Expert opinion on best practice guidelines and competency framework for visual screening in children

PURPOSE: Screening programs to detect visual abnormalities in children vary among countries. The aim of this study is to describe experts' perception of best practice guidelines and competency framework for visual screening in children. METHODS: A qualitative focus group technique was applied during the Portuguese national orthoptic congress to obtain the perception of an expert panel of 5 orthoptists and 2 ophthalmologists with experience in visual screening for children (mean age 53.43 years, SD ± 9.40). The panel received in advance a script with the description of three tuning competencies dimensions (instrumental, systemic, and interpersonal) for visual screening. The session was recorded in video and audio. Qualitative data were analyzed using a categorical technique. RESULTS: According to experts' views, six tests (35.29%) have to be included in a visual screening: distance visual acuity test, cover test, bi-prism or 4/6(Δ) prism, fusion, ocular movements, and refraction. Screening should be performed according to the child age before and after 3 years of age (17.65%). The expert panel highlighted the influence of the professional experience in the application of a screening protocol (23.53%). They also showed concern about the false negatives control (23.53%). Instrumental competencies were the most cited (54.09%), followed by interpersonal (29.51%) and systemic (16.4%). CONCLUSIONS: Orthoptists should have professional experience before starting to apply a screening protocol. False negative results are a concern that has to be more thoroughly investigated. The proposed framework focuses on core competencies highlighted by the expert panel. Competencies programs could be important do develop better screening programs.

Reply to letter to the Editor: Expert opinion on best practice guidelines and competency framework for visual screening in children

The aim of this study was to describe experts’ perception of best-practice guidelines and competency framework for visual screening in children. This study uses qualitative data and shows individual/ group conceptualization. The use of evidence from qualitative studies has traditionally been a fundamental source of knowledge in the clinical and social sciences.

The histopathological approach to inflammatory bowel disease: a practice guide

Inflammatory bowel diseases (IBDs) are lifelong disorders predominantly present in developed countries. In their pathogenesis, an interaction between genetic and environmental factors is involved. This practice guide, prepared on behalf of the European Society of Pathology and the European Crohn's and Colitis Organisation, intends to provide a thorough basis for the histological evaluation of resection specimens and biopsy samples from patients with ulcerative colitis or Crohn's disease. Histopathologically, these diseases are characterised by the extent and the distribution of mucosal architectural abnormality, the cellularity of the lamina propria and the cell types present, but these features frequently overlap. If a definitive diagnosis is not possible, the term indeterminate colitis is used for resection specimens and the term inflammatory bowel disease unclassified for biopsies. Activity of disease is reflected by neutrophil granulocyte infiltration and epithelial damage. The evolution of the histological features that are useful for diagnosis is time- and disease-activity dependent: early disease and long-standing disease show different microscopic aspects. Likewise, the histopathology of childhood-onset IBD is distinctly different from adult-onset IBD. In the differential diagnosis of severe colitis refractory to immunosuppressive therapy, reactivation of latent cytomegalovirus (CMV) infection should be considered and CMV should be tested for in all patients. Finally, patients with longstanding IBD have an increased risk for the development of adenocarcinoma. Dysplasia is the universally used marker of an increased cancer risk, but inter-observer agreement is poor for the categories low-grade dysplasia and indefinite for dysplasia. A diagnosis of dysplasia should not be made by a single pathologist but needs to be confirmed by a pathologist with expertise in gastrointestinal pathology.

Evaluation of exposure parameters in plain radiography: a comparative study with european guidelines

Typical distribution of exposure parameters in plain radiography is unknown in Portugal. This study aims to identify exposure parameters that are being used in plain radiography in the Lisbon area and to compare the collected data with European references [Commission of European Communities (CEC) guidelines]. The results show that in four examinations (skull, chest, lumbar spine and pelvis), there is a strong tendency of using exposure times above the European recommendation. The X-ray tube potential values (in kV) are below the recommended values from CEC guidelines. This study shows that at a local level (Lisbon region), radiographic practice does not comply with CEC guidelines concerning exposure techniques. Further national/local studies are recommended with the objective to improve exposure optimisation and technical procedures in plain radiography. This study also suggests the need to establish national/local diagnostic reference levels and to proceed to effective measurements for exposure optimisation.

Identificação dos parâmetros técnicos de exposição em exames radiológicos convencionais na região de Lisboa: uma comparação com a referência europeia

Em Portugal não são conhecidos estudos publicados que identifiquem com clareza as distribuições típicas dos valores associados aos parâmetros técnicos de exposição utilizados nos exames radiológicos mais comuns. Este estudo tem como objectivos identificar os parâmetros técnicos utilizados em exames radiológicos convencionais na região de Lisboa e comparar os dados com a referência europeia CEC. Os resultados obtidos evidenciam que nas projecções estudadas existe uma predominância para o uso de termos de exposição acima da recomendação CEC e de valores de potencial da ampola (kV) abaixo da recomendação. Esta investigação sugere a necessidade de fixar os NRD nacionais, e/ou locais, e efectuar as respectivas medições, dado que a optimização da exposição é um mecanismo de controlo fundamental para limitar as exposições desnecessárias dos pacientes às radiações ionizantes. Conclui-se que a nível local (região da Grande Lisboa) existe um desconhecimento da prática radiológica enquadrada nos referenciais europeus de boa prática radiológica. Desconhecendo-se a situação a nível nacional, sugerem-se estudos no sentido de identificar os padrões de prática radiológica a nível do País e de promover a optimização dos procedimentos em radiologia convencional. ABSTRACT - Typical distribution of exposure parameters in plain radiography is unknown in Portugal. This study aims to identify exposure parameters that are being used in plain radiography in Lisbon area and to compare collected data with European references (CEC guidelines). Results show that in the four anatomic regions there is a strong tendency of using exposure times above the European recommendation. We also found that x-ray tube potential values (kV) are below the recommended values from CEC guidelines. This study shows that at a local level (Lisbon region) radiographic practice does not fit with CEC guidelines concerning exposure techniques. We suggest continuing national/local studies with the objective to improve exposure optimization and technical procedures in plain radiography. This study also suggests the need to establish national/local DRL’s and to proceed to effective measurements for exposure optimization.

Proof in classroom social practice

How does the construction of proof relate to the social practice developed in the mathematics classroom? This report addresses the role of diagrams in order to focus the complementarity of participation and reification in the process of constructing a proof and negotiating its meaning. The discussion is based on the analysis of the mathematical practice developed by a group of four 9th grade students and is inspired by the social theory of learning

Visual Screening Competencies Questionnaire (VSCQ) and orthoptic practice

The identification of core competencies which are important for undertaking accurate visual screening by orthoptists is considered in this study. The aim was to construct and validate a questionnaire for orthoptists to assess visual screening competency. This study comprised three steps. The first step involved a 69-item self-assessment questionnaire constructed to assess orthoptists' perception of their competencies in visual screening programs for children. This questionnaire was constructed with statements from the Orthoptic Benchmark Statement for Health Care Programmes (Quality Assurance Agency for Higher Education, UK) and included three competency dimensions: interpersonal (IP), instrumental (IT) and systemic (ST). The second step involved questionnaire translation.

Caracterização tecnológica da mamografia digital em Portugal: progresso de um projeto em implementação

Introdução – A mamografia é o principal método de diagnóstico por imagem utilizado no rastreio e diagnóstico do cancro da mama, sendo a modalidade de imagem recomendada em vários países da Europa e Estados Unidos para utilização em programas de rastreio. A implementação da tecnologia digital causou alterações na prática da mamografia, nomeadamente a necessidade de adaptar os programas de controlo de qualidade. Objetivos – Caracterizar a tecnologia instalada para mamografia em Portugal e as práticas adotadas na sua utilização pelos profissionais de saúde envolvidos. Concluir sobre o nível de harmonização das práticas em mamografia em Portugal e a conformidade com as recomendações internacionais. Identificar oportunidades para otimização que permitam assegurar a utilização eficaz e segura da tecnologia. Metodologia – Pesquisa e recolha de dados sobre a tecnologia instalada, fornecidos por fontes governamentais, prestadores de serviços de mamografia e indústria. Construção de três questionários, orientados ao perfil do médico radiologista, técnico de radiologia com atividade em mamografia digital e técnico de radiologia coordenador. Os questionários foram aplicados em 65 prestadores de serviços de mamografia selecionados com base em critérios de localização geográfica, tipo de tecnologia instalada e perfil da instituição. Resultados – Foram identificados 441 sistemas para mamografia em Portugal. A tecnologia mais frequente (62%) e vulgarmente conhecida por radiografia computorizada (computed radiography) é constituída por um detector (image plate) de material fotoestimulável inserido numa cassete de suporte e por um sistema de processamento ótico. A maioria destes sistemas (78%) está instalada em prestadores privados. Aproximadamente 12% dos equipamentos instalados são sistemas para radiografia digital direta (Direct Digital Radiography – DDR). Os critérios para seleção dos parâmetros técnicos de exposição variam, observando-se que em 65% das instituições são adotadas as recomendações dos fabricantes do equipamento. As ferramentas de pós-processamento mais usadas pelos médicos radiologistas são o ajuste do contraste e brilho e magnificação total e/ou localizada da imagem. Quinze instituições (em 19) têm implementado um programa de controlo de qualidade. Conclusões – Portugal apresenta um parque de equipamentos heterogéneo que inclui tecnologia obsoleta e tecnologia “topo de gama”. As recomendações/guidelines (europeias ou americanas) não são adotadas formalmente na maioria das instituições como guia para fundamentação das práticas em mamografia, dominando as recomendações dos fabricantes do equipamento. Foram identificadas, pelos técnicos de radiologia e médicos radiologistas, carências de formação especializada, nomeadamente nas temáticas da intervenção mamária, otimização da dose e controlo da qualidade. A maioria dos inquiridos concorda com a necessidade de certificação da prática da mamografia em Portugal e participaria num programa voluntário. ABSTRACT - Introduction – Mammography is the gold standard for screening and imaging diagnosis of breast disease. It is the imaging modality recommended by screening programs in various countries in Europe and the United States. The implementation of the digital technology promoted changes in mammography practice and triggered the need to adjust quality control programs. Aims –Characterize the technology for mammography installed in Portugal. Assess practice in use in mammography and its harmonization and compliance to international guidelines. Identify optimization needs to promote an effective and efficient use of digital mammography to full potential. Methodology – Literature review was performed. Data was collected from official sources (governmental bodies, mammography healthcare providers and medical imaging industry) regarding the number and specifications of mammography equipment installed in Portugal. Three questionnaires targeted at radiologists, breast radiographers and the chief-radiographer were designed for data collection on the technical and clinical practices in mammography. The questionnaires were delivered in a sample of 65 mammography providers selected according to geographical criteria, type of technology and institution profile. Results – Results revealed 441 mammography systems installed in Portugal. The most frequent (62%) technology type are computerized systems (CR) mostly installed in the private sector (78%). 12% are direct radiography systems (DDR). The criteria for selection of the exposure parameters differ between the institutions with the majority (65%) following the recommendations from the manufacturers. The use of available tools for post-processing is limited being the most frequently reported tools used the contrast/ brightness and Zoom or Pan Magnification tools. Fifteen participant institutions (out of 19) have implemented a quality control programme. Conclusions – The technology for mammography in Portugal is heterogeneous and includes both obsolete and state of the art equipment. International guidelines (European or American) are not formally implemented and the manufacturer recommendations are the most frequently used guidance. Education and training needs were identified amongst the healthcare professionals (radiologists and radiographers) with focus in the areas of mammography intervention, patient dose optimization and quality control. The majority of the participants agree with the certification of mammography in Portugal.

Evaluation of the improvements on pharmacy technicians' work practices after implementation of operational procedures

Several antineoplasic drugs have been demonstrated to be carcinogenic or to have mutagenic and teratogenic effects. The greatest protection is achieved with the implementation of administrative and engineering controls and safety procedures. Objective: to evaluate the improvements on pharmacy technicians' work practices, after the implementation of operational procedures related to individual protection, biologic safety cabinet disinfection and cytotoxic drug preparation. Method: case-study in a hospital pharmacy undergoing a certification process. Six pharmacy technicians were observed during their daily activities. Characterization of the work practices was made using a checklist based on ISOPP and PIC guidelines. The variables studied concerning cleaning/disinfection procedures, personal protective equipment and procedures for preparing cytotoxic drugs. The same work practices were evaluated after four months of operational procedures implementation. Concordance between work practices and guidelines was considered to be a quality indicator (guidelines concordance practices number/total number of practices x 100). Results: improvements were observed after operational procedures implementation. An improvement of 6,25% in personal protective equipment practice was achieved by changing second pair of gloves every thirty minutes. The major progress, 10%, was obtained in disinfection procedure, where 80% of tasks are now realized according to guidelines.By now, we hot an improvement of only 1% at drug preparation procedure by placing one cytotoxic drug at a time inside the biological safety cabinet. Then, 85% of practices are according to guidelines. Conclusion: before operational procedures implementation 80,3% of practices were according to the guidelines, while now is 84,4%. This indicates that is necessary to review the procedures frequently in the benefit to reduce the risks associated with handling cytotoxic drugs and maintenance of drug specifications.

A entrada na profissão do educador de infância: percursos singulares

Dissertação apresentada à Escola Superior de Educação de Lisboa para obtenção do grau de Mestre em Ciências da Educação - Especialidade Supervisão em Educação

Avaliação e controlo da dor em pediatria: uma década

Introdução – A negligência no controlo da dor é um problema amplamente reconhecido em Portugal. Desde 2001 têm sido realizadas inúmeras iniciativas para melhorar a prática de cuidados nesta área. Desenvolveram-se ações de sensibilização e formação dos profissionais de saúde, publicaram-se orientações técnicas e guias de boas práticas e realizaram-se os primeiros estudos para se fazer um diagnóstico da situação. Objetivos – O objetivo deste trabalho foi o de caracterizar os cuidados prestados na avaliação e no controlo da dor nas crianças até aos 18 anos internadas em serviços hospitalares em Portugal e analisar a evolução feita nos cuidados entre os anos de 2002 e 2012. Metodologia – Estudo descritivo, transversal, de consulta retrospetiva seriada de registos intermitentes efetuados no processo clínico em relação a um período de 24 horas. O recrutamento da amostra foi aleatório e incluiu todos os processos clínicos de crianças até aos 18 anos internados em serviços de quatro hospitais Portugueses entre agosto e dezembro de 2011. Resultados – A prevalência de dor reduziu de forma significativa entre 2002 e 2012. As crianças livres de dor subiram de 37% para 75%. O registo da avaliação da intensidade da dor e a colheita de informação sobre a história de dor passou a ser uma prática comum na maioria dos casos (53% e 64%, respetivamente), embora ainda direcionada para o modelo de cuidados biomédico. A prevalência das intervenções farmacológicas não se alterou (43% versus 42%), mas a implementação de estratégias não-farmacológicas baixou significativamente (72% versus 15%). Conclusões – As ações de sensibilização/formação realizadas no âmbito das políticas implementadas nestes últimos dez anos na área da avaliação e controlo da dor pediátrica geraram evidentes ganhos na qualidade de cuidados prestados, pelo que o investimento na formação deve continuar. No entanto, deve ser dada prioridade à formação para a aplicação de estratégias de intervenção não-farmacológicas e ao desenvolvimento de mais investigação que suporte as práticas.

Aplicação dos princípios da manutenção Lean na indústria farmacêutica

Trabalho Final de Mestrado para obtenção do grau de Mestre em Engenharia Mecânica

A construção de uma parentalidade confiante: influência do Modelo Touchpoints na relação educadorfamília

Dissertação apresentada na Escola Superior de Educação de Lisboa, para obtenção do grau de Mestre em Ciências da Educação - Especialidade Intervenção Precoce

O impacto do modelo touchpoints nas representações do educador

Dissertação apresentada na Escola Superior de Educação de Lisboa, para obtenção do grau de Mestre em Ciências da Educação Especialidade Intervenção Precoce

Between theory and practice – teaching maths to elementary school students in Poland

The development of children's school achievements in mathematics is one of the most important aims of education in Poland. The results of research concerning monitoring of school achievements in maths is not optimistic. We can observe low levels of children’s understanding of the merits of maths, self-developed strategies in solving problems and practical usage of maths skills. This article frames the discussion of this problem in its psychological and didactic context and analyses the causes as they relate to school practice in teaching maths