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(��) 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.

O educador de Inf��ncia tamb��m ���brinca���?

Relat��rio da Pr��tica Profissional Supervisionada Mestrado em Educa����o Pr��-Escolar

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.

Avalia����o e controlo da dor em pediatria: uma d��cada

Introdu����o ��� A neglig��ncia no controlo da dor �� um problema amplamente reconhecido em Portugal. Desde 2001 t��m sido realizadas in��meras iniciativas para melhorar a pr��tica de cuidados nesta ��rea. Desenvolveram-se a����es de sensibiliza����o e forma����o dos profissionais de sa��de, publicaram-se orienta����es t��cnicas e guias de boas pr��ticas e realizaram-se os primeiros estudos para se fazer um diagn��stico da situa����o. Objetivos ��� O objetivo deste trabalho foi o de caracterizar os cuidados prestados na avalia����o e no controlo da dor nas crian��as at�� aos 18 anos internadas em servi��os hospitalares em Portugal e analisar a evolu����o feita nos cuidados entre os anos de 2002 e 2012. Metodologia ��� Estudo descritivo, transversal, de consulta retrospetiva seriada de registos intermitentes efetuados no processo cl��nico em rela����o a um per��odo de 24 horas. O recrutamento da amostra foi aleat��rio e incluiu todos os processos cl��nicos de crian��as at�� aos 18 anos internados em servi��os de quatro hospitais Portugueses entre agosto e dezembro de 2011. Resultados ��� A preval��ncia de dor reduziu de forma significativa entre 2002 e 2012. As crian��as livres de dor subiram de 37% para 75%. O registo da avalia����o da intensidade da dor e a colheita de informa����o sobre a hist��ria de dor passou a ser uma pr��tica comum na maioria dos casos (53% e 64%, respetivamente), embora ainda direcionada para o modelo de cuidados biom��dico. A preval��ncia das interven����es farmacol��gicas n��o se alterou (43% versus 42%), mas a implementa����o de estrat��gias n��o-farmacol��gicas baixou significativamente (72% versus 15%). Conclus��es ��� As a����es de sensibiliza����o/forma����o realizadas no ��mbito das pol��ticas implementadas nestes ��ltimos dez anos na ��rea da avalia����o e controlo da dor pedi��trica geraram evidentes ganhos na qualidade de cuidados prestados, pelo que o investimento na forma����o deve continuar. No entanto, deve ser dada prioridade �� forma����o para a aplica����o de estrat��gias de interven����o n��o-farmacol��gicas e ao desenvolvimento de mais investiga����o que suporte as pr��ticas.

A contribui����o do marketing interno para o sucesso das empresas

Disserta����o apresentada �� Escola Superior de Comunica����o Social como parte dos requisitos para obten����o de grau de mestre em Publicidade e Marketing.