Exploring correlation between early clinical skills teaching and self-reported competence of senior medical students; a cross-sectional study

Η εκπαίδευση σε συνθήκες προσομοίωσης σε συνδυασμό με την πρακτική άσκηση υπό επίβλεψη σε πραγματικούς ασθενείς, αποτελούν δύο απαραίτητα βήματα για την ασφαλή και συστηματική εκπαίδευση στις κλινικές δεξιότητες. Η οικοδόμηση της αυτοεκτίμησης των φοιτητών ιατρικής κατά τη διάρκεια των σπουδών τους είναι ζωτικής σημασίας, αλλά δεν αρκεί για να εξασφαλίσει την επιτυχή πραγματοποίηση κλινικών δεξιοτήτων. O σκοπός της μελέτης ήταν να αξιολογήσει την αυτο-αναφερόμενη ικανότητα σε βασικές κλινικές δεξιότητες φοιτητών μεγαλυτέρων ετών της ιατρικής, πριν από την αποφοίτησή τους και να διερευνήσει πιθανές συσχετίσεις με την πρώιμη εκπαίδευση κλινικών δεξιοτήτων σε συνθήκες προσομοίωσης. Μέθοδος: Πραγματοποιήσαμε μια συγχρονική μελέτη σε τελειόφοιτους φοιτητές ιατρικής ένα μήνα πριν από την αποφοίτησή τους. Καλέσαμε τους φοιτητές να κάνουν την αυτοεκτίμηση των ικανοτήτων τους σε 42 βασικές κλινικές δεξιότητες χρησιμοποιώντας ένα ανώνυμο ερωτηματολόγιο μέσω διαδικτύου. Τα δεδομένα αναλύθηκαν λαμβάνοντας υπόψη την προηγούμενη συμμετοχή των φοιτητών στο επιλεγόμενο μάθημα «Εργαστήριο Κλινικών Δεξιοτήτων» (ΕΚΔ). Αποτελέσματα: Η απαντητικότητα των τελειόφοιτων φοιτητών ιατρικής στην ηλεκτρονική μας μελέτης ήταν 24,6%. Τριάντα τέσσερις φοιτητές (38,6%) είχαν παρακολουθήσει το επιλεγόμενα μάθημα ΕΚΔ. Η παρακολούθηση του ΕΚΔ φάνηκε να επηρεάζει την αυτοεκτίμηση της ικανότητας των φοιτητών στην πραγματοποίηση των 15 δεξιοτήτων που διδάσκονται στο επιλεγόμενο μάθημα, σε σχέση με τους φοιτητές που δεν το έχουν παρακολουθήσει (p>0,05). Δεν υπήρχε στατιστικά σημαντική διαφορά μεταξύ των δύο ομάδων φοιτητών σε σχέση με τις άλλες βασικές δεξιότητες που δεν διδάχθηκαν στο ΕΚΔ. Συμπεράσματα: Τα αποτελέσματά μας δείχνουν ότι οι τελειόφοιτοι φοιτητές ιατρικής δεν αισθάνονται αρκετά ικανοί να επιτελέσουν τις βασικές κλινικές δεξιότητες που πρέπει να καλύπτει το προπτυχιακό πρόγραμμα σπουδών της ιατρικής. Η συστηματική εκπαίδευση στις κλινικές δεξιότητες στα πρώτα χρόνια των ιατρικών σπουδών πριν από την επαφή με τους ασθενούς φαίνεται να είναι αρκετή για να αλλάξει την αυτοεκτίμηση των τελειόφοιτων φοιτητών ιατρικής στην πραγματοποίηση επιλεγμένων κλινικών δεξιοτήτων.Introduction: Simulation-based teaching combined with supervised clinical practice, are the necessary steps for safe and systematic clinical skills education. Building medical students’ self-esteem during their undergraduate studies has a positive effect in their competence but is not sufficient to ensure successful clinical skills performance. The aim of the study was to assess senior medical students’ self-reported competence before graduation in basic clinical skills and explore potential correlations with early simulation-based clinical skills teaching. Methods: We conducted a cross-sectional study in final-year medical students one month before their graduation. We invited senior medical students to self-report their competence in 42 basic clinical skills using an online anonymous questionnaire. Medical students’ participation in the clinical skills lab (CSL) elective course was the main factor of analysis. Results: Senior medical students’ response rate in our electronic study was 24.6%. Thirty-four students (38.6%) have attended CSL elective course. Attending CSL seemed to influence senior medical students’ self-reported competence in performing the 15 skills taught in the elective course in comparison with students who have not attended it (p>0.05). There was no statistical difference between the two groups in regard to other basic skills that were not taught in the CSL. Conclusion: Our results indicate that senior medical students do not feel competent enough to perform basic clinical skills that the undergraduate medical curricula should cover. Systematic clinical skills teaching in early years of medical studies before patient contact seemed to be enough to change senior medical students’ self-reported competence in specific clinical skills

Βασικές αρχές και τρόπος λειτουργίας Ελληνικής αγοράς ηλεκτρικής ενέργειας

Εθνικό Μετσόβιο Πολυτεχνείο--Μεταπτυχιακή Εργασία. Διεπιστημονικό-Διατμηματικό Πρόγραμμα Μεταπτυχιακών Σπουδών (Δ.Π.Μ.Σ.) “Παραγωγή και Διαχείριση Ενέργειας

Prevention of orthodontic enamel demineralization: a systematic review with meta‐analyses

Aim of this systematic review was to assess the efficacy of preventive interventions against the development of white spot lesions (WSLs) during fixed appliance orthodontic treatment. Nine databases were searched without limitations in September 2018 for randomized trials. Study selection, data extraction and risk of bias assessment were done independently in duplicate. Random-effects meta-analyses of mean differences (MDs) or relative risks (RRs) with their 95% confidence intervals (CIs) were conducted, followed by sensitivity analyses, and the GRADE analysis of the evidence quality. A total of 24 papers (23 trials) were included, assessing preventive measures applied either around orthodontic brackets (21 trials; 1427 patients; mean age 14.4 years) or molar bands (2 trials; 46 patients; age/sex not reported). Active patient reminders were associated with reduced WSL incidence on patient level compared to no reminder (3 trials; 190 patients; RR: 0.4; 95% CI: 0.31-0.64; Number Needed to Treat [NNT]: 3 patients), flat surface sealants were associated with reduced WSL incidence on tooth level than no sealant (5 trials; 2784 teeth; RR: 0.8; 95% CI: 0.63-0.95; NNT: 33 teeth), and fluoride varnish was associated with reduced WSL severity on tooth level (2 trials; 1160 teeth; MD: -0.32 points; 95% CI: -0.44 to -0.21 points). However, the quality of evidence was low according to GRADE, due to risk of bias. Some evidence indicates that active patient reminders and flat surface sealants or fluoride varnish around orthodontic brackets might be associated with reduced WSL burden, but further research is needed. Keywords: adverse effects; clinical trials; dental caries; evidence-based medicine; fixed appliances; systematic review

Artificial pancreas treatment for outpatients with type 1 diabetes: systematic review and meta-analysis.

OBJECTIVE: To evaluate the efficacy and safety of artificial pancreas treatment in non-pregnant outpatients with type 1 diabetes. DESIGN: Systematic review and meta-analysis of randomised controlled trials. DATA SOURCES: Medline, Embase, Cochrane Library, and grey literature up to 2 February 2018. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomised controlled trials in non-pregnant outpatients with type 1 diabetes that compared the use of any artificial pancreas system with any type of insulin based treatment. Primary outcome was proportion (%) of time that sensor glucose level was within the near normoglycaemic range (3.9-10 mmol/L). Secondary outcomes included proportion (%) of time that sensor glucose level was above 10 mmol/L or below 3.9 mmol/L, low blood glucose index overnight, mean sensor glucose level, total daily insulin needs, and glycated haemoglobin. The Cochrane Collaboration risk of bias tool was used to assess study quality. RESULTS: 40 studies (1027 participants with data for 44 comparisons) were included in the meta-analysis. 35 comparisons assessed a single hormone artificial pancreas system, whereas nine comparisons assessed a dual hormone system. Only nine studies were at low risk of bias. Proportion of time in the near normoglycaemic range (3.9-10.0 mmol/L) was significantly higher with artificial pancreas use, both overnight (weighted mean difference 15.15%, 95% confidence interval 12.21% to 18.09%) and over a 24 hour period (9.62%, 7.54% to 11.7%). Artificial pancreas systems had a favourable effect on the proportion of time with sensor glucose level above 10 mmol/L (-8.52%, -11.14% to -5.9%) or below 3.9 mmol/L (-1.49%, -1.86% to -1.11%) over 24 hours, compared with control treatment. Robustness of findings for the primary outcome was verified in sensitivity analyses, by including only trials at low risk of bias (11.64%, 9.1% to 14.18%) or trials under unsupervised, normal living conditions (10.42%, 8.63% to 12.2%). Results were consistent in a subgroup analysis both for single hormone and dual hormone artificial pancreas systems. CONCLUSIONS: Artificial pancreas systems are an efficacious and safe approach for treating outpatients with type 1 diabetes. The main limitations of current research evidence on artificial pancreas systems are related to inconsistency in outcome reporting, small sample size, and short follow-up duration of individual trials

Management of hyperglycemia in type 2 diabetes: a patient-centered approach: position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD).

Glycemic management in type 2 diabetes mellitus has become increasingly complex and, to some extent, controversial, with a widening array of pharmacological agents now available (1–5), mounting concerns about their potential adverse effects and new uncertainties regarding the benefits of intensive glycemic control on macrovascular complications (6–9). Many clinicians are therefore perplexed as to the optimal strategies for their patients. As a consequence, the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) convened a joint task force to examine the evidence and develop recommendations for antihyperglycemic therapy in nonpregnant adults with type 2 diabetes. Several guideline documents have been developed by members of these two organizations (10) and by other societies and federations (2,11–15). However, an update was deemed necessary because of contemporary information on the benefits/risks of glycemic control, recent evidence concerning efficacy and safety of several new drug classes (16,17), the withdrawal/restriction of others, and increasing calls for a move toward more patient-centered care (18,19). This statement has been written incorporating the best available evidence and, where solid support does not exist, using the experience and insight of the writing group, incorporating an extensive review by additional experts (acknowledged below). The document refers to glycemic control; yet this clearly needs to be pursued within a multifactorial risk reduction framework. This stems from the fact that patients with type 2 diabetes are at increased risk of cardiovascular morbidity and mortality; the aggressive management of cardiovascular

Management of hyperglycaemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)

The American Diabetes Association and the European Association for the Study of Diabetes convened a panel to update the prior position statements, published in 2012 and 2015, on the management of type 2 diabetes in adults. A systematic evaluation of the literature since 2014 informed new recommendations. These include additional focus on lifestyle management and diabetes self-management education and support. For those with obesity, efforts targeting weight loss, including lifestyle, medication and surgical interventions, are recommended. With regards to medication management, for patients with clinical cardiovascular disease, a sodium–glucose cotransporter-2 (SGLT2) inhibitor or a glucagon-like peptide-1 (GLP-1) receptor agonist with proven cardiovascular benefit is recommended. For patients with chronic kidney disease or clinical heart failure and atherosclerotic cardiovascular disease, an SGLT2 inhibitor with proven benefit is recommended. GLP-1 receptor agonists are generally recommended as the first injectable medication

Hydrotherapy (Project Hydriades)

Natural resources are being used for the maintenance of health. According to the Law 3498/2006 of the Greek Parliament the natural health spas must be validated for their therapeutic properties. The Association of Municipalities and Communities of Health Springs of Greece signed a contract with the Research Committee of the Aristotle University of Thessaloniki, Greece, in order to conduct the research programme: ‘Study for the documentation of the therapeutic properties of the thermomineral waters’. The main aim of the project is: (1) the study of biological and therapeutic parameters of the natural health sources, (2) the identification of the indications and contraindications of hydrotherapy. Aims parallel to the main ones have been also set

Effects of Imatinib Mesylate (Gleevec) on Human Islet NF-kappaB Activation and Chemokine Production In Vitro

Imatinib Mesylate (Gleevec) is a drug that potently counteracts diabetes both in humans and in animal models for human diabetes. We have previously reported that this compound in human pancreatic islets stimulates NF-κB signaling and islet cell survival. The aim of this study was to investigate control of NF-κB post-translational modifications exerted by Imatinib and whether any such effects are associated with altered islet gene expression and chemokine production in vitro.Human islets were either left untreated or treated with Imatinib for different timepoints. IκB-α and NF-κB p65 phosphorylation and methylation were assessed by immunoblot analysis. Islet gene expression was assessed using a commercial Pathway Finder microarray kit and RT-PCR. Islet chemokine production was determined by flow cytometric bead array analysis.Human islet IκB-α and Ser276-p65 phosphorylation were increased by a 20 minute Imatinib exposure. Methylation of p65 at position Lys221 was increased after 60 min of Imatinib exposure and persisted for 3 hours. Microarray analysis of islets exposed to Imatinib for 4 hours revealed increased expression of the inflammatory genes IL-4R, TCF5, DR5, I-TRAF, I-CAM, HSP27 and IL-8. The islet release of IL-8 was augmented in islets cultured over night in the presence of Imatinib. Following 30 hours of Imatinib exposure, the cytokine-induced IκB-α and STAT1 phosphorylation was abolished and diminished, respectively. The cytokine-induced release of the chemokines MIG and IP10 was lower in islets exposed to Imatinib for 30 hours.Imatinib by itself promotes a modest activation of NF-κB. However, a prolonged exposure of human islets to Imatinib is associated with a dampened response to cytokines. It is possible that Imatinib induces NF-κB preconditioning of islet cells leading to lowered cytokine sensitivity and a mitigated islet inflammation