Teeth Damage during General Anesthesia.

INTRODUCTION: Dental injuries during anesthesia, especially when advanced airway management is required, represent a legal problem. Factors such as poor dental condition and excessive pressure during intubation contribute to dental damage. The maxillary central incisors are commonly affected. OBJECTIVE: The objective of this review is to know the incidence of dental injuries in adults undergoing anesthesia that requires airway management. MATERIALS AND METHODS: The search was performed in MEDLINE (through Pubmed), ClinicalTrials.gov, Scopus, LILACS (through the Virtual Health Library Regional Portal), and SciELO for all available literature on the subject up to December 2022. Inclusion criteria involved articles that studied patients aged 18 years or older who underwent general anesthesia requiring airway management with tracheal intubation or insertion of a laryngeal mask airway. RESULTS: Of all the articles, nine report dental injury associated with the type of airway management. Only one article does not have dental injury. DISCUSSION: This study addresses dental injuries related to tracheal intubation during general anesthesia. Although techniques are used to prevent them, these injuries still occur. Laryngoscopy, especially with support on the upper central incisors, can cause damage to the teeth. CONCLUSIONS: It is important that the anesthesiologist is aware of dental trauma and that orotracheal intubation or the placement of the laryngeal mask airway is performed systematically and rigorously, always considering the patient's dentition to choose the best approach in each specific situation.

Presenteeism in Non-Academic Staff in a Public University Context: Prevalence, Associated Factors, and Reasons to Work While Sick during the COVID-19 Pandemic.

Presenteeism negatively affects worker performance. We aimed to know the prevalence of presenteeism in non-academic university staff, identify health problems and associated factors, as well as explore the reasons that led to presenteeism during the COVID-19 pandemic. A cross-sectional study was conducted with a convenience sample of 332 non-academic staff. The Portuguese version of the Stanford Presenteeism Scale (SPS-6) was used, and socio-demographic and occupational data were collected. Participants were divided into groups according to the presenteeism cut-off score (no presenteeists, presenteeists with high job performance, presenteeists with low job performance). Multinomial regression was used to identify occupational and demographic characteristics associated with presenteeism. An open question replies analysis made it possible to explore the reasons for going to work while sick. Presenteeism was experienced by 30.1%. Presenteeism with high job performance was not associated with socio-demographic and work factors. Professionals who performed only physical work (OR = 9.4; 95% CI: 1.7; 51.0) and those who conducted hybrid work (OR = 4.1; 95% CI: 1.8; 9.6) showed a higher risk of belonging to the presenteeist group with low job performance. Financial reasons led professionals to work while sick. This study raises the importance of evaluating presenteeism in non-academic staff to create conditions for them to maintain high performance despite presenteeism and to intervene when there is low performance due to presenteeism.

Machiavellian Medical Students Report More Academic Misconduct: A Cocktail Fuelled by Psychological and Contextual Factors.

Purpose: Maladaptive personality traits and some psychological functioning indicators have been linked to academic misbehaviour; yet their role is still poorly explored in medical students. This study aims to assess associations of academic misconduct with dark personality traits and psychological well-being. Methods: Five hundred and ninety-one medical students attending the first, third and fifth-year at one Portuguese medical school replied to the Dark Triad Dirty Dozen, Ryff's Psychological Well-Being Scales and an original Academic Misconduct Questionnaire, using a cross-sectional design. Multiple linear regression was performed to assess associations. Results: Fifth-year medical students who scored higher in Machiavellianism and psychological well-being and perceived greater peer fraud and lower penalty for cheating reported more academic misconduct. The explanatory power of the model was 16.6%. Machiavellianism showed the strongest associations with cheating, while sex and age were not significant predictors. Conclusion: This study offers relevant insights into how maladaptive personalities influence academic misconduct in medical students, and how this relationship is moulded by psychological and contextual factors. These findings can help guide institutional actions to foster academic integrity in future physicians.

The relationship between presenteeism, quality of life and social support in higher education professionals: A cross-sectional path analysis.

Presenteeism is the practice of being present at workplace, but not being able to carry out all the tasks due to health problems. Social support globally associated with health and wellbeing might positively influence presenteeism and consequently, the quality of life of these professionals. With this in mind, the aim of this study was to investigate the relationships between presenteeism, quality of life and social support in the work of non-teaching and non-research professionals within the context of higher education. A cross-sectional study was conducted, in which sociodemographic data were collected and the Portuguese versions of the Stanford Presenteeism Scale (SPS-6) (which includes the dimensions work-completed and distraction avoided) and Quality of Life Index (EUROSHIS-QOL-8) and the subscales of Supervisor's Social Support and Peers' Social Support of the Copenhagen Psychosocial Questionnaire (COPSOQ) were used. The questionnaire was applied online, and 322 professionals from a public university higher education institution in Northern Portugal participated in the study. Presenteeism was reported by 97 (30.1%) professionals. The peers' social support was positively associated with quality of life. The supervisor's social support was positively associated with distraction avoided and work completed and positively indirectly associated with quality of life, and the association was mediated by distraction avoided. We conclude that implementing strategies that can promote social support in the work context, namely strengthening networks between colleagues and competent and well-trained supervisors may prevent or reduce presenteeism in higher education professionals, as well as, provide a better quality of life.

Is the ASA Classification Universal?

OBJECTIVE: The physical status classification of the American Society of Anaesthesiology (ASA) is the most used score in the preoperative evaluation, but inconsistent evaluations and low reliability have been reported. The aim of this study is to evaluate the variability in the evaluation of ASA physical status classification among Portuguese anaesthesiologists. METHODS: Cross-sectional study, in which an electronic questionnaire, was distributed to Portuguese anaesthesiologists with questions regarding their demographic characteristics, professional experience, place of work and how they would categorise 15 clinical cases regarding ASA classification. Three anaesthesiologists and a medicine student wrote the cases. Data analyses were done using R suite version 1.0.143 and IBM SPSS Statistics. The agreement among participants was evaluated through intraclass correlation coefficient (ICC). A value of P < .05 was assumed as statistically significant. RESULTS: 1,850 e-mails were sent, and 259 answers were obtained. Median age of participants was 47 years. 172 were female and 87 males. Ninety percent of work is in the public sector, and 99.6% use this classification on their daily practice. Participants' agreement ranged from 3 to 15 responses, with a mean of 9.2 (SD 6 2.4). In none of the cases was observed a total agreement with the author's classification. The ICC among the participants was 0.726 (0.585; 0.869; P < .001), showing a moderate degree of agreement. CONCLUSION: The results of this sample revealed that the agreement among Portuguese anaesthetists is satisfactory and similar to the values observed in other countries where there were no significant differences between trainees and specialists.

Psychological profiles of patients with suspected drug allergy.

BACKGROUND: Several studies demonstrate an important association between allergic diseases and patients' psychological characteristics. OBJECTIVE: To evaluate any differences in the psychological characteristics of patients studied for suspected drug allergy in comparison with healthy controls. A secondary aim was to assess differences between patients with confirmed versus excluded drug allergy, with respect to the clinical aspects. METHODS: The psychological characteristics of 115 consecutive patients >16 years-old, studied for suspected drug allergy were assessed. They were compared with healthy controls. Four validated questionnaires were used to evaluate anxiety, depression, alexithymia, and personality type. RESULTS: Eighty-eight patients completed the evaluation: 34 had confirmed drug allergy and 33 excluded. Forty-eight healthy subjects filled the 4 questionnaires. Increased neuroticism was associated with increased odds of belonging to the excluded drug allergy group (odds ratio [OR], 1.374; 95% confidence interval [CI], 1.173-1.609). Increased neuroticism (OR, 1.244; 95% CI, 1.065-1.453) and increased anxiety (OR, 1.210; 95% CI, 1.084-1.351) were associated with increased odds of confirmed drug allergy. However, higher extraversion decreased this likelihood (OR, 0.755; 95% CI, 0.643-0.888). The odds of having confirmed drug allergy was reduced by 79.7% (OR, 0.203; 95% CI, 0.060-0.694) for patients with 2 suspected drugs and by 84.6% (OR, 0.154; 95% CI, 0.029-0.809) for those with ≥3 in comparison to those with only one. Patients with moderate to severe reactions were more likely to have confirmed drug allergy (OR, 4.295; 95% CI, 1.105-16.693) than those with milder manifestations. CONCLUSION: Our results highlight that patients with drug allergy have a distinctive psychological profile. Psychological assessment may help to identify patients that would benefit from a targeted intervention.

[The Importance of Autopsy in Early Neonatal Death in Portugal]. / A Importância da Autópsia na Morte Neonatal Precoce em Portugal.

INTRODUCTION: The early neonatal period is the most critical for the newborn's life. The autopsy is important to understand the cause of death, and find other diagnoses not clinically identified. However, the rate of neonatal autopsy is declining worldwide. This study aims to characterize early neonatal death and the clinical importance of the autopsy, evaluating the concordance between clinical and pathological diagnosis. MATERIAL AND METHODS: Retrospective study of the clinical records of all neonates admitted to a level III Neonatal Intensive Care unit in Portugal who died during the first week of life in 10 consecutive years (2008 - 2017). In order to classify the concordance found between clinical and pathological diagnoses, the modified Goldman classification was used. RESULTS: During the first week of life, 76 newborns died. The main causes of death were complications related with prematurity and congenital malformations. The autopsy was performed in 50 newborns. Additional findings were found in 62% of the cases, and in 12% findings with important implications for genetic counseling of future pregnancies. There was concordance between the clinical and pathological findings in 38% of cases. DISCUSSION: An autopsy was performed more frequently in newborns with greater gestational age. The number of additional diagnoses found at autopsy, including diagnoses with implications for genetic counseling, confirm the importance of performing them. CONCLUSION: An autopsy should be proposed to all parents after early neonatal death, given its importance in clarifying the cause of death.

Introdução: O período neonatal precoce é o mais crítico para a vida do recém-nascido. A autópsia é importante para compreender acausa de morte e conhecer outros diagnósticos não identificados clinicamente. No entanto, a taxa de autópsia neonatal está a diminuir em todo o mundo. Este estudo pretende caracterizar a morte neonatal precoce e a importância clínica da autópsia, avaliando a concordância entre o diagnóstico clínico e o anatomopatológico.Material e Métodos: Estudo retrospetivo dos processos clínicos de todos recém-nascidos admitidos numa unidade de CuidadosIntensivos Neonatais de nível III em Portugal e que faleceram durante a primeira semana de vida em 10 anos consecutivos (2008 - 2017). Para classificar a concordância encontrada entre os diagnósticos clínicos e anatomopatológicos foi usada a classificação de Goldman modificada.Resultados: Na primeira semana de vida faleceram 76 recém-nascidos. As principais causas de morte foram complicações relacionadas com prematuridade e anomalias congénitas. A autópsia foi realizada em 50 (65,8%) recém-nascidos. Achados adicionais foram encontrados em 62% dos casos, sendo em 12% achados com implicações importantes no aconselhamento genético de futuras gestações. A concordância entre os achados clínicos e anatomopatológicos foi de 38% dos casos.Discussão: A autópsia foi realizada com maior frequência em recém-nascidos com maior idade gestacional. O número de diagnósticos adicionais encontrados na autópsia, incluindo diagnósticos com implicações para aconselhamento genético, confirmam a importância da sua realização.Conclusão: A autópsia deve ser proposta a todos os pais após a morte neonatal precoce, dada a sua importância no esclarecimento da causa de morte.

Curricular changes: the impact on medical students knowledge of neuroanatomy.

BACKGROUND: Although neuroanatomy is considered an essential requirement in medical curriculum, its teaching has undergone many changes in recent years, with most medical schools starting to implement an integrated approach. The current paper describes the comparative evaluation of the neuroanatomy knowledge scores of medical students who attended two different pedagogic approaches of neuroanatomy in the Faculty of Medicine of the University of Porto. METHODS: Forty fourth-year medical students who attended a traditional stand-alone approach and 42 third-year medical students who attended an integrated approach completed a written test of knowledge. RESULTS: Although there were some significant differences, the results globally revealed no statistically significant difference between the neuroanatomy knowledge scores of the integrated and traditional education groups, with most students obtaining a passing score in both curricula. CONCLUSIONS: Our study is the first attempt to compare the knowledge acquired by medical students from two different pedagogical approaches to neuroanatomy. Although the integrated curricula were only implemented in the Faculty of Medicine of the University of Porto a few years ago, the students who attended these curricula obtained similar scores as those obtained by the students of the traditional curriculum. This finding suggests that an integrated curriculum can be, in light of curricular reform, an efficient approach to teaching neuroanatomy to medical students.

Do reciprocal relationships between academic workload and self-regulated learning predict medical freshmen's achievement? A longitudinal study on the educational transition from secondary school to medical school.

One of the most important factors that makes the transition from secondary school to medical school challenging is the inability to put in the study time that a medical school curriculum demands. The implementation of regulated learning is essential for students to cope with medical course environment and succeed. This study aimed to investigate the reciprocal relationships between self-regulated learning skills (SRLS) and academic workload (AW) across secondary school to medical school transition. Freshmen enrolled in medical school (N = 102) completed questionnaires at the beginning and at the end of their academic year, assessing AW (measured as study time hours and perceived workload), SRLS (planning and strategies for learning assessment, motivation and action to learning and self-directedness) and academic achievement. An exploratory factor analysis (EFA) and a longitudinal path analysis were performed. According to the EFA, study time and perceived workload revealed two factors of AW: students who had a high perceived workload also demonstrated increased study time (tandem AW); and those who had a low perceived workload also demonstrated increased study time (inverse AW). Only a longitudinal relationship between SRLS and AW was found in the path analysis: prior self-directedness was related to later tandem AW. Moreover, success during the first year of medical school is dependent on exposure to motivation, self-directedness and high study time without overload during secondary school and medical school, and prior academic achievement. By better understanding these relationships, teachers can create conditions that support academic success during the first year medical school.

Predictors of Subclinical Inflammatory Obesity: Plasma Levels of Leptin, Very Low-Density Lipoprotein Cholesterol and CD14 Expression of CD16+ Monocytes.

OBJECTIVE: Predictors of subclinical inflammatory obesity (SIO) can be important tools for early therapeutic interventions in obesity-related comorbidities. Waist circumference (WC) and BMI have different SIO sensitivity. We aimed to i) identify SIO predictors and ii) investigate whether CD16+ monocytes are associated with BMI- (generally) or WC-defined (centrally) obesity. METHODS: Anthropometric and metabolic/endocrine (namely catecholamines, adrenaline and noradrenaline) parameters were evaluated, and CD16+ monocytes were studied by flow cytometry in the peripheral blood from 63 blood donors, and compared and correlated to each other. Multiple linear regression analysis was performed to identify variables that best predict SIO. RESULTS: CD16+ monocyte counts were similar in BMI and WC groups. CD16+ monocytes from centrally obese (CO) showed a more inflammatory pattern, as compared to non-CO subjects. WC was sensitive to lipidemia and, in CO subjects, lipidemia was associated with a more inflammatory phenotype of CD16+ monocytes. These differences were not noticed between BMI groups. Adrenaline was correlated with CD16+ monocyte expansion with a lower inflammatory pattern. Leptin, very low-density lipoprotein cholesterol (VLDL-C), and CD14 expression of CD16+ monocytes were found to be CO predictors. CONCLUSIONS: WC-, but not BMI-defined obesity, was associated with a more inflammatory pattern of CD16+ monocytes, without monocyte expansion, suggesting that a monocyte maturation process rather than an independent arise of CD16+ monocytes occurs in CO. Thus, in a population with low cardiovascular risk, leptin, VLDL-C, and CD14 expression of CD16+ monocytes predict CO, constituting a putative tool for screening of SIO.

Differences in the Students' Perceptions on the Teaching of Neuroanatomy in a Medical Curriculum Organized by Disciplines and an Integrated Medical Curriculum.

INTRODUCTION: On the subject of curriculum reform, most European medical schools are moving away from an educational approach consisting of discipline-based courses to an integrated curriculum. The aim of this study was to compare, in the Faculty of Medicine of the University of Porto, Portugal, the teaching of neuroanatomy in a medical curriculum organized by disciplines and in an integrated medical curriculum. MATERIAL AND METHODS: Two hundred sixty one students who completed the Curricular Unit with a discipline-based approach (Neuroanatomy) and 202 students who completed it with an integrated approach (Morphophysiology of the Nervous System) were asked to complete a questionnaire on their perceptions about the Curricular Unit. RESULTS: Our study showed that students of the Curricular Unit with a discipline-based approach had higher grades and evaluated it higher than students who followed the integrated approach. However, it also showed that students' grades had a significant effect on the evaluation of the curricular unit, with students with higher grades evaluating higher than students with lower grades. Besides, the majority of the students of the Curricular Unit with an integrated approach appreciated this curriculum model and highlighted as a positive point the successful integration of contents covered in the three components of the curricular unit. DISCUSSION: The curriculum reform led to the integration of neuroanatomy with other disciplines and resulted in a reduction of the teaching hours, a redefinition of the syllabus contents and the students' learning objectives, the introduction of new educational methods and changes in the evaluation system. CONCLUSION: Our study could not prove conclusively the supremacy of one pedagogic approach to neuroanatomy over the other. Future initiatives to explore different pedagogical models in medical education are needed and should be of major concern to the medical faculty.

Introdução: No contexto da reforma curricular, a maioria das escolas médicas europeias estão a transitar de uma abordagem educacional consistindo em cursos 'baseados em disciplinas' para um currículo integrado. O objetivo deste estudo foi comparar, na Faculdade de Medicina da Universidade do Porto, Portugal, o ensino de neuroanatomia num currículo médico organizado por disciplinas e num currículo médico integrado. Material e Métodos: Duzentos e sessenta e um estudantes que completaram a Unidade Curricular com uma abordagem 'baseada em disciplinas' (Neuroanatomia) e 202 estudantes que completaram a unidade curricular com uma abordagem integrada (Morfofisiologia do Sistema Nervoso) preencheram um questionário sobre as suas percepções acerca da Unidade Curricular. Resultados: O nosso estudo mostrou que os estudantes da unidade curricular com uma abordagem 'baseada em disciplinas' tiveram classificações mais elevadas e avaliaram melhor a unidade curricular que os estudantes da unidade curricular com uma abordagem integrada. No entanto, também revelou que as classificações dos estudantes tiveram um efeito significativo na avaliação da unidade curricular, tendo constatado que os estudantes com classificações mais elevadas avaliaram melhor que os estudantes com classificações mais baixas. De referir ainda que a maioria dos estudantes da unidade curricular com uma abordagem integrada apreciou este modelo de ensino e destacou como um ponto positivo a integração bem-sucedida dos conteúdos abordados nos três componentes da unidade curricular. Discussão: A reforma curricular conduziu à integração da neuroanatomia com outras disciplinas, associada a uma redução das horas de ensino, a uma redefinição do conteúdo programático e dos objetivos de aprendizagem dos alunos, introdução de novos métodos educacionais e mudança no sistema de avaliação. Conclusão: O nosso estudo não provou conclusivamente a supremacia de uma abordagem de ensino de neuroanatomia em detrimento de outra. Futuras iniciativas para explorar diferentes modelos pedagógicos em educação médica são necessárias e devem ser de grande preocupação para a comunidade académica.

[Graduate Students in Medicine Course: Motivation, Socialization and Academic Recognition]. / Licenciados no Curso de Medicina: Motivações, Socialização e Reconhecimento Académico.

INTRODUCTION: Students with a previous degree have personal and professional experiences that can contribute to a different academic path during the medical course. This study aims to: 1) analyze both satisfaction and impact of academic recognition; 2) investigate whether motivations and expectations at entrance are maintained along the course; 3) to evaluate socialization after regress to higher education. MATERIAL AND METHODS: To accomplish the first objective a questionnaire was administered to 82 students who entered the medical school from 2011/2012 to 2013/2014. For the second and third goals a focus group was run (three groups with five students each, representing the three academic years). RESULTS AND DISCUSSION: Students felt satisfied with the recognition, and 50% of them believe that accreditations replace knowledge acquired with the curricular units, and 47% preferred to obtain accreditation. Academic achievement was negatively associated with the satisfaction of recognition and positively with age, background and registration cycle. Socialization of these students is distinct from the younger ones, their motivations at entrance are intrinsic and, contrary to expectations, are maintained along the course. CONCLUSION: Students prefer recognition instead of attending the curricular units. The most satisfied with the recognition accomplish less credits and the younger ones, from health area and enrolled in the clinical cycle, accomplish more. Along the course, motivations become more solid, expectations change and socialization is carried out with greater responsibility.

Introdução: Os estudantes com uma licenciatura prévia têm experiências pessoais e profissionais que contribuem para um percurso académico diferente no curso de medicina. Este estudo tem como objetivos: 1) avaliar a satisfação e o impacto do reconhecimento académico; 2) investigar se a motivações e expetativas de ingresso se mantêm ao longo do curso; 3) avaliar a socialização no regresso ao ensino superior. Material e Métodos: Para o primeiro objetivo foi administrado um questionário a 82 estudantes que ingressaram na Faculdade de Medicina da Universidade do Porto nos anos letivos de 2011/2012 a 2013/2014. Para o segundo e terceiro objetivos foi usado um focus group (três grupos de cinco estudantes cada, representativos dos três anos letivos). Resultados e Discussão: Os estudantes sentiram-se satisfeitos com o reconhecimento, sendo que 50% afirmaram que as creditações substituem o conhecimento que iriam adquirir ao realizar as unidades curriculares e 47% preferiram obter creditação. O sucesso académico associou-se negativamente com a satisfação do reconhecimento e positivamente com a idade, formação anterior e ciclo de inscrição. A socialização destes estudantes é distinta dos mais jovens, as suas motivações de ingresso são intrínsecas e mantêm-se ao longo do curso contrariamente às suas expectativas. Conclusão: Os estudantes preferem o reconhecimento à realização de unidades curriculares. Os mais satisfeitos com o reconhecimento realizam menos créditos e os mais jovens, da área da saúde e inscritos no ciclo clínico, realizam mais. Ao longo do curso, as motivações tornam-se mais sólidas, as expectativas mudam e a socialização é realizada com maior responsabilidade.

Neuroanatomy education: The impact on perceptions, attitudes, and knowledge of an intensive course on general practice residents.

General practitioners are responsible for the management of an increasing number of patients with neurological illness, and thus a solid education in neurosciences is a necessary component of their training. This study examines the effects of an intensive clinical neuroanatomy course on twenty general practice residents' perceptions, attitudes, and knowledge. A knowledge test was completed by the participants and by a control group at four different time points. The participants were asked to answer a questionnaire about their reasons for signing up for the course and their attitudes and perceptions toward the course experience. Experimental and control groups demonstrated identical mean baseline test scores. The experimental group significantly increased its test scores (plus 49.0% correct answers, a mean improvement of 120%) relative to controls after the educational intervention. There were no differences among scores from the evaluated time points after the educational intervention in the experimental group. In the control group, there were likewise no significant differences between the four evaluated time points. Most participants indicated that they signed up for the course to update/acquire knowledge and skills in the field of neurosciences, and also because they had difficulty in diagnosing and managing patients with neurological diseases. Participants' attitudes and perceptions toward the course experience were very positive. Most of the participants (n = 17; 85%) rated the course as "extremely useful," and 3 (15%) rated it as "very useful." This study provides evidence demonstrating the potential positive effect of neurosciences education to general practice residents. Anat Sci Educ 10: 465-474. © 2017 American Association of Anatomists.

Haematological malignancies and acute kidney injury requiring nephrology consultation: challenging the worst of the worst.

BACKGROUND: Acute kidney injury (AKI) often complicates the course of haematological malignancies (HMs) and confers a worse prognosis. The majority of these patients are managed by the attending physician, yet, a small group, mostly coincident with the worst presentation and outcomes, requires nephrology consultation, challenging the clinician with ethical issues regarding the decision to initiate or forgo renal support therapy. The purpose of this work is to identify the prognostic determinants for in-hospital mortality in this population. METHODS: A retrospective, observational chart review was undertaken at a single tertiary referral oncological centre. We reviewed the medical records of in-hospital patients with AKI and HM between 1 January 1995 and 31 December 2014 who met the criteria for RIFLE (Risk, Injury, and Failure; and Loss; and End-stage kidney disease) classification of I or higher and were followed by a nephrologist. RESULTS: Three hundred and forty-five patients were included in the study. Predictors of in-hospital death in patients with HM and AKI were septic shock [odds ratio (OR) 4.290 (95% CI 2.058-8.943)], invasive mechanical ventilation (IMV) [OR 4.305 (95% CI 2.075-8.928)] and allogeneic stem cell transplantation (SCT) [OR 2.232 (95% CI 1.260-3.953)]. The combination of each risk factor was used to estimate the probability of dying. Patients with all three risk factors had a risk of death of 86%. CONCLUSIONS: Septic shock, IMV and allogeneic SCT were identified as independent predictors of death in patients with HM and AKI, with only a small chance of survival if all three were present. Depending on the combination of risk factors, the indication for aggressive life support therapies, such as RST, might be questionable.

Call to Publish in an Undergraduate Medical Course: Dissemination of the Final-Year Research Project.

PROBLEM: Today's medical doctors must not only have the clinical skills to treat patients effectively but also keep current with new advances in medicine and critically analyze evidence to choose the best treatments and explain the risks and benefits of different options. In this article, we aim to share the approach taken at a Portuguese medical school to promote a close connection between research and learning. INTERVENTION: In a blended-learning approach, students studied research and scientific methods and undertook one of three faculty-supervised research and dissemination projects. To support immediate application of new research knowledge, students were offered optional short lectures and problem sets. All course information was featured on a website that also supported a discussion forum. We analyzed 1,350 theses leading to the medical degree, defended in six consecutive academic years (2007-2013). Our aim was to estimate the publication rates and factors associated with publication of the final-year undergraduate research projects. CONTEXT: The present research curriculum was developed at the University of Porto Faculty of Medicine as part of the Bologna process curriculum implemented in the 2007-2008 academic year. From May to June 2014 we looked for corresponding articles published over the period of September 2007 to April 2014. We searched PubMed, Scielo, Scopus, and IndexRMP databases to locate publications resulting from student theses. OUTCOMES: Over 6 years, the diffusion of knowledge produced by medical students, who engaged in clinical practice concurrently with research projects, was fairly low (10.4%). Program modifications that increased student accountability and engagement allowed for an increased rate of publication from 1.0% to 23.9%. Factors associated with publication were research area, publication as a performance assessment criterion, and publication language. LESSONS LEARNED: The results of this study suggest that it is helpful to provide research opportunities that allow aspiring future medical doctors to begin their research careers. Further research is needed to understand difficulties students and supervisors face in project development and to achieve greater balance in topic coverage among projects and, consequently, in departmental involvement in the program.

Pediatric Facial Fractures: A Review of 2071 Fractures.

BACKGROUND: Facial fractures are infrequent in children and adolescents, and there are only few reports that review a significant number of patients. The objective of this study was to analyze the pattern of maxillofacial fractures in pediatric patients of Portugal. STUDY DESIGN: We reviewed the clinical records of a series of 1416 patients 18 years or younger with facial fractures, treated by the Department of Plastic Reconstructive, Aesthetic and of Maxillofacial Surgery of São João Hospital, Porto, Portugal, between 1993 and 2012. The following parameters were evaluated: age; sex; cause of the accident; hour, day, and month of hospital admission; location and type of fractures; presence and location of associated injuries; treatment methods; length of in-hospital stay; and complications. RESULTS: A total of 2071 fractures were treated. The ratio of boys to girls was 3.1:1. Patients between 16 and 18 years old were the major group (43.9%). Motor vehicle accident was the most common cause of injuries (48.7% of patients). Mandibular fractures were the most common (44.4%). Associated injuries occurred in 1015 patients (71.7%). CONCLUSIONS: Pediatric facial fractures are usually associated with severe trauma. There has been a highly significant decrease (P < 0.001) in pediatric facial fractures in Portugal for the past 20 years.

Transition from Secondary School to Medical School: The Role of Self-Study and Self-Regulated Learning Skills in Freshman Burnout.

INTRODUCTION: The transition from secondary to higher education is a challenging and demanding period for medical students. The ability to manage study time effectively and to be a self-regulated learner is essential to cope with the exponential growth of knowledge in medical education. Thus, the purpose of our study was to measure self-regulated learning skills and self-study across secondary higher education transition and to explore its effect on academic burnout in the first year of medical school. MATERIAL AND METHODS: We collected data from 102 (43%) freshman medical students on self-regulated learning, academic achievement, and hours of self-study/week relative to last year of secondary school (at the beginning of academic year) and the first year of medical school (at the end of academic year). Burnout data was collected at the end of academic year. RESULTS: Among the 102 participants, 12% were at risk of burnout. Self-directedness at secondary school and higher education, and strategies for learning and assessment at higher education were protective factors against academic burnout. However, secondary selfdirectedness has an indirect effect on academic burnout mediated by self-directedness in the first year of medical school. In addition, self-study during class period was a risk factor for burnout. CONCLUSION: Our results support the premise that students experience mental health problems from an early stage at medical school. Empowering medical students to develop strategies for learning assessment and self-direction will help them manage their learning and, consequently, promote their well-being. Finally, we found that it is not academic performance that influences burnout but the time dedicated to study.

Introdução: A transição do ensino secundário para o ensino superior é um desafio para o estudante de medicina. Gerir o tempo de estudo e promover as competências de autorregulação da aprendizagem torna-se fundamental para lidar com o exponencial do conhecimento na educação médica. Este estudo pretende avaliar as competências de autorregulação da aprendizagem e o tempo de estudo na transição do secundário para o ensino superior, e explorar o seu efeito no burnout académico no primeiro ano do curso de medicina. Material e Métodos: Foram recolhidos dados de 102 (43%) estudantes do primeiro ano do curso de medicina acerca das competências de autorregulação da aprendizagem, desempenho académico e tempo de estudo/semana no início do ano letivo (relativos ao último ano do secundário) e no final do mesmo (relativos ao primeiro ano do curso) - nesta fase foi também avaliado o burnout. Resultados: A exposição ao burnout ocorreu em 12% dos estudantes. A aprendizagem auto-direcionada no ensino secundário e superior e adoção de estratégias de aprendizagem e de avaliação no ensino superior apresentaram efeito protetor de burnout. Contudo, a aprendizagem auto-direcionada no ensino secundário teve efeito indireto no burnout académico através da aprendizagem autodirecionada no ensino superior. Conclusão: Os estudantes de medicina experienciam problemas de saúde no primeiro ano do curso. Capacitá-los a desenvolver estratégias de aprendizagem e de avaliação e direcionarem autonomamente as suas aprendizagens terá impacto no seu bem-estar. Não é o desempenho académico que influencia o burnout mas o tempo de estudo.

Parkinson's Disease and development of levodopa induced motor complications: Influence of baseline features and first medical approach.

BACKGROUND: The introduction of levodopa in clinical practice represents a hallmark in the treatment of the neurodegenerative disease, Parkinson's Disease. However, levodopa induced motor complications, namely dyskinesias and motor fluctuations, develop in the majority of Parkinson's Disease patients. OBJECTIVE: to identify which Parkinson's Disease's, patient's and therapeutics' initial features are more associated with dyskinesias or motor fluctuations development. METHODS: Patients with diagnosed Parkinson's Disease attending neurology outpatient clinic at Centro Hospitalar São João were selected. For this observational study, data was retrospectively collected from patient's clinical records. A survival analysis model with univariate and multivariate regression analysis was used. RESULTS: 87 patients with a mean of 72 ± 9.7 years were included. After a median follow-up of 6 (range 1-17) years, 35.6% patients developed dyskinesias; and with a median of 5 (range 1-16) years, 32.2% developed motor fluctuations. After multivariate analysis, the akinesia/rigidity subtype was found to have a higher risk of dyskinesias and motor fluctuations development. Age of onset ≤50 years was associated with motor fluctuations development. CONCLUSION: In conclusion, our results suggest that Parkinson's Disease patients' initial characteristics, such as subtype or age of onset, are independently associated with the development of motor complications.

A pilot Tuning Project-based national study on recently graduated medical students' self-assessment of competences--the TEST study.

BACKGROUND: The Tuning Project is an initiative funded by the European Commission that developed core competences for primary medical degrees in Europe. Students' grouped self-assessments are used for program evaluation and improvement of curricula. The TEST study aimed to assess how do Portuguese medical graduates self-assess their acquisition of core competences and experiences of contact with patients in core settings according to the Tuning framework. METHODS: Translation of the Tuning's competences (Clinical Practice - CP), Knowledge (K) items and Clinical Settings (CS) was performed. Questionnaires were created in paper and electronic formats and distributed to 1591 graduates from seven Portuguese medical schools (July 2014). Items were rated in a 6-point Likert scale (0-5) of levels of competence. Exploratory factor analysis (EFA) was conducted and Cronbach's alpha was used to evaluate the internal consistency of the questionnaire. Kruskal-Wallis and Dunn's tests were used for multiple comparisons. RESULTS: Three hundred eighty seven questionnaires were analyzed, corresponding to 24% of the target population. EFA yielded an 11-factor solution for CP and a 6-factor solution for K items. The median value of CP factors was 2.8 (p25 = 2.0; p75 = 3.5) and the median value of K factors was 2.6 (2.0; 3.2). Factor scores ranged from 1.3 (Legal principles) to 4.0 (Ethical principles). Clinical presentations, psychological aspects of illness, evidence-based medicine and promotion of health showed the highest results. Lower scores were detected in medical emergencies, practical procedures, prescribing drugs and legal principles. More than 90% of graduates experienced having contact with patients in 8 CS but only 24% of graduates had contact in all 14 CS. Graduates had the least contact with patients in the emergency rooms, intensive care units, palliative, rehabilitation and anesthetic care. Significant differences (p < 0.05) among schools were detected in 8 factors and 7 settings. CONCLUSIONS: We developed a valid questionnaire supporting national SWOT analysis on the acquisition of core competences in medical education. Results suggest that Portuguese graduates are not fully prepared for clinical practice. Curricular improvements in core competences and the educational development of the transition period between undergraduate and postgraduate education ought to be considered. Outcome-based program evaluation relying on graduates' grouped self-assessments contributes to inform changes in medical education.