Журнал исследований и разработок в области медицинского образования

Background: It is widely acknowledged that medical students need to learn the skills involved in a breast clinic, such as history taking, examination technique, requesting appropriate investigations, giving bad news effectively and adequate post-operative care. In order to gain these skills, medical students are required to attend breast clinics necessitating patient participation. The aim of this audit was to investigate the difference in attitudes of patients towards the presence of male and female medical students in a breast clinic. Methods: In a breast clinic in two teaching hospitals, 132 consecutive patients completed a confidential, self administered questionnaire before the clinical consultation. Results: Only 30% of patients were comfortable with a male medical student taking their history compared to 48% with a female medical student. While 23% of patients were comfortable with a male medical student examining them compared to 45% with a female medical student. Discussion: The perceived acceptance of patients towards the presence of male medical students in a breast clinic is relatively low, potentially highlighting a need for adaptive teaching techniques such as the use of patient focused simulation.

Background: Persons with severe disability often require long-term or life-long placement in residential facilities. Although they often need complex medical treatment, most residential facilities in Denmark do not have staff with health care training. Objective: To improve knowledge on medication safety issues in residential facilities for persons with severe disability (mental illness or physical / intellectual disability) and to test if two clinical pharmacy services could be delivered to residential facilities by community pharmacies in order to improve safety. Setting: Four residential facilities with 47 residents and a pharmacist from the four community pharmacies delivering medicines to these facilities. Method: The pilot study aimed at development and assessment of feasibility of an intervention with two pharmaceutical care services: a quality improvement service supporting the residential facility in quality development of routines for handling medicines, and a pharmaceutical care oriented ‘medicines care’ service aimed at quality improvement of residents’ medication therapy. The ‘medicines care’ service included a technical medication review conducted by a community pharmacist, a ‘medicines care’ meeting at the residential facility, and if needed, a ‘multidisciplinary medicines management conference’. Main outcome measure: Number of completed services, characteristics of and solutions to identified medication therapy problems, suggested changes to routines for handling medicines and implementation thereof, the involved actors’ satisfaction with the intervention, and rated changes in staff’s knowledge and self-efficacy. Results: The quality improvement service resulted in 45 suggestions for changes towards safer routines for handling medicines, mostly concerning administration of medicines. Sixty-six medication therapy problems were identified in 30 of the 47 residents receiving the ‘medicines care’ service. Adverse drug reactions were the most frequent problems (31.8%). Of the 50 suggestions for solving medication therapy problems, 14 were implemented by the facilities, whereas 36 required involvement of the prescriber. The prescribers gave feedback on 22 suggestions of which they accepted 19 (86.4%). One multidisciplinary medicines management conference was conducted. Conclusion: The study generated important knowledge on safety issues in residential facilities, and revealed a number of medication therapy problems for the residents. The pharmaceutical care services were implementable and demonstrated a potential to improve safety, but this has to be confirmed in a larger prospective trial.

Background: The protective effects of exclusive breastfeeding (EBF) to the health of infants and mothers alike have been well documented. The rates of EBF remain low in spite of the recognized benefits and the persistent global call for infants to be breastfed exclusively on breast milk for the first six months of life. Health education has been widely suggested as one of the key intervention strategies for increasing the duration of EBF in low income countries.

Objective: To conduct a systematic review to assess the effectiveness of health education interventions in
increasing the duration of EBF in low income countries. A secondary objective of the review was to identify the theoretical bases of both effective/non-effective interventions and also to identify the educational methods that were utilized.

Methods: Systematic review of experimental and quasi-experimental studies of health education interventions that evaluated exclusive breastfeeding outcome. Studies not published in English language and studies not reporting exclusive breastfeeding outcome were excluded. A narrative synthesis was used.

Data Sources: Studies dating from 1980 – 2013 in English language were searched in the following databases: Cochrane Central Register of Controlled Trials, MEDLINE, Academic Search Complete. ScienceDirect and Google Scholar search engine.

Results: Twelve (12) studies were identified. Five were randomized controlled trials and additional three were before-after studies with control groups. The remaining four were non-randomized controlled trial. Only one study applied a theoretical framework in developing and implementing the intervention. EBF rate was significantly higher in the intervention groups compared with the control groups in ten (10) of the studies. The remaining two (2) studies reported no difference in EBF rates between the intervention groups and the control groups. Most of the studies reviewed had important methodological limitations.

Conclusion: Because of the methodological limitations of most of the included studies, firm conclusion on the effectiveness of health education interventions in increasing the duration of exclusive breastfeeding in low income countries cannot be made. Nonetheless there is a potential for this to be achieved if more methodologically rigorous health education interventions are developed and evaluated in low income countries.