986 resultados para surgical training


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AIM The aim of this evidence-based practice (EBP) project was to promote adherence to the current best practice in monitoring and optimal replacement of peripheral intravenous device (PIVD). METHODS This EBP project took place in a 30-bed acute general surgical ward. Twenty in-patients with PIVD in situ for 4 days or more were recruited. There were five stages in the project: identification of EBP topic, criteria, sample and setting; baseline; dissemination of baseline audit results and identification of best practice barriers; identification of barriers to EBP and implementation of strategies promoting EBP; and postimplementation audit. RESULTS There were eight criteria in this project. The first audit showed moderate compliance in PIVD monitoring and optimal replacement. The project identified three barriers: lack of awareness of the current evidence-based guidelines, hospital policy not being aligned with current guidelines and no standard form of documentation. In order to overcome these barriers the following strategies were used: audit and feedback, interactive educational meetings, reminders and hospital policy change. The second audit showed minor improvements in each criterion. Compliance with documentation remained a challenge, possibly because of the lack of standardised documentation. DISCUSSION Although the project did not render us the results we aimed for, it was successful because it highlighted the current EBP in PIVD management. The major challenges of the project were time and the lack of opinion leaders in our project team. We felt that more time was needed to adapt to the practice change and standardised documentation could not be developed in such a short time period. Further, the role of the opinion leader proved to be vital in this project. We felt that had we recruited more than one opinion leader, the results would have been different.

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Exploring the ethical issues present in professional practice within the field of sport, exercise and performance psychology, this case study outlines challenges that may be encountered, ways to address issues should they arise, and the overall ethical considerations of supporting injury rehabilitation within a dance training context.

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Recent research in posttraumatic growth has been applied to people with life-threatening illnesses to optimise recovery. There is a lack of research exploring posttraumatic growth in coronary artery bypass graft patients. This article describes the recovery experience of 14 coronary artery bypass graft patients (13 males and 1 female) at their first outpatient review post-surgery. Grounded theory analysis was used to develop a model of distinct and shared pathways to growth depending on whether patients were symptomatic or asymptomatic pre-coronary artery bypass graft. Outcomes of posttraumatic growth in this sample included action-based healthy lifestyle growth and two forms of cognitive growth: appreciation of life and new possibilities. The model of posttraumatic growth developed in this study may be helpful in guiding future research into promoting posttraumatic growth and behaviour change in coronary artery bypass graft patients.

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The construction industry is a crucial component of the Hong Kong economy, and the safety and efficiency of workers are two of its main concerns. The current approach to training workers relies primarily on instilling practice and experience in conventional teacher-apprentice settings on and off site. Both have their limitations however, on-site training is very inefficient and interferes with progress on site, while off-site training provides little opportunity to develop the practical skills and awareness needed through hands-on experience. A more effective way is to train workers in safety awareness and efficient working by current novel information technologies. This paper describes a new and innovative prototype system – the Proactive Construction Management System (PCMS) – to train precast installation workers to be highly productive while being fully aware of the hazards involved. PCMS uses Chirp-Spread-Spectrum-based (CSS) real-time location technology and Unity3D-based data visualisation technology to track construction resources (people, equipment, materials, etc.) and provide real-time feedback and post-event visualisation analysis in a training environment. A trial of a precast facade installation on a real site demonstrates the benefits gained by PCMS in comparison with equivalent training using conventional methods. It is concluded that, although the study is based on specific industrial conditions found in Hong Kong construction projects, PCMS may well attract wider interest and use in future.

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This thesis was concerned with the protective mechanisms of first aid training in the context of peer support. Using a randomised control trial design the current program of research explores first aid training in the school setting and identifies the key components of effective school-based first aid training programs. In particular, examining whether first aid training and associated knowledge could be protective for early adolescents. This broader framing considered whether first aid impacted on increasing behaviour and attitudes towards helping an injured friend, and reducing personal risk taking and related injury.

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The desire to solve problems caused by socket prostheses in transfemoral amputees and the acquired success of osseointegration in the dental application has led to the introduction of osseointegration in the orthopedic surgery. Since its first introduction in 1990 in Gothenburg Sweden the osseointegrated (OI) orthopedic fixation has proven several benefits[1]. The surgery consists of two surgical procedures followed by a lengthy rehabilitation program. The rehabilitation program after an OI implant includes a specific training period with a short training prosthesis. Since mechanical loading is considered to be one of the key factors that influence bone mass and the osseointegration of bone-anchored implants, the rehabilitation program will also need to include some form of load bearing exercises (LBE). To date there are two frequently used commercially available human implants. We can find proof in the literature that load bearing exercises are performed by patients with both types of OI implants. We refer to two articles, a first one written by Dr. Aschoff and all and published in 2010 in the Journal of Bone and Joint Surgery.[2] The second one presented by Hagberg et al in 2009 gives a very thorough description of the rehabilitation program of TFA fitted with an OPRA implant. The progression of the load however is determined individually according to the residual skeleton’s quality, pain level and body weight of the participant.[1] Patients are using a classical bathroom weighing scale to control the load on the implant during the course of their rehabilitation. The bathroom scale is an affordable and easy-to-use device but it has some important shortcomings. The scale provides instantaneous feedback to the patient only on the magnitude of the vertical component of the applied force. The forces and moments applied along and around the three axes of the implant are unknown. Although there are different ways to assess the load on the implant for instance through inverse dynamics in a motion analysis laboratory [3-6] this assessment is challenging. A recent proof- of-concept study by Frossard et al (2009) showed that the shortcomings of the weighing scale can be overcome by a portable kinetic system based on a commercial transducer[7].

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The 2014 federal budget implemented a so-called crackdown on what Minister for Social Services Kevin Andrews calls young people who are content to “sit on the couch at home and pick up a welfare cheque”. The crackdown will change access to income support for people under 30 years of age. From January 1 2015, all young people seeking Newstart Allowance and Youth Allowance for the first time will be required to “demonstrate appropriate job search and participation in employment services support for six months before receiving payments”. Upon qualifying, recipients must then spend 25 hours per week in Work for the Dole in order to receive income support for a six-month period. What happens beyond this six months is unclear. What is clear is that these policy changes, together with the Minister’s accompanying statements, are informed by a deficit view of disadvantaged youth. It is a view that demonstrates how little politicians know or understand about these young peoples’ past circumstances.

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Experts are increasingly being called upon to quantify their knowledge, particularly in situations where data is not yet available or of limited relevance. In many cases this involves asking experts to estimate probabilities. For example experts, in ecology or related fields, might be called upon to estimate probabilities of incidence or abundance of species, and how they relate to environmental factors. Although many ecologists undergo some training in statistics at undergraduate and postgraduate levels, this does not necessarily focus on interpretations of probabilities. More accurate elicitation can be obtained by training experts prior to elicitation, and if necessary tailoring elicitation to address the expert’s strengths and weaknesses. Here we address the first step of diagnosing conceptual understanding of probabilities. We refer to the psychological literature which identifies several common biases or fallacies that arise during elicitation. These form the basis for developing a diagnostic questionnaire, as a tool for supporting accurate elicitation, particularly when several experts or elicitors are involved. We report on a qualitative assessment of results from a pilot of this questionnaire. These results raise several implications for training experts, not only prior to elicitation, but more strategically by targeting them whilst still undergraduate or postgraduate students.

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PURPOSE - To present the results of same-day topography-guided photorefractive keratectomy (TG-PRK) and corneal collagen cross-linking (CXL) after intrastromal corneal ring (ISCR) implantation in patients with keratoconus. METHODS - Thirty-three patients (41 eyes) aged between 19 and 45 years were included in this prospective study. All patients underwent a femtosecond laser-enabled (Intralase FS; Abbott Medical Optics, Inc.) placement of intracorneal ring segments (Kerarings; Mediphacos, Brazil). Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and keratometry readings remained stable for 6 months. Same-day PRK and CXL was subsequently performed in all patients. RESULTS - After 12 months of completion of the procedure, mean UDVA in log of minimal angle of resolution was significantly improved (0.74±0.54-0.10±0.16); CDVA did not improve significantly but 85% of eyes maintained or gained multiple lines of CDVA; mean refraction spherical equivalent improved (from -3.03±1.98 to -0.04±0.99 D), all keratometry readings were significantly reduced, from preoperative values, but coma did not vary significantly from preoperative values. Central corneal thickness and corneal thickness at the thinnest point were significantly (P<0.0001) reduced from 519.76±29.33 and 501.87±31.50 preoperatively to 464.71±36.79 and 436.55±47.42 postoperatively, respectively. Safety and efficacy indices were 0.97 and 0.88, respectively. From 6 months up until more than 1 year of follow-up, further significant improvement was observed only for UDVA (P<0.0001). CONCLUSIONS - Same-day combined TG-PRK and CXL after ISCR implantation is a safe and effective option for improving visual acuity and visual function, and it halts the progression of the keratoconus. The improvements recorded after 6 months of follow-up were maintained or improved upon 1 year after the procedure.

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QUT has enacted a university-wide Peer Program’s Strategy which aims to improve student success and graduate outcomes. A component of this strategy is a training model providing relevant, quality-assured and timely training for all students who take on leadership roles. The training model is designed to meet the needs of the growing scale and variety of peer programs, and to recognise the multiple roles and programs in which students may be involved during their peer leader journey. The model builds peer leader capacity by offering centralised, beginning and ongoing training modules, delivered by in-house providers, covering topics which prepare students to perform their role safely, inclusively, accountably and skilfully. The model also provides efficiencies by differentiating between ‘core competency' and ‘program-specific’ modules, thus avoiding training duplication across multiple programs, and enabling training to be individually and flexibly formatted to suit the specific and unique needs of each program.

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Traditional text classification technology based on machine learning and data mining techniques has made a big progress. However, it is still a big problem on how to draw an exact decision boundary between relevant and irrelevant objects in binary classification due to much uncertainty produced in the process of the traditional algorithms. The proposed model CTTC (Centroid Training for Text Classification) aims to build an uncertainty boundary to absorb as many indeterminate objects as possible so as to elevate the certainty of the relevant and irrelevant groups through the centroid clustering and training process. The clustering starts from the two training subsets labelled as relevant or irrelevant respectively to create two principal centroid vectors by which all the training samples are further separated into three groups: POS, NEG and BND, with all the indeterminate objects absorbed into the uncertain decision boundary BND. Two pairs of centroid vectors are proposed to be trained and optimized through the subsequent iterative multi-learning process, all of which are proposed to collaboratively help predict the polarities of the incoming objects thereafter. For the assessment of the proposed model, F1 and Accuracy have been chosen as the key evaluation measures. We stress the F1 measure because it can display the overall performance improvement of the final classifier better than Accuracy. A large number of experiments have been completed using the proposed model on the Reuters Corpus Volume 1 (RCV1) which is important standard dataset in the field. The experiment results show that the proposed model has significantly improved the binary text classification performance in both F1 and Accuracy compared with three other influential baseline models.

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Study/Objective This study examines the current state of disaster response education for Australian paramedics from a national and international perspective and identifies both potential gaps in content and challenges to the sustainability of knowledge acquired through occasional training. Background As demands for domestic and international disaster response increase, experience in the field has begun to challenge traditional assumptions that response to mass casualty events requires little specialist training. The need for a “streamlined process of safe medical team deployment into disaster regions”1 is generally accepted and, in Australia, the emergence of national humanitarian aid training has begun to respond to this gap. However, calls for a national framework for disaster health education2 haven’t received much traction. Methods A critical analysis of the peer reviewed and grey literature on the core components/competencies and training methods required to prepare Australian paramedics to contribute to effective health disaster response has been conducted. Research from the past 10 years has been examined along with federal and state policy with regard to paramedic disaster education. Results The literature shows that education and training for disaster response is variable and that an evidence based study specifically designed to outline sets of core competencies for Australian health care professionals has never been undertaken. While such competencies in disaster response have been developed for the American paradigm it is suggested that disaster response within the Australian context is somewhat different to that of the US, and therefore a gap in the current knowledge base exists. Conclusion Further research is needed to develop core competencies specific to Australian paramedics in order to standardise teaching in the area of health disaster management. Until this occurs the task of evaluating or creating disaster curricula that adequately prepares and maintains paramedics for an effective all hazards disaster response is seen as largely unattainable.