Portfolio learning in palliative medicine

Portfolio learning has recently been described as a postgraduate learning tool. In 1990 it was incorporated as a learning and examining tool for the Diploma in Palliative Medicine, University of Wales College of Medicine. A personal learning portfolio is a highly individualized collection of case study and other clinical or intellectual material which reflects the learning progress. Resource material can be obtained from a wide variety of scientific and artistic sources, for example, medical and lay literature, films, videos, etc. The process of clinical decision-making should be described and defended with appropriate references and ethical principles involved. This record logs the evolution of the course participant's learning over three academic terms and provides a valuable source document for each individual learner.
Marks are given for critical analysis, evidence of reading and its application in clinical practice, evidence of a learning process and organization of ethical issues where appropriate. No marks are awarded on the factual content of any case history alone, although obvious episodes of mismanagement can be questioned. The portfolio is concerned with the process of learning and how decisions are come to rather than which decision is made. We have noted some correlation between the portfolio marks attained by students on the course and marks attained in their course work (essays, etc.). Our first year of experience using portfolio learning in a postgraduate medical context is described.     

EXERCISE,CARDIOVASCULAR DISEASE AND LIPIDS

SUMMARY Epidemiological studies have demonstrated the considerable benefits of habitual vigorous activity, both at work and during leisure time. There are many benefits at all ages and for all levels of fitness, but particular emphasis is being placed on the cardiovascular benefits. Exercise may induce beneficial changes in lipid profile and thus reduce risk of cardiovascular disease. Lifestyle changes cost little, have few side-effects, and are self-administered. Increasing habitual physical activity is a form of lifestyle modification that can be tailored to all needs — a non-therapeutic intervention of proven efficacy and of value to all patients.     

Comparative study of three prostaglandin analogues in the treatment of newly diagnosed cases of ocular hypertension,open‐angle and normal tension glaucoma

Background: To compare the efficacy and tolerance of three prostaglandin analogues, bimatoprost, latanoprost and travoprost in patients with previously untreated open‐angle glaucoma and ocular hypertension. Methods: Prospective randomized single (investigator) masked comparative clinical trial at the Taunton and Somerset NHS Hospital, Taunton, UK. Newly diagnosed, treatment naïve glaucoma/ocular hypertension patients were recruited. Patients were randomized into three groups to receive one of the three prostaglandin analogues. Intraocular pressure (IOP) was measured before starting treatment and after 2 and 6 months of treatment. The IOP reduction and the tolerance profile of each drug were compared. The data were analysed on the basis of intention to treat, using analysis of covariance comparing IOP in the three groups at 2 and 6 months, adjusting for baseline IOP. Tolerance levels were compared using Kruskal–Wallis test. Results: Of the 122 patients, 40 patients were given bimatoprost, 42 received latanoprost and 40 had travoprost. At 2 months, there was a significant difference between the three treatment groups (P = 0.013) with bimatoprost achieving a greater reduction in IOP than the other two drops. However, at 6 months, the difference was not statistically significant (P = 0.13). There was no significant difference in the tolerance profile. Conclusion: All the three topical prostaglandin analogues are effective at lowering IOP, but bimatoprost was found to be most effective in the initial phase of the trial, and there was no statistically significant difference in the efficacy, among the three prostaglandin analogue eye drops after 6 months of treatment.