Palliative care for the elderly - developing a curriculum for nursing and medical students

<p>Abstract</p> <p>Background</p> <p>Delivering palliative care to elderly, dying patients is a present and future challenge. In Germany, this has been underlined by a 2009 legislation implementing palliative care as compulsory in the medical curriculum. While the number of elderly patients is increasing in many western countries multimorbidity, dementia and frailty complicate care. Teaching palliative care of the elderly to an interprofessional group of medical and nursing students can help to provide better care as acknowledged by the ministry of health and its expert panels.</p> <p>In this study we researched and created an interdisciplinary curriculum focussing on the palliative care needs of the elderly which will be presented in this paper.</p> <p>Methods</p> <p>In order to identify relevant learning goals and objectives for the curriculum, we proceeded in four subsequent stages.</p> <p>We searched international literature for existing undergraduate palliative care curricula focussing on the palliative care situation of elderly patients; we searched international literature for palliative care needs of the elderly. The searches were sensitive and limited in nature. Mesh terms were used where applicable. We then presented the results to a group of geriatrics and palliative care experts for critical appraisal. Finally, the findings were transformed into a curriculum, focussing on learning goals, using the literature found.</p> <p>Results</p> <p>The literature searches and expert feedback produced a primary body of results. The following deduction domains emerged: Geriatrics, Palliative Care, Communication & Patient Autonomy and Organisation & Social Networks. Based on these domains we developed our curriculum.</p> <p>Conclusions</p> <p>The curriculum was successfully implemented following the Kern approach for medical curricula. The process is documented in this paper. The information given may support curriculum developers in their search for learning goals and objectives.</p

Acceptance of technology-enhanced learning for a theoretical radiological science course: a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Technology-enhanced learning (TEL) gives a view to improved education. However, there is a need to clarify how TEL can be used effectively. The study compared students' attitudes and opinions towards a traditional face-to-face course on theoretical radiological science and a TEL course where students could combine face-to-face lectures and e-learning modules at their best convenience.</p> <p>Methods</p> <p>42 third-year dental students were randomly assigned to the traditional face-to-face group and the TEL group. Both groups completed questionnaires before the beginning and after completion of the course on attitudes and opinions towards a traditional face-to-face lectures and technology-enhanced learning. After completion of the course both groups also filled in the validated German-language TRIL (Trierer Inventar zur Lehrevaluation) questionnaire for the evaluation of courses given at universities.</p> <p>Results</p> <p>Both groups had a positive attitude towards e-learning that did not change over time. The TEL group attended significantly less face-to-face lectures than the traditional group. However, both groups stated that face-to-face lectures were the basis for education in a theoretical radiological science course.</p> <p>The members of the TEL group rated e-mail reminders significantly more important when they filled in the questionnaire on attitudes and opinions towards a traditional face-to-face lectures and technology-enhanced learning for the second time after completion of the course.</p> <p>The members of the technology-enhanced learning group were significantly less confident in passing the exam compared to the members of the traditional group. However, examination results did not differ significantly for traditional and the TEL group.</p> <p>Conclusions</p> <p>It seems that technology-enhanced learning in a theoretical radiological science course has the potential to reduce the need for face-to-face lectures. At the same time examination results are not impaired. However, technology-enhanced learning cannot completely replace traditional face-to-face lectures, because students indicate that they consider traditional teaching as the basis of their education.</p

Substrate specificity of a peptidyl-aminoacyl-l/d-isomerase from frog skin

In the skin of fire-bellied toads (Bombina species), an aminoacyl-l/d-isomerase activity is present which catalyses the post-translational isomerization of the l- to the d-form of the second residue of its substrate peptides. Previously, this new type of enzyme was studied in some detail and genes potentially coding for similar polypeptides were found to exist in several vertebrate species including man. Here, we present our studies to the substrate specificity of this isomerase using fluorescence-labeled variants of the natural substrate bombinin H with different amino acids at positions 1, 2 or 3. Surprisingly, this enzyme has a rather low selectivity for residues at position 2 where the change of chirality at the alpha-carbon takes place. In contrast, a hydrophobic amino acid at position 1 and a small one at position 3 of the substrate are essential. Interestingly, some peptides containing a Phe at position 3 also were substrates. Furthermore, we investigated the role of the amino-terminus for substrate recognition. In view of the rather broad specificity of the frog isomerase, we made a databank search for potential substrates of such an enzyme. Indeed, numerous peptides of amphibia and mammals were found which fulfill the requirements determined in this study. Expression of isomerases with similar characteristics in other species can therefore be expected to catalyze the formation of peptides containing d-amino acids

New national curricula guidelines that support the use of interprofessional education in Brazilian context : an analysis of key documents

The National Curricular Guidelines (NCGs) are important documents for understanding the history of academic health professions education in Brazil. Key policies within the NCGs have helped to re-orient health professions education and have stimulated curricular changes, including active learning methodologies, more integrated teaching-service environments and, more recently, have introduced interprofessional education (IPE) in both undergraduate and postgraduate sectors. This paper presents the findings of a study that examined the NCGs for nursing, dentistry and medicine courses as juridical foundations for adopting strategies that promote IPE across higher education institutions in Brazil. We employed a comparative and exploratory documentary analysis to understand the role of IPE or collaborative practices in NCGs for the three largest professions in Brazil. Following a thematic analysis of these texts, four key themes emerged: faculty development; competencies for teamwork; curricular structure; and learning metrics. Key findings related to each of these themes are presented and discussed in relation to the wider interprofessional literature. The paper goes on to argue that the statements contained in the NCGs about adoption of IPE and collaborative practices will have an important influence in shaping the future of health professions education in Brazil

Validity of scores from communication skills instruments for patients and their dental student-clinicians

The development of appropriate communication skills by healthcare providers is central to providing quality patient-centred care. Patients can provide valuable feedback to practitioners about their clinical communication. However, in oral health care, their involvement is uncommon and instruments specific for communication in oral health care have not been available. Recently, two complementary instruments have been developed by the Faculty of Dentistry, University of Manitoba for evaluating student-clinicians' clinical communication: one for patient evaluation and one for student self-evaluation. The aim of the current study was to provide validity evidence for the scores related to the internal structure of the revised 2007 versions of these instruments in two dental clinical/education contexts, namely the Universities of Manitoba, Canada (UM) and Adelaide, Australia (UA). The proposed factor structure and loadings, and their stability across contexts were assessed using confirmatory factor analysis, and the adequacy of the internal consistency reliability of the scores was analysed using Cronbach's alpha. The factor structure of the current 2007 versions of the patient and student instruments, derived from the previously developed longer versions of these instruments, was confirmed and was consistent across the two clinical/educational contexts. A model of partial invariance provided the best fit for these data due to variations in the magnitude of the factor loadings between sites. The internal consistency reliability of scores was high with a range of 0.88–0.97. In conclusion, the current study provides preliminary evidence regarding the validity of the scores of the current 2007 instruments, in terms of the internal structure, as measuring the five factors well. Replication of the factor structure of these instrument scores with more participants at both UA and other institutions is required.T. A. Winning, A. Kinnell, M. E. Wener, N. Mazurat and D. J Schönwette

Copyright Reform in South Africa: Two Joint Academic Opinions on the Copyright Amendment Bill [B13B 2017]

South Africa is in the process of reforming its copyright law, attempting to update and align it with constitutional rights and existing and prospective international treaty obligations. With the adoption of the Copyright Amendment Bill [B13B-2017] by both Houses of Parliament in March 2019, the apartheid-era Copyright Act of 1978 had almost successfully been amended, when the President of the Republic withheld his assent to the Bill referring it back to Parliament citing reservations about its constitutionality. Following calls for public comment by the parliamentary Portfolio Committee on Trade and Industry on the President's reservations, a coalition of copyright and constitutional law experts, convinced of the constitutionality of the Bill, submitted two legal opinions to the Committee. The two opinions presented in this contribution underline the importance of copyright reform, as envisaged in the Bill, to bringing South African copyright law into the digital age and realising several constitutional rights including the rights to education, cultural participation, language, freedom of expression, and access to knowledge of everyone, without discrimination

A nondestructive method for extracting maternally derived egg yolk carotenoids

Maternally deposited carotenoids are a prominent component of egg yolk and are vital for the development and growth of the embryo. In most studies of avian yolk carotenoids, eggs are destructively sampled and this may limit both the number of clutches studied and the research questions addressed. We describe an empirical field trial for a nondestructive biopsy method to extract small samples (0.05 ml) of egg yolk for highperformance liquid chromatography (HPLC) analysis of yolk carotenoid concentrations.We sampled 180 clutches (N = 44 biopsies) of two species of introduced thrushes (genus Turdus) from agricultural habitats in central North Island, New Zealand. Once the protocol was established, all biopsied eggs from clutches that were not depredated or deserted before candling were found to be developing normally after 3–5 d of incubation (N = 28) and all hatched. Biopsy samples (>0.02 g) produced concentrations of yolk carotenoids (and variances) that were statistically indistinguishable from whole yolk destructive samples. In addition, our samples (>0.02 g) confirmed previously reported differences in yolk carotenoid concentrations between the two thrush species and revealed a significant decline in yolk carotenoid concentration with laying order. Further examination of how variability in yolk carotenoid concentration and identity influences offspring sex, success, and survival or, later in life, reproductive success and ability to efficiently incorporate dietary carotenoids into both integument and immune tissues will require larger sample sizes. Studies to date have been restricted by the number of destructive samples that investigators are willing (or permitted) to obtain from wild species. Thus, we hope that our nondestructive method of sampling yolk will promote further examination of the links between carotenoid uptake from the environment and maternal investment in the avian yolk.Phillip Cassey, John G. Ewen, Rebecca L. Boulton, Filiz Karadas, Anders P. Møller and Tim M. Blackbur