collection took place from March to April, 1998. The analysis showed the absence of vaccinal coverage as well as of the implementation of emergency prophylaxis. The two patients' conditions developed to death, which confirmed the high mortality due to tetanus in this age group. The critical reflection pointed out the urgency of a collective health approach