Guidelines on the standards for the training of specialised health professionals dealing with breast cancer.

According to EUSOMA position paper 'The requirements of a specialist breast unit', each breast unit should have a core team made up of health professionals who have undergone specialist training in breast cancer. In this paper, on behalf of EUSOMA, authors have identified the standards of training in breast cancer, to harmonise and foster breast care training in Europe. The aim of this paper is to contribute to the increase in the level of care in a breast unit, as the input of qualified health professionals increases the quality of breast cancer patient care.

John Warren's copy of votes from a meeting of the Boston Medical Society, 1784 May 3

This document lists the eleven votes cast at a meeting of the Boston Medical Society on May 3, 1784. It was authorized as a "true coppy" by Thomas Kast, the Secretary of the Society. The following members of the Society were present at the meeting, all of them doctors: James Pecker, James Lloyd, Joseph Gardner, Samuel Danforth, Isaac Rand, Jr., Charles Jarvis, Thomas Kast, Benjamin Curtis, Thomas Welsh, Nathaniel Walker Appleton, and doctors whose last names were Adams, Townsend, Eustis, Homans, and Whitwell. The document indicates that a meeting had been held the previous evening, as well (May 2, 1784), at which the topics on which votes were taken had been discussed. The votes, eleven in total, were all related to the doctors' concerns about John Warren and his involvement with the emerging medical school (now Harvard Medical School), that school's relation to almshouses, the medical care of the poor, and other related matters. The tone and content of these votes reveals anger on the part of the members of the Boston Medical Society towards Warren. This anger appears to have stemmed from the perceived threat of Warren to their own practices, exacerbated by a vote of the Harvard Corporation on April 19, 1784. This vote authorized Warren to apply to the Overseers of the Poor for the town of Boston, requesting that students in the newly-established Harvard medical program, where Warren was Professor of Anatomy and Surgery, be allowed to visit the hospital of the almshouse with their professors for the purpose of clinical instruction. Although Warren believed that the students would learn far more from these visits, in regards to surgical experience, than they could possibly learn in Cambridge, the proposal provoked great distrust from the members of the Boston Medical Society, who accused Warren of an "attempt to direct the public medical business from its usual channels" for his own financial and professional gain.

MITIE C-Arm - Advanced innovation in education

Aim: In 2013 QUT introduced the Medical Imaging Training Immersive Environment (MITIE) as a virtual reality (VR) platform that allowed students to practice general radiography. The system software has been expanded to now include C-Arm. The aim of this project was to investigate the use of this technology in the pedagogy of undergraduate medical imaging students who have limited to no experience in the use of the C-Arm clinically. Method: The Medical Imaging Training Immersive Environment (MITIE) application provides students with realistic and fully interactive 3D models of C-Arm equipment. As with VR initiatives in other health disciplines (1–2) the software mimics clinical practice as much as possible and uses 3D technology to enhance 3D spatial awareness and realism. The application allows students to set up and expose a virtual patient in a 3D environment as well as creating the resultant “image” for comparison with a gold standard. Automated feedback highlights ways for the student to improve their patient positioning, equipment setup or exposure factors. The students' equipment knowledge was tested using an on line assessment quiz and surveys provided information on the students' pre-clinical confidence scale, with post-clinical data comparisons. Ethical approval for the project was provided by the university ethics panel. Results: This study is currently under way and this paper will present analysis of initial student feedback relating to the perceived value of the application for confidence in a high risk environment (i.e. operating theatre) and related clinical skills development. Further in-depth evaluation is ongoing with full results to be presented. Conclusion: MITIE C-Arm has a development role to play in the pre-clinical skills training for Medical Radiation Science students. It will augment their theoretical understanding prior to their clinical experience. References 1. Bridge P, Appleyard R, Ward J, Phillips R, Beavis A. The development and evaluation of a virtual radiotherapy treatment machine using an immersive visualisation environment. Computers and Education 2007; 49(2): 481–494. 2. Gunn T, Berry C, Bridge P et al. 3D Virtual Radiography: Development and Initial Feedback. Paper presented at the 10th Annual Scientific Meeting of Medical Imaging and Radiation Therapy, March 2013 Hobart, Tasmania.

Education for social responsibility: Ethics and imagination for engaging students and teachers in educational reform

In this chapter we make assumptions about the primary role of education for the life of its beneficiaries and for society. Undoubtedly, formal education plays an important role in enhancing the likelihood for participation in future social life, including enjoyment and employment, by the student as well as the development of the well being of society in general. Similarly, education is often seen as a main means for intergenerational transmission of knowledge and culture. However, as Dewey (1916) argues, in liberal societies, education has the capacity of enhancing democratic participation in society that goes beyond passive participation by its members. One can argue that the achievement of the ideals of democracy demands a free and strong education system. In other words, while education can function as an instrument to integrate students into the present society, it also has the potential to become an instrument for its transformation by means of which citizens can develop an understanding of how their society functions and a sense of agency towards its transformation. Arguably, this is what Freire (1985) meant when he talked about the role of education to “read and write” the world. A stream of progressive educators (e.g., Apple (2004), Freire, (1985), Giroux (2001) and McLaren (2002)) taught us that the reading of the world that is capable of leading into writing the world is a critical reading; i.e., a reading that poses “Why” questions and imagines “What else can be” (Carr & Kemmis, 1987).

Self-management education for cystic fibrosis

Background: Self-management education may help patients with cystic fibrosis and their families to choose, monitor and adjust treatment requirements for their illness, and also to manage the effects of illness on their lives. Although self-management education interventions have been developed for cystic fibrosis, no previous systematic review of the evidence of effectiveness of these interventions has been conducted. Objectives: To assess the effects of self-management education interventions on improving health outcomes for patients with cystic fibrosis and their caregivers. Search methods: We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register (date of the last search: 22 August 2013). We also searched databases through EBSCO (CINAHL; Psychological and Behavioural Sciences Collection; PsychInfo; SocINDEX) and Elsevier (Embase) and handsearched relevant journals and conference proceedings (date of the last searches: 01 February 2014 ). Selection criteria: Randomised controlled trials, quasi-randomised controlled trials or controlled clinical trials comparing different types of self-management education for cystic fibrosis or comparing self-management education with standard care or no intervention. Data collection and analysis: Two authors assessed trial eligibility and risk of bias. Three authors extracted data. Main results: Four trials (involving a total of 269 participants) were included. The participants were children with cystic fibrosis and their parents or caregivers in three trials and adults with cystic fibrosis in one trial. The trials compared four different self-management education interventions versus standard treatment: (1) a training programme for managing cystic fibrosis in general; (2) education specific to aerosol and airway clearance treatments; (3) disease-specific nutrition education; and (4) general and disease-specific nutrition education. Training children to manage cystic fibrosis in general had no statistically significant effects on weight after six to eight weeks, mean difference -7.74 lb (i.e. 3.51 kg) (95% confidence interval -35.18 to 19.70). General and disease-specific nutrition education for adults had no statistically significant effects on: pulmonary function (forced expiratory volume at one second), mean difference -5.00 % (95% confidence interval -18.10 to 8.10) at six months and mean difference -5.50 % (95% confidence interval -18.46 to 7.46) at 12 months; or weight, mean difference - 0.70 kg (95% confidence interval -6.58 to 5.18) at six months and mean difference -0.70 kg (95% confidence interval -6.62 to 5.22) at 12 months; or dietary fat intake scores, mean difference 1.60 (85% confidence interval -2.90 to 6.10) at six months and mean difference 0.20 (95% confidence interval -4.08 to 4.48) at 12 months. There is some limited evidence to suggest that self-management education may improve knowledge in patients with cystic fibrosis but not in parents or caregivers. There is also some limited evidence to suggest that self-management education may result in positively changing a small number of behaviours in both patients and caregivers. Authors' conclusions: The available evidence from this review is of insufficient quantity and quality to draw any firm conclusions about the effects of self-management education for cystic fibrosis. Further trials are needed to investigate the effects of self-management education on a range of clinical and behavioural outcomes in children, adolescents and adults with cystic fibrosis and their caregivers.

What Education Studies is and what it might be

Education Studies at the University of Greenwich is presented as an example of what Education Studies is – at least at one Higher Education Institution. As a field of practice to which a body of knowledge can be applied, Education Studies shares common features with other disciplinary fields of study. It is also unique in that its field – learning, is also what its students do – learn. What Education Studies isn’t is then discussed in relation to studies of schooling, the psychology of learning, sociology of education, traditional education degrees and teacher training. Lastly, what Education Studies could become is presented with reference to Ranson’s (1993) argument for the centrality of education as the common focus of all HE study. It is suggested that the subject could then contribute to expanding critical space in (higher) education through making research/ scholarship and creation an integral part of the Independent Study of all students at all levels of learning. This would be a necessary complement to the wider democratic transformation now demanded for human survival. It would also accord with what Marx called humanity’s “species being” as a “learning animal” (Morris). Such a social theory of learning can discriminate between information and competence at one level of learning and (corresponding terms) knowledge and skill at another more generalised level in relation to new divisions of knowledge and labour. Potentially these levels can be combined to create a new form of polytechnic learning, relating theory to practice, education to training and further to higher education.

Foreskin surgery under local anaesthetic – OK? Or oh no!

Aim: Foreskin surgical procedures such as circumcision, prepuceplasty, frenuloplasty, dorsal slit, reduction of paraphimosis etc. in the adult male is usually performed by both general surgeons and urologists. Our aim was to evaluate the acceptance of performing these procedures in the day procedure unit or in the emergency unit under penile block. 
Method: Fifty patients who underwent foreskin surgeries under local anaesthetic (LA) were evaluated with their experience. Twenty patients who underwent circumcision, 20 patients who underwent foreskin preserving operations such as frenuloplasty or prepuceplasty and 10 patients who underwent other procedures such as reduction of paraphimosis (five) and dorsal slit (five) were included inthe study. The patients were asked about their symptoms such as pain or discomfort during local infiltration of lignocaine, any discomfort during the actual procedure, post-operative discomfort and general acceptance. All the patients were given penile block using smaller size needle (25 gauge, 5/8th inch orange sterile luer slip hypodermic needle) and 1% plain lignocaine. Thirty doctors from general surgery (10), urology (10) and emergency medicine (10) participated in the survey. They were asked about their opinion, confidence and preference about performing foreskin surgical procedures under LA. This included both junior trainees, middle grade doctors and consultants. The majority of middle grade doctors and consultants were fairly confident in performing procedures under LA, whereas the junior trainees in surgery, urology and emergency were lacking confidence. 
Conclusion: Penile block is a safe and effective way ofproviding sufficient anaesthesia for foreskin surgeries. Thetechnique is easy to learn. It reduces post-operative pain aswell. It can reduce the risk and cost of administering generalanaesthesia. doctors who are in training surgical specialityand emergency medicine should be encouraged to learnthe principles and technique in administering penile block.

Still Playing Together(?): A Recall to Physical Education and Sport History Intersections.

As academic disciplines, Physical Education and Sport History share interests in performance, participation, physique and the politics of corporeal praxis. Engendering unity between the two disciplines, however, has not been without concern. Scholars working within (and across) both fields have highlighted how the potential for shared knowledge production and meaning making has been, to a degree, stymied by epistemological and methodological criticism and trepidation. Issues over contextualization, rigour, narrative schemas, conceptualizations of the body, and notions of agency and power still, in particular, constrain our current educational and historical readings and renderings of physical culture(s). Scholarly schisms and methodological differences can be overcome, however, and need not prohibit disciplinary collaborations that might better address prevailing ethical questions and affect political cause; vis-à-vis the body, the physical and sport. This brief piece is, consequently, recourse to the scholarly symbiosis between Physical Education and Sport History and echoes the encouragement of our earlier colleagues to play, inquire, create and produce together.

Replicating the Networking, Mentoring and Venture Creation Benefits of Entrepreneurship Centres on a Shoestring: A Student-centred Approach to Entrepreneurship Education and Venture Creation

As support for both university-level entrepreneurial education and the use of experiential learning methods to foster student entrepreneurs increases, so too have the number of university-established or affiliated entrepreneurship centers. The activity at the center of this study aimed to combine experiential learning methods with assets associated with entrepreneurship centers, including venture creation, networking, and mentoring. Students were invited to participate in a competition wherein they were guided through the business creation process and pitched their ideas to investor judges who chose the winner and provided capital start-up funding and consulting. This research puts forth that university faculty at institutions without entrepreneurship centers can organize experiences to provide the benefits of entrepreneurship centers. The study used interviews to find that many of the benefits of entrepreneurship centers were able to be replicated using this method. The project is outlined, outcomes are analyzed, and the results and lessons learned are discussed.

Legal education in crisis: healing and humanizing Canadian law schools /

Western law schools are suffering from an identity and moral crisis. Many of the legal profession's problems can be traced to the law school environment, where students are taught to reason and practice in ways that are often at odds with their own personalities and values and even with generally accepted psychologically healthy practices. The idealism, ethic of care, and personal moral compasses of many students become eroded and even lost in the present legal education system. Formalism, rationalism, elitism, and big business values have become paramount. In such a moment of historical crisis, there exists the opportunity to create a new legal education story. This paper is a conceptual study of both my own Canadian legal education and the general legal education experience. It examines core problems and critiques of the existing Western legal education organizational and pedagogical paradigm to which Canadian law schools adhere. New approaches with the potential to enrich, humanize, and heal the Canadian law school experience are explored. Ultimately, the paper proposes a legal education system that is more interdisciplinary, theoretically and practically integrated, emotionally intelligent, technologically connected, morally accountable, spiritual, and humane. Specific pedagogical and curricular strategies are suggested, and recommendations for the future are offered. The dehumanizing aspects of the law school experience in Canada have rarely been studied. It is hoped that this thesis will fill a gap in the research and provide some insight into an issue that is of both academic and public importance, since the well-being of law students and lawyers affects the interests of their clients, the general public, and the integrity and future of the entire legal system.

Desarrollo de un nuevo protocolo de cirugía general, que disminuya las devoluciones de medicamentos e insumos al almacén de cirugía del Hospital Méderi

Esta tesis surge como una oportunidad de mejora en el almacén de cirugías del Hospital MÉDERI, debido a la recurrente devolución de medicamentos e insumos solicitados por las auxiliares de enfermería para las cirugías generales, lo cual repercute directamente en pérdidas de productividad laboral por los re-procesos, un aumento en los errores humanos y posibles pérdidas de medicamentos e insumos. Tras esta clara oportunidad de mejora, se toma la decisión de evaluar el proceso interno del almacén de cirugías con el fin de conocer el punto crítico que genera esta situación; dando como resultado los protocolos de cirugías, los cuales al haber sido diseñados varios años atrás basados en una demanda presentada en ese momento, no están acorde con la realidad que se vive actualmente el almacén de cirugía. Por lo tanto se decidió implementar un pronóstico de promedio móvil, para identificar la demanda real que se presentan en el Hospital MÉDERI, esto seguido de una identificación gráfica comparativa que permitiera definir el nuevo protocolo de cirugía general, lo cual permite disminuir la cantidad de material solicitado, con lo cual se generan disminuciones significativas en el inventario, perdidas y un aumento en la productividad.

Análisis de la calidad en la atención del paciente de cirugía general de urgencia

Objetivo: proponer un instrumento para el seguimiento de la calidad de la atención de pacientes con patologías quirúrgicas abdominales urgentes. Métodos: se revisaron restropectivamente historias clínicas de pacientes quienes requirieron cirugía general de urgencia (CGU) en agosto de 2013. Se analizaron variables demográficas, factores de riesgo, severidad y desenlace hasta el día 30 postoperatorio. Se incluyeron los indicadores de calidad del National Surgical Quality Improvement Program (NSQIP) y el National Trauma Data Bank, y se adicionaron otros. Resultados: Se intervinieron 231 pacientes de 261 procedimientos de CGU. La edad promedio fue 49 años. Los procedimientos más comunes fueron la colecistectomía laparoscópica (37.2%), la apendicectomía (35.6%), la laparotomía exploratoria (12.6%), el drenaje de colección abdominal (9.1%) y la liberación de adherencias (6.9%). La mortalidad fue de 3.46% (n=8), la morbilidad severa fue de 8.04%. La duración de la hospitalización fue de 6.54 días +/- 5.180 y la de hospitalización en Unidad de Cuidado Intensivo fue de 5.7 días +/- 4.42. La oportunidad de salas de cirugía para la apendicetomía fue de 5 horas para las apendicitis con peritonitis generalizada, y de 8 horas para las apendicitis localizadas, 37 horas para colecistitis, 7.48 horas para colangitis y 2.42 horas para diverticulitis. Conclusiones: Crear de un instrumento para la medición de la calidad de la atención de los pacientes en CGU, es necesario para la autoevaluación institucional y para definir planes de mejoramiento y distribución de los recursos.

Respuesta inflamatoria sistémica en el donante como predictor de infección en el primer mes del trasplante renal

Introducción: El objetivo principal de la selección del donante es disminuir la posibilidad de transmisión de enfermedades infecciosas o neoplásicas en el receptor. De forma cruda se calcula que aproximadamente el 50% de los potenciales donantes son contraindicados, la mayoría por infección. La alta demanda de órganos obliga a revalorar las contraindicaciones que hasta hace poco eran absolutas, el reto es diferenciar el SIRS del donante por Muerte Encefálica con el SIRS por infecciones. Método: Estudio de cohorte retrospectivo; que busca evaluar la respuesta inflamatoria sistémica (SIRS) como predictor de infección en pacientes con trasplante renal en el primer mes pos trasplante. Resultados: El contraste de hipótesis proporciono una significancia bilateral (P= 0,071). La pruebas de hipótesis aceptaron la hipótesis nula (P= 0,071), que no existe asociación entre la presencia de SIRS en el donante con la incidencia de infección en el primer mes del pos trasplante renal. La estimación del riesgo de no reingreso por infección al primer mes pos trasplante renal es de 0.881 veces para los donantes con SIRS (IC 0.757 – 1.025). Conclusión: A pesar de no encontrar significancia estadística: el SIRS en el donante no se asocia con un aumento en la incidencia de infección en el primer mes postrasplante. Para encontrar la significancia se propone un estudio con un tamaño de muestra mayor.