Promoting professionalism through an online professional development portfolio: successes, joys, and frustrations.

Medical educators strive to promote the development of a sound professional identity in learners, yet it is challenging to design, implement, and sustain fair and meaningful assessments of professionalism to accomplish this goal. The authors developed and implemented a program built around a Web-based Professional Development Portfolio (PDP) to assess and document professional development in medical students at New York University School of Medicine. This program requires students to regularly document their professional development through written reflections on curricular activities spanning preclinical and clinical years. Students post reflections, along with other documents that chronicle their professional growth, to their online PDP. Students meet annually with a faculty mentor to review their portfolios, assess their professional development based on predetermined criteria, and establish goals for the coming year. In this article, the authors describe the development of the PDP and share four years of experience with its implementation. We describe the experiences and attitudes of the first students to participate in this program as reported in an annual student survey. Students' experiences of and satisfaction with the PDP was varied. The PDP has been a catalyst for honest and lively debate concerning the meaning and behavioral manifestations of professionalism. A Web-based PDP promoted self-regulation on an individual level because it facilitated narrative reflection, self-assessment, and goal setting, and it structured mentorship. Therefore, the PDP may prepare students for the self-regulation of the medical profession--a privilege and obligation under the physician's social contract with society.     

Chlamydia pneumoniae community-acquired pneumonia: A review of 62 hospitalized adult patients

Summary In a prospective study,Chlamydia pneumoniae was identified as the etiological agent in 62 (17.9%) of 346 adult patients hospitalized over the course of one year for community-acquired pneumonia at the Soroka Medical Center in Beer-Sheva, Israel. The diagnosis ofC. pneumoniae infection was based on serological testing of antibodies by the MIF technique. In 43 of these patients (69.4%), at least one other etiological agent, in addition toC. pneumoniae for community-acquired pneumonia was identified.Streptococcus pneumoniae was identified in 34 patients withC. pneumoniae (54.8%), as an additional causative factor in infection. Community-acquired pneumonia patients withC. pneumoniae were significantly older than non-C. pneumoniae patients (p=0.03), had a higher APACHE II score on admission (p<0.05), a higher rate of positive blood cultures (p=0.02), and longer periods of hospitalization (p=0.022). Seven patients with pureC. pneumoniae infection recovered, despite treatment which is not considered to be specific forC. pneumoniae. It was concluded thatC. pneumoniae is a common etiological agent for community-acquired pneumonia in our region, particularly in the elderly, and is characterized by a high rate of concomitant infections with other pulmonary pathogens. No specific clinical or radiological pattern was discerned that could distinguish betweenC. pneumoniae community-acquired pneumonia and non-C. pneumoniae community-acquired pneumonia.

---

Ambulant erworbene Pneumonien durchChlamydia pneumoniae: Übersicht über 62 stationär behandelte erwachsene Patienten

Zusammenfassung Unter 346 im Rahmen einer prospektiven Studie erfaßten Patienten mit ambulant erworbener Pneumonie fanden sich 62 Fälle (17,9%), bei denenChlamydia pneumoniae als der verantwortliche Erreger identifiziert wurde. Die Studie lief über einen Zeitraum von einem Jahr am Soroka Medical Center in Beer-Sheva, Israel. Die Diagnose basierte auf dem serologischen Nachweis von anti-C. pneumoniae Antikörpern mit der MIF-Technik. Bei 43 dieser Patienten fand sich mindestens noch ein zusätzlicher Erreger (69,4%). Bei 34 Patienten wurdeStreptococcus pneumoniae isoliert (54,8%). Patienten mit einerC. pneumoniae-Infektion waren signifikant älter als Patienten, bei denenC. pneumoniae nicht der Erreger war (p=0,03), diese Patienten hatten außerdem bei Einweisung einen höheren APACHE Score (p<0,05), häufiger positive Blutkulturen (p=0,02) und mußten länger stationär behandelt werden (p=0,022). Obwohl keine erregerspezifische Behandlung vorgenommen worden war, erholten sich 7 Patienten, die an einerC. pneumoniae Pneumonie erkrankt waren. Wir schließen aus den Daten, daßC. pneumoniae in unserer Region ein häufiger Pneumonieerreger ist, der vorwiegend ältere Personen befällt. Typischerweise besteht eine hohe Rate an Begleitinfektionen mit anderen Pneumonieerregern. Wir fanden kein spezifisches radiologisches Muster oder klinische Konstellationen, die eine Unterscheidung zwischenC. pneumoniae-Pneumonie und Pneumonien anderer Ätiologie ermöglichen würden.

     

The role of the resource teacher in child care programs: An Ontario study

Resource teachers are one group of professionals involved in the mainstreaming of young children into child care programs. While the responsibilities of resource teachers have been generally outlined by the province of Ontario, little is known about what, in fact, resource teachers are doing in practice. This discussion paper summarizes the results of two sets of questionnaires sent to resource teachers in the province of Ontario. It was found that resource teachers spend the majority of their time in direct contact with children, followed by contact with parents, and then administrative duties. The resource teachers felt challenged by their work with parents and families. Coordinating services and supporting families were areas mentioned. The implications of the findings for the development of training programs for resource teachers are discussed.     

Modulation of electrically induced pain by paired pulse transcranial magnetic stimulation of the medial frontal cortex.

OBJECTIVE: Aim of this study was to investigate whether paired pulse transcranial magnetic stimulation (ppTMS) applied over the medial frontal cortex (MFC) affects acute Adelta fiber-mediated electrically induced pain. In addition, we investigated whether this effect depends on the time course of the stimulation, on the noxious stimulus intensity or on the ppTMS intensity. METHODS: For painful stimulation, the electrical stimulus for the nociceptive flexion reflex (NFR) was used. PpTMS (ISI: 50 ms) was applied over the medial frontal cortex at different intervals ranging from 0 to 1,000 ms following the previous elicited NFR in 10 healthy volunteers. Three sequences at 3 different NFR stimulus intensities (at NFR threshold, 1.3 x and 1.6 x NFR threshold) with a ppTMS stimulus intensity at 1.2 x resting motor threshold (RMT) and one sequence with elevated ppTMS at 1.6 x RMT stimulus intensity were performed. Pain intensity and pain unpleasantness were assessed by visual analogue scales. RESULTS: Pain ratings differed in dependence of the interstimulus interval between NFR and ppTMS. Post-hoc t-tests revealed an increased verbal pain report within interstimulus intervals from 25 to 75 ms at NFR threshold as well as for 25 ms at 1.3 x NFR threshold when ppTMS was applied at 1.2 x RMT and from 0 to 75 ms at 1.6 x NFR threshold when ppTMS was applied at 1.6 x RMT. CONCLUSIONS: The present data suggest that ppTMS over MFC-applied in a certain time window-can enhance pain perception of acute Adelta fiber-mediated electrically induced pain. We hypothesize that the increase of pain is due to interference between ppTMS and the incoming nociceptive input. Further pain processing might be modulated by direct effects on MFC or indirect effects on anterior cingulate cortex (ACC) or spinal nociception. SIGNIFICANCE: Brain areas involved in cognitive and emotional adaptation to pain can be used, in place of primary motor areas, as cortical targets in TMS trials of experimental or ongoing pain.     

Colonization of personal digital assistants carried by healthcare professionals.

This study evaluated personal digital assistant (PDA) microbial colonization before and after cleaning with alcohol. Samples from 75 PDAs were processed. Before cleaning, 96% of the samples were culture positive. After cleaning, 75% became culture negative. PDAs cleaned with an alcohol swab demonstrated significant reduction in colonization.     

Multidrug-resistant urinary tract isolates of escherichia coli from Ribeir?o Preto, S?o Paulo, Brazil.

Multiple resistances to antimicrobial drugs arising in Escherichia coli isolates may complicate therapeutic management of urinary tract infection (UTI) by this organism. In order to assess the multidrug resistance (MDR) among urinary E. coli isolates, we have tested 11 antimicrobial drugs against 67 isolates from outpatients attended in a tertiary-care teaching hospital and of 78 isolates from a municipal health unit, respectively in Ribeir?o Preto, State of S?o Paulo, Brazil. Seventy-six percent and 22% of the isolates from the tertiary-care hospital and the municipal unit, respectively, were resistant to three or more different classes of agents, and were considered to present MDR. Among the isolates from the hospital patients, 73.0%, 65.0%, 58.0%, 58.0% and 31.0% were resistant to tetracycline, ampicillin, cephalothin, trimethoprim-sulfamethoxazole (TMP/SMX) and norfloxacin, respectively; resistance from the municipal unit patients were 31.0%, 37.0%, 8.0%, 29.0% and 12.0% respectively, to the same drugs. The predominant phenotype among the MDR isolates presented is ampicillin, TMP/SMX and tetracycline resistance. The high prevalence of drug resistance among UTI patients calls for continuous surveillance to assure effective control of this infection.