Orifice diseases project - experience of the "Hospital das Clínicas" University of São Paulo Medical Center in day-hospital of anorectal disease

The treatment of malignant or benign colorectal pathologies that require more complex management are priorities in tertiary hospitals such as "Hospital das Clínicas" University of São Paulo Medical Center (HCFMUSP). Therefore, benign, uncomplicated orifice conditions are relegated to second place. The number of patients with hemorrhoids, perianal fistulas, fissures, condylomas and pilonidal cysts who seek treatment at the HFMUSP is very great, resulting in over-crowding in the outpatient clinics and a long waiting list for recommended surgical treatment (at times over 18 months). The authors describe the experience of the HCFMUSP over an eight-day period with day-hospital surgery in which 140 patients underwent surgery. Data was prospectively taken on the patients undergoing surgery for benign orifice pathologies including age, sex, diagnosis, surgery performed, immediate and late postoperative complications, and follow-up. 140 patients operated on over eight days were studied. 68 were males (48.75%) with ages ranging from 25 to 62 (mean 35.2 yrs.). Hemorrhoids was the most frequent condition encountered (82 hemorrhoidectomies, 58.6%), followed by perineal fistula (28 fistula repairs, 20.0%). The most common complication was headache secondary to rachianesthesia occurring in 9 patients (6.4%). One patient (0.7%) developed bleeding immediately PO that required reoperation. Mean follow-up was 104 days. Day-surgery characterized by quality care and low morbidity is feasible in tertiary public hospitals, permitting surgery for benign orifice pathologies on many patients within a short period of time.

The World Health Organization Multi-Professional Patient Safety Curriculum : implementation of key modules and its impact on patient safety knowledge, skills, and attitudes of medical students at the University of Algarve

ABSTRACT - Objectives: We attempted to show how the implementation of the key elements of the World Health Organization Patient Safety Curriculum Guide Multi-professional Edition in an undergraduate curriculum affected the knowledge, skills, and attitudes towards patient safety in a graduate entry Portuguese Medical School. Methods: After receiving formal recognition by the WHO as a Complementary Test Site and approval of the organizational ethics committee , the validated pre-course questionnaires measuring the knowledge, skills, and attitudes to patient safety were administered to the 2nd and3rd year students pursuing a four-year course (N = 46). The key modules of the curriculum were implemented over the academic year by employing a variety of learning strategies including expert lecturers, small group problem-based teaching sessions, and Simulation Laboratory sessions. The identical questionnaires were then administered and the impact was measured. The Curriculum Guide was evaluated as a health education tool in this context. Results: A significant number of the respondents, 47 % (n = 22), reported having received some form of prior patient safety training. The effect on Patient Safety Knowledge was assessed by using the percentage of correct pre- and post-course answers to construct 2 × 2 contingency tables and by applying Fishers’ test (two-tailed). No significant differences were detected (p < 0.05). To assess the effect of the intervention on Patient Safety skills and attitudes, the mean and standard deviation were calculated for the pre and post-course responses, and independent samples were subjected to Mann-Whitney’s test. The attitudinal survey indicated a very high baseline incidence of desirable attitudes and skills toward patient safety. Significant changes were detected (p < 0.05) regarding what should happen if an error is made (p = 0.016), the role of healthcare organizations in error reporting (p = 0.006), and the extent of medical error (p = 0.005). Conclusions: The implementation of selected modules of the WHO Patient Safety Curriculum was associated with a number of positive changes regarding patient safety skills and attitudes, with a baseline incidence of highly desirable patient safety attitudes, but no measureable change on the patient safety knowledge, at the University of Algarve Medical School. The significance of these results is discussed along with implications and suggestions for future research.

Experience with the first Internet-based course at the Faculty of Medicine, University of São Paulo

PURPOSE: The Internet expands the range and flexibility of teaching options and enhances the ability to process the ever-increasing volume of medical knowledge. The aim of this study is to describe and discuss our experience with transforming a traditional medical training course into an Internet-based course. METHOD: Sixty-nine students were enrolled for a one-month course. They answered pre- and post-course questionnaires and took a multiple-choice test to evaluate the acquired knowledge. RESULTS: Students reported that the primary value for them of this Internet-based course was that they could choose the time of their class attendance (67%). The vast majority (94%) had a private computer and were used to visiting the Internet (75%) before the course. During the course, visits were mainly during the weekends (35%) and on the last week before the test (29%). Thirty-one percent reported that they could learn by reading only from the computer screen, without the necessity of printed material. Students were satisfied with this teaching method as evidenced by the 89% who reported enjoying the experience and the 88% who said they would enroll for another course via the Internet. The most positive aspect was freedom of scheduling, and the most negative was the lack of personal contact with the teacher. From the 80 multiple-choice questions, the mean of correct answers was 45.5, and of incorrect, 34.5. CONCLUSIONS: This study demonstrates that students can successfully learn with distance learning. It provides useful information for developing other Internet-based courses. The importance of this new tool for education in a large country like Brazil seems clear.

Use of licit and illicit drugs at the university of Alfenas

This paper reports the study of drug consumption carried out within the population of undergraduate students from 2 colleges of Alfenas, in the state of Minas Gerais state. Both licit and illicit drugs were studied, including alcohol, tobacco, marijuana, cocaine, heroin, crack, inhalants, glue, tranquilizers, stimulants, and others. METHODOLOGY: The research included a wide bibliographical search and the application of a questionnaire to approximately 23% of the students (total of 6500 students). RESULTS: A total of 1500 students participated in this investigation. The results demonstrated that there was a significant consumption of both licit and illicit drugs. The pattern of drug consumption in the research sample was similar to other investigations conducted in Brazil and in other countries. DISCUSSION: It was observed that 55% of the university students use drugs. However, the most surprising finding was that most of the students (88%) answered "yes" to the inquiry, "Have you already tried any type of drug, including alcohol and cigarettes?" The students revealed that they had taken drugs even prior to the admission to the university. The results suggest clearly that the university environment does not necessarily represent the starting point for student drug consumption.

Vocalizations of primary forest frog species in the Central Amazon.

The calls of 18 species of Amazonian forest frogs were recorded in 3 localities: the Tapajos National Park near Itaituba, the Reserva Ducke near Manaus, and the INPA-WWF reserves near Manaus. Structural and time parameters and sonographs of these calls including previously undescribed vocalization by 10 species are presented. Unlike open habitat species, several forest frong species characteriscally demonstrated one on more of the following temporal parameters: very low call rates, sporadic intervals, infrequent nights of calling and synchronized chorusing. It is hypothesized that predation has influenced the evolution of vocal behaviour in Amazonian forest frogs.

The relationship between stem vessel parameters and the development of strata in the early stages of secondary forest succession in Amazonia

In order to compare the development of strata in the early stages of secondary forest succession with vessel parameters of the tree species, a forest inventory was carried out in 4-year (Q1: 48 m2), 11-year (Q2: 400 m2) and 20-year (Q3: 400 m2) forests and vessel parameters were investigated from stem cross sections of 18 species obtained in Q2. Thirty three species (21 families), 77 species (35 families), 39 species (20 families) were found in Ql, Q2, Q3, respectively. The percentage of dead individuals, dead stems and the percentage of individuals with multiple stems increased with time after clear cutting. Also, the total D2H of Q3 was 26.1 times that of Q1, and the development of strata started in Q2 and Q3. The image analysis of vessel size, area and number of vessels revealed that species which reach the forest canopy had a large D2H value, vessel diameter and area, while species which remain near the forest floor had smaller ones. Poecilanthe effusa (Huber) Ducke is an example of the latter case, with a large number of individuals and abundant sprouting of new stems from stumps, but with high mortality.

Changes in institutional governance and management of higher education in Laos: National University of Laos

PhD thesis in Educational Sciences (specialization in Politics of Education).

Environmental determinants for natural regeneration of gallery forest at the Cerrado/Amazonia boundaries in Brazil

Natural regeneration and structure and their relationship to environmental variables were studied in three sections of a gallery forest, in Eastern Mato Grosso, Brazil (14º43′S and 52º21′W). The assumption was that natural regeneration is constrained by environmental determinants at all stages of development of the tree community. The objective was to analyse the forest structure and to verify the relationship between species distribution and abundance at different stages of regeneration and environmental variables. In each section, 47 contiguous (10x10m) permanent plots were established to sample trees (gbh≥15cm), following a systematic design. Seedlings (0.01 to 1m height), saplings (1.01 to 2m) and poles (from 2.01m height to gbh<15cm) were sampled in sub-plots of 1x1m, 2x2m and 5x5m, respectively. In each plot, soil properties, gaps projection, bamboos, rocky cover, declivity and depth of ground watertable were determined. The relationships between the environmental variables with trees and seedling communities were assessed by canonical correspondence analysis. In spite of the sections being near to each other, they presented large differences in floristics, structure and site conditions. The forest soil presented a low cation exchange capacity and a high level of Al saturation. The occurrence of bamboos and gaps and the depth of ground watertable limited the occurrence of poles and trees. The high degree of structural heterogeneity for each regeneration category was related primarily to a humidity gradient; but soil fertility (Ca+Mg) was also a determinant of seedling and sapling communities.

Carnegie Institution of Washington publication.

no.248,v.1 (1919)

Carnegie Institution of Washington publication.

no.248,v.2 (1920)

Carnegie Institution of Washington publication.

no.248,v.3 (1922)

Carnegie Institution of Washington publication.

no.248,v.4 (1923)

Diseño y evaluación de alternativas de manejo sustentable para la recuperación y conservación de bosques degradados de la región del Espinal en la provincia de Córdoba. Design and evaluation of sustainable management alternatives for the recovery and conservation of degraded forest in the Espinal Region in Córdoba province.

El avance de la frontera agropecuaria y la urbanización han reducido la superficie boscosa del Espinal en Córdoba a fragmentos que son sumamente valiosos como relictos del ambiente original del Algarrobal y como barreras frente a la acción erosiva del agua y los vientos. Por su estructura, degradada y enmarañada, el productor agropecuario generalmente los visualiza como una molestia ya que le restan superficie apta para el cultivo y resultan poco aprovechables para el pastoreo de los animales. Bajo pautas de manejo adecuadas estos bosquecillos podrían rehabilitarse para el aprovechamiento del ganado y otros usos complementarios. Para que el productor local cuente con herramientas de manejo sustentable de sus recursos naturales es necesario generar información confiable para la zona. En ese contexto, se plantea la siguiente Hipótesis General: Existen alternativas de manejo que, aplicadas sobre los bosques del Espinal, permiten recuperar y conservar la biodiversidad a la vez que mejoran la rentabilidad del productor. El Objetivo General es diseñar y evaluar, en términos ecológicos, tecnológicos y socio-económicos, alternativas de manejo sustentable de bosques degradados del Espinal de la provincia de Córdoba tendientes a su recuperación y conservación. El proyecto se localizará en el bosque fragmentado del Campo Escuela de la FCA-UNC. Se establecerán parcelas con distintos niveles de cobertura arbustiva en las que se medirán el efecto de los arbustos sobre la regeneración de especies arbóreas deseables, la producción y calidad de la pastura, el crecimiento de los árboles y las condiciones edáficas del sistema. Además, la incidencia del ganado vacuno sobre la regeneración de especies arbóreas deseables, la riqueza y abundancia de especies forrajeras deseables y las condiciones edáficas del sistema. Se hará enriquecimiento con plantines de tres especies de Prosopis tanto en el bosque con distintos anchos de fajas como en suelo desmontado, para evaluar su comportamiento. También se probará la diseminación y establecimiento posterior de estas especies por medio de la ingesta del ganado vacuno. Se relevarán especies medicinales, aromáticas, melíferas, tintóreas y ornamentales nativas, y se las valorará económicamente según su uso actual y potencial en esta y otras zonas de la provincia y el país. Se efectuará la caracterización socio-económica y ambiental del área circundante al Campo Escuela y mediante encuestas se determinará el grado de valorización del bosque que tienen los pobladores zonales. Se realizará el análisis económico y financiero del sistema propuesto versus el sistema sin proyecto, considerando bienes producidos y servicios ambientales del bosque y se socializará el proyecto a través de encuestas y reuniones participativas con los productores zonales. Para el análisis de toda la información se usará el software INFOSTAT 2007. Se harán tablas y gráficos de estadística descriptiva para visualizar la distribución de datos. Se usará análisis de correlación, análisis de regresión lineal múltiple, ANAVA y test a posteriori. Se espera generar pautas preliminares de manejo, sencillas y económicas, fácilmente adoptables por los productores de la región, que aseguren la persistencia de estos fragmentos boscosos, relictos de la vegetación original del Espinal.