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Copyright of Zeitschrift für Individualpsychologie is the property of Vandenhoeck & Ruprecht GmbH & Co. KG and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Congenital interventricular septal aneurysms (IVSA) of the muscular septum are rare and can be associated with other familial abnormalities of the ventricular septum, arrhythmias, additional congenital heart disease, and chromosomal abnormalities. IVSA is also linked to ventricular dysfunction and non-compaction, although there are limited reports of this association presenting in utero. We describe a case of fetal ventricular septal aneurysm associated with ventricular dysfunction and pericardial effusion. [ABSTRACT FROM AUTHOR]

Introduction: Peer assessment in dental and medical education is a key tool for evaluating attitudes and communication skills, serving as an effective formative learning method. It not only boosts academic performance and encourages lifelong learning and reflective practice but also fosters collaboration, effective communication, and constructive feedback among peers. Objective: This study aimed to assess dental students' satisfaction and perceptions regarding implementing peer assessment in case presentations, including contribution to their learning. Methods: This cross‐sectional study involved third (n = 26), fourth (n = 54), and sixth (n = 71) dental students divided into five groups. Each student received peer assessments (n = 8) from the students of the other groups regarding their clinical presentation. At the end of the process, students were invited to complete an anonymous 9‐item questionnaire to assess student perceptions of the peer‐assessment process. Data were analyzed to evaluate students' perception and satisfaction with the peer assessment task. The bivariate analysis explored associations among questionnaire items. Results: A total of 151 students participated in the current study. Results showed a high level of agreement for most of the students regarding their preparedness for peer and self‐assessment. More than 75% of the students at all academic levels found it challenging to evaluate their peers. Student satisfaction scores increased with the level of education, (4.076, 4.214, and 4.246 out of five, respectively) with moderate correlations between peer evaluation characteristics. Conclusion: Peer assessment appears to enhance learning and professional development in dental students. Students' satisfaction with peer assessment grows with education level, reflecting its role in fostering critical evaluation skills and feedback. [ABSTRACT FROM AUTHOR]

Copyright of AYNA Clinical Psychology Journal is the property of AYNA Clinical Psychology Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This article explores the use of between-session homework (BSH) in psychotherapy and its effectiveness in promoting positive outcomes for clients. The authors present six case studies that demonstrate how BSH can be applied in different treatment modalities and for various disorders. They emphasize the importance of tailoring BSH to each individual client's needs and strengths, and stress the need for collaboration between therapists and clients in selecting and reviewing BSH. The article advocates for the integration of BSH into clients' daily lives to promote symptom improvement and personal growth. [Extracted from the article]

Background: Interstitial ectopic pregnancy is an ectopic gestation developing in the uterine part of the fallopian tube. The condition is rare and presents challenges for clinical as well as radiological diagnosis. This case report presents a rare case of interstitial ectopic pregnancy diagnosed intraoperatively. Case presentation: A 36-year-old Black woman, referred from a peripheral health facility, presented at the emergency department with severe abdominal pains, vaginal spotting, nausea, and vomiting, with a 2-month history of irregular menstrual flow. Clinical and laboratory findings were suggestive of an acute abdomen likely due to a ruptured ectopic pregnancy (ultrasound was not available). An emergency exploratory laparotomy was done, which revealed a right adnexal ruptured interstitial pregnancy of a lifeless female fetus weighing 500 g (estimated mean gestational age of 22–23 weeks). The left fallopian tube looked normal. The site of rupture was repaired, followed by cleaning and closure of the abdomen. The post-operative period was uneventful, and the patient was discharged on postoperative day 7. Conclusion: Interstitial pregnancies are uncommon and rarely attain advanced gestational ages, as in this case, compared with other tubal ectopic pregnancies. However, women presenting with signs of hypovolemic shock and acute abdomen, with a positive pregnancy test, warrant a high index of suspicion. [ABSTRACT FROM AUTHOR]

Copyright of Interazioni is the property of FrancoAngeli srl and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Case presentation assessment is common in both medicine and dentistry and is known under various names depending on the country and institution. It relates mainly to aspects of diagnosis and treatment planning and is considered highly authentic and useful. The COVID-19 pandemic necessitated the movement of this assessment from face-to-face to online. The aim of this investigation was to explore the students' impressions of the two different examination modalities. With this information, a decision on future diets of this examination can be made to accommodate the students' perspectives. Methods: Quantitative and qualitative data were gathered using an online, self-administered survey. Results: The students were split 50/50 regarding which assessment modality they preferred. Overall, they considered the online examination to be fair, and the majority agreed that the online format allowed them to display their knowledge as well as face-to-face. Conclusions: The delivery of case presentation examination is possible online. An online case presentation is a fair, useful, and authentic assessment that is appropriate to the needs of the faculty and students. Satisfaction with the two possible methods of conducting this assessment suggests it would be reasonable to conduct this examination online in the future. [ABSTRACT FROM AUTHOR]

Background: We needs to study Primary Large cell Non-Hodgkin's Lymphoma of the cranial vault, which is rare, and its association with COVID19 has not been reported, which may have an immunosuppressive effect to aggravate its progression. Patient details: Our patient, a 53-year-old male, noticed fast growth of posterior cranial vault lesion from 2 to 10 cm size in last 6 months after COVID 19 affliction. MRI brain with contrast revealed lesions suggesting meningioma. The whole-body PET scan was normal. Following Subtotal excision of the mass, histopathology revealed large B-cell Non- Hodgkin's lymphoma (DLBCL). Immunohistochemistry showed positive results for CD10, CD20, CD45 (LCA), ALK, and BCL-VE with a Ki-67 index of 90-95%. Following radiotherapy and chemotherapy patient is disease-free on imaging and doing well at 5 months of follow-up. Conclusions: Early intervention with excisional biopsy and timely chemo and radiotherapy in favorable immunostaining may add survival benefits even in malignant features induced by immunosuppressing diseases such as COVID19 in diffuse large B-cell lymphoma (DLBCL) of the scalp. [ABSTRACT FROM AUTHOR]

Background: Insulinoma is an uncommon insulin-secreting neuroendocrine tumor that presents with severe recurrent hypoglycemia. Although cases of extrapancreatic insulinomas have been reported, the majority of insulinomas occur in the pancreas. The number of reported cases of ectopic insulinomas with follow-up assessments is limited and they do not report disease recurrence. The current report presents the first documented case of recurrent extrapancreatic insulinoma with 8 years of follow-up, provides relevant literature review, and proposes surveillance and treatment strategies. Case presentation: We describe an insulinoma localized in the duodenal wall of a 36-year-old female who presented in 2013 with weight gain and Whipple's triad and was successfully managed with duodenotomy and enucleation. She presented again in 2017 with recurrent Whipple's triad and was found to have metastatic disease localized exclusively to peripancreatic lymph nodes. Primary pancreatic insulinoma was not evident and her hypoglycemia resolved following lymph node dissection. Eight years after initial presentation continuous glucose monitoring (CGM) showed a trend for euglycemia, and PET-CT Gallium 68 DOTATATE scan evaluation indicated absence of recurrent disease. Conclusion: Insulinomas are rare clinical entities and extrapancreatic insulinomas are particularly uncommon. Follow-up evaluation and treatment strategies for ectopic insulinoma recurrence presents a significant clinical challenge as the condition has hitherto remained undescribed in the literature. Available evidence in the literature indicates that lymph node metastases of intrapancreatic insulinomas likely do not change prognosis. Given the absence of long-term data informing the management and monitoring of patients with extrapancreatic insulinoma, we suggest patient education for hypoglycemic symptoms, monitoring for hypoglycemia with CGM, annual imaging, and a discussion with patients regarding treatment with octreotide or alternative somatostatin receptor analog therapies. [ABSTRACT FROM AUTHOR]

Cardiac tamponade is a rare life-threatening condition in breast cancer. About 25% of patients who have pericardial metastasis develop pericardial effusion, and only a small proportion of cases develop cardiac tamponade. The prognosis of patients presenting with cardiac tamponade is shadowy, with a survival rate ranging from a few days to 14 months, with a median survival of 5.5 months. We present the case of a 55-year-old woman diagnosed in 2020 with right luminal B stage IIIB breast cancer. After eight cycles of neoadjuvant chemotherapy (four cycles of liposomal doxorubicin and four cycles of paclitaxel/carboplatin), a Madden mastectomy with right axillary lymph node dissection was performed, followed by intensity-modulated radiation therapy (IMRT) and adjuvant hormonal therapy. After three years of no signs of oncological progression, the patient presented to the emergency room with clinical Beck’s triad. Echocardiography revealed a massive pericardial effusion with “swinging” heart and collapsed right atrium and right ventricle. To release the pericardial fluid, a pericardiocentesis followed by thoracocentesis were performed, significantly decreasing the symptomatology. The cytology examination confirmed the pericardial effusion containing metastatic breast cancer cells. The tumor board considered palliative chemotherapy treatment with liposomal doxorubicin/cyclophosphamide. After two cycles, no further accumulation of pericardial effusion was visible on the CT scan. In conclusion, given the fact that malignant pericardial effusion is considered to be an end-stage disease because it may lead to sudden cardiac death when left uncontrolled, the correct clinical diagnosis followed by the right therapeutic approach is crucial for the patient’s survival. [ABSTRACT FROM AUTHOR]

Materials and method. We used the information from the database of the Medical Oncology Ward of the “Elias” Emergency University Hospital, Bucharest, Romania. Objective. This article describes the management of a case of gastric adenocarcinoma with its challenges regarding the diagnosis of certitude, treatment protocols and toxicities. Results. We present the case of a 53-year-old Caucasian male, with locally advanced gastric adenocarcinoma, HER2+, pMMR, who underwent surgery and six out of eight cycles of peri-surgical chemotherapy, with complete response to treatment, then he neglected the oncological follow-up. After two years, he presented to the emergency room with jaundice, due to an invading tumoral mass. He underwent palliative surgical management and biopsies, which confirmed the relapse – negative for HER2, pMMR. The imaging revealed metastases in the liver and lymphatic nodes. He started the systemic treatment for recurrent disease, with multiple challenges regarding the treatment options and adverse events. Throughout the treatment, he preserved his quality of life. Conclusions. In this case report, we underline the relevance of a tumor board, the difficulty of treatment choices, the close follow-up, the palliative care and the management of adverse events in patients with gastric adenocarcinoma. [ABSTRACT FROM AUTHOR]

Case presentations have been researched as both an important form of intra/inter-professional communication, where a patient's clinical information is shared among health professionals involved in their care, and an equally key discursive tool in education, where learners independently assess a patient and present the case to their preceptor and/or care team. But what happens to the case presentation, a genre that governs physician (and learner) talk about patients, when it is used in patients' presence? While they were commonly used at the bedside in the past, case presentations today are more commonly performed in hallways or conference rooms, out of patient earshot. This paper draws on interview data from a study involving patient-present case presentations in a medical education setting. Our analysis asks what participants' metageneric comments about the encounter can teach us about the genre, about patient involvement in medical education, and about linguistic adaptations to the genre that the profession might make to support patient involvement. [ABSTRACT FROM AUTHOR]

This study explored the application of a model for teaching tooth wear diagnosis, risk assessment, and treatment decisions to undergraduates at the UCLouvain, Belgium, based on an inverted classroom combined with case presentations. The aim was to explain its implementation and assess improvement in learning, engagement, and satisfaction. The hypothesis tested was that this model would enhance students' performance. This controlled clinical trial included 29 dental students in the test group and 30 in the control group. All students received instructions and pre-class material for reading via e-mail 2 weeks prior to class time (T0). The test group included students attending the class time (attendance was not obligatory). The control group consisted of students only attending the preclinical training (attendance was obligatory). Both groups assessed three case presentations with no, moderate, and severe erosive tooth wear. The test group assessed the cases at the beginning of the class time (T1). One week later, at the beginning of the preclinical training, the students of the control group assessed the case presentations (T2). In parallel, to measure the contribution of the class time to students' performance, the test group reassessed the cases (T2). This was followed by discussion of each case in which the lecturer presented the benchmark assessments. Students' perception of their learning experience was recorded. The generalized linear mixed regression model showed that for the overall assessments of cases, students in the control group were significantly less likely to agree with the benchmark than students in the test group (OR = 0.62; p = 0.006). Students' satisfaction was higher in the test group than in the control group but only significantly regarding the quality of the cases presentations (Fisher test p < 0.01). The class time contributed significantly to students' improvement in learning in the test group (liner mixed model; p < 0.01). In conclusion, the model applied improved significantly in performance, learning, and to some extent satisfaction. However, the motivation strategy applied resulted in only half of the students adhering/engaging to the complete interactive model of teaching. Further motivation strategies should be implemented to make the complete model more widely accepted by students. [ABSTRACT FROM AUTHOR]

Background: Atrial septal defect is the most common acyanotic congenital cardiac anomaly in the adults after bicuspid aortic valve with high prevalence in females. Major challenges in the management of large ASD with severe pulmonary hypertension includes hypoxemia, hypercarbia, hypothermia leading to reversal of shunt (Eisenmenger syndrome), fatal arrhythmias and congestive heart failure. Case presentation: We report the successful management of the case of 44-year-old female patient with large ASD and severe pulmonary arterial hypertension posted for total abdominal hysterectomy with salpingectomy. She had history of palpitations with exertional dyspnoea and history of abnormal uterine bleeding with failed medical treatment. Echocardiography showed large OS-ASD (24 mm) with left to right shunt, moderate TR, severe PAH with estimated RVSP 60 mmHg, LVEF 50% and grossly dilated RA/RV. She underwent total abdominal hysterectomy with salpingectomy under regional anaesthesia with prophylactic use of adrenaline infusion. Conclusions: Cardiac patients for non-cardiac surgery can be managed under regional anaesthesia. [ABSTRACT FROM AUTHOR]

Background: Most individuals with eating disorders will either recover, settle into an unrecovered but self-defined acceptable quality of life, or continue to cycle from crisis to relative stability over time. However, a minority of those with severe and enduring eating disorders recognize after years of trying that recovery remains elusive, and further treatment seems both futile and harmful. No level of harm reduction proves achievable or adequately ameliorates their suffering. In this subgroup, many of those with anorexia nervosa will experience the medical consequences of malnutrition as their future cause of death. Whereas anyone who wishes to keep striving for recovery despite exhaustion and depletion should wholeheartedly be supported in doing so, some patients simply cannot continue to fight. They recognize that death from anorexia nervosa, while perhaps not welcome, will be inevitable. Unfortunately, these patients and their carers often receive minimal support from eating disorders health professionals who are conflicted about terminal care, and who are hampered and limited by the paucity of literature on end-of-life care for those with anorexia nervosa. Case presentation: Three case studies elucidate this condition. One patient was so passionate about this topic that she asked to be a posthumous co-author of this paper. Conclusions: Consistent with literature on managing terminal illness, this article proposes clinical characteristics of patients who may be considered to have a terminal eating disorder: diagnosis of anorexia nervosa, older age (e.g. age over 30), previous participation in high quality care, and clear and consistent determination by a patient who possesses decision-making capacity that additional treatment would be futile, knowing their actions will result in death. By proposing the clinical characteristics of terminal anorexia nervosa, we hope to educate, inspire compassion, and help providers properly assess these patients and provide appropriate care. We hope that this proposal stimulates further expert consensus definitions and clinical guidelines for management of this population. In our view, these patients deserve the same attendant care and rights as all other patients with terminal illness, up to and including medical aid in dying in jurisdictions where such care is legal. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Analytical Psychology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Inflammatory aneurysms and mycotic aneurysms make up a minority of abdominal aortic aneurysms. Mainly autoimmune mechanisms are proposed in the pathogenesis of inflammatory aneurysms, and it is not routine to check for infectious agents as disease culprits.Case Presentation: A 58-year-old European male with complaints of abdominal and back pain for 8 weeks was admitted after a semi-urgent computed tomography scan revealed an 85 mm inflammatory abdominal aortic aneurysm. The patient had normal vital signs, slightly elevated inflammatory markers, and mild anemia on admission. Clinical examination revealed a tender pulsating mass in his abdomen. His clinical condition was interpreted as impending rupture and urgent repair of the aneurysm was deemed necessary. Due to the patient's relatively young age and aneurysm neck morphology, open aortic repair was preferred. Preoperatively, the aneurysm appeared inflamed, with fibrous wall thickening and perianeurysmal adhesions. Aneurysm wall biopsies were sent to histopathological and microbiological diagnostics. Routine cultures were negative, but 16S rRNA gene real-time polymerase chain reaction was positive and Borrelia afzelii was identified by DNA sequencing of the polymerase chain reaction product. B. afzelii was also identified by sequencing the polymerase chain reaction product of a Borrelia-specific groEL target. Immunoglobulin G and M anti-Borrelia antibodies were present on serological analysis. Histopathological analysis displayed loss of normal aortic wall structure and diffuse infiltration of lymphocytes and plasma cells. The patient had an uneventful recovery and was discharged after 1 week to a regional rehabilitation facility. Though the patient fares clinically well and inflammatory markers had normalized, antimicrobial treatment with doxycycline continues at 3 months follow-up due to remaining radiologic signs of inflammation.Conclusions: Borrelia infection in the setting of acute aortic pathology is a rare entity. To our knowledge, this is the first case report to demonstrate a mycotic abdominal aortic aneurysm as a rare manifestation of Lyme disease. Aortic wall biopsies and real-time polymerase chain reaction analysis of the specimen were essential for accurate diagnosis. This finding may contribute to the understanding of the etiology of inflammatory aneurysmal disease and abdominal aneurysms in general. [ABSTRACT FROM AUTHOR]

Background: The management of non-small cell lung cancer (NSCLC) has become increasingly complex due to the evolution of personalized medicine approaches. Such approaches are characterized by the necessity of adequate tumor samples; hence, improved biopsy techniques are needed. Transbronchial lung cryobiopsy is a novel endoscopic procedure designed to collect peripheral pulmonary tissue, and it is currently employed in interstitial lung diseases. The use of this technique in oncology might result in improved mediastinum staging and molecular characterizations; however, available data involving the use of a cryoprobe on mediastinal lymph nodes are still limited.Case Presentation: Here we present a series of five consecutive patients who underwent endoscopic assessment of mediastinal lymph nodes for oncologic reasons. All patients were subjected both to endobronchial ultrasound-guided transbronchial needle aspiration (EBUS TBNA) and cryobiopsy of mediastinal lymph nodes during the same procedure, and no complications were observed. In three of the reported cases, both cryobiopsy and cell block from EBUS TBNA were positive, while in one case cryobiopsy was not diagnostic and EBUS TBNA was negative; moreover, one case showed discordance between the procedures, as cryobiopsy was negative and cell block obtained from multiple stations was diagnostic for small cell lung cancer. In one case involving a patient treated for lymphoma, cryobiopsy provided more complete histologic characterization, and in another case involving a patient affected by NSCLC cryobiopsy provided more material for molecular analyses.Conclusion: This case presentation series suggests that cryobiopsy, which has been generally used on peripheral lung lesions so far, is a feasible and safe approach for diagnosis and staging of mediastinal lymph nodal involvement, especially when station 7 is involved. Compared to EBUS TBNA, cryobiopsy might provide more adequate histological samples, with a possible impact on molecular characterizations and, therefore, therapeutic decisions. However, the learning curve of the procedure has not to be understated and optimal protocols for implementing this technique are needed. In our opinion, further studies designed to integrate the routine use of cryobiopsy in current practice for solid and eventually hematologic tumors with mediastinal lymph node involvement are warranted. [ABSTRACT FROM AUTHOR]

Copyright of Implantologie is the property of Quintessenz Verlags GmbH and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Impaction of foreign body is a common condition presented to ear, nose, and throat department among Asian population. The commonest foreign body seen among this population has been documented as fish bone. Fish bone can migrate to lateral neck space or related organs around the neck and chest. By presenting this case report, we aim to emphasize the importance of taking proper history and make clinicians aware of the possibility of a fish bone migrating into different spaces. This will help to prevent diagnosis delay leading to complications due to migrated fish bone.Case Presentation: A 50-year-old female Sinhalese patient presented to ear, nose, and throat department with right-sided neck pain for 2 days, who had a history of suspected fish bone impaction a few days ago that subsided without any investigations or treatments. She did not have any symptoms related to throat, and neck examination showed mild swelling and tenderness. Computer tomography revealed a migrated fish bone into the lateral neck close to carotid artery, and the fish bone was removed by neck exploration under general anesthesia without any complications.Conclusion: In conclusion, migrated fish bone should be suspected if patient is having persistent symptoms mainly in the neck without having difficulty swallowing and who gives a history of fish bone impaction and having negative laryngoscopic examination. Proper history taking is very important in the assessment of these patients to prevent misdiagnosis of the condition. Clinicians should aware that migrated fish bones are not uncommon and that early suspicion can prevent later diagnosis and complications. [ABSTRACT FROM AUTHOR]

Background: Left ventricular noncompaction is a rare cardiomyopathy characterized by a thin, compacted epicardial layer and a noncompacted endocardial layer, with trabeculations and recesses that communicate with the left ventricular cavity. In the advanced stage of the disease, the classical triad of heart failure, ventricular arrhythmia, and systemic embolization is common. Segments involved are the apex and mid inferior and lateral walls. The right ventricular apex may be affected as well.Case Presentation: A 29-year-old Caucasian male was hospitalized with dyspnea and fatigue at minimal exertion during the last months before admission. He also described a history of edema of the legs and abdominal pain in the last weeks. Physical examination revealed dyspnea, pulmonary rales, cardiomegaly, hepatomegaly, and splenomegaly. Electrocardiography showed sinus rhythm with nonspecific repolarization changes. Twenty-four-hour Holter monitoring identified ventricular tachycardia episodes with right bundle branch block morphology. Transthoracic echocardiography at admission revealed dilated left ventricle with trabeculations located predominantly at the apex but also in the apical and mid portion of lateral and inferior wall; end-systolic ratio of noncompacted to compacted layers > 2; moderate mitral regurgitation; and reduced left ventricular ejection fraction. Between apical trabeculations, multiple thrombi were found. The right ventricle had normal morphology and function. Speckle-tracking echocardiography also revealed systolic left ventricle dysfunction and solid body rotation. Abdominal echocardiography showed hepatomegaly and splenomegaly. Abdominal computed tomography was suggestive for hepatic and renal infarctions. Laboratory tests revealed high levels of N-terminal pro-brain natriuretic peptide and liver enzymes. Cardiac magnetic resonance evaluation at 1 month after discharge confirmed the diagnosis. The patient received anticoagulants, antiarrhythmics, and heart failure treatment. After 2 months, before device implantation, he presented clinical improvement, and echocardiographic evaluation did not detect thrombi in the left ventricle. Coronary angiography was within normal range. A cardioverter defibrillator was implanted for prevention of sudden cardiac death.Conclusions: Left ventricular noncompaction is rare cardiomyopathy, but it should always be considered as a possible diagnosis in a patient hospitalized with heart failure, ventricular arrhythmias, and systemic embolic events. Echocardiography and cardiac magnetic resonance are essential imaging tools for diagnosis and follow-up. [ABSTRACT FROM AUTHOR]

Background: Abiraterone is a medication frequently used for metastatic castrate-resistant prostate cancer. We report a case of non-sustained episodes of TdP associated with severe hypokalemia due to androgen-deprivation therapy. Few case presentations describe this association; the novelty lies in the potentially lethal cardiovascular events among cancer patients receiving hormonal therapy.Case Presentation: A 70-year-old male presented with recurrent syncope without prodrome. ECG revealed frequent ventricular ectopy, non-sustained episodes of TdP, and severe hypomagnesemia and hypokalemia. During potassium and magnesium infusion for repletion, the patient underwent temporary transvenous atrial pacing. As part of the work-up, coronary angiography revealed a mild coronary artery disease, and transthoracic echocardiogram showed a moderately depressed ejection fraction. After electrolyte disturbances were corrected, the QT interval normalized, and transvenous pacing was no longer necessary. Abiraterone was discontinued during the admission, and the patient returned to baseline.Conclusions: Cancer treatment is complex and requires a multidisciplinary approach. We presented a case of non-sustained TdP associated with androgen-deprivation therapy in an elderly patient with mild coronary artery disease and moderately reduced ejection fraction. Close follow-up and increased awareness are required in patients with hormonal treatment, especially in the setting of other cardiovascular risk factors. [ABSTRACT FROM AUTHOR]

Social media is an increasingly popular forum for medical education. Many educators, including those in infectious diseases, are now creating and sharing unique and educational patient cases online. Unfortunately, some educators unknowingly threaten patient privacy and open themselves to legal liability. Further, the use of published figures or tables creates risk of copyright infringement. As more and more infectious diseases physicians engage in social media, it is imperative to create best practices to protect both patients and physicians. This summary will define the legal requirements of patient de-identification as well as other practical recommendations as they relate to use of clinical case information, patient images, and attribution of primary references on social media. [ABSTRACT FROM AUTHOR]

Copyright of GMS Journal for Medical Education is the property of German Medical Science Publishing House gGmbH and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: One-minute preceptor (OMP) and SNAPPS (a mnemonic for Summarize history and findings; Narrow the differential; Analyze the differential; Probe the preceptor about uncertainties; Plan management; and Select case-related issues for self-study) are educational techniques developed to promote learners' expression of clinical reasoning during the case presentation in the workplace. The aim of this present study was to compare the content of the case presentation between the SNAPPS and the OMP methods. Methods: This was a randomized controlled trial comparing SNAPPS and OMP in 60 medical students at the beginning of their fifth year of medical school. After an introduction session, students presented and discussed two cases based on real patients and provided in written format. All case presentations were recorded and evaluated by two researchers. The assessed elements of the case presentations were divided into three subgroups related to expression of clinical reasoning, time and initiative to guide the presentation. Results: There were 30 participants in each group. There was no difference in the expression of clinical reasoning between OMP and SNAPPS groups (number of differential diagnoses, justification of most likely diagnosis and differential diagnosis, expression of comparing and contrasting hypotheses). However, students in the SNAPPS group expressed significantly more questions and uncertainties (p < 0.001), and more often took the initiative to present and justify the most likely diagnosis, differential diagnosis and management plan than students in the OMP group, both in simple and complex cases (all p values <0.001) without extending the length of the teaching session. Conclusion: OMP and SNAPPS equally promote medical students' expression of clinical reasoning. The SNAPPS technique was more effective than the OMP technique in helping students to take on an active role during case presentation. We propose SNAPPS as an effective learning tool, engaging students and promoting the expression of their clinical reasoning as part of a case presentation. [ABSTRACT FROM AUTHOR]

Background: Vogt-Koyanagi-Harada syndrome is a rare disease characterized by skin and eyelash bleaching, chronic granulomatous iridocyclitis and exudative retinal detachment, and aseptic meningitis and encephalopathy. IgA nephropathy complicated by Vogt-Koyanagi-Harada syndrome is very rare, even though they might have similar pathogeneses. Ocular lesions often are not examined when patients are diagnosed with IgA nephropathy, which affects the prognosis.Case Presentation: We describe a 55-year-old male IgA nephropathy patient who was admitted with high fever and hematuria. Physical examination revealed impaired binocular vision with blurred vision, impaired hearing, and a congestive rash on the chest and back. Renal ultrasound examination showed no abnormalities. Laboratory examination showed that glomerulonephritis was complicated by infection, and anti-infection therapy was ineffective. Bilateral fluorescein angiography showed Vogt-Koyanagi-Harada syndrome. Further renal biopsy confirmed IgA nephropathy. Hormone shock therapy and cyclophosphamide adjuvant therapy were administered, and the patient's symptoms improved.Conclusion: For the first time, we reported the case of simultaneous onset of IgA nephropathy and Vogt-Koyanagi-Harada syndrome, which is very rare. The onset of Vogt-Koyanagi-Harada syndrome is rapid and serious, while that of IgA nephropathy is relatively milder, making it easy for specialized doctors to neglect this condition. Doctors should be highly alert to the clinical concomitant occurrence of the two diseases with similar mechanisms, especially in the case of neurological defects and ocular symptoms in IgA nephropathy patients, since timely immunosuppressive treatment may improve the outcome of ocular diseases. [ABSTRACT FROM AUTHOR]

L4 and L5 fractures are different from those at the thoracolumbar area. These differences include anatomy, biomechanics, classification, and treatment possibilities. Given the accessible literature and lack of high-quality information about the management of low lumbar fractures, we describe the case of a young 26-year-old male was referred to our emergency medical center with a severe L4 vertebral body comminuted burst fracture with complete spinal canal compression (AO type 4). Incredible, all neurological functions were intact initially. The patient was cured through a one-stage posterior only vertebrectomy and fusion with preservation of all neurological functions. Clinical and radiologic follow-up was satisfactory after 2 years. In more severe lumbar injuries, decisions contain spinal decompression and stabilization through a posterior or anterior approach based on the surgeon's favorite. In our experience in this patient, a posterior approach only was used both for decompression and stabilization without routine challenging existing in anterior approaches. [ABSTRACT FROM AUTHOR]

Background: Management of warfarin-associated major haemorrhage in prosthetic valve diseases is difficult as there is a fine line between haemorrhage and thrombosis. An individual's propensity towards thrombosis, such as pregnancy, makes this situation even more complicated. Cases like these are very rare in the literature.Case Presentation: A 26 weeks pregnant, gravida two, para one, 35-year-old patient with prosthetic aortic and mitral valves presented to an external emergency clinic with clouding of consciousness. Her international normalised ratio(INR) was 8.9 at presentation. Brain MRI revealed a left subdural haematoma with no significant mass effect. Warfarin treatment was discontinued. On the second day of follow-up, she was referred to our centre for further evaluation of her clinical deterioration. She was haemodynamically stable on admission to the intensive care unit and followed up with a stable condition until the fourth day when she developed right eye drop and subsequent loss of consciousness. Her haematoma was surgically evacuated, and her condition improved. Eventually, she and a healthy newborn were discharged.Conclusion: Intracranial haemorrhage during pregnancy is a relatively rare complication that requires a multidisciplinary management plan. Although the thrombogenic risk is high, it is vital to complete a reversal of warfarin anticoagulation in pregnant women with major bleeding. [ABSTRACT FROM AUTHOR]

Purpose of Review: Progestogen hypersensitivity (PH) is a condition which typically occurs in women in childbearing years with a spectrum of symptoms ranging from urticaria with or without angioedema, dermatitis to systemic anaphylaxis. Herein, a clinical case of PH is presented followed by a discussion on the evaluation, diagnosis, and management of PH. Recent Findings: Progestogen hypersensitivity (a.k.a. "autoimmune progesterone dermatitis") symptoms are associated with exogenous progestin exposure (e.g., contraceptive medicines, in vitro fertilization therapy) or endogenous progesterone from progesterone surges during the luteal phase of the menstrual cycle and pregnancy. This condition can be difficult to recognize due to its heterogeneous clinical presentation. The mechanism of PH is believed to be primarily IgE-mediated; however, less commonly other immune responses may be involved. There is now a useful progesterone specific IgE immunoassay to assist in diagnosis and well-defined treatment algorithms that can be used to successfully manage PH. Summary: The epidemiology of PH is still poorly elucidated but is likely to be encountered by clinicians and especially allergists given the extensive use of oral contraceptives and increased use of supra-physiologic doses of progesterone required to support pregnancy in IVF. Including PH in the differential diagnosis of women presenting with cyclic hypersensitivity will accelerate diagnosis and successful management of this condition. [ABSTRACT FROM AUTHOR]

Case presentations have totemic significance in medical sociology, in which they are analysed as emblematic of medical professional culture. This article makes a case for conceptualising these exchanges in terms of Mauss' account of gift-giving, which theorises sociality in terms of obligations voluntarily incurred and reciprocated and the performative recognition of hierarchy. This contrasts with two alternatives in existing literature: the case presentation as an instance of pedagogically oriented supervision and legitimate peripheral participation; and as representative of professional discourse more generally. We make our case for re-framing the case presentation in relation to video and audio data generated within a study of an Accident and Emergency department in the UK. We conclude that Mauss' concept of community allows us to see discursive phenomena that have been overlooked, and to theorise the work of junior doctors in terms of collegiality in a hierarchically organised profession, by contrast to a defective version of the work of their superiors or the manifestation of singular professional discourse. [ABSTRACT FROM AUTHOR]

Aim: We developed a new case presentation technique, SITUPS, and studied its impact on the patient presentations by medical students at a paediatric emergency department. The students' opinions about the usefulness of the technique were also assessed.Methods: The students saw patients both before and after introduction to SITUPS. Their presentations were analysed by the clinical instructor using a student assessment form. The students filled in a 15-item questionnaire about their opinion of SITUPS as a learning tool.Results: Twenty-eight students were evaluated both without and with SITUPS in a total of 78 presentations. Using SITUPS, the students gave more complete case presentations without increasing the presentation time. The main areas of improvement were discussing differential diagnoses, proposing a management plan, and identifying where they lacked knowledge and needed to ask the instructor questions. The students found SITUPS particularly helpful in identifying family and social issues of significance, thinking of relevant questions to ask the patient and the family, and thinking through differential diagnoses.Conclusion: We propose a new case presentation technique, SITUPS, for use at the paediatric emergency department. With the help of SITUPS, the medical students gave more complete case presentations in a time-effective manner. [ABSTRACT FROM AUTHOR]

Children with Autistic Spectrum Disorders (TSA) often engage in stereotypical behaviors that greatly impede interaction with the environment and the learning process. Because these behaviors are self-reinforcing, they are often difficult to reduce. Moreover, for a method to be effective, we believe it is necessary to analyze the context in which they occur and the level of development of the child in each area that may influence the appearance or maintenance of these behaviors, besides analyzing their antecedents, consequences and functions. There are few studies that approach stereotypical behaviors in an integrative perspective. The goal of the current study is to analyze the stereotypical behaviors of a child with ASD from an integrative perspective, including Applied Behavior Analysis (ABA), The Neurosequential Model of Therapeutics (NMT) and Sensory Integration Therapy. This study has a great practical relevance because, based on theoretical foundation, it presents a complex perspective of analyzing the stereotypic behaviors and provides practical recommendations for intervention. Further research could test the hypotheses derived from this case presentation. [ABSTRACT FROM AUTHOR]

Purpose of Review: Progestogen hypersensitivity (PH) is a rare disorder which usually occurs in women of childbearing age with symptoms ranging from urticaria with or without angioedema, multiple organ involvement consistent with allergic anaphylaxis, to a spectrum of other non-evanescent skin eruptions. In this review, we present a clinical vignette of PH and discuss the clinical presentation and proposed pathomechanisms, diagnosis, and treatment of PH.Recent Findings: The hypersensitivity symptoms are associated with exogenous progestin exposure (e.g., contraceptive medicines, in vitro fertilization therapy) or endogenous progesterone from progesterone surges during the luteal phase of the menstrual cycle and pregnancy. Recognition of this condition can be challenging to the clinician due to its heterogeneous clinical presentation. It has been recently proposed to use the new term “progestogen hypersensitivity” to replace “autoimmune progesterone dermatitis” due to the lack of evidence supporting an autoimmune mechanism for this disorder. In addition, diagnostic and treatment algorithms are now available that can lead to successful management of this condition. More new developments of Progesterone desensitization protocols are now available which appear to be the safest and most effective long-term treatment option for PH.Summary: With the extensive use of oral contraceptives and increased use of supra-physiologic doses of progesterone to support pregnancy in in vitro fertilization, there is likely to be a higher prevalence of PH in the future than currently recognized. Therefore, the allergist-immunologist will be required to collaborate with gynecologists and reproductive endocrinologists to diagnose and treat this condition. [ABSTRACT FROM AUTHOR]

Background: Clinical reasoning, comprising the processes of clinical thinking, which form the basis of medical decisions, constitutes a central competence in the clinical routine on which diagnostic and therapeutic steps are based. In medical curricula in Germany, clinical reasoning is currently taught explicitly only to a small extend. Therefore, the aim of this project was to develop and implement a clinical reasoning course in the final year of undergraduate medical training. Project description: A clinical reasoning course with six learning units and 18 learning objectives was developed, which was taught by two to four instructors on the basis of 32 paper cases fromthe clinical practice of the instructors. In the years 2011 to 2013, the course of eight weeks with two hours per week was taught seven times. Before the first and after the last seminar, the participating students filled out a self-assess-ment questionnaire with a 6-point Likert scale regarding eight different clinical reasoning skills. At the same times, they received a patient case with the assignment to prepare a case presentation and differential diagnoses. Results: From 128 participating students altogether, 42 complete data sets were available. After the course, participants assessed themselves significantly better than before the course in all eight clinical reasoning skills, for example in "Summarizing and presentation of a paper case" or in the "Skill to enumerate differential diagnoses" (p<0.05). The greatest increase occurred in the skill to recognize typical cognitive er-rors in medicine and to identify risk situations for their occurrence (pre: 2.98±0.92 and retro-pre: 2.64±1.01, respectively, versus post: 4.38±0.88). Based on the ratio of number of words used per keywords used the problem presentation of the paper case was significantly more focused after the course (p=0.011). A significant increase in the number of gathered differential diagnoses was not detected after the course. Conclusion: The newly developed and established Clinical Reasoning Course leads to a gain in the desired skills from the student's self-assessment perspective and to a more structured case presentation. To establish better options to exercise clinical reasoning, a longitudinal implementation in the medical curriculum seems to be desirable. Faculty training would be useful to implement the concept as standardized as possible. [ABSTRACT FROM AUTHOR]

We are going to discuss the clinical case of a 66-year-old woman, with a history of controlled type 2 diabetes and hypertension. In March 2022, she underwent mammography, revealing a BIRADS 5 lesion in the right breast and a suspicious right axillary lymph node with biopsy indication. The histologic examination confirmed the diagnosis of luminal B HER2-negative NST breast cancer. Further investigations confirmed the diagnosis of stage IV breast cancer with peritoneal metastases. The treatment with abemaciclib was initiated in May 2022, but it was poorly tolerated and resulted in persistent grade 3 diarrhea, that required switching to palbociclib, which was better tolerated. TAP CT scan from September 2022 displayed a partial response, with the resolution of peritoneal metastases. In April 2023, she was enrolled in a screening program for occult bleeding, which resulted in a positive FIT test and a further recommendation for colonoscopy. The colonoscopy examination was incomplete due to severely congested erythematous mucosa, and multiple biopsies were obtained from the rectum, ascending and transverse colon which revealed metastasis of the same histology as breast carcinoma in the ascending colon. In conclusion, we had a partial response to CDK4/6 treatment in metastatic breast cancer with peritoneal metastases from the onset and an incidental discovery of colonic metastasis after a positive FIT test in an asymptomatic patient with no gastrointestinal symptoms and no suggestive CT scan of preexisting colonic metastasis or progressive disease at this level. [ABSTRACT FROM AUTHOR]

Introduction. Metastatic ovarian cancer represents a significant challenge in oncology due to its aggressive nature and therapeutic complexities. This case report provides insights into the experience of a 45-year-old female patient with metastatic ovarian cancer, revealing the details of her diagnosis, treatment, and outcomes. Patient considerations. The patient's journey started in March 2022, with the presence of lower abdominal pain leading to her hospitalization, where she went through a radical hysterectomy with bilateral oophorectomy. Imaging showed multiple secondary lesions in the lungs and lymph nodes, highlighting the severity of her condition. The surgical specimen was analyzed by pathologists, revealing a high-grade serous tubal carcinoma, while the subsequent genetic testing showed a positive BRCA1 mutation, signifying a genetic predisposition. Diagnosis. The patient was therefore diagnosed with stage IV ovarian cancer (pT2a-cN1 cM1pul,lym), characterized by a serous tubal carcinoma and BRCA1 positive mutation. Interventions. After the diagnosis, the patient underwent six cycles of platinum-based chemotherapy combined with targeted therapy (paclitaxel + carboplatin + bevacizumab), followed by maintenance targeted therapy, which incorporated a PARPi (olaparib), as indicated by her mutational status (BRCA1 positive). Outcomes and lessons. Following chemotherapy and maintenance targeted therapy, the subsequent imaging revealed a stable disease, highlighting the importance of patient-oriented interventions using genetic insights to guide treatment decisions. [ABSTRACT FROM AUTHOR]

Breast cancer represents the most common type of malignancy among women and is the second leading cause of death through neoplasia. Breast cancer is a heterogeneous disease, therefore tumors with different biological features have different clinical outcomes and responses to therapy. The prognosis and treatment choices are based on the characterization of tumor growth factor, the receptor status – ER, PR and HER2 expression. In the following, we will discuss the clinical case of a 59-year-old female patient diagnosed with left invasive ductal carcinoma. Immunohistochemistry tests revealed ER, PR receptors positive and HER2 expression negative. The first CT scan didn’t show any distant metastasis. It was initiated neoadjuvant chemotherapy followed by conservatory surgery. Postmastectomy, it was pointed out residual tumor and positive lymph nodes, therefore the next steps of the therapeutic behavior were radiotherapy followed by adjuvant chemotherapy, which was continued with hormonotherapy. The patient’s clinical status deteriorated fast, and pain alongside walking disability set in. The imaging reassessment indicated disease progression through bone metastasis. It was initiated the treatment with CDK4/6 inhibitors associated with aromatase inhibitors. The therapeutic response was spectacular, proving the treatment efficiency in a very short time, without any reactions. The patient’s clinical status improved within a few months and currently she is still under treatment. In conclusion, we present the management of a HER2-negative HR-positive breast cancer case and the efficiency proved by CDK4/6 inhibitors associated with aromatase inhibitors for metastatic disease. [ABSTRACT FROM AUTHOR]

We present the case of a 54-year-old woman who underwent in 2009 radical surgery for left luminal B breast cancer, followed by adjuvant chemoradiotherapy. Thirteen years later, in July 2022, the patient presented as an emergency with severe acute abdominal pain and fever. A full body CT scan revealed pneumoperitoneum due to perforation of an ileal mass, a left pulmonary infiltrative mass, mediastinal and abdominal lymphadenopathy. An emergency segmental enterectomy was performed. The histological examination showed ileal metastasis of a triple-negative breast cancer, establishing the diagnosis of metastatic breast carcinoma. The case was discussed at the multidisciplinary board. Biopsy of the pulmonary mass along with additional testing were decided in the first place. The lung sample testing revealed the presence of a poorly differentiated NSCLC adenocarcinoma – ALK negative, EGFR negative, PD-L1<1%, confirming a second primary carcinoma. The tumor board decided the treatment initiation with paclitaxel, carboplatin, atezolizumab and bevacizumab for six cycles, followed by atezolizumab maintenance. At the moment, the patient is on atezolizumab, having registered a partial response. The highlights of the clinical case are the belated unusual recurrence of the breast cancer and the diagnosis of the second primary lung cancer. Moreover, the decision regarding the right treatment that fights both primary malignancies, while taking into consideration the cumulative toxicities and the available clinical protocols, was a challenging one. The patient’s response to treatment remains a matter of ongoing observation. It is anticipated that a decision regarding the subsequent line of therapy will be notably intricate. [ABSTRACT FROM AUTHOR]

Introduction. Invasive pulmonary aspergillosis (IPA) is a serious fungal infection, a major cause of mortality in immunocompromised patients, especially in those with underlying pulmonary disease. The most afflicted categories are: patients with AIDS, hematologic malignancies, transplant recipients, those with a history of chest radiotherapy, prolonged neutropenia or with a history of corticosteroids use. Case presentation. A 44-yearold premenopausal woman, with no significant hereditary or personal pathological history, was diagnosed with stage IIIA left breast cancer. She had received a neoadjuvant dose-dense epirubicin-cyclophosphamide (EC) regimen, with growth factor support, followed by weekly paclitaxel, with corticosteroids support as premedication for the prophylaxis of taxane hypersensitivity reactions, for 11 weeks. In her last chemotherapy cycle, she presented fever, dyspnea, loss of appetite with weight loss, her vital signs being as follows: temperature 39°C, blood pressure 139/77 mmHg, pulse 107 beats/min, and O2 saturation of 97% on room air. On auscultation, we noticed diminished vesicular murmur bilaterally. The laboratory results revealed grade 3 lymphopenia and an elevated CRP level (120 mg/l), with negative urine cultures and negative tests for respiratory syncytial virus, influenza A/B and SARS-CoV-2. The cardiological evaluation ruled out a cardiac cause of dyspnea. Chest CT revealed nonspecific interstitial pneumonia (NSIP) with subpleural fibrosis, and broad-spectrum antibiotic therapy was initiated, but with the persistence of the febrile syndrome. The patient underwent bronchoscopy and bronchoalveolar lavage, positive for Pneumocystis jiroveci and Aspergillus. Based on these results, we decided on antibiotic treatment with Tienam®, linezolid and TMP/SMX and antifungal therapy with voriconazole, with improved clinical and biological status. After two months, the patient underwent radical mastectomy, with nonpathological complete response. Next, she received adjuvant chemotherapy with capecitabine and external adjuvant radiotherapy. After another three months, the patient was diagnosed with brain metastases and she underwent external palliative radiotherapy. During her hospitalization in the radiotherapy department, she developed respiratory symptoms, being again diagnosed with invasive pulmonary aspergillosis, with a more severe evolution than in the first episode. In the context of this pulmonary complication, both the curative treatment and the treatment for the metastatic disease were delayed. We mention that the patient had PD-L1 and BRCA negative status. In both scenarios, the therapy would have been a real challenge. If the patient had a BRCA mutation, the use of olaparib would have required caution regarding the concomitant administration of strong inhibitors of CYP3A enzyme, such as voriconzole. Also, the immunotherapy use would have been difficult to manage, with this atypical respiratory infection with reactivations, but we cannot talk about therapeutic safety neither using again the chemotherapy regimens. Discussions. The prognosis of invasive pulmonary aspergillosis is poor, despite antifungal therapy options. In patients with solid tumors, there is still a lack of data, with nonspecific symptoms and imaging, but usually the dosedense regimens, especially with corticotherapy use, have a major risk. In some cases, corticotherapy can mask the symptoms, which delays the diagnosis of aspergillosis. [ABSTRACT FROM AUTHOR]

In 2022, more than 100,000 cases of melanoma were reported, leading to more than 15,000 deaths, mostly in adult men. Immunotherapy has increased the survival rate of patients with metastatic disease but, despite these advances, many patients will relapse. Thus, the development of additional therapeutic options was imperative. This is how TIL immunotherapy was developed, consisting of lymphocytes with the ability to infiltrate the tumor. These lymphocytes are extracted from the patients’ body, grown to very large numbers in a laboratory with interleukin-2 and infused back into the body where they actively attack cancer cells. Next, we will present the case of a 62-year-old male treated with adjuvant PD-1 inhibitor, who subsequently progressed with bone metastases. The BRAF V600E mutation was identified and BRAF/MEK inhibitor was chosen, but new oncological lesions appeared shortly after, located subcutaneous and in the testicles. We switched to anti-PD-1 combined with CTLA4 for four cycles, remaining in maintenance with anti-PD-1. Although the clinical benefit existed, new lesions appeared in the adrenal glands and peritoneum. The patient was referred to TIL therapy which he underwent in August 2023. He presented 10 days after the completion of TIL with complete clinical regression of two 2/3 cm subcutaneous masses. The patient will continue maintenance therapy with anti-PD-1 and he will be followed-up closely both clinically and by imaging. [ABSTRACT FROM AUTHOR]

Copyright of Revista Latinoamericana de Psicopatologia Fundamental is the property of Associacao Universitaria de Pesquisa em Psicopatologia Fundamental and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Latinoamericana de Psicopatologia Fundamental is the property of Associacao Universitaria de Pesquisa em Psicopatologia Fundamental and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This article begins by reviewing psychoanalysis's conflicted relationship with pleasure as both a desired and feared goal. Freud implicitly changed his stance on pleasure as he elaborated the meaning of his grandson'sfort-dagame suggesting that pleasure is necessary for the mastery of loss and trauma. This article discusses several current theoretical aspects of pleasure including a phobic attitude towards pleasure and the experience of confusion and doubt within the transference–countertransference relationship that occurs as a result of shared moments of pleasure. I suggest that shared experiences of pleasure are inherent aspect of change in psychotherapy because they allow externalized disowned aspect of the self to become internalized as active, meaningful subjective experiences. A lengthy clinical illustration is presented in which songs are used as pleasurable and frightening transitional experiences that allow for the expression and symbolization of disowned aspects of the patient's self. [ABSTRACT FROM PUBLISHER]

The aim of this study was to evaluate whether the objective structured clinical examination (OSCE) and case presentation (CP) as forms of active assessment were effective measures of overall didactic knowledge and clinical performance in a predoctoral dental curriculum. This evaluation was conducted by statistical analysis of quality points (QP) awarded for didactic and clinical performance, CP grades, and OSCE scores for 185 students at Harvard School of Dental Medicine who graduated during the period 2010-14. As part of the requirements for graduation, each student takes three OSCEs and presents two patient cases. Data for the study were obtained from the Office of the Registrar. The results showed no direct correlation between QP and CP grades and no correlation between CP grades and OSCE scores. However, there was a correlation between OSCE scores and QP. Students with honors-level scores on any of the three OSCEs received significantly more QP than students who did not receive honors. In addition, students with passing scores on OSCEs 2 and 3 received significantly more QP than students with failing or marginal OSCE scores. Innovative formats of active assessment such as OSCEs and CPs can promote a student-centered learning environment. These data indicated that, within this study population, there was a positive association between OSCE scores and clinical and didactic performance, supporting the value of OSCEs as a means of assessment. [ABSTRACT FROM AUTHOR]

Background: Various techniques have been developed to enable preceptors to teach residents effectively in outpatient settings to promote active learning, including SNAPPS and the One-Minute Preceptor (OMP). This study aimed to ascertain the differences between SNAPPS and the OMP in case presentation content and learner evaluation when used to teach residents about case presentation. Methods: From 2011 to 2013, participants were 71 junior clinical residents employed in two hospitals for clinical training. They were randomly allocated to two groups, one using SNAPPS and the other the OMP. From recorded discussions, the “differential diagnoses”, “questions and uncertainties”, “treatment plans”, and “learning issues” were counted. Also, a self-evaluation form was distributed at the end of the study to evaluate the residents’ satisfaction with the case presentation. Results: Members of the SNAPPS group used significantly more meaning units related to questions and uncertainties compared with those of the OMP group (P < 0.001). Self-evaluation sheets revealed that members of the SNAPPS group had significantly higher positive responses than those of the OMP group in terms of the following evaluations: “It was easy to bring up questions and uncertainties” (P = 0.046), “It was easy to present the case efficiently” (P = 0.002), “It was easy to present the case in the sequence given” (P = 0.029), and “I was able to give an in-depth case presentation” (P = 0.005). Conclusions: SNAPPS may induce more meaning units related to questions and uncertainties and give more satisfaction to residents than the OMP. [ABSTRACT FROM AUTHOR]

Copyright of Psychotherapie Forum is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The problem-oriented medical record is the widespread, standardized format for presenting and recording information about patients, which is taught to future physicians early in their medical training. Based on our participant observation of medical training, we analyze the ways in which the patient presentation operates in medical training as a disciplinary technology that manages uncertainty in the clinical decision-making process. We uncover various mechanisms at work including the construction of a coherent narrative structure in which chaotic experiences are re-organized and re-interpreted to fit neatly in a linear plot with a predictable ending, the atomization of the patient as a whole into separable 'problems,' the attempt to solve these 'problems' as though they are independent of one another, and the mystification of translations in scale, which give rise to much of the uncertainty in medicine. Operating at the boundary of the chaotic and often ungraspable world of the suffering experience of the patient and the highly structured realm of the medical record, a patient presentation is one medium through which both a disciplined record of experience and disciplined medical practitioners are produced. This process functions to transform the human subject patient into a recognizable, generic clinical case, and the medical student into an identifiable, professional future physician. [ABSTRACT FROM AUTHOR]