A program of nurse algorithm-guided care for adult patients with acute minor illnesses in primary care

Background: Attention to patients with acute minor-illnesses requesting same-day consultation represents a major burden in primary care. The workload is assumed by general practitioners in many countries. A number of reports suggest that care to these patients may be provided, at in least in part, by nurses. However, there is scarce information with respect to the applicability of a program of nurse management for adult patients with acute minor-illnesses in large areas. The aim of this study is to assess the effectiveness of a program of nurse algorithm-guided care for adult patients with acute minor illnesses requesting same-day consultation in primary care in a largely populated area. Methods: A cross-sectional study of all adult patients seeking same day consultation for 16 common acute minor illnesses in a large geographical area with 284 primary care practices. Patients were included in a program of nurse case management using management algorithms. The main outcome measure was case resolution, defined as completion of the algorithm by the nurse without need of referral of the patient to the general practitioner. The secondary outcome measure was return to consultation, defined as requirement of new consultation for the same reason as the first one, in primary care within a 7-day period. Results: During a two year period (April 2009-April 2011), a total of 1,209,669 consultations were performed in the program. Case resolution was achieved by nurses in 62.5% of consultations. The remaining cases were referred to a general practitioner. Resolution rates ranged from 94.2% in patients with burns to 42% in patients with upper respiratory symptoms. None of the 16 minor illnesses had a resolution rate below 40%. Return to consultation during a 7-day period was low, only 4.6%. Conclusions: A program of algorithms-guided care is effective for nurse case management of patients requesting same day consultation for minor illnesses in primary care.

A program of nurse algorithm-guided care for adult patients with acute minor illnesses in primary care

Background: Attention to patients with acute minor-illnesses requesting same-day consultation represents a major burden in primary care. The workload is assumed by general practitioners in many countries. A number of reports suggest that care to these patients may be provided, at in least in part, by nurses. However, there is scarce information with respect to the applicability of a program of nurse management for adult patients with acute minor-illnesses in large areas. The aim of this study is to assess the effectiveness of a program of nurse algorithm-guided care for adult patients with acute minor illnesses requesting same-day consultation in primary care in a largely populated area. Methods: A cross-sectional study of all adult patients seeking same day consultation for 16 common acute minor illnesses in a large geographical area with 284 primary care practices. Patients were included in a program of nurse case management using management algorithms. The main outcome measure was case resolution, defined as completion of the algorithm by the nurse without need of referral of the patient to the general practitioner. The secondary outcome measure was return to consultation, defined as requirement of new consultation for the same reason as the first one, in primary care within a 7-day period. Results: During a two year period (April 2009-April 2011), a total of 1,209,669 consultations were performed in the program. Case resolution was achieved by nurses in 62.5% of consultations. The remaining cases were referred to a general practitioner. Resolution rates ranged from 94.2% in patients with burns to 42% in patients with upper respiratory symptoms. None of the 16 minor illnesses had a resolution rate below 40%. Return to consultation during a 7-day period was low, only 4.6%. Conclusions: A program of algorithms-guided care is effective for nurse case management of patients requesting same day consultation for minor illnesses in primary care.

EEG windowed statistical wavelet scoring for evaluation and discrimination of muscular artifacts

EEG recordings are usually corrupted by spurious extra-cerebral artifacts, which should be rejected or cleaned up by the practitioner. Since manual screening of human EEGs is inherently error prone and might induce experimental bias, automatic artifact detection is an issue of importance. Automatic artifact detection is the best guarantee for objective and clean results. We present a new approach, based on the time–frequency shape of muscular artifacts, to achieve reliable and automatic scoring. The impact of muscular activity on the signal can be evaluated using this methodology by placing emphasis on the analysis of EEG activity. The method is used to discriminate evoked potentials from several types of recorded muscular artifacts—with a sensitivity of 98.8% and a specificity of 92.2%. Automatic cleaning ofEEGdata are then successfully realized using this method, combined with independent component analysis. The outcome of the automatic cleaning is then compared with the Slepian multitaper spectrum based technique introduced by Delorme et al (2007 Neuroimage 34 1443–9).

The Total Deviation Index estimated by Tolerance Intervals to evaluate the concordance of measurement devices

Background In an agreement assay, it is of interest to evaluate the degree of agreement between the different methods (devices, instruments or observers) used to measure the same characteristic. We propose in this study a technical simplification for inference about the total deviation index (TDI) estimate to assess agreement between two devices of normally-distributed measurements and describe its utility to evaluate inter- and intra-rater agreement if more than one reading per subject is available for each device. Methods We propose to estimate the TDI by constructing a probability interval of the difference in paired measurements between devices, and thereafter, we derive a tolerance interval (TI) procedure as a natural way to make inferences about probability limit estimates. We also describe how the proposed method can be used to compute bounds of the coverage probability. Results The approach is illustrated in a real case example where the agreement between two instruments, a handle mercury sphygmomanometer device and an OMRON 711 automatic device, is assessed in a sample of 384 subjects where measures of systolic blood pressure were taken twice by each device. A simulation study procedure is implemented to evaluate and compare the accuracy of the approach to two already established methods, showing that the TI approximation produces accurate empirical confidence levels which are reasonably close to the nominal confidence level. Conclusions The method proposed is straightforward since the TDI estimate is derived directly from a probability interval of a normally-distributed variable in its original scale, without further transformations. Thereafter, a natural way of making inferences about this estimate is to derive the appropriate TI. Constructions of TI based on normal populations are implemented in most standard statistical packages, thus making it simpler for any practitioner to implement our proposal to assess agreement.

EEG Windowed statitical wavelet deviation for estimation of muscular artifacts

Electroencephalographic (EEG) recordings are, most of the times, corrupted by spurious artifacts, which should be rejected or cleaned by the practitioner. As human scalp EEG screening is error-prone, automatic artifact detection is an issue of capital importance, to ensure objective and reliable results. In this paper we propose a new approach for discrimination of muscular activity in the human scalp quantitative EEG (QEEG), based on the time-frequency shape analysis. The impact of the muscular activity on the EEG can be evaluated from this methodology. We present an application of this scoring as a preprocessing step for EEG signal analysis, in order to evaluate the amount of muscular activity for two set of EEG recordings for dementia patients with early stage of Alzheimer’s disease and control age-matched subjects.

Comparative study of two needle models in terms of deflection during inferior alveolar nerve block

Objectives: The purpose of this study is to determine the possible differences in deflection between two needles of same length and external gauge but with different internal gauges during truncal block of the inferior alveolar nerve. The initial working hypothesis was that greater deflection may be expected with larger internal gauge needles. Study design: Four clinicians subjected 346 patients to inferior alveolar nerve block and infiltrating anesthesia of the buccal nerve trajectory for the surgical or conventional extraction of the lower third molar. A nonautoaspirating syringe system with 2 types of needle was used: a standard 27-gauge x 35-mm needle with an internal gauge of 0.215 mm or an XL Monoprotect® 27-gauge x 35-mm needle with an internal gauge of 0.265 mm. The following information was systematically recorded for each patient: needle type, gender, anesthetic technique (direct or indirect truncal block) and the number of bone contacts during the procedure, the patient-extraction side, the practitioner performing the technique, and blood aspiration (either positive or negative). Results: 346 needles were used in total. 190 were standard needles (27-gauge x 35-mm needle with an internal gauge of 0.215 mm) and 156 were XL Monoprotect®. Incidence of deflection was observed in 49.1% of cases (170 needles) where 94 were standard needles and 76 XL Monoprotect®. Needle torsion ranged from 0º and 6º. Conclusions: No significant differences were recorded in terms of deflection and internal gauge, operator, patient-extraction side, the anesthetic technique involved and the number of bone contacts during the procedure

El desarrollo personal y profesional mediante el aprendizaje reflexivo : una experiencia en el grado de Educación Social

In the last years, an increase of the interest to develop educational practices in higher education, based on the approach of the reflective learning, is observed. Nevertheless, we scarcely find in our context researches or experiences that allow knowing students’ perceptions about this teaching and learning approach. We have developed an experience in the bachelor of Social Education at the University of Girona with the aim to contribute to the personal and professional development of future social educators in their initial training, using reflective learning methodology. In this article we present an evaluation of the experience based on students’ perceptions. They assessed the usefulness they think the module has for their training, the methodology and the activities. This evaluation has been carried out through in-depth interviews to 17 students who participated in the module in 2010-11 academic year. The results show that students assess positively the experience, either its general usefulness or the methodology of reflective learning, although they acknowledge some difficulties to carry out such a process which involves a high degree of introspection and a difficulty to set the boundaries in the narration of personal questions. The study also shows some challenges related on the need, but also the difficulty, to include personal and professional development as a powerful axis in the higher education curriculum, as well as elements linked to reflective learning assessment

Los Sufijos apreciativos en la enseñanza de ELE

El principal objetivo de este trabajo es realizar una pequeña aportación a la enseñanza/aprendizaje del español como lengua extranjera. La finalidad es que pueda servir tanto a profesores como a alumnos, ofreciendo una exposición de la sufijación apreciativa no solo como un aspecto más dentro de la gramática, sino concediendo al alumno una serie de estrategias que le ayuden a favorecer un aprendizaje reflexivo de la gramática y, en particular, de la formación de palabras. Todo esto unido siempre a aspectos socioculturales, pragmáticos, e incluso relacionados con el elemento intercultural

La evaluación de la actividad reflexiva a partir del portafolio del estudiante

Reflective competence is considered one of the key competencies of students‟ education in all teaching levels and in the daily practice of professionals. A lack of conceptual clarity can lead to critical difficulties for teachers when designing activities that promote reflective skills and also to confusion on the part of the students who have to put them into practice. A short introduction to the scientific study of reflective activity which tries to set the stage of the investigation as well as an innovative experience within the framework of the first year of the Degree in Psychology Studies are presented here. This study presents the work on the reflective skills through a reflective portfolio. Five hierarchical levels of reflection are specified as a guide for the making of the portfolio for the students, and as a support for the mentoring and assessment tasks of teachers. As a conclusion, a three-step model for the training of „reflective beginners‟ is outlined

LUDOLITERACY Informe sobre la alfabetización mediática en el juego digital. Experiencias en Europa

El informe que a continuación presentamos recoge 18 experiencias, proyectos, actividades,investigaciones o políticas más significativas que se realizan en Europa relacionadas con la alfabetización mediática en el contexto de los videojuegos (ludoliteracy). La ludoliteracy tiene como finalidad potenciar las capacidades y competencias analíticas, reflexivas y creativas alrededor del juego digital. Se trata, en conjunto, de propuestas que permiten al ciudadano (joven o adulto, profesional o usuario) y a la sociedad en general ser más conscientes de nuestros propios placeres, tener capacidad crítica y competencia creativa en el campo específico de los juegos digitales.El objetivo final del informe es ofrecer recomendaciones en un campo socialmente controvertido y económicamente situado a la cabeza de las industrias culturales pero institucionalmente emplazado en los márgenes de las políticas educativas estatales y europeas.

Metodologías de enseñanza y aprendizaje reflexivos en la universidad. Una investigación centrada en la percepción de estudiantes de grado de la Universidad de Girona

The aim of the research presented in this article is to understand undergraduate students’ appraisal of the influence of reflective learning methodology in different aspects of their learning, and to obtain evidence of the main difficulties encountered by students and the main contributions of this kind of methodology into their learning process. The study was conducted in four different degree courses (Social education, Environmental sciences, Nursing, and Psychology) at the University of Girona Through the development of a self-report reflective learning questionnaire and its application to 162 students who participated in the experiences, we conclude that reflective learning can be positively assessed as having great potential to train university undergraduates

The Art & Science of Learning Design

We live in an era defined by a wealth of open and readily available information, and the accelerated evolution of social, mobile and creative technologies. The provision of knowledge, once a primary role of educators, is now devolved to an immense web of free and readily accessible sources. Consequently, educators need to redefine their role not just ¿from sage on the stage to guide on the side¿ but, as more and more voices insist, as ¿designers for learning¿.The call for such a repositioning of educators is heard from leaders in the field of technology-enhanced learning (TEL) and resonates well with the growing culture of design-based research in Education. However, it is still struggling to find a foothold in educational practice. We contend that the root causes of this discrepancy are the lack of articulation of design practices and methods, along with a shortage of tools and representations to support such practices, a lack of a culture of teacher-as-designer among practitioners, and insufficient theoretical development.The Art and Science of Learning Design (ASLD) explores the frameworks, methods, and tools available for teachers, technologists and researchers interested in designing for learning Learning Design theories arising from findings of research are explored, drawing upon research and practitioner experiences. It then surveys current trends in the practices, methods, and methodologies of Learning Design. Highlighting the translation of theory into practice, this book showcases some of the latest tools that support the learning design process itself.