Telemedicine for new neurological outpatients: putting a randomized controlled trial in the context of everyday practice

In a retrospective review, the telemedical management of 65 outpatients from a randomized controlled trial (RCT) of telemedicine for non-urgent referrals to a consultant neurologist was compared with the management of 76 patients seen face to face in the same trial, with that of 150 outpatients seen in the neurology clinics of district general hospitals and with that of 102 neurological outpatients seen by general physicians. Outcome measures were the numbers of investigations and of patient reviews. The telemedicine group did not differ significantly from the 150 patients seen face to face by neurologists in hospital clinics in terms of either the number of investigations or the number of reviews they received. Patients from the RCT seen face to face had significantly fewer investigations but a similar number of reviews to the other 150 patients seen face to face by neurologists (the disparity in the number of investigations may explain the negative result for telemedicine in that RCT). Patients with neurological symptoms assessed by general physicians had significantly more investigations and were reviewed significantly more often than all the other groups. Patients from the RCT seen by telemedicine were not managed significantly differently from those seen face to face by neurologists in hospital clinics but had significantly fewer investigations and follow-ups than those patients managed by general physicians. The results suggest that management of new neurological outpatients by neurologists using telemedicine is similar to that by neurologists using a face-to-face consultation, and is more efficient than management by general physicians.

Knowledge of the national emergency telephone number and prevalence and characteristics of those trained in CPR in Queensland: baseline information for targeted training interventions

Members of the community contribute to survival from out-of-hospital cardiac arrest by contacting emergency medical services and performing cardiopulmonary resuscitation (CPR) prior to the arrival of an ambulance. In Australia there is a paucity of information of the extent that community members know the emergency telephone number and are trained in CPR. A survey of Queensland adults (n = 4490) was conducted to ascertain current knowledge and training levels and to target CPR training. Although most respondents (88.3%) could state the Australian emergency telephone number correctly, significant age differences were apparent (P < 0.001). One in five respondents aged 60 years and older could not state the emergency number correctly. While just over half the respondents (53.9%) had completed some form of CPR training, only 12.1% had recent training. Older people were more likely to have never had CPR training than young adults. Additional demographic and socio-economic differences were found between those never trained in CPR and those who were. The results emphasise the need to increase CPR training in those aged 40 and over, particularly females, and to increase the awareness of the emergency telephone number amongst older people. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.

Phenomenological turbulence and innovation in knowledge systems

Most considerations of knowledge management focus on corporations and, until recently, considered knowledge to be objective, stable, and asocial. In this paper we wish to move the focus away from corporations, and examine knowledge and national innovation systems. We argue that the knowledge systems in which innovation takes place are phenomenologically turbulent, a state not made explicit in the change, innovation and socio-economic studies of knowledge literature, and that this omission poses a serious limitation to the successful analysis of innovation and knowledge systems. To address this lack we suggest that three evolutionary processes must be considered: self-referencing, self-transformation and self-organisation. These processes, acting simultaneously, enable system cohesion, radical innovation and adaptation. More specifically, we argue that in knowledge-based economies the high levels of phenomenological turbulence drives these processes. Finally, we spell out important policy principles that derive from these processes.

Beyond hearing aid fitting: improving communication for older adults

Many older adults with hearing impairment continue to have substantial communication difficulties after being fitted with hearing aids, and many do not choose to wear hearing aids. Two group communication education programs aimed at such older people are described. The 'Keep on Talking' program has a health promotion focus, and is aimed at maintaining communication for older adults living in the community. An experimental group (n=120) attended the program, and a control group (n=130) received a communication assessment but no intervention. Significant improvements were found in the experimental participants in terms of knowledge about communication changes with age and about strategies to maintain communication skills. At the follow-up evaluation at 1 year, 45% of the experimental group, compared to 10% of the control group, had acted to improve their communication skills. The 'Active Communication Education' program focuses on the development of problem-solving strategies to improve communication in everyday life situations. Preliminary outcomes have been assessed on a small scale (n=14) to date. It is concluded that communication programs represent an important adjunct to, or supplement for, the traditional approach that focuses on hearing aid fitting.

Valuing of firm's prior knowledge: A measure of knowledge distance

Knowledge, especially scientific and technological knowledge, grows according to knowledge trajectories and guideposts that make up the prior knowledge of an organization. We argue that these knowledge structures and their specific components lead to successful innovation. A firm's prior knowledge facilitates the absorption of new knowledge, thereby renewing a firm's systematic search, transfer and acquisition of knowledge and capabilities. In particular, the exponential growth in biotechnology is characterized by the convergence of disparate scientific and technological knowledge resources. This paper examines the shift from protein-based to DNA-based diagnostic technologies as an example, to quantify the value of a firm's prior knowledge using relative values of knowledge distance. The distance between core prior knowledge and the rate of transition from one knowledge system to another has been identified as a proxy for the value a firm's prior knowledge. The overall difficulty of transition from one technology paradigm to another is discussed. We argue this transition is possible when the knowledge distance is minimal and the transition process has a correspondingly high value of absorptive capacities. Our findings show knowledge distance is a determinant of the feasibility, continuity and capture of scientific and technological knowledge. Copyright © 2003 John Wiley & Sons, Ltd.

Everyday incivility: towards a benchmark

Commonplace incivility is a topic of longstanding interest within social theory, perhaps best exemplified by Goffman's studies of the interaction order. Nevertheless we know very little about its distribution and expression in everyday life. Current empirical work is dominated by criminological agendas. These tend to focus on more serious and illegal activities rather than minor deviant acts that are simply inconsiderate or rude. The paper reports findings from a focus group study conducted in Melbourne, Australia that set out to benchmark everyday incivilities. The results suggest that perpetrators of incivility have a surprisingly broad social distribution as does the range of locales that might be characterised as 'high risk'. Turning to the work of Putnam and Wolfe, we call for a research focus on low-level incivilities as key symptoms of the state of civic virtue and the strength of moral ties within civil society. Drawing on Virilio, Bauman and Durkheim, it is suggested that the experience of incivility is underpinned by the growth of freedom and movement in contemporary urban settings, and has ambivalent implications that not only invoke boundary maintenance and retreatism, but also offer the possibility for boundary expansion and tolerance of difference.

Knowledge-based system on optimum design of liquid retaining structures with genetic algorithms

This paper delineates the development of a prototype hybrid knowledge-based system for the optimum design of liquid retaining structures by coupling the blackboard architecture, an expert system shell VISUAL RULE STUDIO and genetic algorithm (GA). Through custom-built interactive graphical user interfaces under a user-friendly environment, the user is directed throughout the design process, which includes preliminary design, load specification, model generation, finite element analysis, code compliance checking, and member sizing optimization. For structural optimization, GA is applied to the minimum cost design of structural systems with discrete reinforced concrete sections. The design of a typical example of the liquid retaining structure is illustrated. The results demonstrate extraordinarily converging speed as near-optimal solutions are acquired after merely exploration of a small portion of the search space. This system can act as a consultant to assist novice designers in the design of liquid retaining structures.

A coupled knowledge-based expert system for design of liquid-retaining structures

This paper describes a coupled knowledge-based system (KBS) for the design of liquid-retaining structures, which can handle both the symbolic knowledge processing based on engineering heuristics in the preliminary synthesis stage and the extensive numerical crunching involved in the detailed analysis stage. The prototype system is developed by employing blackboard architecture and a commercial shell VISUAL RULE STUDIO. Its present scope covers design of three types of liquid-retaining structures, namely, a rectangular shape with one compartment, a rectangular shape with two compartments and a circular shape. Through custom-built interactive graphical user interfaces, the user is directed throughout the design process, which includes preliminary design, load specification, model generation, finite element analysis, code compliance checking and member sizing optimization. It is also integrated with various relational databases that provide the system with sectional properties, moment and shear coefficients and final member details. This system can act as a consultant to assist novice designers in the design of liquid-retaining structures with increase in efficiency and optimization of design output and automated record keeping. The design of a typical example of the liquid-retaining structure is also illustrated. (C) 2003 Elsevier B.V All rights reserved.

Does participation in a pain course based on the international association for the study of pain's curricula guidelines change student knowledge about pain?

The People in Pain course was set up as a joint initiative of the Departments of Occupational Therapy and Physiotherapy within the School of Health and Rehabilitation Sciences at The University of Queensland. It was instigated in response to the publication of Pain Curricula for Occupational Therapy and Physiotherapy by the International Association for the Study of Pain (IASP) in 1994 (1). The first year it was offered, the "People in Pain" course comprised 14 h of lecture content. It was then expanded to encompass 28 h of lectures and seminar involvement. OBJECTIVES: To evaluate the impact of participation in a university pain course that meets the IASP pain curricula guidelines to increase health professional students' knowledge about pain. METHODS: Students who participated in the People in Pain course over the first three years were invited to complete the Revised Pain Knowledge and Attitudes Questionnaire (R-PKAQ) pre- and postcourse. Data obtained from 22 students in the short course formed a pilot project, and data from 22 students in the longer version of the course were used in the present study. RESULTS: Examination of the correlation matrix indicated substantial correlations between all R-PKAQ subscales except physiological basis of pain and pharmacological management of pain. In both the pilot project during the first year of the course and the expanded course in the following two years, significant improvement was found in the students' knowledge on five of the six subscales of the R-PKAQ: physiological basis of pain, psychological factors of pain perception, assessment and measurement of pain, cognitive-behavioural methods of pain relief, and pharmacological management of pain. Improvements in the developmental aspects of pain perception subscale failed to reach significance. CONCLUSIONS: An integrated pain course developed according to the pain curriculum guidelines developed by the IASP resulted in increased student knowledge regardless of the length of the program attended.

Os espaços/tempos da pesquisa sobre o professor

Analisa como a questão do professor se apresenta na produção científica brasileira. Toma como base o discurso apresentado na SBPC, por, entre outros fatores, ser originário de entidade que congrega cientistas de todas as áreas de conhecimento e ser representativo da produção docente e discente de graduação e pós-graduação das várias regiões e instituições do país. Usa como metodologia a abordagem histórico-documental. Utiliza como fontes os resumos publicados nos anais de 2001 e da década de 1980. Os resultados evidenciam: 1) um aumento extraordinário do número de trabalhos sobre o professor, a permanência da origem institucional (universidade pública) e territorial (Sudeste); 2) alteração do predomínio do enfoque temático, da formação do professor, em nível superior e médio, para a prática pedagógica exercida no cotidiano escolar do ensino fundamental; 3) alteração no enfoque metodológico, passando dos estudos exploratório-descritivos para a pesquisa-ação crítica voltada para a intervenção no cotidiano escolar do ensino fundamental. Conclui pela negação dos espaços/tempos da produção científica sobre o professor, visto que os espaços/tempos são ações de sujeitos históricos, que exibem operações de troca, intercâmbios, compartilhamentos coletivos e não a determinação do "lugar próprio" do pesquisador e/ou da "autoria marcada". Os discursos expressos pareceram, cada um, ocupar um "lugar próprio" e isolado, não permitindo a sua acepção como conjunto da obra sobre a questão do professor, não se vislumbrando uma tessitura temática coletiva, com gênese nos espaços/tempos da academia em sua relação com a realidade educacional e social do Brasil.

Um seminário dispositivo : a humanização do Sistema Único de Saúde (SUS) em debate

O artigo discute o processo de construção do seminário "Humanização do SUS em Debate" indicando sua conexão com os desafios atuais do SUS e com as proposições da Política Nacional de Humanização (PNH). Apresenta os princípios e diretrizes da Política Nacional de Humanização do SUS e seu processo de construção, discutindo os diversos sentidos do termo humanização. Ao final é indicada a aposta metodológica do seminário que se destinou a promover um amplo debate sobre a humanização do SUS, por meio de rodas de conversação que objetivavam a interface com profissionais que atuam na formação dos trabalhadores do SUS, responsáveis pela produção de conhecimento na área da saúde e pela formação dos acadêmicos neste campo.

A criança com Síndrome de Asperger na educação infantil : um estudo de caso

Esta pesquisa teve como objetivo compreender as ações pedagógicas constituídas por uma unidade municipal de ensino de Vitória/ES, visando ao processo de inclusão escolar de uma criança com Síndrome de Asperger no contexto da Educação Infantil. Contou com as contribuições teóricas dos estudos da matriz histórico-cultural e de autores dedicados a estudar a infância, como Kramer, Sarmento, Aries, dentre outros, bem como de pesquisadores interessados em investigar os pressupostos da Educação Especial em uma perspectiva inclusiva. Como aporte teórico-metodológico, apoiou-se no estudo de caso do tipo etnográfico que advoga pela possibilidade de, por meio da pesquisa científica, produzir conhecimento sobre a realidade social. O trabalho de pesquisa foi realizado em uma unidade municipal de Educação Infantil de Vitória/ES, envolvendo uma criança com Síndrome de Asperger, professores, pedagogos, dirigente escolar e responsável pelo estudante investigado. O processo de coleta de dados se efetivou no período de março de 2013 a setembro de 2013. O pesquisador esteve de uma a duas vezes por semana no campo de pesquisa, participando das observações em sala de aula, em espaços para planejamento e formação continuada e também observando momentos informais na entrada, recreio e saída dos alunos. Para a organização do estudo, trabalhou com quatro eixos: a) ações implementadas em favor do processo de inclusão escolar de alunos com Síndrome de Asperger no contexto da Educação Infantil; b) proposta pedagógica do CMEI “Alegria da Cinderela”: espaços de planejamento, formação e utilização dos apoios pedagógicos para a inclusão escolar; c) concepções dos profissionais envolvidos na pesquisa e da família sobre a inclusão escolar da criança com Síndrome de Asperger; d) principais possibilidades e/ou dificuldades encontradas pela unidade de ensino mediante o processo de ensino-aprendizagem da criança com Síndrome de Asperger. Como resultados, a pesquisa aponta: a importância de pensar nessas crianças como sujeitos de direitos e capazes de aprender; a necessidade de investimentos na formação inicial e continuada de professores para que os estudantes tenham maiores possibilidades de aprender; a urgência de o professor assumir a inclusão escolar como um movimento ético comprometido com a formação e com o reconhecimento da diversidade/diferença humana; a necessidade de reconhecer o cotidiano da Educação Infantil como um rico espaço para todas as crianças se desenvolverem e produzirem conhecimentos com seus pares e por meio das mediações pedagógicas dos professores.

Redes de saberesfazeres, complexidade e tensões : os cotidianos do ensino médio de uma escola pública do Espírito Santo

A ciência com suas verdades passou a ser um artefato essencial nos cotidianos escolares. Esses saberes se enredam com outros saberes que despotencializados e silenciados, permanecem nos interstícios do discurso hegemônico da modernidade na escola causando tensões. Potencializar a ocorrência dessas redes nesses cotidianos pode intensificar essas tensões e assim abalar esse domínio da ciência. Os muitos caminhos possíveis de serem percorridos nas tessituras desprivilegiam quaisquer saberes e fazeres que se pretendem exclusivos. Assumindo a metáfora das redes, os praticantes da escola podem potencializar as inter-relações que ocorrem na vida. A remoção de instâncias de poder hierárquico de saberes, enredando-os e o compartilhamento solidário das práticasteoriaspráticas, não significa a diluição da autoridade. Agora a autoridade cumpre um novo papel que é de constituir uma rede de relações de autoridade partilhada. Desejamos perceber esses múltiplos sentidos e problematizar o quão potentes são ou não para a vida. Participamos juntamente com os alunos e alunas das aulas e posteriormente, os convidamos para conversasentrevistas, gravando e fotografando esses momentos. Percorremos, nos turnos matutino e noturno, todos os seus espaçostempos, nos conectando nas redes que se tecem. Optamos por estar nas turmas de ensino médio de formação geral e nas turmas de ensino médio na modalidade Educação de Jovens e Adultos. As entrevistasconversas foram feitas com três alunos ao mesmo tempo, sempre de uma mesma turma, para que se estabelecesse uma conversa e para que a produção de sentidos dos cotidianos da escola pudesse ser mais potencializada. Dos alunos entrevistados, estão entre os seus desejos mais comuns para além dos saberes científicos, as atividades esportivas, artísticas, literárias, religiosas, cursos de formação profissional, dança, canto, campanhas educativas, passeios. As relações de amizade e outros modos relacionais como entre professores e alunos, têm sido citados com grande frequência, pelos estudantes, nas entrevistasconversas. Não tem se conseguido implantar na sua totalidade os preceitos da modernidade nos escola. Há, portanto, um visível esgotamento do monopólio do comportamento científico nos cotidianos da escola pública pesquisada. São nesses espaçostempos escolares nos quais pode se dar a experiência. Apesar do discurso moderno na escola produzir mecanismos que impedem a experiência, esse controle é acompanhado de diversos mecanismos de escapes. É pela “voz” dos alunos que se apresentam as ausências da escola. A “voz” dos estudantes é a grande presença na escola e sua grande potência. Talvez esse seja o maior desperdício no contexto educacional escolar.