RESUMEN
Medical education in Laos has undergone significant developments over the last century. A transition from a foreign to locally trained medical workforce has taken place, with international partners having an ongoing presence. Undergraduate and postgraduate medical education in Laos is now delivered by a single, government administered university. The transition to locally based training has had many flow-on benefits, including the retention of Lao doctors in the country and having graduates who are familiar with the local health system. A number of challenges do however exist. Medical resources in the Lao language are limited, teacher numbers and capacity are lacking and complex factors have led to a lack of uniformity in graduate competencies. Despite these challenges, the situation for medical education in Laos is a story of great optimism. Local staff has recognized the need for simple yet innovative solutions and processes are in place for the establishment of a licensing system for medical doctors and reforming existing curricula. Sustained, long-term relationships with partner organizations along with constructive use of technology are likely to be important factors affecting the future direction of medical education in Laos.
Asunto(s)
Educación Médica , Facultades de Medicina , Curriculum , Educación Médica/métodos , Educación Médica/organización & administración , Evaluación Educacional , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Relaciones Interinstitucionales , Laos , Facultades de Medicina/historiaRESUMEN
This retrospective study was conducted to assess the differences in clinical features between children and adults with dengue hemorrhagic fever/ dengue shock syndrome (DHF/DSS) admitted to Ratchaburi Hospital, Ratchaburi Province, Thailand. A total of 273 patients with DHF/DSS admitted to Ratchaburi Hospital during January 2007 to May 2008 were included in the study. The median age (range) of studied subjects was 16 years (6 months to 62 years) and the ratio of adults to children was 1.6:1. Forty-eight percent of subjects were 16-30 years old. The common signs, symptoms and clinical features were: nausea/vomiting (74.0%), a positive tourniquet test (73.0%), anorexia (67.0%), hemoconcentration (58.0%), headache (54.0%), abdominal tenderness (43.0%), myalgia (39.0%) and pleural effusion (20.0%). Children had anorexia, a positive tourniquet test, abdominal tenderness and a convalescent rash more frequently than adults. Children also had significantly more prominent plasma leakage as shown by lower serum albumin and sodium and a higher prevalence of pleural effusion, ascites and shock. Although not statistically significant, the prevalence of bleeding in children was higher than in adults but more adults needed blood transfusion. This study provides additional insight into the clinical picture of DHF/DSS in adults and children and may be beneficial for clinicians caring for these adults and children.