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Hedy S. Wald Jordan White Shmuel P. Reis Angela Y. Esquibel David Anthony 《Medical teacher》2019,41(2):152-160
Aim: Clerkship-specific interactive reflective writing (IRW)-enhanced reflection may enhance professional identity formation (PIF), a fundamental goal of medical education. PIF process as revealed in students? reflective writing (RW) has been understudied.Methods: The authors developed an IRW curriculum within a Family Medicine Clerkship (FMC) and analyzed students? reflections about challenging/difficult patient encounters using immersion-crystallization qualitative analysis.Results: The qualitative analysis identified 26 unique emergent themes and five distinct thematic categories (1. Role of emotions, 2. Role of cognition, 3. Behaviorally responding to situational context, 4. Patient factors, and 5. External factors) as well as an emergent PIF model from a directed content analysis. The model describes students? backgrounds, emotions and previous experiences in medicine merging with external factors and processed during student?patient interactions. The RWs also revealed that processing often involves polarities (e.g. empathy/lack of empathy or encouragement/disillusionment) as well as dissonance between idealized visions and lived reality.Conclusions: IRW facilitates and ideally supports grappling with the lived reality of medicine; uncovering a “positive hidden curriculum” within medical education. The authors propose engaging learners in guided critical reflection about complex experiences for meaning-making within a safe learning climate as a valuable way to cultivate reflective, resilient professionals with “prepared” minds and hearts for inevitable challenges of healthcare practice. 相似文献
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Marcelo Sato‐Sano Solange Pistori Teixeira Juliano Cordova Vargas Otvio Cesar Carvalho Guimares Baiocchi Milvia Maria Simes e Silva Enokihara Elimar Elias Gomes Mariana Dias Batista 《The Journal of dermatology》2019,46(7):618-621
Eosinophilic dermatosis of hematological malignancy is a paraneoplastic skin eruption associated with chronic lymphocytic leukemia and other B‐cell malignancies. It clinically resembles an insect bite reaction and it can precede the symptoms of the hematological malignancy or be related to a more aggressive course. Different treatments have been proposed, but partial response and recurrence are frequent. Herein, we describe a case of eosinophilic dermatosis associated with mantle cell lymphoma with remission after lenalidomide therapy. 相似文献
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Edson Donizetti Verri Gabriel Pdua da Silva Evandro Marianetti Fioco Nayara Soares da Silva Saulo Csar Valin Fabrin Cesar Augusto Bueno Zanella Camila Roberta Garrefa Milton Faria Júnior Selma Sissere Jaime Eduardo Cecilio Hallak Marcelo Palinkas Thais Cristina Chaves Simone Cecilio Hallak Regalo 《Journal of oral rehabilitation》2019,46(10):912-919
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Flávia Silva Arbex Borim Tiago da Silva Alexandre Anita Liberalesso Neri Roberta de Oliveira Máximo Marcela Fernandes Silva Cesar de Oliveira 《Journal of the American Medical Directors Association》2019,20(1):47-52
Background and objective
There is little epidemiologic evidence considering the combined effect of dynapenia and low 25-hydroxyvitamin D [25 (OH) D] on incident disability. Our aim was to investigate whether the combination of dynapenia and low 25 (OH) D serum levels increases the risk of activities of daily living (ADL) incident disability.Design
Prospective cohort study.Settings
English Longitudinal Study of Aging.Participants
A total of 4630 community-dwelling adults aged 50 years and older without ADL disability at baseline.Measurements
The baseline sample was categorized into 4 groups (ie, nondynapenic/normal 25 (OH) D, low 25 (OH) D only, dynapenic only, and dynapenic/low 25 (OH) D according to their handgrip strength (<26 kg for men and <16 kg for women) and 25 (OH) D (≤50 nmol/L). The outcome was the presence of any ADL disability 2 years after baseline according to the modified Katz Index. Incidence rate ratios (IRRs) adjusted by sociodemographic, behavioral, and clinical characteristics were estimated using Poisson regression.Results
The fully adjusted model showed that older adults with dynapenia only and those with lower serum levels of 25 (OH) D combined with dynapenia had higher incident ADL disability risk compared with nondynapenic and those with normal serum levels of 25 (OH) D. The IRRs for lower 25 (OH) D serum levels combined with dynapenia were higher than for dynapenia only, however, the confidence intervals (CIs) showed similar effect for these 2 groups. The IRRs were 1.31 for low 25(OH) D only (95% CI 0.99–1.74), 1.77 for dynapenia only (95% CI 1.08–2.88), and 1.94 for combined dynapenia and low 25(OH)D (95% CI 1.28–2.94).Conclusions
Dynapenia only and dynapenia combined with low 25 (OH) D serum levels were important risk factors for ADL disability in middle-aged individuals and older adults in 2 years of follow-up. 相似文献8.
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