111 resultados para Conscious Sedation
Resumo:
Aims and objectives
To explore issues and challenges associated with nurse-administered procedural sedation and analgesia in the cardiac catheterisation laboratory from the perspectives of senior nurses.
Background
Nurses play an important part in managing sedation because the prescription is usually given verbally directly from the cardiologist who is performing the procedure and typically, an anaesthetist is not present.
Design
A qualitative exploratory design was employed.
Methods
Semi-structured interviews with 23 nurses from 16 cardiac catheterisation laboratories across four states in Australia and also New Zealand were conducted. Data analysis followed the guide developed by Braun and Clark to identify the main themes.
Results
Major themes emerged from analysis regarding the lack of access to anaesthetists, the limitations of sedative medications, the barriers to effective patient monitoring and the impact that the increasing complexity of procedures has on patients' sedation requirements.
Conclusions
The most critical issue identified in this study is that current guidelines, which are meant to apply regardless of the clinical setting, are not practical for the cardiac catheterisation laboratory due to a lack of access to anaesthetists. Furthermore, this study has demonstrated that nurses hold concerns about the legitimacy of their practice in situations when they are required to perform tasks outside of clinical practice guidelines. To address nurses' concerns, it is proposed that new guidelines could be developed, which address the unique circumstances in which sedation is used in the cardiac catheterisation laboratory.
Relevance to clinical practice
Nurses need to possess advanced knowledge and skills in monitoring for the adverse effects of sedation. Several challenges impact on nurses' ability to monitor patients during procedural sedation and analgesia. Preprocedural patient education about what to expect from sedation is essential.
Resumo:
Background : The sedation needs of critically ill patients have been recognized as a core component of critical care and meeting these is vital to assist recovery and ensure humane treatment. There is growing evidence to suggest that sedation requirements are not always optimally managed. Sub-optimal sedation incorporates both under- and over-sedation and has been linked to both short-term (e.g. length of stay) and long-term (e.g. psychological recovery) outcomes. Various strategies have been proposed to improve sedation management and address aspects of assessment as well as delivery of sedation.
Objectives : To assess the effects of protocol-directed sedation management on the duration of mechanical ventilation and other relevant patient outcomes in mechanically ventilated intensive care unit (ICU) patients. We looked at various outcomes and examined the role of bias in order to examine the level of evidence for this intervention.
Search methods : We searched the Cochrane Central Register of Controlled trials (CENTRAL) (2013; Issue 11), MEDLINE (OvidSP) (1990 to November 2013), EMBASE (OvidSP) (1990 to November 2013), CINAHL (BIREME host) (1990 to November 2013), Database of Abstracts of Reviews of Effects (DARE) (1990 to November 2013), LILACS (1990 to November 2013), Current Controlled Trials and US National Institutes of Health Clinical Research Studies (1990 to November 2013), and reference lists of articles. We re-ran the search in October 2014. We will deal with any studies of interest when we update the review.
Selection criteria : We included randomized controlled trials (RCTs) conducted in adult ICUs comparing management with and without protocol-directed sedation.
Data collection and analysis : Two authors screened the titles and abstracts and then the full-text reports identified from our electronic search. We assessed seven domains of potential risk of bias for the included studies. We examined the clinical, methodological and statistical heterogeneity and used the random-effects model for meta-analysis where we considered it appropriate. We calculated the mean difference (MD) for duration of mechanical ventilation and risk ratio (RR) for mortality across studies, with 95% confidence intervals (CI).
Main results : We identified two eligible studies with 633 participants. Both included studies compared the use of protocol-directed sedation, specifically protocols delivered by nurses, with usual care. We rated the risk of selection bias due to random sequence generation low for one study and unclear for one study. The risk of selection bias related to allocation concealment was low for both studies. We also assessed detection and attrition bias as low for both studies while we considered performance bias high due to the inability to blind participants and clinicians in both studies. Risk due to other sources of bias, such as potential for contamination between groups and reporting bias, was considered unclear. There was no clear evidence of differences in duration of mechanical ventilation (MD -5.74 hours, 95% CI -62.01 to 50.53, low quality evidence), ICU length of stay (MD -0.62 days, 95% CI -2.97 to 1.73) and hospital length of stay (MD -3.78 days, 95% CI -8.54 to 0.97) between people being managed with protocol-directed sedation versus usual care. Similarly, there was no clear evidence of difference in hospital mortality between the two groups (RR 0.96, 95% CI 0.71 to 1.31, low quality evidence). ICU mortality was only reported in one study preventing pooling of data. There was no clear evidence of difference in the incidence of tracheostomy (RR 0.77, 95% CI 0.31 to 1.89). The studies reported few adverse event outcomes; one study reported self extubation while the other study reported re-intubation; given this difference in outcomes, pooling of data was not possible. There was significant heterogeneity between studies for duration of mechanical ventilation (I2 = 86%, P value = 0.008), ICU length of stay (I2 = 82%, P value = 0.02) and incidence of tracheostomy (I2 = 76%, P value = 0.04), with one study finding a reduction in duration of mechanical ventilation and incidence of tracheostomy and the other study finding no difference.
Authors' conclusions : There is currently insufficient evidence to evaluate the effectiveness of protocol-directed sedation. Results from the two RCTs were conflicting, resulting in the quality of the body of evidence as a whole being assessed as low. Further studies, taking into account contextual and clinician characteristics in different ICU environments, are necessary to inform future practice. Methodological strategies to reduce the risk of bias need to be considered in future studies.
Resumo:
AIMS: Assess the effects of protocol-directed sedation management on the duration of mechanical ventilation and other relevant patient outcomes in mechanically ventilated intensive care unit patients. BACKGROUND: Sedation is a core component of critical care. Sub-optimal sedation management incorporates both under- and over-sedation and has been linked to poorer patient outcomes. DESIGN: Cochrane systematic review of randomized controlled trials. DATA SOURCES: Cochrane Central Register of Controlled trials, MEDLINE, EMBASE, CINAHL, Database of Abstracts of Reviews of Effects, LILACS, Current Controlled Trials and US National Institutes of Health Clinical Research Studies (1990-November 2013) and reference lists of articles were used. REVIEW METHODS: Randomized controlled trials conducted in intensive care units comparing management with and without protocol-directed sedation were included. Two authors screened titles, abstracts and full-text reports. Potential risk of bias was assessed. Clinical, methodological and statistical heterogeneity were examined and the random-effects model used for meta-analysis where appropriate. Mean difference for duration of mechanical ventilation and risk ratio for mortality, with 95% confidence intervals, were calculated. RESULTS: Two eligible studies with 633 participants comparing protocol-directed sedation delivered by nurses vs. usual care were identified. There was no evidence of differences in duration of mechanical ventilation or hospital mortality. There was statistically significant heterogeneity between studies for duration of mechanical ventilation. CONCLUSIONS: There is insufficient evidence to evaluate the effectiveness of protocol-directed sedation as results from the two randomized controlled trials were conflicting.
Resumo:
Background: Sedation is crucial for the recovery of patients in intensive care units (ICUs). Maintaining comfort and safety promotes optimal care for critically ill patients. Purpose: To examine sedation assessment and management undertaken by health professionals for mechanically ventilated patients in one Australian ICU. Methods: A retrospective clinical audit was undertaken of medical records of all eligible, mechanically ventilated patients admitted to an ICU of an Australian metropolitan, teaching hospital over a 12-month period. A Sedation Audit Tool was used to collect data from the day of intubation to 5 days after intubation. Findings: Data were extracted from medical records of 150 patients. The Riker Sedation-Agitation Scale (SAS) was the scoring system used. Patients were unarousable or very sedated between 57% and 81% at some point during the study period, while between 5% and 11% were agitated, very agitated or extremely agitated across this time. Patients' sedation scores were not documented in between 3.3% and 23.3% of patients. Medications commonly used were propofol, midazolam, morphine, and fentanyl. There were 135 situations of adverse events, which related to patients pulling endotracheal tubes leading to malpositioning, patients biting endotracheal tubes causing desaturation, patient experiencing excessive agitation requiring restraint use, patients experiencing increased intracranial pressure above desired limits, patients self-extubating, and patients experiencing over-drowsiness leading to delays in extubation. Conclusions: Many patients were either very sedated or agitated at some point during the study period, and some patients experienced adverse outcomes associated with sedation practices. The findings inform future quality initiatives to improve sedation practices.
Resumo:
OBJECTIVE: High-fat diet (HFD)-induced hypertension in rabbits is neurogenic because of the central sympathoexcitatory actions of leptin. Hypothalamic melanocortin and neuropeptide Y (NPY) neurons are recognized as the major signalling pathways through which leptin exerts its central effects. In this study, we assessed the effects of specific antagonists and agonists to melanocortin and NPY receptors on HFD-induced sympathoexcitation and hypertension. METHODS: Rabbits were instrumented with intracerebroventricular cannula, renal sympathetic nerve activity (RSNA) electrode, and blood pressure telemetry transmitter. RESULTS: After 3 weeks HFD (13.5% fat, n = 12) conscious rabbits had higher RSNA (+3.8 nu, P = 0.02), blood pressure (+8.6 mmHg, P < 0.001) and heart rate (+15 b/min, P = 0.01), and brain-derived neurotrophic factor levels in the hypothalamus compared with rabbits fed a control diet (4.2% fat, n = 11). Intracerebroventricular administration of the melanocortin receptor antagonist SHU9119 reduced RSNA (-2.7 nu) and blood pressure (-8.5 mmHg) in HFD but not control rabbits, thus reversing 100% of the hypertension and 70% of the sympathoexcitation induced by a HFD. By contrast, blocking central NPY Y1 receptors with BVD10 increased RSNA only in HFD rabbits. Intracerebroventricular α-melanocortin stimulating hormone increased RSNA and heart rate (P < 0.001) in HFD rabbits but had no effect in control rabbits. CONCLUSION: These findings suggest that obesity-induced hypertension and increased RSNA are dependent on the balance between greater activation of melanocortin signalling through melanocortin receptors and lesser activation of NPY sympathoinhibitory signalling. The amplification of the sympathoexcitatory effects of α-melanocortin stimulating hormone also indicates that the underlying mechanism is related to facilitation of leptin-melanocortin signalling, possibly involving chronic activation of brain-derived neurotrophic factor.
Resumo:
BACKGROUND: Midazolam is used for sedation before diagnostic and therapeutic medical procedures. It is an imidazole benzodiazepine that has depressant effects on the central nervous system (CNS) with rapid onset of action and few adverse effects. The drug can be administered by several routes including oral, intravenous, intranasal and intramuscular. OBJECTIVES: To determine the evidence on the effectiveness of midazolam for sedation when administered before a procedure (diagnostic or therapeutic). SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL to January 2016), MEDLINE in Ovid (1966 to January 2016) and Ovid EMBASE (1980 to January 2016). We imposed no language restrictions. SELECTION CRITERIA: Randomized controlled trials in which midazolam, administered to participants of any age, by any route, at any dose or any time before any procedure (apart from dental procedures), was compared with placebo or other medications including sedatives and analgesics. DATA COLLECTION AND ANALYSIS: Two authors extracted data and assessed risk of bias for each included study. We performed a separate analysis for each different drug comparison. MAIN RESULTS: We included 30 trials (2319 participants) of midazolam for gastrointestinal endoscopy (16 trials), bronchoscopy (3), diagnostic imaging (5), cardioversion (1), minor plastic surgery (1), lumbar puncture (1), suturing (2) and Kirschner wire removal (1). Comparisons were: intravenous diazepam (14), placebo (5) etomidate (1) fentanyl (1), flunitrazepam (1) and propofol (1); oral chloral hydrate (4), diazepam (2), diazepam and clonidine (1); ketamine (1) and placebo (3); and intranasal placebo (2). There was a high risk of bias due to inadequate reporting about randomization (75% of trials). Effect estimates were imprecise due to small sample sizes. None of the trials reported on allergic or anaphylactoid reactions. Intravenous midazolam versus diazepam (14 trials; 1069 participants)There was no difference in anxiety (risk ratio (RR) 0.80, 95% confidence interval (CI) 0.39 to 1.62; 175 participants; 2 trials) or discomfort/pain (RR 0.60, 95% CI 0.24 to 1.49; 415 participants; 5 trials; I² = 67%). Midazolam produced greater anterograde amnesia (RR 0.45; 95% CI 0.30 to 0.66; 587 participants; 9 trials; low-quality evidence). Intravenous midazolam versus placebo (5 trials; 493 participants)One trial reported that fewer participants who received midazolam were anxious (3/47 versus 15/35; low-quality evidence). There was no difference in discomfort/pain identified in a further trial (3/85 in midazolam group; 4/82 in placebo group; P = 0.876; very low-quality evidence). Oral midazolam versus chloral hydrate (4 trials; 268 participants)Midazolam increased the risk of incomplete procedures (RR 4.01; 95% CI 1.92 to 8.40; moderate-quality evidence). Oral midazolam versus placebo (3 trials; 176 participants)Midazolam reduced pain (midazolam mean 2.56 (standard deviation (SD) 0.49); placebo mean 4.62 (SD 1.49); P < 0.005) and anxiety (midazolam mean 1.52 (SD 0.3); placebo mean 3.97 (SD 0.44); P < 0.0001) in one trial with 99 participants. Two other trials did not find a difference in numerical rating of anxiety (mean 1.7 (SD 2.4) for 20 participants randomized to midazolam; mean 2.6 (SD 2.9) for 22 participants randomized to placebo; P = 0.216; mean Spielberger's Trait Anxiety Inventory score 47.56 (SD 11.68) in the midazolam group; mean 52.78 (SD 9.61) in placebo group; P > 0.05). Intranasal midazolam versus placebo (2 trials; 149 participants)Midazolam induced sedation (midazolam mean 3.15 (SD 0.36); placebo mean 2.56 (SD 0.64); P < 0.001) and reduced the numerical rating of anxiety in one trial with 54 participants (midazolam mean 17.3 (SD 18.58); placebo mean 49.3 (SD 29.46); P < 0.001). There was no difference in meta-analysis of results from both trials for risk of incomplete procedures (RR 0.14, 95% CI 0.02 to 1.12; downgraded to low-quality evidence). AUTHORS' CONCLUSIONS: We found no high-quality evidence to determine if midazolam, when administered as the sole sedative agent prior to a procedure, produces more or less effective sedation than placebo or other medications. There is low-quality evidence that intravenous midazolam reduced anxiety when compared with placebo. There is inconsistent evidence that oral midazolam decreased anxiety during procedures compared with placebo. Intranasal midazolam did not reduce the risk of incomplete procedures, although anxiolysis and sedation were observed. There is moderate-quality evidence suggesting that oral midazolam produces less effective sedation than chloral hydrate for completion of procedures for children undergoing non-invasive diagnostic procedures.
Resumo:
A key criterion by which any building will be judged when its environmental impact is assessed is its thermal performance. This paper describes the simulation of an office module in a three-storey university building in south eastern Australia. The module, located at the north-west corner of the top floor of the building, was chosen because it is likely to have the highest cooling load - a primary concern of energy conscious designers of commercial buildings for most parts of Australia.
In the paper, the initial key assumptions are stated, together with a description of a "reference" or base case, against which improvements in thermal performance were measured. The simulation process identified the major influences on thermal performance. This enabled changes in materials and construction, as well as basic design concepts to be evaluated. Features incorporated into the base case such as a metal roof and glazed walkway were found to have adverse influence on energy consumption, and were consequently rejected in preference for an improved design which included a hypocaust slab system on the roof of the office module. The final design was predicted to reduce the annual energy consumption for heating and cooling by 72% and 76% respectively.
La performance thermique est l'un des critegraveres cleacutes de l'eacutevaluation environnementale de tout bacirctiment. Cet article deacutecrit la simulation d'un module de bureau appartenant agrave un immeuble de trois eacutetages d'une universiteacute du sud-est de l'Australie. Ce module, situeacute agrave l'angle nord-ouest de l'eacutetage supeacuterieur du bacirctiment a eacuteteacute choisi car c'eacutetait lui qui, vraisemblablement, avait la charge de refroidissement la plus eacuteleveacutee, ce qui est une preacuteoccupation majeure des concepteurs conscients des problegravemes d'eacutenergie des bacirctiments commerciaux dans la plus grande partie du pays. Le processus de simulation a fait apparaicirctre trois influences principales sur la performance thermique par rapport agrave un cas de base. Cela a permis d'eacutevaluer les modifications apporteacutees aux mateacuteriaux et agrave la construction ainsi qu'aux avant-projets. Les caracteacuteristiques inteacutegreacutees dans le cas de base comme le toit meacutetallique et la passerelle vitreacutee avaient une influence neacutefaste sur la consommation d'eacutenergie et ont donc eacuteteacute rejeteacutees au beacuteneacutefice d'un concept ameacutelioreacute qui comprenait une dalle de type hypocauste sur le toit du module de bureau. Le concept final devrait reacuteduire la consommation annuelle d'eacutenergie pour le chauffage et le refroidissement de 72 % et 76 % respectivement, ce qui donne une ideacutee de la valeur ajouteacutee au processus de production agrave partir de proceacutedures avanceacutees de modeacutelisation et de simulation.
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Introduction: There is wide variation in emergency nursing practice in terms of initial patient assessment and the interventions implemented in response to these patient assessment findings. It is hypothesised that written ED nursing practice standards will reduce variability in documentation standards related to initial patient assessment.
Aim: This study aimed to examine the effect of written ED nursing practice standards augmented by an in-service education programme on the documentation of the initial nursing assessment.
Method: A pre-test/post-test design was used. Initial patient assessment was assessed using the Emergency Department Observation Chart. All adult patients (>18 years) who presented with chest pain and who were triaged to the general adult cubicles were eligible for inclusion in the study. Random sampling was used to select the patients for the pre-test (n = 78) and post-test groups (n = 74).
Results: There was significant improvement in documentation of all aspects of symptom assessment except quality and historical variables: pre-hospital care, cardiac risk factors, and past medical history. Improvements in documentation of elements of primary survey assessment were variable. There were significant increases in documentation of respiratory effort, chest auscultation findings, capillary refill and conscious state. There was a significant 18.3% decrease in the frequency of documentation of respiratory rate and no significant changes in documentation of oxygen saturation, heart rate or blood pressure.
Conclusion: Written ED nursing practice standards were effective in improving the documentation of some elements of initial nursing assessment for patients with chest pain. Active implementation strategies are important to ensure effective uptake of written practice standards and the relationship between nursing documentation and actual clinical practice warrants further consideration using a naturalistic approach in real practice settings.
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How do teacher educators prepare students to become teachers for a world which is global in its outlook and influences? There are now strong imperatives for teacher educators to develop pre- service students' understandings about a world which is 'global'. It is not only curriculum statements, textbooks, films, videos, that are the carriers and resources in global education but teachers themselves through their own stories
and narratives and the meanings attached to these. The role of teachers' lived experiences in teaching global education is often silenced in teacher education courses, policy documents and school classrooms.
In searching for meaning in global education, it is the capacity of the teacher to reflect not only on their own multiple identities but on the nexus between their local and global worlds and the struggle often evident here. A resource teachers have to teach global education is their own stories, lived experiences of being in a global world. This comes from giving meaning to travel, of living in a multi-cultural multi-faith world of viewing and noticing similarities and differences and giving meaning to these.
Despite increasing demands from education systems and governments for teachers to teach with a global focus, many teachers do not feel confident or prepared to do so. Importantly curriculum policy statements are carrying imperatives to teach to a global world that is rapidly changing. Curriculum statements in Society and Environment area in Australia include 'global' in their rationale. However this does not mean that global education is taught nor understood by teachers who translate these documents to practice. In curriculum documents such as those
produced by the state and territory governments there is some inclusion of global education. Singh (1998) argues that there is a marginalisation of global education in official curriculum policies in Australia. Integrating global education into different subjects is really up to the creativity, expertise and experience of teachers. If it is up to teachers to teach global education as stated by Singh then it will be the capacity of the teacher to draw on a range of resources, pedagogy and approaches to teach global education. One resource is teachers' stories and
narratives and students own lived experiences and stories.
Banks (2001, p. 5) states that "teachers must develop reflective cultural national and global identifications themselves if they are to help students become thoughtful caring and reflective citizens in a multicultural world society." Teacher educators who wish to embed global perspectives in their teaching require reflective practices on their own identities, prejudices, choice of curriculum content and pedagogy.
Teaching global education requires a conscious understanding and reflection to begin the journey of self as located in the classroom. The central issue of this paper is to bring forth emphasis on the lived experiences of teachers and teachers educators in order to develop deeper global understandings in students.
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This paper provides an overview of the main questions about men’s involvement in policies and practices toward gender equality and the key debates and issues that arise from them. It argues for the importance of locating this issue in the context of the limitations and potential of gender mainstreaming and an understanding of the gendered nature of the state and the social construction of men’s gender interests. It articulates the case for encouraging men’s involvement in gender equality, whilst being conscious of the dangers of involving men, and outlines a strategy to work through the dilemmas and tensions.
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There has been a considerable growth in the use of flexible methods of delivery for workplace learning and development. However, in designing programmes of flexible learning there is often the assumption that learners will exhibit uniformity in the ways in which they process and organise information (cognitive style), in their predispositions towards particular learning formats and media (instructional preferences) and the conscious actions they employ to deal with the demands of specific learning situations (learning strategies). In adopting such a stance one runs the risk of ignoring important aspects of individual differences in styles, preferences and strategies. Our purpose in this paper will be to: (i) consider some aspects of individual difference that are pertinent to the delivery of flexible learning in the workplace; (ii) identify some of the challenges that extant differences in styles and preferences between individuals may raise for instructional designers and learning facilitators; (iii) suggest ways in which models of flexible learning design and delivery may acknowledge and accommodate individual differences in styles and preferences through the use of an appropriate range of instructional design, learning and support strategies.
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The idea of a gateway or portal to another world is common in myth and fantasy, and, obviously, far older than the use of the same notion in computing. While computing portals take researchers to other domains of data, the use of portals in myths is often far more complex. In creation myths, the passing of portals has immense consequences for humankind, as in Adam and Eve's expulsion from their carefree existence in the Garden of Eden (unleashing the world's woes upon their descendants), and in the carrying away of Persephone by Pluto into the Underworld (leaving a legacy of cold and sunless months each year). In other types of myths, and in the fantastic tales they have bequeathed, portals provide heroes with strange and wonderful adventures, and with experiences that leave heroes irrevocably changed. This article will now explore these types of portals in more detail.The idea of a gateway or portal to another world is common in myth and fantasy, and, obviously, far older than the use of the same notion in computing. While computing portals take researchers to other domains of data, the use of portals in myths is often far more complex. In creation myths, the passing of portals has immense consequences for humankind, as in Adam and Eve's expulsion from their carefree existence in the Garden of Eden (unleashing the world's woes upon their descendants), and in the carrying away of Persephone by Pluto into the Underworld (leaving a legacy of cold and sunless months each year). In other types of myths, and in the fantastic tales they have bequeathed, portals provide heroes with strange and wonderful adventures, and with experiences that leave heroes irrevocably changed. This article will now explore these types of portals in more detail.
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This paper argues that the influence of multimedia on exhibition practices can be felt not only by the presence of multimedia interactives in the exhibition itself but more generally by the presence of similar structural principles. The argument is conducted by borrowing from Stephen Johnson’s (2005) thesis that contemporary forms of popular culture, particularly those found in video games, television and film, are based on an ‘architecture of rewards’. In taking this term across to exhibition practices, I use it to analyse an approach to the interpretation of a heritage site, which attempts neither to reconstruct its former uses nor to insert traditional forms of ‘contextual’ displays. Instead, I argue that the curatorial attempt to find ways in which the site could become the principal object of display resulted in the conscious production of narrative gaps which become the structural armature for the encouragement of game playing in a similar process to that discussed by Johnson in relation to video games.
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Deakin University’s School of Architecture and Building is renowned for producing graduates who possess relevant attributes that make them job ready for the building and construction industry. Graduate destination surveys indicate that in the last eight (8) years, 100% of all Infrastructure Logistics (Construction and Facility Management) course graduates found relevant employment. This success is a direct result of a curriculum that is responsive to industry needs alongside educational methodology that focuses on excellent teaching and research while seeking new ways of developing and delivering courses.
The Infrastructure Logistics course prepares graduates to successfully compete in today’s global job market, and allows them to showcase relevant knowledge and skills that are critical in seeking and sustaining employment. Traditionally, tailored resumes served this purpose; however, in many professional fields, professional portfolios are now becoming a more desirable way of providing a summary of relevant attributes alongside evidence of professional abilities.
Sustaining employment, appraisals, and applying for a promotion are often subject to adequate evidence of professional standards and growth. Professional bodies require records of contribution to Continuing Professional Development (CPD) schemes; and accrediting organisations require professionals applying for professional registration to provide documented evidence of their relevant experience and abilities. The Australian Institute of Project Management (AIPM 2007) requires candidates wanting to become Registered Project Managers (RegPM) to demonstrate their current work-based experience and competencies.
This paper reports on a teaching strategy adopted in the Project Management (PM) stream, offered as part of Infrastructure Logistic courses. The teaching strategy is based on a combination of constructivism theory of learning, problem and project based learning, and active learning. The strategy requires systematic reflection and conscious creation of documented evidence of PM attributes and competences in the form of a portfolio.
Preliminary results of action research monitoring the effectiveness of systematic reflection indicate that students respond very positively to the idea of professional journals and professional portfolios. Preliminary results also indicate that students accept reflection and conscious documentation of their achievements as an integral part of their study and future practice.
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AMP-activated protein kinase (AMPK) has recently emerged as a key signaling protein in skeletal muscle, coordinating the activation of both glucose and fatty acid metabolism in response to increased cellular energy demand. To determine whether AMPK signaling may also regulate gene transcription in muscle, rats were given a single subcutaneous injection (1 mg/g) of the AMP analog 5-aminoimidazole-4-carboxamide-1-ß-D-ribonucleoside (AICAR). AICAR injection activated (P < 0.05) AMPK-α2 (~2.5-fold) and transcription of the uncoupling protein-3 (UCP3, ~4-fold) and hexokinase II (HKII, ~10-fold) genes in both red and white skeletal muscle. However, AICAR injection also elicited (P < 0.05) an acute drop (60%) in blood glucose and a sustained (2-h) increase in blood lactate, prompting concern regarding the specificity of AICAR on transcription. To maximize AMPK activation in muscle while minimizing potential systemic counterregulatory responses, a single-leg arterial infusion technique was employed in fully conscious rats. Relative to saline-infused controls, single-leg arterial infusion of AICAR (0.125, 0.5, and 2.5 µg · g-1 · min-1 for 60 min) induced a dose-dependent increase (2- to 4-fold, P < 0.05) in UCP3 and HKII transcription in both red and white skeletal muscle. Importantly, AICAR infusion activated transcription only in muscle from the infused leg and had no effect on blood glucose or lactate levels. These data provide evidence that AMPK signaling is linked to the transcriptional regulation of select metabolic genes in skeletal muscle.
