The pedagogical value of parallel charts for dental students in clinical education: A qualitative study

INTRODUCTION

Narrative medicine is a novel approach aimed at attending to the socio-emotional aspects of illness and care. Parallel charts represent one of the tools of narrative medicine and are brief accounts of care in which practitioners can express their feelings and emotions towards patients and treatments. They are, therefore, intended to collect practitioners' feedback in the form of "narrative" tools to encourage reflection.

MATERIALS AND METHODS

This is a single-centre observational pilot study comprising the setting up and analysis of parallel charts in two classes of 5th and 6th year students in a Paediatric Dentistry Department in France. Forty-four students completed 126 parallel charts. A qualitative, thematic, analysis was conducted and the charts were also classified according to the three types of description of illness made by Arthur Kleinman.

RESULTS

This work showed that dental students mainly compiled parallel charts from a disease-centred perspective. The qualitative analysis identified the various themes addressed by the student: relationship with patients and managing children's anxiety, student stress, relationship with the environment or with lecturers.

CONCLUSION

The qualitative analysis highlighted the usefulness of compiling parallel charts by the students to allow them to express both positive and negative feelings, and thus to adopt a self-evaluative approach regarding their practices based on emotional impact. Parallel charts may improve patient-practitioner relationship, but more extensive studies over longer periods of time need to be undertaken.

Évaluation quasi-expérimentale d’une intervention d’éducation nutritionnelle auprès des aides à domicile de personnes âgées

BACKGROUND

The French National Program on Nutrition and Health has defined two specific objectives targeting older persons: (i) to improve their status in calcium and vitamin D and (ii) to prevent undernutrition. Home help provides support in activities of daily living, including meals, to dependent persons. The objective of our study was to evaluate the impact of a nutritional education intervention on knowledge and practices among home support assistants for the elderly.

METHODS

Three facilities providing home support in Gironde (France) selected 132 home support assistants to follow an education program and 134 controls. Nutrition training was conducted in the intervention group by a dietician during two half-day sessions in May-June 2004. A non randomized controlled trial design was used for evaluation. Nutritional knowledge (20 questions) and practice (5 questions) of home support assistants were assessed by questionnaire before (April 2004) and after (September 2004) the training period in each group. Satisfaction of the intervention group was also assessed.

RESULTS

The intervention group included 101 participants and the control group 106 persons who answered both questionnaires before and after the education program. The intervention group was significantly younger (p < 0.05), less educated (p = 0.01) and had less often participated to previous nutrition training (p < 0.001) than the control group. There was no significant difference between the two groups before intervention for their mean scores of knowledge or practices. The intervention group significantly improved its knowledge score (mean gain 2.5 points, p < 0.001) after the training period, whereas the score remained unchanged in the control group (mean gain 0.5 points, p = 0.06). The impact of the nutritional education was very significant (p < 0.0001) after adjustment for the characteristics which differed between the two groups. The practice scores did not differ significantly after intervention in multivariate analyses. Satisfaction of trained home support assistants was very high.

CONCLUSION

An education program of home support assistants for elderly persons can improve their nutritional knowledge, but this study cannot conclude that the intervention was efficient to improve the nutritional status of older persons.

A mathematical programming approach for scheduling physicians in the emergency room

Preparing a schedule for physicians in the emergency room is a complex task, which requires taking into account a large number of (often conflicting) rules, related to various aspects: limits on the number of consecutive shifts or weekly hours, special rules for night shifts and weekends, seniority rules, vacation periods, individual preferences,... In this paper, we present a mathematical programming approach to facilitate this task. The approach models the situation in a major hospital of the Montreal region (approximately 20 physicians are members of the working staff). We show that the approach can significantly reduce the time and the effort required to construct a six-month schedule. A human expert, member of the working staff, typically requires a whole dedicated week to perform this task, with the help of a spreadsheet. With our approach, a schedule can be completed in less than one day. Our approach also generates better schedules than those produced by the expert, because it can take into account simultaneously more rules than any human expert can do.

The impact of urodynamic parameters on the upper tracts of spinal cord injured men who void reflexly

Few studies have evaluated which urodynamic parameters impact the upper urinary tracts in men with complete spinal cord injuries (SCI) who void reflexly. Previous studies focused primarily on voiding pressures. This study investigated the effects of bladder wall compliance, opening pressure, maximum detrusor voiding pressure, duration of the uninhibited contraction, cystometric bladder capacity and post-void residual on vesicoureteral reflux and stasis of the upper tracts. Urodynamic studies, cystograms and renal scans of 84 consecutive men with complete SCI who void reflexly were evaluated. Of the 84 patients (168 renal units), 71 men (142 renal units) had normal upper tracts, four patients (four renal units) had vesicoureteral reflux and nine patients (15 renal units--12 bilateral, three unilateral) had upper urinary tract stasis. There was no statistical difference between those with reflux and those without reflux with regards to any urodynamic parameter evaluated. When comparing those with and without upper urinary tract stasis, the only statistically significant difference in urodynamic parameters was the duration of bladder contraction. The mean duration of the uninhibited contraction in the non-stasis group was 113.7 seconds +/- 84 seconds (1.9 minutes +/- 1.4 minutes). The mean duration of the uninhibited contraction in the stasis group was 236.4 seconds +/- 139.1 seconds (3.9 minutes +/- 2.3 minutes, p = 0.0098). In summary, the duration of bladder contraction, which reflects both detrusor and sphincter function, was found to be an important variable in those with upper tract stasis. This should be considered when evaluating and treating men with complete SCI who void reflexly.