Sepsis and severe infection

General characterization

Prerequisites

Available soon

Bibliography

Available soon

Teaching method

The CU runs in both semesters with half the students in each semester.
The pedagogical methodology of the CU is of the flipped learning type in which the
time of teacher-student contact is used mainly to clarify and systematize
concepts/clinical cases/key situations. In each semester, that is in each of the 15
teaching weeks, there will be 2 types of classes:
1. Theoretical classes with an expository nature, with a variable number and
duration, using e-learning platforms, to be previewed before the theoretical-
practical classes; at least 15 classes with contents related to the topics to be
addressed in the theoretical-practical classes or others that the teachers
considered pertinent, after evaluation of the UC and the students listened to;
2. Theoretical-practical classes directed to small groups of students (always <15
students) lasting 50 minutes in total of N = 15 (see table below). These classes
are always interactive, held in clinical simulation environment with features
of real clinical cases and the methodology of problem-solving learning
among others. With these classes we intend to train clinical reasoning (fast
thinking and slow thinking). The clinical case will be read and presented by
the students themselves. Throughout the course of the case, the professor
interacts with students asking questions and raising problems, serving as
moderator of clinical discussion among students, with the aim of
stimulating discussion and clinical reasoning. At each stage of the clinical
case will be discussed the differential diagnosis, proposals for diagnostic
tests, analysis and interpretation of the results, consulting request other
medical/surgical specialties, the treatment plan, which is expected in terms
of clinical outcome, the most frequent complications and the prognosis. It is
intended that there is maximum interaction in order the student being
confronted with the need to take multiple clinical and therapeutic decisions
throughout the class.
3. The last class, in addition of being a class of doubts, intends to be a class of
team-based learning; the class depending on the clinical case will have to
perform all the clinical reasoning and approach of the patient.
4. Microbiology Laboratory - virtual visits will be made to the Microbiology
Laboratory (available on the YouTube platform) where the processing of
biological samples (blood cultures, respiratory samples and urine) from
entry into the laboratory to the final result will be addressed.
Theoretical-practical classes are mandatory. Students who miss more than 1/3 of the
number of classes taught, will be automatically disapproved to the discipline so
they cannot be admitted to the exam.

Evaluation method

The assessment consists of a final written
exam carried out in person using the Quizone platform.

Subject matter

A patient with Severe Infection presents a particularly high risk of death. Moreover,
in recent years no significant pharmacological development improved its
prognosis. Hence, opportunities to improve these patients¿ management are to do
better with the available tools. The aim of this CU is to systematize the information
available to accomplish a better approach of Sepsis, coming from large consensus
on the concepts, definitions and proven effective interventions, whenever available.
The recent pandemic COVID19 has shown how important it is to have a rational
attitude when choosing proven therapeutic interventions and not to treat patients
based on momentary inspirations. Learning objectives involve specific skills in
medicine and surgery without focusing on specific subjects in these areas. That is,
there will be a need to resort on knowledge from several basic medical sciences as
well as various clinical areas although not explicitly mentioned. With this approach,
we intend to promote clinical reasoning, stimulate the students' intellectual
autonomy and develop a holistic view of the practice of medicine, always based on
the best and most robust evidence available.
The paradigm shift in the approach of these patients begin with the creation of the
Surviving Sepsis Campaign (SSC) and the consensus generated around this
important initiative, which was reinforced by the publication of the
recommendations SSC 2004, which were successively updated (last publication
2017 and an update in 2018 and 2019, and for COVID19 in 2020). These
recommendations, as well as the initiative from the Institute of Healthcare
Improvement (IHI), were instrumental to change and structure the management
of sepsis and to systematize procedures. And, at the present time, it is recognized
that the implementation of these procedures was responsible for a marked
reduction in mortality of these patients worldwide. In addition, adaptations of these
recommendations have also been made to low- and middle-income countries, with
great success.
The syllabus are based on the subjects contained in Despacho n.º 4412/2018 (Diário
da República, 2nd series - N.º 86 - May 4, 2018 - Model of the National Access
Examination), namely those contained in list in the field Medicine - Infectious area
of knowledge (except HIV / AIDS and tuberculosis - discussed in other CU). It should
be noted that some of the programmatic contents contained in the
aforementioned Despacho will not be specifically addressed (due to time
limitation), namely imported malaria and Dengue (endemic in Madeira), since these
are two frequent situations in Portugal. Therefore, students will have to prepare
them and can clarify any doubts with their teachers. And in the face of pneumonia
caused by SARS CoV2 this disease will also be addressed in the community-
acquired pneumonia class, as it is a potential cause.

Programs

Programs where the course is taught: