f. Further topic discussion bedside clinical case specific and based on type of
situation .... By: James F McKenzie, Robert R Pinger, and Jerome E. Kotecki.
MINISTRY OF HEALTH OF THE REPUBLIC OF MOLDOVA STATE UNIVERSITY OF MEDICINE AND PHARMACY «Nicolae Testemitanu» Approved Medicine Faculty Council meeting No. 2 Protocol nr.__ date ________________ No.2 Medicine faculty decan Prof., PhD Gavriliuc Mihail
Approved Medical clinics no.6 meeting Protocol nr.2 date 03.10.2012 Head of Medical Clinic no. 6 PhD, D.m.s.Ivan Butorov
ANALITICAL PROGRAM Course title: Occupational Diseases Type of Course: Occupational Diseases Medicine Department Total hours - 35 hours Including course - 10 hours practical classes - 25 hours Number of credits allocated to courses: II Names of the authors who teach course units: PhD, associated professor, D. Barba PhD, assistent professor, S. Nichita PhD, assistent professor, N. Antonova
Chişinau 2012
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The purpose of discipline occupational disease are: to provide theoretical and practical skills, support and cultivate skills and attitudes necessary to practice medicine as an important part of maintaining occupational health and working capacity. Training objectives in the discipline of occupational diseases: 1. The level of knowledge and understanding • Knowledge of the causes and genesis of diseases affecting the human health; • Acquisition of knowledge necessary to make the diagnosis of each professional diseases; • Acquisition of knowledge in specifying clinical examination and laboratory features for patients with diseases caused by noise, poisonings and diseases, caused by exposure to chemicals, diseases caused by overuse of locomotor diseases, caused by dust and azbestogene silicogene diseases and occupational skin diseases, caused by vibration; • Development of clinical reasoning principle of knowledge and identification of various disease symptoms and signs present in occupational diseases; • Preparation of clinical thinking, the skills of analysis and to systematize clinical examination and laboratory results; • Develop of a clinical diagnosis (establishing occupational exposure), positive and differential professional diseases. 2. Development of clinical reasoning: assessing the results of clinical examination of patient treatment, presumptive diagnosis reasoning, reasoning program preparation and laboratory investigations and consultations from other physicians, specialists, making differential diagnosis: conditions that must be taken into consideration, the criteria of differentiation; • knowledge of the diagnostic algorithm and argument individually appropriate treatment, etiologic treatment and treatment tactics in cases of unidentified etiology, pathogenetic treatment, symptomatic (drugs, doses, route of administration, mechanism of action, adverse actions and their prevention, contraindications, duration of treatment, predicting the evolution of pathology established the patient in question); • enhance, enrich and implementation in clinical practice knowledges in the field of ethics and medical ethics; • acquisition of issuing medical documents; • acquisition habit of prophylactic recommendations (technical and organizational measures and health measures) and control depending on the particularities of each professional diseases with major impact on health. 3.At the application level: • application of skills and the theoretical analysis of a process or phenomenon in the impact of pollution on environmental quality, state of health by their continued supervision; • training of specialists in organizing practical works in the monitoring of processes with negative environmental impact; • develop specific discipline reports and comments; 2
• use knowledge gained in the process of law by strengthening, enriching and implementation in clinical practice. 4. The
level of integration: • appreciate the importance of occupational diseases in the context of internal medicine and related disciplines health integration; • occupational medicine to address problems creatively; • possess the skills to implement and integrate knowledge in occupational medicine clinical disciplines; • be able to objectively evaluate and self-assess knowledge in the field; • to implement the principle of integrated activities (education, health care, scientific research), which involves acquiring the appropriate methodology to solve the problems of medical practice • be able to assimilate new developments in the discipline of occupational diseases. 5. Preparation and preliminary requirements Occupational diseases are diseases that occur following exercise of a trade or profession caused by harmful factors of physical, chemical, biological or psychosocial job characteristics and the strain aparatesi different body systems work in process, regardless of the type the employment contract. Knowledge of occupational morbidity structure is important because it reflects the effect of occupational exposure to harmful agents in working environment, allowing early preventive measures to remedy the technical and organizational health. Occupational diseases are studying the causes (etiology), clinical manifestations and effects on organs (clinical pathology), recognition (diagnosis), treatment (therapy) and prevention (prophylaxis) disease caused by noise, poisonings and diseases caused by exposure to chemicals, diseases caused by musculoskeletal overuse professional, occupational diseases caused by dust and azbestogene silicogene and skin diseases, diseases caused by vibration, poisoning by pesticides and other chemical compounds used in agriculture (chlorine-, phosphorus-organic and derivatives nitrophenol) that affect the human body. To acquire good sound knowledge of the discipline required in anatomy, biochemistry, physiology, pathophysiology, biology, etc.. Discipline occupational diseases is one of the disciplines in the university training of doctors, regardless of specialty that will choose a later, is the widest field of integration and implementation of fundamental knowledge (anatomy, Human Physiology, pathophysiology, chemistry, pharmacology, biology, etc. .) in clinical practice. In this discipline, along with studying the etiology, pathogenesis, clinical manifestations, evolution, treatment and prevention of diseases profesonale specialist accumulate practical skills for investigating and assessing patient outcomes, assess the impact that new technologies have on the body, put the basis of clinical, which ensures proper diagnosis, appropriate treatment and early detection of diseases.
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The basic content of the course: A. Lectures: Nr. 1.
Theme
Introduction to the discipline of Occupational Medicine. Definition. Purposes of occupational medicine. Areas of occupational medicine component. Condition of employment. Occupational hazards. The action of professional hazards. Diagnosis and management of poisoning with organophosphates insecticide. Diagnosis and management of organochlorines insecticide poisoning. Occupational diseases induced by physical factors. Vibration, noise and non-ionizing radiation. Pneumoconiosis. Definition. Types. Pathogenesis. Signs and symptoms. Complications. Diagnosis. Treatment. Prevention.
2.
3. 4.
5.
Nr.of hours 2h
2h
2h 2h
Poisoning with benzene and its homologues. Aetiology. Pathophysiology. The clinical picture. Positive diagnosis. Differential diagnosis. Treatment. Prophylaxis. Specific ecological relationships. Poisoning with metals, metalloids and their derivates.
2h
Total
10 h
B. Practical + internships Nr. 1.
2.
Theme
Nr.h
Introduction to the discipline of Occupational Medicine. The methodology of knowledge of working conditions. Clinical examination of patients with pathologies and objective examination in occupational diseases. The methodology of knowledge of working conditions. Patient’s curation. Knowledge necessary to identify categories of risk factors and agents: occupational hazards. Principles and methods used in risk assessment: hazard identification, dose-response assessment, exposure assessment, risk characteristics, toxic effects impaired digestive system, CNS, respiratory, cardiac, haematopoetic, treatment
5+1 h
Diagnosis and management of organophosphates poisoning. Diagnosis and management of organochlorines insecticide poisoning. Professional with lead poisoning. Aetiology. Pathophysiology. The clinical picture. Positive diagnosis. Differential diagnosis. Sequelae. Expertise working capacity. Treatment. Prophylaxis. Specific ecological relationships.
5+1 h
. 3.
Occupational diseases induced by Vibration, noise and non-ionizing radiation.
physical
factors.
5+1 h 4
Illness through exposure to physical factors: • Occupational vibration syndrome • Hand-arm vibration (HAV) • Whole-body vibration (WBV) • Vibration white finger (VWF) • Hand-arm vibration syndrome (HAVS) • Raynaud's phenomenon a. The action of noise on the human body. Effects on the body. Hearing loss and deafness professional. Etiology. Pathophysiology. The clinical picture. Positive diagnosis. Differential diagnosis. Treatment. Prophylaxis. General effect. b. Illness through exposure to vibrations (vibration). Aetiology. General pathophysiology. 4.
5.
Occupational Respiratory Lung Disease. Definition. Etiology (main etiologic factor, favoring etiological factors for occupational exposure). Pathophysiology. a. Silicosis. Definition. Eetiology. Pathophysiology. The clinical picture. Positive diagnosis. Differential diagnosis. Complications. Evolution. Expertise working capacity. Treatment. Prophylaxis. b. asbestosis. Definition. Eetiology. Pathophysiology. The clinical picture. Positive diagnosis. Differential diagnosis. Complications. Evolution. Expertise working capacity. Treatment. Prophylaxis. c. coal miner pneumoconiosis. Definition. Eetiology. Pathophysiology. The clinical picture. Positive diagnosis. Differential diagnosis. Complications. Evolution. Treatment. Prophylaxis.
5+1 h
Professional benzene poisoning. Etiology. Pathophysiology. The clinical picture. Positive diagnosis. Differential diagnosis. Treatment. Prophylaxis. Specific ecological relationships. Poisoning with metals, metalloids and their derivates. Total
25 h
Syllabus for practical work 1.The methodology of knowledge of working conditions. 2.Clinical examination of patients with pathologies and objective examination in occupational diseases. 3.Detection of clinical syndromes main argument clinical diagnosis according to clinical examination and laboratory investigations and laboratory results. 4.Knowledge necessary to identify categories of risk factors and agents: occupational hazards. Principles and methods used in risk assessment: hazard identification, doseresponse assessment, exposure assessment, risk characteristics, toxic effects impaired digestive system, CNS, respiratory, cardiac, haematopoetic, treatment. 5
5.Determination and assessment of occupational dust to a job. 6.Determination and assessment of occupational noise. 7.Cardiovascular functional tests. 8. Respiratory functional tests. 9. Application of measures of hygiene and safety at work, individual and collective protection measures against labor population exposure to physical, chemical, biological, toxic, others. 10. Registration of the observation form for assessing the professional route of occupational diseases. 11.Knowledge of contemporary treatment of occupational diseases. 10. Prescribing of drugs in the main groups. Laboratory examinations for asserting professionalism in asthma. 12.Read a standard chest X-ray pneumoconiosis. 13.Report, declaration, investigation and recording of occupational diseases 14.Qualified first aid for: -Acute organophosphates pesticide poisoning -Acute organochlorines pesticide poisoning -Acute pesticide poisoning nitrophenol compounds -Acute poisoning by benzene and its derivatives -Acute poisoning with lead -Poisoning by heavy metals and their compounds -Poisoning mercuroorganici complex - Industrial powder poisoning (asbestoz, antracoz, siderosis, silicatoz, silicosis) - Poisoning with non-metals: selenium, boron, arsenic, phosphorus. - Poisoning by organic compounds: organic solvents, aliphatic hydrocarbons, aromatic hydrocarbons. Teaching
and
learning
methods
used
Methods of teaching - learning: lecture, heuristic conversation, explanation, discussion, problem-solving, simulation of situations, methods of group work and individual study curriculum documents and references. Discipline of Occupational Diseases discipline is taught in the classical manner: with lectures and practical work. The theoretical lectures will be read during the current holders. At the theoretical lectures will be read by the current owners. Department reserves the right to spend the practical work and lectures in an interactive manner. Algorithm practical lesson of Occupational Diseases duration - 5 academic hours (225 min) a. Report visperale guard by the student, who performed guard the day before - 5-7 min. b. Answers to questions on the topic by the teacher - 10 to 15 min. 6
c. The initial knowledge base (pretest) - 15 to 20 min. d. Work independently with patients - 30 - 35 min. e. Topic discussion using teaching and illustrative materials - 60 min. f. Further topic discussion bedside clinical case specific and based on type of situation problems with the results of laboratory and instrumental investigations. 60 min h. Estimate practical properties of the theme, conclusions - 10 min. Theoretical courses are taught as classical, slides, interactive. Practical lessons are spent at high methodically, using widely different illustrative clinical material. Depending on the time dynamics of the educational process, apply various types of seminar sessions, such as: introductory workshops, seminars basic overview seminars, discussion, lecture, problematized, applications, making instructional objective (informative) - education (formative), which is based on such characteristics as: mobility, diversification, specialization. Practical works are proposed: • the bedside examination of patients together with students, and laboratory interpretation of laboratory investigations, assessment of the work; • periodic testing of practical knowledge; • student involvement in the preparation of clinical cases or exposures theoretical topics; • presentation of materials with different disease conditions generating professional work, concrete ways positive diagnosis of occupational diseases • the development of clinical reasoning: assessing the clinical examination of patient outcomes in the context of individual clinical case, the argument presumptive diagnosis, preparation and laboratory investigations program arguments and advice of other doctors - specialists, making the differential diagnosis, formulate a positive diagnosis (clinical) practice Clinic reserves the right to spend some practical work in interactive and modern approach: teaching strategies focused on active learning and interactive: -Centered and activity benefeciar -Multidirectional communication -With an emphasis on developing thinking -With skills training skills -To encourage participation, initiative, creativity -To assess their own work -Transformed benefeciarul of learning object and subject - Predominantly formative component, cognitive component balanced evaluative component Oriental
suggestions
for
individual
activities
The effective acquisition of occupational diseases module is proposed as methods of learning that: • Synthetic Learning. The material is small and easy: read and repeat the global 7
• Learn analytical sequence. First is learned and then global depth, noting in pencil •learning through problem-question-answer • Browse, questions, reading the text, remembering the main points, reviewing the plan • Learning is more economical way than mechanical. Reproduce the text in your own words • Learn self-organized, autonomous, creative learning, cooperative learning, learning through problem solving, lifelong learning, etc. •Learning is through discovery and interaction •search and obtaining information • The appropriate use of existing databases and virtual library to communicate multifunctional space and time, without constraints • The selection and use of the most interesting sites (capacity of choice and information • To create text, graphics, tables, drawings, charts and diagrams, to integrate images into text; • To make specific products: logs, summaries, reports, videos, sites, exhibitions, etc. • To work in groups to explore virtual environments • Ability to perform simulations, to sort and manipulate information / data and to design the final documents telematics • To work independently and to be fit in time (timeliness autofixate Methods of assessment The discipline of occupational diseases during the studies evaluating students' knowledge is made: The assessment of theoretical knowledge (oral) - The completion of the module by performing practical tests by examining and discussing a clinical case; By assessing the clinical observation sheets (staff) - Is carried out according to the course work and practical lessons - By checking periodically tests and oral knowledge grid. At the end of occupational diseases subject it has finished with the colocvium conversation. Assessment methods: Estimation of the students during the module: a. practical lessons - every lesson student is rated at under estimate pretest (most commonly in the form of pop quiz), worked at the bedside, communication, refer to the theme, and the theme of practical properties. b medical observation card is noted at her presentation and discussion at the end module. At promotion examination in the subject students are not admitted with yearly average in grade under 5, and students who have not recovered absences from the practical work. Examination in the subject (summary assessment) is a combination of oral test and practical skills assessment = colocvium. Rating Scale 8
Assessment of knowledge must be assessed with a mark of 10 to 1 without decimals. Grades 5 to 10, obtained as a result of evaluation of the course unit, allow their appropriations, according to the curriculum. The final grade is the sum of weighted grades from current assessments and final examination, student service rounded up to integer. Students note that the current assessment is less than "5" are not allowed in the final evaluation. • Note 10 or 'excellent' is given to demonstrate the profound and remarkable theoretical and practical skills developed course unit, creativity and skills in the application of acquired skills, working independently and considerable knowledge of the respectable version of literature. Student has mastered 91-100% of the material included in the curriculum of the course unit. • Note 9 or "very good" is given for very good demonstration of practical and theoretical skills developed course unit, good skills in applying competences acquired a few minor errors / essential. The student has acquired 81-90% of the material included in the syllabus of the course unit. • Note 8 or "good" is given to demonstrate good theoretical and practical skills developed course unit / module skills in the application of the aims of the study with a certain lack of confidence and uncertainty related depth and refine course, but that student can correct them with answers to additional questions. The student has acquired 71-80% of the material included in the syllabus of the course unit. • Notes 6 and 7 or "satisfactory" are given to demonstrate the basic skills developed course unit and the ability to apply them in typical situations. Student response lacks confidence and finds significant gaps in knowledge of the course unit / module. Student has mastered respectable 61-65% and 66-70% of the material. • Note 5 or "weak" is given to demonstrate the minimum competencies of the course unit, the implementation of which faces many difficulties. 51-60% The student has mastered the material. • Notes 3 and 4 are given when a student fails to demonstrate minimum competencies and promote course unit requires additional work. Student has mastered 31-40% and 4150% of the material. • Notes 1 and 2 or "unsatisfactory" are awarded to students who copied or showed a minimal knowledge of the matter by 0-30%. To promote unity of course more take trains to work a lot. Recommended References: Recommended References: ARTHUR L. FRANK / National Institute for Occupational Safety and Health;Occupational Lung Disease; Occupational Safety and Health; Occupational Safety and Health Administration) National Institute for Occupational Safety and Health (2000). Worker Chartbook, 2000. Washington, DC: NIOSH. Source: Encyclopedia of Public Health, ©2002 Gale Cengage. All Rights Reserved.Full copyright.
1-Essentials of Managed Health Care (2004), 4th edition. By: Peter R. Kongstvedt. Aspen Publisher. 9
2-An Introduction to Community Health (2005), 5ht edition. By: James F McKenzie, Robert R Pinger, and Jerome E Kotecki. Jones and Bartlett Publishers, UK 3-Epidemiology, Biostatistics, and Preventive Medicine (2007), 3rd edition. By: James F Jekel, David L Katz, Joann G Elmore and Dorothea MG Wild. Saunders Elsevier Publishers, USA. 4-Park’s Textbook of Preventive and Social Medicine (2005), 18th edition. By: K. Park. Banarsidas Bhanot Publishers, India. b) Presentations. c) Websites: www.aspenpublishers.com/books/kongstvedt/
In English: Head of Medical Clinic No.6, professor, doctor of medical sciences
Ivan Butorov
Head of studies Associate Professor, PhD
Doina Barba
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