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Vargas Pelaez AF, Ramirez SI, Valdes Sanchez C, Piedra Abusharar S, Romeu JC, Carmichael C, Bascoy S, Baron R, Pichardo-Lowden A, Albarracin N, Jones CC, Silveyra P. Implementing a medical student interpreter training program as a strategy to developing humanism. BMC Med Educ 2018; 18:141. [PMID: 29914460 PMCID: PMC6006684 DOI: 10.1186/s12909-018-1254-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 06/11/2018] [Indexed: 05/19/2023]
Abstract
BACKGROUND Humanistic care in medicine has shown to improve healthcare outcomes. Language barriers are a significant obstacle to humanistic care, and trained medical interpreters have demonstrated to effectively bridge the gap for the vulnerable limited English proficiency (LEP) patient population. One way in which medical schools can train more humanistic physicians and provide language access is through the implementation of programs to train bilingual medical students as medical interpreters. The purpose of this prospective study was to evaluate whether such training had an impact on bilingual medical student's interpretation skills and humanistic traits. METHODS Between 2015 and 2017, whole-day (~ 8 h) workshops on medical interpretation were offered periodically to 80 bilingual medical students at the Penn State College of Medicine. Students completed a series of questionnaires before and after the training that assessed the program's effectiveness and its overall impact on interpretation skills and humanistic traits. Students also had the opportunity to become certified medical interpreters. RESULTS The 80 student participants were first- to third- year medical students representing 21 languages. Following training, most students felt more confident interpreting (98%) and more empathetic towards LEP patients (87.5%). Students' scores in the multiple-choice questions about medical interpretation/role of the interpreter were also significantly improved (Chi-Square test, p < 0.05). All students who decided to take the exam were able to successfully become certified interpreters. Ninety-two percent of participants reported they would recommend the program and would be willing to serve as a future "coaches" for interpreter training workshops delivered to peer students. CONCLUSIONS Our program was successful in increasing self-reported measures of empathy and humanism in medical students. Our data suggests that implementation of medical interpreter training programs can be a successful strategy to develop of humanism in medical students, and aid in the development of sustainable language access for LEP patients.
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Affiliation(s)
| | - Sarah I. Ramirez
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA USA
| | | | | | - Jose C. Romeu
- Department of Medicine, Penn State College of Medicine, Hershey, PA USA
| | | | | | - Rose Baron
- Penn State College of Medicine, Hershey, PA USA
| | | | | | | | - Patricia Silveyra
- Departments of Pediatrics, Biochemistry and Molecular Biology, and Humanities, Penn State College of Medicine, 500 University Drive, Mail Code H085, Hershey, PA 17033 USA
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Rodrigues AM, Canhão H, Marques A, Ambrósio C, Borges J, Coelho P, Costa L, Fernandes S, Gonçalves I, Gonçalves M, Guerra M, Marques ML, Pimenta S, Pinto P, Sequeira G, Simões E, Teixeira L, Vaz C, Vieira-Sousa E, Vieira R, Alvarenga F, Araújo F, Barcelos A, Barcelos F, Barros R, Bernardes M, Canas da Silva J, Cordeiro A, Costa M, Cunha-Miranda L, Cruz M, Duarte AC, Duarte C, Faustino A, Figueiredo G, Fonseca JE, Furtado C, Gomes J, Lopes C, Mourão AF, Oliveira M, Pimentel-Santos FM, Ribeiro A, Sampaio da Nóvoa T, Santiago M, Silva C, Silva-Dinis A, Sousa S, Tavares-Costa J, Terroso G, Vilar A, Branco JC, Tavares V, Romeu JC, da Silva J. Portuguese recommendations for the prevention, diagnosis and management of primary osteoporosis - 2018 update. Acta Reumatol Port 2018; 43:10-31. [PMID: 29602163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Advances in osteoporosis (OP)case definition, treatment options, optimal therapy duration and pharmacoeconomic evidence in the national context motivated the Portuguese Society of Rheumatology (SPR) to update the Portuguese recommendations for the diagnosis and management of osteoporosis published in 2007. METHODS SPR bone diseases' working group organized meetings involving 55 participants (rheumatologists, rheumatology fellows and one OP specialist nurse) to debate and develop the document. First, the working group selected 11 pertinent clinical questions for the diagnosis and management of osteoporosis in standard clinical practice. Then, each question was investigated through literature review and draft recommendations were built through consensus. When insufficient evidence was available, recommendations were based on experts' opinion and on good clinical practice. At two national meetings, the recommendations were discussed and updated. A draft of the recommendations full text was submitted to critical review among the working group and suggestions were incorporated. A final version was circulated among all Portuguese rheumatologists before publication and the level of agreement was anonymously assessed using an online survey. RESULTS The 2018 SPR recommendations provide comprehensive guidance on osteoporosis prevention, diagnosis, fracture risk assessment, pharmacological treatment initiation, therapy options and duration of treatment, based on the best available evidence. They attained desirable agreement among Portuguese rheumatologists. As more evidence becomes available, periodic revisions will be performed. Target audience and patient population: The target audience for these guidelines includes all clinicians. The target patient population includes adult Portuguese people. Intended use: These recommendations provide general guidance for typical cases. They may not be appropriate in all situations - clinicians are encouraged to consider this information together with updated evidence and their best clinical judgment in individual cases.
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Vieira-Sousa E, Cavaleiro J, Mourão AF, Rodrigues AM, Albino-Teixeira A, Pimentel-Santos FM, Oliveira-Ramos F, Canhão H, Polido-Pereira J, Fonseca JE, Pereira da Silva JA, Romeu JC, Melo Gomes J, Costa L, Graça L, Leandro MJ, Santos MJ, Machado PM, Ramiro S. Acta Reumatológica Portuguesa: perspectives in 2017. Acta Reumatol Port 2017; 42:110-111. [PMID: 28693032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Castro A, Romeu JC, Geraldes R, Pereira da Silva JA. Encephalopathy with upper body hypertonia and myoclonus in patient with systemic lupus erythematosus and anti-CASPR2. Lupus 2016; 26:84-87. [PMID: 27432809 DOI: 10.1177/0961203316657431] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 06/01/2016] [Indexed: 11/16/2022]
Abstract
Systemic lupus erythematosus (SLE) may involve the nervous system but there are no specific biomarkers of neuroSLE. Limbic encephalitis has been rarely associated with SLE. We present a case of a 22-year-old black woman where typical SLE psychosis evolved to an encephalopathy with atypical features, normal MRI, electroencephalogram slowing and frontal and occipito-temporal hypometabolism on fluorodeoxyglucose positron emission tomography (FDG PET).Memory deficits, bizarre behaviour, psychosis, neuromyotonia and movement disorders have been described in autoimmune central nervous system disorders and associated with specific antibodies. Brain MRI may be normal and cortical brain hypometabolism on FDG PET scans has been reported. We have not found any report of limbic encephalitis or other SLE neurological manifestation associated to positive titres of anti-CASPR2 antibodies and this may warrant systematic investigation. In the rare cases of limbic encephalitis associated with SLE no specific antibodies were documented. Anti-CASPR2 antibodies have been associated not only with limbic encephalitis but also with neuromyotonia and Morvan syndrome. Although our patient had a specific pattern of tone abnormalities with an impressive cervical and upper limb hypertonicity and flaccid lower limbs, no myotonic discharges were found. We did not find any association between myoclonus and anti-CASPR2 antibodies. We cannot exclude that a non determined autoantibody could have played a role; however, clinical and FDG PET improvement supports an antibody-mediated injury, in this case of neuroSLE.
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Affiliation(s)
- A Castro
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisboa, Portugal
| | - J C Romeu
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisboa, Portugal
| | - R Geraldes
- Hospital de Santa Maria, Unidade de AVC, Serviço de Neurologia, Centro Hospitalar de Lisboa Norte, Lisboa, Portugal
| | - J A Pereira da Silva
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisboa, Portugal
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Fernandes S, Romeu JC, da Silva JA. Platelet Rich Plasma: What should the rheumatologist expect? Acta Reumatol Port 2015; 40:214-222. [PMID: 26337531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
In the last few decades, thousands of patients have benefited from platelet rich plasma (PRP) therapies, emerging as a safe alternative in many different medical fields. Current evidence suggests that PRP may be of benefit over standard treatment in osteoarthritis patients and, in the musculoskeletal soft tissue injuries potential healing effects are waiting to be confirmed with robust evidence. Finally, in systemic rheumatic diseases PRP seems to have a role to play in the treatment of extra-articular symptoms.
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Fernandes S, Capela S, Resende C, Romeu JC, Pereira da Silva JA. Severe vertical atlanto-axial subluxation in rheumatoid arthritis. Acta Reumatol Port 2015; 40:91-92. [PMID: 25341803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Vieira-Sousa E, Rodrigues A, Caetano Lopes J, Capela S, Ramos F, Figueira R, Polido-Pereira J, Ponte C, Campanilho-Marques R, Barros R, Romeu JC, Pereira da Silva JA. A4.4 Zoledronate efficacy and safety in active paget’s disease- long-term follow-up and retreatment in clinical practice. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2013-205124.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Rodrigues A, Caetano-Lopes J, Nery A, Sousa E, Polido-Pereira J, Vale M, Amaral P, Romeu JC, Viana Queiroz M, Monteiro J, Vaz MF, Fonseca JE, Canhão H. Evaluation of bone mechanical strenght and fracture risk assessment (Frax) in patients with hip joint replacement surgery. Acta Reumatol Port 2009; 34:504-510. [PMID: 19830928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Fracture risk assessment tools are useful to calculate the long term probability of osteoporotic fracture. However, how it reflects bone quality is unknown. The aim of this study was to correlate the WHO clinical fracture risk assessment tool, FRAX, with bone mechanical properties. METHODS Six patients submitted to hip replacement surgery, either due to osteoporotic fractures or to osteoarthritis, were evaluated. Bone samples were collected and the mechanical properties assessed by compression tests. Patients' data regarding the presence of clinical risk factors for fracture were registered. Laboratorial assessment of bone metabolic parameters and a dual X-ray absorptiometry(DXA) were done. RESULTS Analysis of the load-displacement curves showed that patients with fragility fractures (n=4) had low values of elastic modulus, yield load and energy absorbed until yield point. Osteoarthritis patients tend to have a better biomechanical performance.Femoral neck DXA scan was also performed in 3 patients. Fragility fracture patients had a lower bone mineral density than the patients with osteoarthritis. FRAX algorithm was applied and a positive relation was found between FRAX results and biomechanical parameters. Blood bone metabolic markers were within the normal range for all the subjects. CONCLUSIONS The worse mechanical properties observed in the fragility fracture patients were related to high probability of fracture given by FRAX. These observations, in a very small sample, need further confirmation. However, they suggest that the fracture risk assessment tool, FRAX, may reflect the current mechanical bone behavior of the patient.
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Affiliation(s)
- A Rodrigues
- Rheumatology Research Unit, Instituto de Medicina Molecular,Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
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Canhão H, Lucas R, Fonseca JE, Costa L, Romeu JC, Branco J, Barros H. Factors influencing calcaneus quantitative ultrasound measurements in an urban population. Clin Exp Rheumatol 2008; 26:67-72. [PMID: 18328149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To estimate the effect of demographic, social, behavioural and anthropometric factors on quantitative ultrasound (QUS) parameters in an urban population. METHODS Cross-sectional evaluation of consecutive subjects selected as part of the EPIPorto study, Portugal. Information was obtained on demographic, social, clinical and behavioural characteristics using a standard protocol. Calcaneus QUS parameters (Broadband Ultrasound Attenuation-BUA, and Speed of Sound-SOS) were obtained for men and women, stratified by age group. Comparisons according to exposure levels were made using the Kruskal-Wallis test and the multivariate effect on QUS parameters was estimated by linear regression. RESULTS 1482 consecutive subjects (1010 females and 472 males), aged from 18 to 92 years. Higher levels of QUS parameters were found in the younger groups and progressive decrease with age were reported. Men showed higher values as compared to women in all parameters and differences between them increased with age. Differences were significant for BUA after the age of 39 and for SOS after the age of 59. In women, the multivariate model showed that age, body mass index (BMI) and smoking status were independent predictors of BUA and SOS. In men, age, BMI and calcium intake were significantly associated with BUA and SOS. CONCLUSION The reference values in our Portuguese population are similar to others obtained in Southern European countries. In the Portuguese population, QUS parameters have age, sex and BMI as its major determinants. In addition, BUA and SOS may reflect specific bone characteristics influenced by a different set of independent determinants.
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Affiliation(s)
- H Canhão
- Department of Hygiene and Epidemiology, University of Porto Medical School, Porto, Portugal.
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Canhão H, Fonseca JE, Leandro MJ, Romeu JC, Pimentão JB, Costa JT, Queiroz MV. Cross-sectional study of 50 patients with calcium pyrophosphate dihydrate crystal arthropathy. Clin Rheumatol 2001; 20:119-22. [PMID: 11346223 DOI: 10.1007/s100670170081] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Calcium pyrophosphate dihydrate crystal arthropathy (CPPA) is a well known but heterogeneous disease with a variable presentation and course. We present a cross-sectional study undertaken in a Portuguese rheumatology unit with the aim of analysing clinical and radiological patterns of CPPA in our population. The study population included 50 patients, 34 (68%) women and 16 (32%) men. The mean age was 69.8 +/- 8.8 years. The onset features were acute arthritis in 19 (38%) patients and chronic joint complaints in 26 (52%); five (10%) patients were asymptomatic at the time of diagnosis, which was based only on radiological findings. The diagnosis was established in 37 (74%) cases by clinical and radiographic features, in eight (16%) by clinical, X-ray and synovial fluid analysis, and in five (10%) by clinical features and fluid analysis. The disease course was characterised by acute episodic arthritis in 16 (32%) patients and by persistent symptoms (with or without synovitis) in 34 (68%). The pattern of CPPA in 20 (40%) patients was pseudo-osteoarthritis with synovitis, pseudo-osteoarthritis without synovitis in nine (18%), pseudogout in nine (18%), monoarthropathy in eight (16%) and pseudorheumatoid arthritis in four (8%). The phosphocalcium balance was altered in nine (18%) cases: six patients had hypercalciuria two hyperphosphaturia, two hypocalciuria, one hypophosphaturia and one hypercalcemia. Five patients had abnormal thyroid hormone levels, but only one presented with clinical hypothyroidism. Four patients showed increased parathormone levels, but only one presented with clinical hyperparathyroidism. Radiographic findings showed that 43 (86%) patients had meniscus calcifications, 20 (40%) radiocarpal and 16 (32%) calcification of the symphysis pubis. The study confirms the clinical variability of the disease in a population of Portuguese patients. The knee meniscus calcifications were the most sensitive single finding for establishing the diagnosis of CPPA. Almost all our patients had sporadic idiopathic CPPA without associated pathological conditions.
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Affiliation(s)
- H Canhão
- Hospital de Santa Maria, Lisbon, Portugal.
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Costa MM, Romeu JC, da Costa T. Pachydermodactyly a rare cause of finger joint swelling. J Rheumatol 1995; 22:2374-5. [PMID: 8965276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Costa MM, Romeu JC, da Silva P, de Queiroz V. Successful treatment of ischaemic optic neuropathy secondary to giant cell arteritis with intravenous pulse of methylprednisolone. Clin Rheumatol 1995; 14:713-4. [PMID: 8608696 DOI: 10.1007/bf02207944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Costa MM, Lisboa M, Romeu JC, Caldeira J, De Queiroz V. Henoch-Schonlein purpura associated with coxsackie-virus B1 infection. Clin Rheumatol 1995; 14:488-90. [PMID: 7586994 DOI: 10.1007/bf02207691] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Coelho PC, Reis P, Leandro MJ, Romeu JC, de Queiroz MV. [Osteoporosis in adult men]. ACTA MEDICA PORT 1995; 8:307-12. [PMID: 7625230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Osteoporosis in men, despite being a less important public health problem than osteoporosis in women, should not be neglected as it has many deleterious effects as well as social and economic costs. Finding the cause of osteoporosis is more complex in men than in women, and prevention should be based on an early evaluation of the various possible risk factors and on taking up measures that tend to maximise the peak bone mass. Further studies need to be carried out in order to establish the differences and similarities that characterise this phenomenon when considering different sexes.
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Affiliation(s)
- P C Coelho
- Unidade de Reumatologia, Serviço de Medicina IV, Hospital de Santa Maria, Lisboa
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Coelho PC, da Silva JA, Romeu JC, da Costa JC, de Queiroz MV. Simultaneous appearance of Behçet's disease and pulmonary tuberculosis. Clin Exp Rheumatol 1994; 12:692. [PMID: 7895412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Paiva T, da Silva JC, Pimentel T, Romeu JC, Rosa A, Rosa CM, Fred A, Queiroz MV. Neurophysiological tests in neurolupus. ACTA MEDICA PORT 1988; 1:261-4. [PMID: 3247852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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