The development of speech language therapy students into clinicians is an area of increasing interest as educators focus on how knowledge, skills and attitudes are taught and learnt within the profession. The personal journeys of students through experiences of service learning have potential to further our understanding of the impact of civic engagement on the student experience and their learning. This paper explores the journeys of first year speech and language therapy students through a Thematic Analysis of reflective letters written by students to themselves at the beginning and completion of a service learning module. Analysis demonstrates development of interpersonal and preclinical skills as well as an understanding of attitudes and values inherent in the social model of disability. The skills and attitudes developed by the students through participation in the Conversation Partner Scheme are consistent with social model principles that support therapists to fully address the long-term, real life needs of clients with aphasia (the acquired communication disorder that frequently follows stroke). The interface between the social model of disability and the role of service learning in nurturing the attitudes and values which underpin this model are explored.
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Introduction: Gestational trophoblastic neoplasia (GTN) is a collective term for gestational trophoblastic diseases that invade locally or metastasize. Hydatiform mole is the most common form of GTN; others are invasive mole, choriocarcinoma, and placental site trophoblastic tumor (PSTT). A placental site trophoblastic tumour is a rare tumor, representing from 0.23 to 3% of gestacional trophoblastic neoplasms. It mainly affects women of childbearing age. This tumor can arise during or after a normal pregnancy, a miscarriage, an abortion, or a molar pregnancy, and can occur during post-menopause, years after the last pregnancy. Most patients present with abnormal bleeding per vaginum with varying periods of amenorrhea and/or effects of metastasis to various organs. A wide range of other presenting symptoms have been reported including galactorrhoea, virilization, nephrotic syndrome, polycythaemia and cutaneous metastases. Beta-HCG levels are moderately high, unlike the levels found in the hydatiform moles. Rarely is the diagnosis of PSTT made on a dilatation and curettage specimen since this usually presents as intermediate trophoblasts infiltrating the myometrium. Placental site trophoblastic tumor behaviour is characterized by a slower growth, as well as a tendency to diffuse through lymphatic ways. Therefore, they are relatively resistant to chemotherapies. The preferred treatment for PSTT is essentially surgical and is based on hysterectomy with lymphatic sampling. Case report: A 41 years old woman, 7 weeks pregnant, reported to the emergency unit with menorrhagia. We suspected hydatiform mole after performing a pelvic ultrasound showing a distended endometrial cavity containing innumerable, variably sized anechoic cysts with intervening hyperechoic material. In the first assessment beta-HCG levels were 24880 mU/mL. The patient underwent cervical dilation and aspiration of the uterine content. The histological diagnosis showed hydatiform mole. After uterine evacuation have persisted elevated values of beta-HCG despite the pelvic ultrasound show an empty cavity. Due to the hypothesis of invasive mole and after multidisciplinary discussion, total hysterectomy was performed, with conservation of adnexa. Histopathologic examination of the surgical specimen showed placental site trophoblastic tumor. In the consultation after surgery was decided to conduct chemotherapy. After four months of followup beta-HCG levels return to normal range. Conclusion: This case differs from the others by high beta-HCG values that led to the suspicion of hydatidiform mole. Due to its rarity and varied biological behaviour it presents a diagnostic challenge and treatment dilemma to both the pathologist and clinicians. It is important to make this specific diagnosis as it is distinct from other GTN.
Ms X is a 34 year old para 1 woman who presented at 26+5 weeks’ gestation with fever, neurological symptoms and history of a viral illness. She was treated empirically for bacterial meningitis and transferred to a tertiary maternity hospital. Cerebrospinal fluid (CSF) polymerase chain reaction (PCR) was positive for enteroviral ribonucleic acid (RNA), confirming viral meningitis. Ms X improved clinically and was discharged after six days. A high index of suspicion is required for diagnosis of meningitis in pregnancy. Thorough history, examination and workup is vital for timely treatment. Prognosis in viral meningitis is excellent with no clear adverse fetal or neonatal outcomes.
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