Hypothetical Clinical Case Research Articles

Relationship between characteristics of health professionals and the respect for the autonomy of cancer patients at the end of life.

This study investigated whether providers respected patient's autonomy, investigating providers' pattern of decisions and their associated characteristics. Cross-sectional study, conducted through anonymous questionnaire with hypothetical clinical cases, presented to providers at one oncology center. Decision-making patterns were pre-stablished accordingly to the response´s pattern. Of 151 responses, decisions patterns were paternalistic in 38%, shared in 38%, obstinate in 10.6% and consumerist in 13.2%. The consumerist providers reported never having participated in an EOL class in 35% and 30% had never trained in palliative care. Among providers with paternalistic pattern, 35.1% had never attended ethic lectures. In the obstinate group, 31.2% had no training in palliative care. When asked how subjects saw themselves about their pattern of decision, 100% of obstinate, 95% of consumerist and 89% of paternalistic patterns exhibited cognitive dissonance. Significative differences between decisions and how the providers judge themselves were observed.

Using case-based learning to teach evidence-based practice: A pilot study.

The American Speech-Language-Hearing Association (ASHA) promotes the use of evidence-based practice (EBP) in the provision of clinical services by speech-language pathologists (SLPs). Therefore, training in the EBP process is vital in the education of future SLPs. Case-based learning (CBL) has been found effective in facilitating transfer of knowledge and skills in various fields; however, its utilisation to teach EBP to SLP students is understudied. This phenomenological investigation explores the use of CBL, an active learning strategy that gives students the opportunity to practice application of knowledge to realistic scenarios, to teach EBP to graduate SLP students. Graduate SLP students worked in small groups to complete an article review activity centred around an assigned hypothetical clinical case. Students submitted article review papers and written reflections on their learning process. The written reflections and review papers were analysed using qualitative content analysis to understand students' approach to clinical cases and their perspectives on the CBL approach. Analysis of the papers and reflections indicated that students tended to rely heavily on scientific evidence for clinical decision making, often to the exclusion of clinical expertise or client perspectives. Students reported that the project was applicable to their future clinical practice. Further, they reported learning from multiple sources, including the instructor, class discussion and their peers. Results indicate that graduate SLP students found CBL activities beneficial for learning the principles of EBP. Students specifically indicated an appreciation for the realistic nature of the activities. Future applications are examined.

Assessment and management of dysphagia in the neonatal intensive care units in India: A survey report

BackgroundEvidence-based assessment and management of dysphagia in neonates, especially those in the neonatal intensive care unit (NICU), are limited. Understanding existing clinical practices may be the first step toward developing a consensus. The current study aimed to identify clinical practice patterns of speech-language pathologists (SLPs) in India towards facilitating the development of feeding skills and assessment and management of dysphagia among neonates. MethodAn electronic survey questionnaire comprising 46 questions categorized into two main sections (demographics and a hypothetical case scenario) was emailed to 35 SLPs practicing in the NICU. The hypothetical clinical case was created to include considerations of assessment and management of dysphagia in the NICU, and the participants answered questions about clinical decision-making. ResultsAs many as 22 individuals completed the survey. The responses were analyzed descriptively to identify themes and trends in practice patterns. Our results revealed varied practice patterns in the clinical swallowing assessment and management approaches for neonatal dysphagia. ConclusionThere is a need to develop a consensus statement and standard guidelines for the assessment and intervention for dysphagia by the SLP in the NICU. Translation of current evidence-based research into clinical practice is critical to patient care.

Changes in Testing and Treatment Methods in Osteoporosis Care.

Osteoporosis treatment plays a crucial role in preventing fractures, particularly in bedridden patients. We conducted a questionnaire survey presenting hypothetical clinical cases in 2015 and 2020 to investigate trends over a 5-year period. The target population included physicians working in clinics and hospitals within our neighbourhood. The cases were presented, and the questionnaire was administered in a confidential format. The orthopaedic surgeons were matched for age and practice, resulting in 74 cases being included in the analysis. Comparing the 2015 and 2020 results, we observed a notable increase in physicians who would perform "bone mineral density measurements of the lumbar spine and hip." Furthermore, there was a significant rise in the percentage of respondents willing to test for bone metabolic markers, such as serum type I collagen cross-linked N-telopeptide (NTX), procollagen I N-terminal propeptide (P1NP), and tartrate-resistant acid phosphatase 5b (TRACP-5b). Regarding therapeutic agents, bisphosphonates decreased in usage, whereas parathyroid hormone and romosozumab witnessed an increase. In conclusion, the percentage of physicians requesting bone mineral density measurements of the lumbar spine and hip increased over the five-year period. In addition, more physicians chose to utilise bone metabolic markers due to their ease of measurement through blood tests and reduced diurnal variation. Finally, there was a marked trend towards the administration of drugs capable of rapidly and effectively increasing bone mineral density at an early stage of treatment.

Continuous Deep Sedation Until Death of Children at the End of Life: French Physicians' Opinions.

Objectives: To evaluate physicians' opinions concerning continuous deep sedation until death (CDSUD) and implementation of Claeys-Leonetti; a law intended to be applicable to all patients, but without a specific framework for children thus giving rise to ethically and legally complex situations. The secondary objective was to identify if physicians' characteristics could influence their opinions. Study Design: This was a national, multicenter, noninterventional cross-sectional survey from January 30, 2020, until March 1, 2020. The target population consisted of French physicians involved in children's end-of-life situations. The validated questionnaire explored respondents' characteristics and their opinions on four hypothetical pediatric clinical cases. Results: Analysis was conducted on 391 respondents. The oncological situation was more easily recognized as end of life compared with the neurological pathology (77% vs. 40.4%). Dependence on mechanical ventilation was another major factor influencing physicians in identifying end-of-life situations. Physicians clearly recognized the difference in intention between CDSUD and euthanasia. They accepted to implement CDSUD more easily in newborns. The withdrawal of artificial nutrition and hydration gave rise to divergent opinions. Respondents were in favor of adolescents' decision-making autonomy and their access to drafting advance directives. The child's best interest prevailed in case of objection by parents, except in situations outside the law's framework or in cases of disagreement within the health care team. Conclusion: Results of our study showed differences in the interpretation of the law concerning the CDSUD application framework and provide elements for reflection, which may ultimately contribute to the development of specific guidelines in CDSUD in children at the end of life.

Do summative entrustment decisions actually lead to entrustment?

Entrustable professional activities (EPAs) were introduced across Dutch postgraduate programmes between 2017 and 2019. We aimed to understand the extent to which residents actually were granted increased clinical responsibility upon receiving summative entrustment for an EPA, a critical feature of its use. A survey study was conducted among all Dutch residents who started dermatology training in 2018 and 2019 and all Dutch dermatology programme directors (PDs). We chose an EPA designed for early entrustment in residency (identification, treatment and care regarding a simple dermatological problem in the ambulatory setting). The survey contained two hypothetical clinical cases that aligned with this EPA. The questions were aimed to determine whether and when residents should request supervision. Similar questions were posed to PDs. Twenty four residents (56%) and 19 PDs (79%) completed the survey. The majority of the residents (65%) and PDs (63%) confirmed that competent dermatology residents (level 4) are generally allowed to perform EPA1 unsupervised, particularly when seeing patients from GPs. However, still a substantial proportion of the level 4 residents, working in University Medical Centers (36%) indicated that they had to request supervision in the assessment of these patients. For 2nd opinions, the results were typically the opposite. This study demonstrated that, at least in one specialty and one country, the introduction of EPAs and entrustment decision making procedure generally led to the intended autonomy of the resident.

AI in the repurposing of potential herbs for filariasis therapy.

The goal of this study was to see how well an AI language model called Chat Generative Pre-trained Transformer (ChatGPT) assisted healthcare personnel in selecting relevant medications for filariasis therapy. A team of medical specialists and tropical medicine experts reviewed ChatGPT's recommendations for ten hypothetical filariasis clinical situations. The purpose of this study was to look at the effectiveness of an AI language model called Chat Generative Pre-trained Transformer (ChatGPT) in supporting healthcare providers in picking appropriate drugs for filariasis treatment. Ten hypothetical filariasis clinical cases were submitted to ChatGPT, and its recommendations were evaluated by a panel of medical professionals and tropical medicine experts. ChatGPT gave appropriate suggestions for potential medication repurposing in filariasis treatment in all ten clinical scenarios. Its drug recommendations were in line with current medical research and literature. Despite the lack of particular treatment regimens, ChatGPT's general ideas proved useful for healthcare practitioners, providing insights and updates on prospective drug repurposing tactics. ChatGPT shows promise as a useful method for repurposing drugs in the treatment of filariasis. Its thorough and brief responses make it useful for finding possible pharmacological candidates. However, it is critical to recognize ChatGPT's limitations, such as the requirement for additional clinical information and the inability to change therapy. Further research and development are required to optimize its use in filariasis therapy settings.

Physicians' preferencesfor radioiodine treatment of differentiated thyroid cancer in Brazil: an observational study.

The aim of this observational, cross-sectional study was to investigate physicians' preferences for radioiodine (RAI) treatment in patients with differentiated thyroid cancer (DTC) in Brazil and the factors influencing RAI indications. A survey was distributed to physicians potentially involved in DTC care in Brazil to understand the factors influencing RAI indications. The survey collected information on the profiles of the physicians, along with the characteristics of their workplaces and their preferences regarding RAI indications in three hypothetical clinical cases. Cases 1, 2, and 3 described the cases of patients with DTC and variations to the case that included different scenarios to assess how the respondents would change their RAI recommendations. The analysis included the RAI indications across different medical specialties. A total of 175 physicians answered the survey. There was considerable variability in RAI recommendations in all three cases. The training background influenced the respondents' preferences for RAI indications and their approaches to preparing patients for RAI treatment. The findings of this study reaffirm the need for a Brazilian consensus among physicians across multiple specialties to help guide health care professionals treating patients with DTC in Brazil.

Laboratory evaluation for the differential diagnosis of possible multiple sclerosis in the United States: A physician survey

BackgroundThere is limited evidence and lack of guidelines for diagnostic laboratory evaluation of patients with possible multiple sclerosis (MS). ObjectiveTo survey neurologists on their practice of laboratory testing in patients with possible MS. MethodsAn online survey was developed to query the frequency of serum and cerebrospinal fluid (CSF) studies ordered in the routine evaluation of patients with possible MS, and in three hypothetical clinical cases. Non-MS specialist neurologists who evaluate patients for MS in their practice were invited to participate by MedSurvey (a medical market research company). ResultsThe survey was completed by 190 neurologists. A mean of 17.2 (SD: 17.0) tests in serum and CSF were reported “always” ordered in the evaluation of patients with possible MS. CSF oligoclonal bands was the most frequently selected (“always” among 73.7% of participants). Antinuclear antibody (43.2%), erythrocyte sedimentation rate (34.2%), and thyroid stimulating hormone (31.6%) were also among the most frequently ordered. DiscussionExtensive laboratory evaluations are often completed in the evaluation of possible MS. However, many of these tests have poor specificity and false positive results could yield unnecessary increased costs, diagnostic delay, and potentially misdiagnosis. Further research is needed to identify optimal laboratory approaches for possible MS.

Surgeons' perspectives on operation report documentation.

Operation report documentation is essential for safe patient care and team communication, yet it is often imperfect. This qualitative study aims to understand surgeons' perspectives on operation report documentation, with surgeons reviewing cleft palate repair operation reports. It aims to determine how surgeons write an operation report (in narrative and synoptic report formats) and explore the consequences of incomplete documentation on patient care. A qualitative semi-structured interview was conducted with cleft surgeons who were asked to consider operation reports and hypothetical clinical cases. Eight operation reports performed at one centre for cleft palate repair were randomly selected for review. An operation report's purpose-patient care, complication documentation, future surgery, and research-will influence the detail documented. All cleft palate repair operation reports had important information missing. Synoptic report writing provides clearer documentation; however, narrative report writing may be a more robust communication and education tool. Surgeons described a bell-curve response in the level of training required to document an operation report-residents knew too little, fellows documented clearly, and Consultants documented briefer reports to highlight salient points. An understanding of surgeons' perspectives on operation report documentation is richer after this study. Surgeons know that clear documentation is essential for patient care and a skill that must be taught to trainees; barriers may be the documentation method. The flexibility of a hybrid operation report format is necessary for surgical care.

The Ability of Dental Interns and Freshly Graduated Dentists to Assess Tooth Restorability. A Multicenter, Cross-Sectional Study.

Treatment planning should be integrated to gain and apply essential data to decide. It is necessary to evaluate theendodonticand periodontal conditionof the tooth, in addition to its restorability. Treatment planning is emphasized as a crucial clinical skill for a certified dental practitioner in the General Dental Council learning outcomes. The role of dental schools is to guarantee that dental graduates have the knowledge, skills, and competence to choose appropriate treatment options for teeth. The primary objective of our study was to assess the ability ofdental interns and recently graduated dentists from different dental schoolsfortooth restorability. This was a multicentral, cross-sectional study. Participant recruitment was achieved by sending an online questionnaire to the interns and graduate units at the assigned universities. The questionnaire consisted two parts. The first part record general information about participants and opinions regarding their training of restorability assessment. The second part include five hypothetical clinical case scenarios, where the participants were asked to choose the restorability decisions, rationales for the options, and prognosis of the tooth/teeth. The data was analyzed by using SPSS software version 26. 104 respondents participated in this survey. The decision and prognosis of all clinical scenarios were not significantly associated with gender, experience, place of work and place of study. Only the decision and prognosis of scenario 1 showed significant relationship with place of graduation. Developing universities graduates showed significantly higher percentage for restorability as against developed universities graduates (p=0.001) and developing universities and recently established institutions graduates showed significantly higher percentage for the questionable prognosis as against developed universities graduates (p=0.018). The inability of dental interns and freshly graduate dentalpractitioners to make decisions highlighted questions regarding the conditionof learning outcomes and graduate attributes.

Reflecting Before, During, and After the Heat of the Moment: A Review of Four Approaches for Supporting Health Staff to Manage Stressful Events.

Being a healthcare professional in both paediatric and adult hospitals will mean being exposed to human tragedies and stressful events involving conflict, misunderstanding, and moral distress. There are a number of different structured approaches to reflection and discussion designed to support healthcare professionals process and make sense of their feelings and experiences and to mitigate against direct and vicarious trauma. In this paper, we draw from our experience in a large children's hospital and more broadly from the literature to identify and analyse four established approaches to facilitated reflective discussions. Each of the four approaches seeks to acknowledge the stressful nature of health professional work and to support clinicians from all healthcare professions to develop sustainable skills so they continue to grow and thrive as health professionals. Each approach also has the potential to open up feelings of uncertainty, frustration, sorrow, anguish, and moral distress for participants. We argue, therefore, that in order to avoid unintentionally causing harm, a facilitator should have specific skills required to safely lead the discussion and be able to explain the nature, scope, safe application, and limits of each approach. With reference to a hypothetical but realistic clinical case scenario, we discuss the application and key features of each approach, including the goals, underpinning theory, and methods of facilitation.

A Clinical Decision Support System Design Framework for Nursing Practice

AbstractBackground As nurses increasingly engage in decision-making for patients, a unique opportunity exists to translate research into practice using clinical decision support systems (CDSSs). While research has shown that CDSS has led to improvements in patient outcomes and nursing workflow, the success rate of CDSS implementation in nursing is low. Further, the majority of CDSS for nursing are not designed to support the care of patients with comorbidity.Objectives The aim of the study is to conceptualize an evidence-based CDSS supporting complex patient care for nursing.Methods We conceptualized the CDSS through extracting scientific findings of CDSS design and development. To describe the CDSS, we developed a conceptual framework comprising the key components of the CDSS and the relationships between the components. We instantiated the framework in the context of a hypothetical clinical case.Results We present the conceptualized CDSS with a framework comprising six interrelated components and demonstrate how each component is implemented via a hypothetical clinical case.Conclusion The proposed framework provides a common architecture for CDSS development and bridges CDSS research findings and development. Next research steps include (1) working with clinical nurses to identify their knowledge resources for a particular disease to better articulate the knowledge base needed by a CDSS, (2) develop and deploy a CDSS in practice using the framework, and (3) evaluate the CDSS in the context of nursing care.

Referral to immediate postoperative care in an intensive care unit from the perspective of anesthesiologists, surgeons, and intensive care physicians: a cross-sectional questionnaire

Introduction and objectiveDue to the high cost and insufficient offer, the request for Intensive Care (ICU) beds for postoperative recovery needs adequate criteria. Therefore, we studied the characteristics of patients referred to postoperative care at an ICU from the perspective of anesthesiologists, surgeons, and intensive care physicians. MethodsA questionnaire on referrals to postoperative intensive care was applied to physicians at congresses in Brazil. Anesthesiologists, surgeons, and intensive care physicians who agreed to fill out the questionnaire were included. The questionnaire consisted of hypothetical clinical scenarios and cases for participants to choose which would be the priority for referral to the ICU. Results360 physicians participated in the study, with median time of 10 (5–18) years after graduation. Of the interviewees, 36.4% were anesthesiologists, 30.0% surgeons, and 33.6% intensive care physicians. We found that anesthesiologists were more conservative, and surgeons less conservative in ICU referrals. As to patients with risk of bleeding, 75.0% of the surgeons would refer them to the ICU, in contrast with 52.1% of the intensive care physicians, and 43.5% of the anesthesiologists (p < 0.001). As to elderly persons with limited reserve, 62.0% of the surgeons would refer them to the ICU, in contrast with 47.1% of the intensive care physicians, and 22.1% of the anesthesiologists (p < 0.001). As to patients with risk of respiratory complications, 64.5% of the surgeons would recommend the ICU, versus 43.0% of the intensive care physicians, and 32.1% of the anesthesiologists (p < 0.001). Intensive care physicians classified priorities better in indicating ICU, and the main risk indicator was the ASA physical status in all specialties (p < 0.001). There was no agreement among the specialties and surgeries on prioritizing post-operative intensive care. ConclusionAnesthesiologists, surgeons, and intensive care physicians presented different perspectives on postoperative referral to the ICU.

Case Studies AAOS Clinical Practice Guideline: Management of Rotator Cuff Injuries.

Shoulder disease is a major cause of musculoskeletal disability in the United States. Chronic shoulder pain has been estimated to affect approximately 8% of all American adults, second only to chronic knee pain in our society's burden of musculoskeletal disease. Rotator cuff pathology is the leading cause of shoulder-related disability seen by orthopaedic surgeons, and surgical volume is on the rise. One study, for example, notes a 141% increase in rotator cuff repairs from 1996 to 2006 in the United States. Because rotator cuff disease is such a common condition with evidence of various strength supporting different common treatments, the American Academy of Orthopaedic Surgeons published a clinical practice guideline to help elucidate best practices for its treatment. A summary of these guidelines with the strength of the recommendations is available at OrthoGuidelines (http://www.orthoguidelines.org/topic?id=1027) with links to rationale behind each of the conclusions. This study will illustrate the use of these guidelines through presentation and discussion of hypothetical clinical cases.

An intersectionality-informed psychotherapy approach to reduce HIV stigma.

HIV stigma represents a major barrier across the continuum of HIV care that is associated with compromised engagement and retention in HIV care along with adherence to antiretroviral treatment. Therefore, stigma reduction efforts are critical to improving HIV health outcomes. However, there is no gold-standard evidence-based psychotherapy intervention for addressing stigma related to HIV or other marginalized identities. This article examines the role of psychotherapy to address the adverse cognitive, emotional, and behavioral effects of HIV stigma among persons with HIV, with the aims of promoting psychological well-being and supporting health behaviors associated with enhanced HIV treatment retention, adherence, and overall health outcomes. A psychotherapy approach informed by intersectionality theory is proposed, according to which multiple categories of identity, social status, privilege, and oppression simultaneously influence psychological life, including the experience of HIV stigma. Intersectionality-informed psychotherapy strategies to address HIV stigma are described and illustrated using a hypothetical clinical case example. Implications of an intersectionality-informed framework for therapist advocacy also are discussed. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Limitation of life-sustaining treatment in NICU: Physicians' beliefs and attitudes in the Buenos Aires region

ObjectiveTo explore the ethical beliefs and attitudes of Argentinean neonatologists regarding limitation of life-sustaining treatment (LST) for very sick infants. MethodsWe used an anonymous questionnaire including direct questions and hypothetical clinical cases (inevitable demise and anticipated survival with severe long-term disability). Multivariable analysis was carried out to assess the relation between type of clinical case and physicians' LST attitudes. ResultsOverall, 315 neonatologists in 34 units in the Buenos Aires region participated (response rate 54%). Most responders would agree with decisions to start or continue LST. In both clinical cases, continuing current treatment with no therapeutic escalation was the only form of LST limitation acceptable to a substantial proportion (about 60%) of neonatologists. Agreement with LST limitation was slightly but significantly more likely when death was inevitable. ConclusionArgentinean neonatologists showed a conservative attitude regarding LST limitation. Patient prognosis and options of non-treatment decision significantly influenced their choices.

Physician Perspectives on Deprescribing Cardiovascular Medications for Older Adults.

Guideline-based management of cardiovascular disease often involves prescribing multiple medications, which contributes to polypharmacy and risk for adverse drug events in older adults. Deprescribing is a potential strategy to mitigate these risks. We sought to characterize and compare clinician perspectives regarding deprescribing cardiovascular medications across three specialties. National cross-sectional survey. Ambulatory. Random sample of geriatricians, general internists, and cardiologists from the American College of Physicians. Electronic survey assessing clinical practice of deprescribing cardiovascular medications, reasons and barriers to deprescribing, and choice of medications to deprescribe in hypothetical clinical cases. In each specialty, 750 physicians were surveyed, with a response rate of 26% for geriatricians, 26% for general internists, and 12% for cardiologists. Over 80% of respondents within each specialty reported that they had recently considered deprescribing a cardiovascular medication. Adverse drug reactions were the most common reason for deprescribing for all specialties. Geriatricians also commonly reported deprescribing in the setting of limited life expectancy. Barriers to deprescribing were shared across specialties and included concerns about interfering with other physicians' treatment plans and patient reluctance. In hypothetical cases, over 90% of physicians in each specialty chose to deprescribe when patients experienced adverse drug reactions. Geriatricians were most likely and cardiologists were least likely to consider deprescribing cardiovascular medications in cases of limited life expectancy (all P < .001), such as recurrent metastatic cancer (84% of geriatricians, 68% of general internists, and 45% of cardiologists), Alzheimer dementia (92% of geriatricians, 81% of general internists, and 59% of cardiologists), or significant functional impairment (83% of geriatricians, 68% of general internists, and 45% of cardiologists). While barriers to deprescribing cardiovascular medications are shared across specialties, reasons for deprescribing, especially in the setting of limited life expectancy, varied. Implementing deprescribing will require improved processes for both physician-physician and physician-patient communication. J Am Geriatr Soc 68:78-86, 2019.

Religion as a determining factor for invasive care among physicians in end-of-life patients.

Describe the knowledge of physicians in an Oncology Clinic and a school hospital, of both the private health network, located in Manaus-AM about palliative care (PC), and define the role of religion in medical care of patients with advanced severe illness, with no disease modifying therapy. This is a cross-sectional, descriptive, and observational study. After signing the Free and Informed Consent Term, the physicians included completed a professional membership record and answered questions about a hypothetical clinical case through multiple choice answers. The clinical case described a patient with advanced chronic disease not a candidate for disease-modifying therapy in the final phase of life. The questions involved aspects related to nutrition, venous access, and hospitalization in the intensive care unit (ICU). A total of 31 physicians from different specialties were included. About 67.7% consider their knowledge about PC insufficient, and none of the participants is unaware of this modality of care. The prevalence of invasive behaviors related to patient nutrition, venous access, and indication of ICU and cardiopulmonary resuscitation (CPR) was higher among physicians without religion (HR = 1.84; HR = 2.89; HR = 1.04, respectively) than among those who follow a religion. Absence of religion is associated with higher invasive behaviors on the part of physicians. Further studies are needed to better define this relationship.

Biochemistry and Renal Function: Use of Inquiry-Based Teaching Sequences for Retrieval of Specific Concepts

ABSTRACT Current teaching proposals involve teaching strategies that seek to assist and encourage the construction of knowledge by the students, turning them into active participants during the learning process and these have been the subject of several researches. This article reports a didactic sequence carried out with students of applied training for the first year Medical Sciences USP – Bauru, and proposes, as part of its pedagogical design, Problem Based Learning (PBL) as the main teaching strategy. In this didactic sequence we used experimental investigative activities. A didactic sequence that includes investigative activities can be characterized as a gradual evolutionary process, with the objective of intertwining the scientific perspective and the students’ conceptions, through well-planned teaching and learning activities contextualized and empirically adapted to the student’s reasoning. The objective of this work is to share an assertive experience of the application of a contextualized research didactic sequence that involved concepts ranging from the simplest chemical properties of biomolecules and ions to the association and discussion of a hypothetical clinical case involving proteinuria. Its pathophysiology consists of the excretion of protein in the urine, mainly albumin, and occurs when there is some damage to the kidneys. Therefore, the dosage of the protein fraction in urine (albuminuria) is mainly used for the early detection of chronic or acute kidney disease and can also be an instrument for the diagnosis of cardiovascular diseases. Therefore, one should be aware of the possible interferences and the various causes of errors inherent to this examination. In this way, through a didactic resource involving contextualized research experimental activities, having proteinuria as the key problem, we were able to re-approximate specific concepts and to value procedural and attitudinal knowledge, which is important for students in this training phase. In this proposal, the students were protagonists of the learning process, where they were able to raise and test their hypotheses, interconnecting knowledge, acquiring specific skills and competences, allowing reflection on the importance of fundamentals and applications of the basic sciences. The purpose of the investigative and contextualized didactic sequences is to form autonomous subjects, who know how to make decisions and work in teams and have a sound and critical understanding of how scientific knowledge evolves and is related.