Amélioration des habiletés communicationnelles en médecine à l'aide du jeu de rôle : étude auprès de 28 étudiants de deuxième cycle d'études médicales

Background:

Medical teaching is usually centred on an objective-based approach and influenced by a flexnerian approach inducing an emphasis on abilities and skills more than the know-how. The know-how is usually under taught and assessed.

Aim:

To assess the competencies in announcing bad news of students in medicine in addition to their satisfaction about the methods used which were serious games.

Methods:

Students in the third-pregraduate year of medicine who performed their externship in a Department of Pathology of a university Hopsital were included during the year 2018-2019. Seven groups including 4 externs performing a 3-week-period were included. The training started with a pre-test, which consisted in an Objective-Structured-Clinical situation with a simulated patient and a evaluator with a checklist. The students were asked to perform a serious game, then they assisted to a lecture-based learning about the rules of announce of bad news. The serious game was screened then watched by all the students. After a debriefing session, the students were asked to fulfill a post test and a questionnaire-test

Results:

Twenty-eight students were included. The mean score accounted for 6,76 +/- 2,78 over 20 for the pre-test and 13,17 +/- 1,99 over 20 for the post-test. A significant difference was observed between the pre and post test (p<0.0001). All the students expressed their satisfaction. 27 students wished to repeat the experience. All the students put emphasis on the importance of the peer and auto-evaluation phase using videos. 14 students suggested to integrate this teaching method to the curriculum of the Faculty before their internship.

Conclusion:

Inspite of some limits, this study highlighted the improvement of the students’ relational competences in addition to their satisfaction related to the use of role play in the acquisition of relational competences related to particular situation such as the announce of bad news.     

Convivialité des municipalités canadiennes à l’égard des aînés : portrait et facteurs associés

ObjectivesThis study aimed to (1) document, globally and by domain, Canadian municipalities’ level of age-friendliness, and (2) identify municipality characteristics most associated with age-friendliness.MethodsA cross-sectional survey was sent to all Canadian municipalities (N=3406) with an online survey of 56 items from 9 domains providing age-friendliness scores. These scores were then crossed with the following municipality characteristics: percentage of adults aged 65 and older, population density, material deprivation, social deprivation, degree of metropolitan influence, implementation step of an age-friendly municipality initiative and geographic area.ResultsNine hundred twenty-one municipalities completed the survey. Overall, municipalities’ age-friendliness total score is good (58.4%). Four domains have high scores: Security (80.0%), Respect and social inclusion (65.0%), Outdoor spaces and building (62.2%), and Social participation (62.2%). Higher age-friendliness is associated with metropolitan municipalities, regions other than Prairies and Atlantic, higher residential density, greater proportion of older adults, greater social deprivation, lower material deprivation, and the last step of an age-friendly initiative.ConclusionThis portrait of Canadian municipalities’ age-friendliness can be used to strengthen actions promoting active aging.     

Apport de la simulation dans l'apprentissage de l'examen du fond d'œil.

Introduction: Simulation is emerging as an essential part of health sciences training programs as it provides safer patient care by reducing the risk of error. In the healthcare environment, simulation continues to spread in emergency specialties, but it is still underdeveloped in ophthalmology and there is a shortage of publications on this subject in Tunisia. Objective: To evaluate the effectiveness of procedural simulation as a teaching tool for funduscopic examination training. Methods and population studied: This was a prospective study including students who underwent procedural simulation training sessions during their ophthalmology internship. The included students were assessed at the initiation and end of each session by a pre-test and post-test. The procedure for performing the funduscopic examination was evaluated by a specific performance score. Student satisfaction was assessed at the end of each session. Results: During the study period, four groups of 12 students were included, for a total of 48 participants spread over 4 simulation sessions. Simulation training improved post-test. assessment scores with an overall median delta of +4.00. It also provided specific skills for performing the funduscopic examination, with an overall median specific performance score of 5.5/8 (5/8 to 7/8). The majority of students were satisfied upon completion of the simulation session. Conclusion: The training of fundus examination using an ophthalmoscopic simulator can improve the skills and knowledge of ophthalmic learners. This type of training can be an innovative addition to traditional learning. methods.     

Satisfaction des patients diabétiques surla qualité des services de santé ambulatoires

Aim: To assess the degree of satisfaction of diabetic patients with health care services and to determine the factors that influence it. Methods: It was a cross sectional study conducted in 2018 among diabetic outpatients of the department of endocrinology of the university hospital La Rabta. Patients general characteristics were noted. Each patient responded to a questionnaire, asked orally, in Tunisian dialect, by two physicians, about health care services including 20 questions grouped into three items. Each question was scored from 1 to 4 according to the degree of satisfaction. The global score as well as the scores of the items were calculated by adding the scores of the corresponding questions. Results: 150 diabetic patients responded to the questionnaire; mean age: 58.9±12.2 years [18-88], sex-ratio: 0.51.Cronbach coefficient was 0.78. The overall score was 62.2±6.5 [46-80]. Ninety-seven patients (64.7%) had a score ≥60. The item concerning ‘human contact and communication’ was considered good in 98% of cases. The item concerning ‘premises, cleanliness, comfort and safety’ was considered intermediate in 64% of cases. Patients were very satisfied with the accessibility of the department inside the hospital (76.7%), the attitude of the agents during the administrative formalities (74%) and particularly the behaviour of the doctor (96%). However, they were dissatisfied with the noise (72%) and overcrowding (67.4%) of the waiting room. There were no statistically significant associations between the overall score and the studied data. Conclusion: The diabetic patients were overall satisfied with the provided services. Actions must be taken to reduce overcrowding and long waiting times..     

Facteurs de sévérité chez les patients Algériens hospitalisés pour COVID-19

Introduction. Determining the profile of COVID-19 patients with low pulsed hemoglobin saturation in oxygen (SpO₂) could help clinicians identify those with a poor prognosis. Aim. To identify and to compare the clinical, biological and radiological data of Algerian patients hospitalized for COVID-19 and divided according to the SpO₂ measured at admission, at rest, and in ambient air. Methods. A prospective study was carried out on Algerian patients hospitalized for COVID-19 during the period from March 9 to April 30, 2020. The general characteristics of the patients and the clinical, biological and radiological data were determined. Results. 86 patients were included in the study [G₁: SpO₂ >95% (n=51) and G₂: SpO₂ ≤95% (n=35)]. Compared to G₁, G₂ was older (48±14 vs. 61±12 years, p=0.0001), included more patients aged ≥ 50 years (37.2 vs. 80.0%, p=0.0001), having an arterial-hypertension (21.6 vs. 45.7%, p=0.0180), a cancer (0.0 vs. 14.3%, p=0.0054), an anemia (25.6 vs. 56.3%, p=0.0069), a leukocytosis (4.7 vs. 21.9%, p=0.0236), a biological inflammatory syndrome (82.5 vs. 100%, p=0.0142), a hyper-uremia (7.0 vs. 37.5%, p=0.0185), a hyper-creatininaemia (4.7 vs. 18.8%, p=0.0356), a tissue damage (41.0 vs. 66.7%, p=0.0341), a diffuse ground-glass opacity (52.0 vs. 71.4%, p=0.0397), band condensations (30.0 vs. 54.3%, p=0.0244), a severe extension (2.0 vs. 25.7%, p=0.0008), and included fewer patients who complained from diarrhea (49.0 vs. 22.9%, p=0.0145), having a nodular ground-glass (66.0 vs. 40.0%, p=0.0177) and a slight extension (78.0 vs. 40.0%, p=0.0004). Conclusion. Criteria associated with low SpO₂ in hospitalized COVID-19 patients were advanced age, a history of arterial-hypertension and cancer, high frequencies of certain biological abnormalities or radiological signs. The diarrhea symptom, the radiological appearance of nodular ground glass, and a slight extension of the radiological lesions appear as protective elements.     

Interprofessional education in undergraduate healthcare programmes: the reaction of student dietitians

BACKGROUND: Interprofessional education (IPE) is a novel teaching and learning initiative where students of more than one health profession learn interactively together. However, despite its potential for improving interprofessional relationships, there is little information regarding the participation of student dietitians in IPE. The aim of this paper was to consider the reaction of student dietitians to an IPE course in order to stimulate debate between dietitians regarding the issues relating to IPE. METHODS: Student dietitians participated in an IPE course consisting of seven sessions on communication and ethics in health care together with students of medicine and nursing. Student dietitians completed an evaluation questionnaire following each session that surveyed their reaction to the session using both a Likert scale and free-text comments. RESULTS: Twenty-six student dietitians completed the IPE course. All sessions were rated positively for interest value (P < or = 0.14), learning experience (P < or = 0.036) and value for clinical practice (P < or = 0.05). The limited number of free-text comments indicated some positive experiences regarding interprofessional learning, teaching content and teaching strategy. CONCLUSIONS: This is one of very few evaluations to describe the reaction of student dietitians to IPE. Student dietitians had largely positive reactions to the IPE course. Further research is required to evaluate whether these positive reactions were a direct consequence of the inclusion of students from other health professions and whether these translate into positive effects on learning, behaviour and results. The opportunities for the dietetic profession posed by students' involvement in IPE are discussed.     

Évaluation de la voie radiale distale dans les interventions coronaires percutanées. Essai contrôlé, randomisé de non infériorité

Research Problem: The conventional radial approach is the recommended vascular access for percutaneous coronary interventions. It is effective and feasible but associated with a risk of occlusion of the radial artery.The distal radial approach is proposed as a new approach to reduce complications and preserve the radial artery. However, few clinical trials in real life were conducted in North African patients.This trial aims to evaluate the efficacy and safety of the distal radial approach versus the conventional radial approach. Investigative process: This trial is a non-inferiority, randomized controlled trial with two parallel arms: distal radial approach and conventional radial approach. Two hundred fifty patients scheduled for percutaneous coronary intervention will be included.The two main endpoints are the puncture success rate with a non-inferiority margin of 10% and the occlusion rate of the punctured radial artery attributed to the end of hemostasis and to 30 days. Secondary endpoints: catheterization success, crossover rate, procedure time, radial artery spasm, bleeding complications, QuickDASH pain score, Operator satisfaction.A single blind analysis will be led according to the per-protocol and intention-to-treat methods. Research Plan: Ethical considerations will be undertaken and respected. This trial will run for four months from February 2022. The results will provide parameters related to the efficacy and safety of the distal radial approach, improving clinical practice.Trial registration : {"type":"clinical-trial","attrs":{"text":"NCT05311111","term_id":"NCT05311111"}}NCT05311111     

Students' and teachers' perceived and actual verbal interactions in seminar groups

Objectives  This study set out to examine how much time students and teachers devote to different learning-oriented interactions during seminar sessions and students' and teachers' perceptions about the occurrence and desirability of these interactions.
Methods  Students and teachers participating in eight seminar group sessions in Year 4 of an undergraduate veterinary curriculum completed an 11-item questionnaire which asked them to rate, on a 5-point Likert scale, the frequency of occurrence and level of desirability of three learning-oriented types of interaction: exploratory questioning; cumulative reasoning, and handling of conflict about knowledge. The questionnaire also invited positive and negative responses to aspects of group interactions and an overall mark (1–10) for the seminars and group interactions. Four group sessions were video-recorded and analysed using a coding scheme. The amount of time devoted to the different interactions was calculated.
Results  Both students and teachers gave scores of 3.0–3.5 for frequency of occurrence of exploratory questioning and cumulative reasoning and < 3.0 for occurrence of handling of conflict about knowledge. The desired occurrences of all interaction types were significantly higher than the actual occurrences according to students and teachers. Teachers were responsible for the majority of the interactions (93%). The percentages of session time devoted to teacher-centred cumulative reasoning, exploratory questioning and handling of conflict about knowledge were 65.8%, 15.6% and 3.1%, respectively.
Conclusions  Group interactions in seminar groups are dominated by the posing of questions by teachers to students. The moderate occurrence of group interactions as perceived by students and teachers may be explained by the inadequate preparation of teachers and students to stimulate group interactions.     

Audit de l’équilibre glycémique de patients diabétiques sous analogues de l’insuline : à propos de 2915 assurés de la CNAM (Tunisie)

Background: Insulin analogues are increasingly prescribed in Tunisia. These molecules, covered by the National Health Insurance Fund (CNAM) in Tunisia under certain conditions, have an important and constantly increasing cost. Aim: To audit the diabetes control among insured in the Northern district of the CNAM (Tunisia), treated with insulin analogues in 2019 and to assess factors associated with good glycemic control. Methods: Retrospective observational study including patients with diabetes who applied for renewal of insulin analogues between March and April 2019 in the northern district of the CNAM. Results: Our study included 2915 diabetic insured. The sex ratio was 1.08. The mean age was 56.5 ±18.56 years. More than half of the diabetic insured were followed by a specialist physician (44% by endocrinologists, 7% by internists, 6% by nutritionists and 4% by other specialists). The average duration of treatment with insulin analogues was 5 years ± 1.41. Almost three quarters (74%) of the diabetic insured were type 2 diabetics. The mean daily dose of rapid-acting, short-acting and premixed insulin analogues were 30±15.49 IU/d, 38±18.36 IU/d and 65±19.38 IU/d respectively. HbA1c targets were achieved in 8% of the diabetic insured. In univariate analysis, the variables significantly associated with diabetes balance were follow-up by a physician specializing in endocrinology (OR=3.14, 95% CI [0.98-10.08]), internal medicine (OR=5.06, 95% CI [1.49-17.21]) or nutrition (OR=2.06, 95% CI [0.54-7.77]), type 1 diabetes (OR=1.67, 95% CI [1.26-2.22]) and basal insulin therapy regimen (OR=1.88, 95% CI [1.39-2.54]). In multivariate analysis, the independent and significant factors associated with glycemic control were type 1 diabetes (ORa=1.81, 95% CI [1.37-2.39]) and basal insulin therapy regimen (ORa= 1.77, 95% CI [1.30-2.40]). Conclusion: This study showed that the majority of diabetic insured on insulin analogues had a poor controlled diabetes. Type 1 diabetes and basal insulin therapy regimen were the two factors associated with good glycemic control after multivariate analysis. A review of criteria for reimbursement of insulin analogues by the National Health Insurance Fund is necessary in order to rationalize the expenses related to these molecules.     

Bactériémies à bactéries multirésistantes chez les greffés de cellules souches-hématopoïétiques

Background:

Bacteremia become fearsome in hematopoietic stem cell transplant (HSCT) recipients with the emergence of multidrug-resistant (MDR) strains.

Aim:

Our purpose was to investigate the prevalence of MDR bacteremia in HSCT recipients at the Tunisian National Bone Marrow Transplant Center, associated factors and attributable mortality rate.

Methods:

Our retrospective study (January 2010-December 2017) included all MDR bacteremia in the Hematology department. MDR rods were: extended spectrum beta-lactamase producing Enterobacterales (ESBL-E), P. aeruginosa and A. baumannii resistant to at least three families of antibiotics, methicillin-resistant S. aureus (MRSA) and vancomycin resistant E. faecium (VRE).

Results:

The prevalence of MDR bacteremia among HSCT recipients was 5.9% (48/816) with a stable trend over time (rs=0.18). Neutropenia, prior hospitalization, prior antibiotherapy and prior colonization with MDR pathogens were observed in 59%, 58%, 48% and 31% of cases, respectively. Imipenem was the most prescribed first-line antibiotic (50%). The attributable mortality rate was 13%. MDR bacteria (n=48) belonged to ESBL-E (60%), P. aeruginosa (19%), A. baumannii (13%), MRSA (4%) and VRE (4%). For ESBL-E and P. aeruginosa, the rates of antibiotic resistance were respectively, 17% and 44% to imipenem, 31% and 56% to amikacin and 15% and 0% to colistin. Strains of A. baumannii were susceptible only to colistin. The MRSA (n=2) were resistant to ciprofloxacin and gentamicin and susceptible to glycopeptides. The VRE (n=2) were susceptible to linezolid and tigecycline.

Conclusion:

Low prevalence of MDR bacteremia in HSCT recipients but high attributable mortality rate, requiring reinforcement of hygiene measures.     

E-learning pour la Continuité de la Formation en Ophtalmologie Pendant la Pandémie COVID-19 : Degré de Satisfaction des Résidents de l'Institut Hédi Raies d'Ophtalmologie de Tunis

Introduction:

COVID-19 pandemic created great challenges for the continuity of medical education. At the Hédi Raies Institut of Ophthalmology of Tunis (HRIO), the need to ensure continuity in the teaching of ophthalmology has stimulated the development of a new e-learning resource based on clinical case studies.

Aim: 

To evaluate level of satisfaction of HRIO residents in regard to clinical case-study-based e-learning of ophthalmology.

Methods:

Cross-sectional survey including 40 ophthalmology residents doing their internship at the ROHI during the first half of 2020. Learners were tutored in e-learning via the Moodle online learning platform and using a problem-solving format based on clinical case studies describing various ophthalmologic conditions. Data collection was carried out through an online survey after four months of training, designed to assess learners'' satisfaction with the e-learning.

Results:

Mean age of participants was 29.95 ± 1.73 years. The majority had found the navigation easy, the content relevant to their training objectives, and were satisfied with the discussion forums as a method of communication. All respondents were satisfied with clinical cases presented through the platform and felt that they helped them to better understand the content. Among them, 97.5% considered that this teaching method corresponded to their training needs. There was a statically significant difference in the level of knowledge before and after e-learning teaching, taking into account the residents'' appreciation (p<0.001).

Conclusions:

This study highlights the importance of virtual learning in ophthalmology in the era of the COVID-19 pandemic. E-learning is well appreciated by ophthalmology residents, relatively easy to integrate to their training program, and reduces issues of time, patient availability and case exposure.     

L’influence de l’identité professionnelle sur la détresse psychologique dans les métiers spécialisés des secteurs de la construction et manufacturier au Québec

ObjectiveThis study explores how the structure of professional identity and its undermining are associated with symptoms of psychological distress in the skilled trades, focusing on the construction and manufacturing sectors in Quebec. One limitation of the current research is its neglect of professional identity, even though this concept is important to explaining psychological distress symptoms.MethodsThe sample includes 282 workers from four manufacturing and seven construction sites in Quebec. Data were collected for the years 2016 and 2017. Multilevel regression analysis was carried out with the statistical software Stata 13. Five variables were controlled in this study: sex, gender, age, type of team and occupational sector.ResultsThe results of multilevel regression models, addressing variations across 54 participating teams, suggested that a low skilled trades self-esteem, a higher professional identification, a low integration of differences, heavy demands at work, and job insecurity are associated with psychological distress, as are the factors of being a woman or being a younger worker.ConclusionStudy results corroborate the importance of taking preventive actions on identity dimensions to reduce psychological distress symptoms. In particular, at the level of skilled trades culture, it would be beneficial to incorporate values based on a better inclusion of all workers and an open mind with regard to differences.     

Evaluation of a tele-education programme in Brazil

We evaluated a tele-education programme for primary care staff in Pernambuco State, Brazil. During 2008 and 2009, tele-education sessions occurred four times each week for one hour per day. The topics included public health, child and adolescent health, mental health and nursing. After each session, participants completed an evaluation questionnaire. A total of 73 municipalities and 141 health centres participated in the programme. There were 254 tele-education sessions scheduled during the 20-month study period; of these, 224 sessions were successfully performed and 30 were cancelled. We collected 3504 responses from the satisfaction survey. There was high acceptance of the programme: 97% rated it as excellent or good.