Multimorbidity is increasingly becoming the norm, particularly in the older population, and presents enormous challenges for patients and their doctors. Diagnosis has important implications for multimorbid patient care, research, and medical policy. Over the past 100 years, diagnostic testing has become a critical feature of standard medical practice. Diagnostic process is a complex, patient-centered, collaborative activity that involves information gathering and clinical reasoning with the goal of determining a patient's health problem. Performing a clinical history and interview, conducting a physical exam, performing diagnostic laboratory/genetics/instrumental testing, and referring or consulting with other clinicians are all ways of accumulating information that may be relevant to understanding a patient's health problem.
Multimorbidity, defined as the presence of multiple chronic conditions in an individual, is highly prevalent in clinical practice today. Guidelines for single conditions may not apply in a person with more than one of these conditions, and aggressively treating several conditions may do more harm than good. For people with multimorbidity, consideration needs to be given to individualising care and designing it around each person's needs and priorities.
Chronic kidney disease (CKD) is an excellent example of multimorbidity. Causes of chronic kidney disease (CKD) include diabetic nephropathy, hypertension, glomerulonephritis, pyelonephritis, polycystosis and others. The kidney has many functions, including excretory, endocrine and metabolic functions which decline together in most CKDs. Therefore, kidney damage refers to a broad range of abnormalities/secondary diseases observed during clinical assessment, which may be insensitive and non-specific for the cause of disease but may precede reduction in kidney function.
The course includes biochemical-, immunological-, genetic laboratory and instrumental assessments, theory discussions, practical measurements and interpretation. And, multimorbid patients case-based discussions and treatment procedures performing or viewing as well.
Aim of this programme is to teach laboratory and instrumental assessments theory, practical measurements and interpretation, multimorbid patients case-based discussions and treatment procedures performing or viewing.
Applications are evaluated based on
Motivation letter (up to 1.5 page) that demonstrates the applicant’s motivation to participate, explains his/her expectations about the programme and how participation in the summer programme is connected with his/her studies and interests, and how the applicant plans to use the gained experience and knowledge in the future.
Level: BA and MA
Credits: 4 ECTS
Time: 02–13 August; 2021
Alternatively participants can arrange their own housing and in this case the tuition fee for the academic and cultural programme is ??? €.
Professor of Nephrology in Medical Faculty at the University of Tartu, Head of the Nephrology Division at the Tartu University Hospital, Estonia.
Since 1988 up today she is employed in Tartu University starting as clinical associate, followed as an associate professor and currently since 2012 full professor of nephrology. She performed during 1995-1997 the ISN fellowship in the Brigham and Women’s Hospital at Harvard University, tutor Barry M. Brenner. In 1998, she defended her PhD (Tartu University, Estonia). In parallel, she continued clinical nephrology practice, and currently since 2016, she works as a Head of Nephrology Division at the Tartu University Hospital. Her expertise includes glomerular disease management, renal biopsy work-up, treatment of hypertension in chronic kidney disease, hemo- and peritoneal dialysis-related complications and kidney transplant recipients‘ long-term management. Current main fields of research are continously connected with the studies investigating factors (body composition, nutrition, physical activity) that influence the progression of CKD in different patient populations (transplanted patients, diabetics, predialysis patients).
Kalle Kisand, MD, PhDProfessor of Laboratory Medicine in Medical Faculty at the University of Tartu, Estonia.
Since 1988 up today, he is employed in Tartu University starting as a researcher in Laboratory of Immunology. In 1990, he defended a PhD by Moscow 2nd State Medical Institute (Russia). He performed a post-doc fellowship during 2005-2005 at University of Uppsala. Since 2017 he has been a full professor of laboratory medicine in Clinic of Internal Medicine. His expertise includes laboratory methods in immunology, pathogenesis of autoimmune diseases, especially autoimmune liver diseases and type 1 diabetes. Current main field of research is connected with investigations of biomarkers of osteoarthritis, non-alcohol fatty liver disease and SARS-CoV2.
Katrin Õunap, MD, PhDProfessor of Clinical Genetics in Institute of Clinical Medicine at the University of Tartu, Head of the Department of Clinical Genetics at the Tartu University Hospital, Estonia.
She is a certified pedriatrician and medical geneticist. She has worked as a clinical geneticist for many years and has experience with the interpretation of laboratory analyses. In 1993 she was one of the people who introduced newborn screening for phenylketonuria to Estonia. In 1999, she defended her PhD thesis on a subject „Phenylketonuria in Estonia: incidence, newborn screening, diagnosis, clinial characterization and genotype/phenotype correlation“. She has studied clinical genetics and metabolic medicine in Moscow (1990), in Helsinki University Children's Hospital (1992) in Germany – Charite Wirchow Clinicum (in 1994 and 1996), in Gotheborg University (1996) and in Dresden, Germany (2002). In 2018-2019 she worked in Center of Mendelian Genomics at Broad Institute. The main research focus of her research team is to discover new rare disorders and their pervalence.
Alastair Forbes, MD, PhDVisiting Professor at the University of Tartu in Estonia.
He is also Emeritus Professor of Medicine at the University of East Anglia, UK where he was until August 2020 Research Director and Clinical Gastroenterologist. He works mainly on intestinal failure and nutrition in inflammatory bowel disease, with a career-long interest in medical education and ethical issues. He was previously at UCL and at St. Mark's Hospital in London. He has been Education Director of ESPEN, General Secretary of the British Society of Gastroenterology, and Chairman of the British Association for Parenteral and Enteral Nutrition. He has written >250 original papers, many reviews and contributions to guidelines, and has a Scopus “h” score of over 70.
Riho Runnel, RNMedical Simulation Specialist at the University of Tartu, Instructor at the Estonian Military Academy, Team Leader at the Pärnu Ambulance Service
He has 13 years of experience in the Estonian Defence Forces and 10 years’ experience in the Ambulance Service. He is an instructor for various trauma courses such as Prehospital Trauma Life Support, Tactical Combat Casualty Care, Advanced Trauma Care for Nurses, Major Incident Medical Management and Support. He has been on several missions such as Afghanistan and Lebanon.
The main task of the institute is to conduct teaching, research and development activities in its disciplines and related disciplines. The institute is the main coordinator of the residency (postgraduate specialist medical) training, the clinical medicine doctoral (PhD) studies and the doctors’ continuing education at the University of Tartu and in Estonia.
As of 1st of October 2019, the institute has 229 employees of whom 187 are academic employees, including 19 professors and 32 associate professors. Most of the academic staff are clinicians, who hold different positions at the Tartu University Hospital.