Effects of an exercise training program in physical condition after liver transplantation in familial amyloidotic polyneuropathy: a case report

Introduction: Familial amyloidotic polyneuropathy (FAP) is a neurodegenerative disease that leads to sensory and motor polyneuropathies as well as functional limitations. So far, liver transplantation is the only treatment for FAP because the mutated protein causing the disease is mainly produced in the liver. With the increasing survival of transplant recipients, functional and cardiovascular problems as consequences of immunosuppressant side effects are increasing associated with sedentary lifestyles and/or retransplantation status. We sought to analyze the impact of exercise training programs on 1 FAP patient’s course long-term after liver transplantation. Methodology. A FAP patient (female; 49 years of age; body mass index 18.8 kg/m2) underwent a liver transplantation 133 months before assessment. She was assessed for body composition, isometric quadriceps muscle strength, functional capacity, fatigue, and levels of physical activity before and after a 6-month period of combined exercise training. Results: After the exercise training program, almost all variables were improved, namely, total body skeletal muscle mass, proximal femoral bone mineral density, quadriceps strength, maximal oxygen consumption on 6 minutes walk test (6mwt) or VO2peak, total ventilation on 6mwt, and fatigue. The improvement in distance on 6mwt (69.2 m) was clinically significant. Preintervention the levels of physical activity were below international recommendations for health; after the program they achieved the recommendations. Conclusion: The results showed an improvement in functional capacity with a decrease in future disability risk associated with a better lifestyle with respect to physical activity levels in 1 patient.

Formação contínua e supervisão pedagógica: o impacto do Programa Nacional do Ensino do Português no desenvolvimento profissional de professores do 1º Ciclo do Ensino Básico

Este estudo pretende descrever e compreender o processo formativo dos professores do 1º ciclo do Ensino Básico, no contexto do Programa Nacional de Ensino do Português (PNEP), as suas dimensões mais relevantes e como é percecionada a supervisão nesse processo de formação contínua. A metodologia adotada nesta investigação foi de natureza qualitativa e baseou-se num conjunto de entrevistas semi-diretivas realizadas a formandos que frequentaram o PNEP entre 2008/2010. Dos resultados obtidos foi possível verificar o impacto positivo que esta modalidade de formação contínua teve no desenvolvimento profissional dos professores preparando-os para a implementação do novo programa de português e permitindo-lhes desmistificar o papel do supervisor através da participação numa experiência de supervisão. O trabalho colaborativo entre professores emergiu durante este processo formativo fomentando a construção de saber em colaboração. A prática pedagógica dos professores apresentou mudanças que pretenderam repercutir-se no aproveitamento dos alunos na área da língua portuguesa. - Abstract This study aims to comprehend and describe the formative process and practice of teachers in Basic education (1st Cycle), in the context of the National Programme for the Teaching of Portuguese Language (PNEP), its most relevant dimensions, the factors which affected it and how supervision was perceived by the teachers involved. A qualitative approach was used, based on semi-directed interviews done to teachers that attended the PNEP, from 2008 to 2010. The impact of this type of continuing training on teachers‟ professional development was positive. They felt prepared for the implementation of the new Portuguese Language Programme. They also demystified the role of the supervisor through the participation in an experience of supervision. The teachers‟ collaborative work emerged during this formative process, promoting the construction of knowledge among teachers. Added to this, teachers‟ pedagogical practice also improved reflected on the students‟ proficiency in the Portuguese language.

De intruso a tutor: impactos da formação em contexto PNEP

Este trabalho decorre de uma experiência de formação contínua de âmbito nacional, durante um ano letivo, relacionada com o ensino do português no 1º Ciclo no contexto do Programa Nacional de Ensino do Português (PNEP). Para se compreender o impacto da formação e do seu modelo, analisaram-se as produções escritas (do género narrativo e epistolar) dos alunos do 1º ao 4º ano de escolaridade, os resultados das Provas de Aferição de Língua Portuguesa do 4º ano, os inquéritos de avaliação dos formandos à própria formação, da competência da Comissão Nacional de Acompanhamento (CNA) e, ainda, as reflexões dos portefólios produzidos pelos formandos ao longo da formação. Em génese, pretende-se aferir de que modo esta formação interferiu nas aprendizagens e no desenvolvimento de competências dos alunos no domínio da língua materna, nomeadamente ao nível da escrita. Nessa perspetiva, são comparados dois grupos de alunos do mesmo agrupamento, do distrito de Lisboa, sendo o grupo experimental constituído pelos alunos cujos professores frequentaram a ação de formação PNEP e o grupo de controlo formado por alunos cujos professores nunca frequentaram a referida ação. Todavia, podendo o PNEP ser considerado como uma formação inovadora, porque se desenvolve em contexto, procura-se também saber como se sentiram os professores ao longo desta formação, bem como que repercussões e mais-valias obtiveram para as suas práticas pedagógicas e para a resolução real dos problemas vividos na sala de aula. Por fim, cruzando todos os dados de que se dispõe, aspira-se compreender o papel e o contributo da figura do formador no contexto PNEP, o que poderá conduzir a uma nova abordagem de formação, mais consentânea com o conceito de “mentoria”, e seus processos, do que com os pressupostos iniciais assentes numa lógica de “tutoria”. - This study originates from a one year education experience, nation wide, in the wake of the PNEP (Programa Nacional de Ensino do Português, in its maiden form) program. The aim is to understand how the model herein impacts first to fourth year primary school children’s learning and writing skills, how it influences the fourth year’s final exam results, and how it is reflected on practitioners’ (teachers undergoing the PNEP) performance evaluation inquires, and on concept development within their portfolios. In genesis, we seek to analyse whether the PNEP changed the way children attending primary school learn and master Portuguese, particularly its written expression. To do so, the study focus on two different publics, whereby an experimental group was build around a set of classes whose teachers had completed the PNEP education and training program, and a control group, set around a similar sample, but where teachers had no PNEP education or training at all. In addition, because PNEP might be considered as an advanced education model, we also wanted to disclosure how it adds to schoolteachers’ education techniques, and how it would help them solve daily ordinary problems within the classroom. Last but not the least, the study reveals that PNEP can change Portuguese standard education perspectives, changing classic tutorial methodologies towards a, more responsive, mentoring approach.

The impact of exercise training on liver transplanted familial amyloidotic polyneuropathy (FAP) patients

Liver transplantation is nowadays the only effective answer to adjourn the outcome of functional limitations associated with familial amyloidotic polyneuropathy (FAP), a neurodegenerative disease characterized by sensory and motor polyneuropathies. Nevertheless, there is a detrimental impact associated with the after-surgery period on the fragile physical condition of these patients. Exercise training has been proven to be effective on reconditioning patients after transplantation. However, the effects of exercise training in liver transplanted FAP patients have not been scrutinized yet.

Radiographers and radiation protection: education, training and CPD

The increasing use of ionizing radiation for medical purposes emphasizes the concern about safety and justification of using ionizing radiation. This is linked with the use of new and high-dose X-ray technology (particularly CT). According to the UNSCEAR 2010 Report the total number of diagnostic medical examinations (both medical and dental) is estimated to have risen from 2.4 billion (period 1991–1996) to 3.6 billion (period 1997– 2008) - a marked increase in collective doses. An appropriate use of technology aiming diagnostic or therapy and respecting the ALARA principle is a mandatory requisite to safely perform any radiological procedure. Radiation protection is thus, a concern of all specialists in the radiology field ( radiologists, radiographers, medical physicists, among other professional groups). The importance of education and training of these professionals in reducing patients’ doses while maintaining the desired level of quality in medical exposures, as well as precise therapeutic treatments is well recognized. Education, training and continuing professional development (CPD) constitute a triad pointing towards the radiographers’ development of competences in the radiation protection field. This presentation excludes the radiographer role and competences in the fields of ultrasonography and MRI.

Os programas de matemática do ensino básico de 1990 e de 2007 e o processo de implementação do programa de 2007, no 1º ciclo do Ensino Básico

Mestrado em Educação Matemática na Educação Pré – Escolar e nos 1.º e 2.º Ciclos do Ensino Básico

Avaliação do desempenho docente e supervisão pedagógica: implementação numa escola do ensino particular e cooperativo

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

The influence of experience and training in a group of novice observers: a jackknife alternative free-response receiver operating characteristic analysis

Purpose - The study evaluates the pre- and post-training lesion localisation ability of a group of novice observers. Parallels are drawn with the performance of inexperienced radiographers taking part in preliminary clinical evaluation (PCE) and ‘red-dot’ systems, operating within radiography practice. Materials and methods - Thirty-four novice observers searched 92 images for simulated lesions. Pre-training and post-training evaluations were completed following the free-response the receiver operating characteristic (FROC) method. Training consisted of observer performance methodology, the characteristics of the simulated lesions and information on lesion frequency. Jackknife alternative FROC (JAFROC) and highest rating inferred ROC analyses were performed to evaluate performance difference on lesion-based and case-based decisions. The significance level of the test was set at 0.05 to control the probability of Type I error. Results - JAFROC analysis (F(3,33) = 26.34, p < 0.0001) and highest-rating inferred ROC analysis (F(3,33) = 10.65, p = 0.0026) revealed a statistically significant difference in lesion detection performance. The JAFROC figure-of-merit was 0.563 (95% CI 0.512,0.614) pre-training and 0.677 (95% CI 0.639,0.715) post-training. Highest rating inferred ROC figure-of-merit was 0.728 (95% CI 0.701,0.755) pre-training and 0.772 (95% CI 0.750,0.793) post-training. Conclusions - This study has demonstrated that novice observer performance can improve significantly. This study design may have relevance in the assessment of inexperienced radiographers taking part in PCE or commenting scheme for trauma.

Relatório de estágio

I - As minhas expectativas eram elevadas pois este regresso à Escola Superior de Música de Lisboa permitia-me voltar a trabalhar com os professores que me formaram como músico e professor e com eles poder actualizar-me sobre vários temas ligados à pedagogia. Este aspecto é muito importante pois chego à conclusão que o tempo por vezes provoca-nos excesso de confiança que parece “cegar-nos” não nos deixando ver erros pedagógicos muitas vezes evitáveis. Quando ingressei neste estágio sentia-me confiante e seguro quanto às minhas capacidades como professor. O momento de viragem na minha perspectiva do estágio dá-se quando surgem as observações/gravações e respectivas análises e reflexões das aulas. Procurei trabalhar nessas aulas da forma mais natural possível pois o meu objectivo era observar o meu trabalho diário. A primeira observação das aulas permitiu-me anotar algumas coisas menos boas. Contudo, quando essa observação foi feita com o professor de didática os aspectos menos positivos ganharam uma enorme proporção: (1) falhas ao nível da instrução: demasiado longo, (2) feedback de pouca qualidade ou eficácia , (3) pouca percentagem de alunos que atingiam os objectivos., (4) ritmo de aula por vezes baixo devido a períodos longos de instrução ou devido a uma má gestão do espaço. Todos estes problemas eram mais visíveis quando as turmas eram maiores. Ao longo do estágio, e após a detecção destas falhas, fui procurando evitar estas práticas em todas as turmas onde leccionava. Senti que o ritmo de aula aumentou substancialmente não apenas à custa da energia do professor e de boas estratégias mas porque sobretudo se “falava menos e trabalhava-se mais”. Os erros dos alunos passaram a ser corrigos enquanto trabalhavam (feedback corretivo próximo do momento positivo ou negativo), o feedback positivo passou a ser mais destacado, a disposição da sala alterou-se de forma aos alunos estarem mais perto do professor, e este procurou ser menos “criativo” no momento de alterar o plano de aula devido a ideias momentâneas o que provocou mais tempo para cada estratégia e para que mais alunos fossem atingindo os objectivos. Apesar da evolução no sentido de proporcionar aos alunos aulas mais rentáveis e de ainda melhor qualidade, existe a consciência que alguns dos erros cometidos eram hábitos e como tal poderão levar algum tempo a ser corrigidos. Contudo, existe a consciência e a vontade em debelá-los da minha prática docente.

Impact of a training course on the quality of malaria diagnosis by microscopy in Angola

Background: In Angola, malaria is an endemic disease having a major impact on the economy. The WHO recommends testing for all suspected malaria cases, to avoid the presumptive treatment of this disease. In malaria endemic regions laboratory technicians must be very comfortable with microscopy, the golden standard for malaria diagnosis, to avoid the incorrect diagnosis. The improper use of medication promotes drug resistance and undesirable side effects. The present study aims to assess the impact of a three-day refresher course on the knowledge of technicians, quality of blood smears preparation and accuracy of microscopy malaria diagnosis, using qPCR as reference method. Methods: This study was implemented in laboratories from three hospitals in different provinces of Angola: Bengo, Benguela and Luanda. In each laboratory samples were collected before and after the training course (slide with thin and thick blood smears, a dried blood spot and a form). The impact of the intervention was evaluated through a written test, the quality of slide preparation and the performance of microscopy. Results: It was found a significant increase on the written test median score, from 52.5% to 65.0%. A total of 973 slides were analysed to evaluate the quality of thick and thin blood smears. Considering all laboratories there was a significant increase in quality of thick and thin blood smears. To determine the performance of microscopy using qPCR as the reference method we used 1,028 samples. Benguela presented the highest values for specificity, 92.9% and 98.8% pre and post-course, respectively and for sensitivity the best pre-course was Benguela (75.9%) and post-course Luanda (75.0%). However, no significant increase in sensitivity and specificity after the training course was registered in any laboratory analysed. Discussion: The findings of this study support the need of continuous refresher training for microscopists and other laboratory staff. The laboratories should have a quality control programme to supervise the diagnosis and also to assess the periodicity of new training. However, other variables needed to be considered to have a correct malaria diagnosis, such as adequate equipment and reagents for staining and visualization, good working conditions, motivated and qualified personnel.

Nuclear medicine technologist education and training in Europe: literature and web-based findings

Purpose - The education and training of a nuclear medicine technologist (NMT) is not homogeneous among European countries, which leads to different scope of practices and, therefore, different technical skills are assigned. The goal of this research was to characterize the education and training of NMT in Europe. Materials and methods - This study was based on a literature research to characterize the education and training of NMT and support the historical evolution of this profession. It was divided into two different phases: the first phase included analysis of scientific articles and the second phase included research of curricula that allow health professionals to work as NMT in Europe. Results - The majority of the countries [N=31 (89%)] offer the NMT curriculum integrated into the high education system and only in four (11%) countries the education is provided by professional schools. The duration in each education system is not equal, varying in professional schools (2-3 years) and high education level system (2-4 years), which means that different European Credit Transfer and Accumulation System, such as 240, 230, 222, 210 or 180 European Credit Transfer and Accumulation System, are attributed to the graduates. The professional title and scope of the practice of NMT are different in different countries in Europe. In most countries of Europe, nuclear medicine training is not specific and curriculum does not demonstrate the Nuclear Medicine competencies performed in clinical practice. Conclusion - The heterogeneity in education and training for NMT is an issue prevalent among European countries. For NMT professional development, there is a huge need to formalize and unify educational and training programmes in Europe.