Feblesa de tutories: manca de feedback i autoregulació en l'estudiant d'infermeria. Valoració de l'avaluació continuada en l'assignatura Ciències Psicosocials Aplicades a la Salut en el Grau d'Infermeria (EEES), (2009-2010)

Resum: En el nou model derivat de l"Espai Europeu d"Educació Superior (EEES), l"ensenyament aprenentatge (E-A) es centra en l"estudiant, enfront del rol més destacat del professor en l"ensenyament tradicional. El procés d"experimentació al que assistim en el nostre medi, requereix la valoració de les primeres experiències. Objectiu: L"objectiu d"aquest estudi és identificar si la metodologia utilitzada en l"assignatura Ciències Psicosocials Aplicades a la Salut, en el Grau d"Infermeria a l"Escola d" infermeria de la Universitat de Barcelona, està ben enfocada per assolir una avaluació continuada de qualitat. Metodologia: Es presenta a traves d"un estudi descriptiu. La població estudiada mitjançant un qüestionari, ha estat els estudiants dels quatre grups de primer curs, del primer any de desenvolupament del Grau d"Infermeria en el nostre Centre, passades el curs acadèmic 2009-2010, amb una mostra total de 221 alumnes. Conclusions: Els resultats permeten tres franges interpretatives: 1) qualificació de notable que fa referència a la modalitat disciplinar i experiència docent del professorat, 2) qualificació entre notable i aprovat referida a la metodologia didàctica i organitzativa, 3) qualificació d"aprovat que fa referència a les tutories.

Toiminnan laadun parantaminen organisaation itsearvioinnilla – tutkimus Suomen puolustusvoimien tulosyksiköissä

Laajoilla kyselylomaketutkimuksilla on tutkittu organisaation itsearvioinnin käyttöönoton motiiveja, käyttöä ja käytön hyötyjä 1990-luvulla ja 2000-luvun alussa. Organisaation itsearviointia on myös tutkittu laatupalkintomallien soveltamisen yhteydessä. Kolmas tutkimussuuntaus, johon myös tämä tutkimus sisältyy, on organisaation itsearvioinnin tutkiminen erilaisissa asiayhteyksissä. Tämän tutkimuksen tarkoituksena on lisätä tietoa ja ymmärrystä organisaation itsearvioinnista ja sen vaikuttavuudesta tutkimalla, miten organisaatiota itsearvioidaan maavoimien valmiusyhtymissä ja Maasotakoulussa. Näissä neljässä paikallistutkimuksessa käytin tutkimusotteena tapaustutkimuksen mukaista tutkimusstrategiaa. Aiempien tutkimuksien tulosten perusteella tärkein yhdistävä tekijä toiminnan parantamisessa on pyrkimys kokonaisvaltaisuuteen toiminnan laadun parantamisessa ja erinomaisuuden tavoittelussa. Osin kokonaisvaltaisuuteen sisältyviä ja sitä tukevia tekijöitä ovat jatkuvan parantamisen periaatteen käyttäminen ja oppivan organisaation edellyttämien toimintaedellytyksien luominen ja niiden huomioon ottaminen toiminnassa. Edelleen yhteisenä tekijänä ovat johdon sitoutumisen ja osallistumisen vaikutukset työntekijöiden osallistumiseen ja sitoutumiseen. Teorian perusteella olen arvioinut muodostuvan kolme organisaation itsearvioinnin strategisen tason johtamiskäytäntöä, jotka ovat ”Laatupalkinnon hakeminen”, ”Toiminnan ja tulosten arviointi” sekä ”Toiminnan kypsyyden arviointi”. Tutkimuksen tulosten perusteella organisaation itsearvioinnin vaikuttavuuden merkityskokonaisuus on selitettävissä viiden teeman avulla. Koko tutkimusaineiston yhdistäväksi vaikuttavuuden teemaksi, josta myös organisaation itsearvioinnin vaiheistus saa tukea, muodostuu teema ”organisaation itsearviointi ja tulosjohtaminen”. Tämän teeman perusteella organisaation itsearvioinnin vaikuttavuus perustuu itsearvioinnin käyttämiseen sekä tulosyksikön sisäisenä että johdon strategisen tason itsearviointina osana tulosjohtamista. Samoin teema ”ollaanko samaa perhettä” löytyy jokaisesta tutkimuskohteena olleesta tulosyksiköstä. Teeman perusteella vaikuttavuus perustuu siihen, että organisaation itsearvioinnin tilaisuus koetaan sosiaalisena tapahtumana ja organisaation itsearviointi vahvistaa työntekijöiden osallistumista ja sitoutumista toiminnan laadun parantamiseen. Vaikuttavuuden teemoissa ”poistetaan kivi kengästä, ja hiertäminen loppuu siihen”, ”strateginen valinta” ja ”henkilöstön työhyvinvoinnin edistäminen” organisaation itsearvioinnin vaikuttavuus on tulosyksikkökohtainen. Organisaation itsearvioinnista haetaan vaikuttavuutta organisaation itsearvioinnista saatavien tulosten nopealla toimeenpanolla. Vaikuttavuuteen pyritään systemaattisella eri organisaation tasoilla tehtävillä toiminnan kuvauksilla, mihin liittyy laatupalkinnon hakeminen. Vaikuttavuuteen voidaan myös päästä työpistelähtöisesti henkilöstön johtamisen ja hallinnon kautta. Vaiheistettua organisaation itsearviointia voidaan käyttää osana tulosjohtamista. Muita keskeisiä tutkimustuloksia ovat organisaation itsearvioinnin välittömät ja välilliset vaikutukset. Tutkimuksen tulosten perusteella teen suositukset organisaation itsearvioinnin johtamiskäytännöistä ja organisaation itsearvioinnin vaiheistuksesta osana tulosyksikön tulosjohtamista. Kolmas suositus käsittää organisaation itsearvioinnin käytön palautejärjestelmänä.

Evaluation of markets for irrigation water in the internal river basins of Catalonia, Spain

Irrigated agriculture has come under close scrutiny in Europe recently because of its high share of total water consumption and its apparent inefficiency. Several water policies have been advocated, in particular the use of economic instruments such as water markets. This paper simulates the impact of a policy based upon water markets on agricultural production in the internal river basins of Catalonia (Spain). This zone presents certain particularities that make it very interesting to study: competition between sectors for the resource (agriculture-urban consumption-recreational uses), recent periods of resource insufficiency and conflicts between irrigators as a result of the measures taken by the hydraulic administration in drought situations. The results show that these markets would guarantee an optimal reassignment of the resource in situations of supply restrictions, and although compared to the situation without markets they would not mean higher economic profits for the irrigators, they could prevent conflicts between them. Nevertheless, doubts exist about their acceptance by irrigators

Marketing in support of sales in industrial high technology company

The aim of this study is to find out how Metso Paper’s marketing could better support sales and how sales people are executing marketing during the sales processes. This study is done from sales people’s point of view. The study is limited to cover only company’s internal environment. This research was executed through literature review and qualitative theme interviews, where 20 of Metso Paper’s sales people were interviewed. The interviewees were asked to tell their opinions about marketing’s support, marketing materials, information and the relationship between sales and marketing. The results of this study show that the relationship between marketing and sales is rather good, but there is still a great need for improvements. It is hoped that marketing would take more part in the selling processes. In addition, more information about the launches and schedules were also hoped for. Marketing is told to be quite Finland centric and sales people are wishing for more adopted marketing materials and occasions. It came up during the interviews, that sales people are not so willing to give regular feedback to marketing and quite often they think that marketing’s role in Metso Paper is not important at all.

L'informatique: un outil remarquable pour l'enseignement de la médecine interne générale [The informatics: a remarkable tool for teaching general internal medicine].

INTERMED training implies a three week course, integrated in the "primary care module" for medical students in the first master year at the school of medicine in Lausanne. INTERMED uses an innovative teaching method based on repetitive sequences of e-learning-based individual learning followed by collaborative learning activities in teams, named Team-based learning (TBL). The e-learning takes place in a web-based virtual learning environment using a series of interactive multimedia virtual patients. By using INTERMED students go through a complete medical encounter applying clinical reasoning and choosing the diagnostic and therapeutic approach. INTERMED offers an authentic experience in an engaging and safe environment where errors are allowed and without consequences.

Dix ans de revue de la littérature en médecine interne générale--un premier bilan [Ten years of literature review in general internal medicine--a first assessment].

A group of family physicians in an outpatient clinic in Switzerland prospectively followed scientific literature for ten years. What to remember among the numerous articles retrieved and which paper really changed our practice? If many readings are quickly forgotten, some of them marked our minds and changed our habits. This article is a summary of our efforts to keep the essential tools in clinical practice.

Customer-Related Internal Communication in a Global Matrix Organization

The objective of the thesis was to explore the nature and characteristics of customer-related internal communication in a global industrial matrix organization during a specific customer relationship, and how it could be improved. The theoretical part of the study views the field of the concepts of intra-organizational information and knowledge sharing. The theoretical part also views the internal communications influences to customer relationships, its problematic, and the suggestions to improve internal communication in literature. The empirical part of the study was conducted with the Content Analysis and the Social Network Analysis as research methods. The data was collected by interviews and a questionnaire. Internal communication was observed first generally within the organization from the point of view of a certain business, and secondly, during a specific customer relationship at personal level and at departmental level. The results of the study describe the nature and characteristics of internal communication in the organization. The results give 13 suggestions for improving internal communication in the organization. Although the study has been done in one specific organization, it also offers insights for other organizations as well as managers to improve their internal communication.

Feedback i oportunitats de millora: una avaluació orientada a l"aprenentatge actiu

This paper analyzes an innovative experience of formative assessment aimed at improving the teaching of Statistics, which could be easily extrapolated to other studies. We detail the implementation of the double correction, consisting of correcting students' work twice. With the first correction, carried out by classmates according to a rubric developed by the academic, possible errors or deficiencies are discovered, and students are provided with a feedback that allows them to correct and improve their work before being graded by the teacher; whereas in the second correction of the work, once upgraded, the professor evaluates and grades the work. As a result, there is a significant improvement in the quality of students" works, and an active learning from their own mistakes. Both contents and competencies are reinforced by the experience.

L'année 2014 mise en perspective par les internistes hospitaliers [What is new in 2014 for the specialist in hospital internal medicine? The point of view of university hospital chief residents].

The year 2014 was rich in significant advances in all areas of internal medicine. Many of them have an impact on our daily practice and on the way we manage one problem or another. From the use of the ultrasound for the diagnosis of pneumonia to the choice of the site of venous access and the type of line, and the increasing complexity of choosing an oral anticoagulant agent, this selection offers to the readers a brief overview of the major advances. The chief residents in the Service of internal medicine of the Lausanne University hospital are pleased to share their readings.

Challenges to patient-centred care in a general internal medicine context: findings from an exploratory study

Introduction. If we are to promote more patient-centred approaches in care delivery, we have to better characterize the situations in which being patient-centred is difficult to achieve. Data from professionals in health and social care are important because they are the people charged with operationalizing patient-centred care (PCC) in their daily practice. However, empirical accounts from frontline care providers are still lacking, and it is important to gather experiences not only from doctors but also from the other care providers. Indeed, experiences from different professions can help inform our understanding of patient care, which is expected to be both patient-centred and collaborative. Methods. This study was based on the following research question: What factors make the provision of PCC difficult to achieve? Sample and setting. A purposeful sampling technique was used, allowing for a series of choices about the participants and their professional affiliation. Because patient-centredness is the focus, 3 professions appeared to be of special interest: general internists, nurses and social workers. The study was undertaken in the General Internal Medicine Division of a teaching hospital located in a North American context. Data Collection. To answer the research question, a methodological approach based on a theory called phenomenology was chosen. Accordingly, semi-structured interviews were used since they generate understanding of the meanings different individuals have of their lived world. Interviews with 8 physicians, 10 nurses and 10 social workers were eventually conducted. Data analysis. An inductive thematic analysis was employed to make sense of the interview data. Results. The thematic analysis allowed identifying various types of challenges to PCC. Although most of the challenges were perceived by all three groups of professionals, they were perceived to a different degree across the professions, which likely reflected the scope of practice of each profession. The challenges and their distribution across the professions are illustrated in Table 1. Examples of challenges are provided in Table 2. Discussion. There is a tension between what is supposed to be done - what stands in the philosophy of patient -centredness - and what is currently done - the real life with all the challenges to PCC. According to some participants' accounts, PCC clearly risks becoming a mere illusion for health care professionals on which too great pressures are imposed.

Complete internal audit of a mammography service in a reference institution for breast imaging

Objective Undertaking of a complete audit of the service of mammography, as recommended by BI-RADS®, in a private reference institution for breast cancer diagnosis in the city of São Paulo, SP, Brazil, and comparison of results with those recommended by the literature. Materials and Methods Retrospective, analytical and cross-sectional study including 8,000 patients submitted to mammography in the period between April 2010 and March 2011, whose results were subjected to an internal audit. The patients were followed-up until December 2012. Results The radiological classification of 7,249 screening mammograms, according to BI-RADS, was the following: category 0 (1.43%), 1 (7.82%), 2 (80.76%), 3 (8.35%), 4 (1.46%), 5 (0.15%) and 6 (0.03%). The breast cancer detection ratio was 4.8 cases per 1,000 mammograms. Ductal carcinoma in situ was found in 22.8% of cases. Positive predictive values for categories 3, 4 and 5 were 1.3%, 41.3% and 100%, respectively. In the present study, the sensitivity of the method was 97.1% and specificity, 97.4%. Conclusion The complete internal audit of a service of mammography is essential to evaluate the quality of such service, which reflects on an early breast cancer detection and reduction of mortality rates.

Negative feedback regulation of calcineurin-dependent Prz1 transcription factor by the CaMKK-CaMK1 axis in fission yeast

Calcium signals trigger the translocation of the Prz1 transcription factor from the cytoplasm to the nucleus. The process is regulated by the calciumactivated phosphatase calcineurin, which activates Prz1 thereby maintaining active transcription during calcium signalling. When calcium signalling ceases, Prz1 is inactivated by phosphorylation and exported to the cytoplasm. In budding yeast and mammalian cells, different kinases have been reported to counter calcineurin activity and regulate nuclear export. Here, we show that the Ca2+/calmodulin-dependent kinase Cmk1 is first phosphorylated and activated by the newly identified kinase CaMKK2 homologue, Ckk2, in response to Ca2+. Then, active Cmk1 binds, phosphorylates and inactivates Prz1 transcription activity whilst at the same time cmk1 expression is enhanced by Prz1 in response to Ca2+. Furthermore, Cdc25 phosphatase is also phosphorylated by Cmk1, inducing cell cycle arrest in response to an increase in Ca2+. Moreover, cmk1 deletion shows a high tolerance to chronic exposure to Ca2+, due to the lack of cell cycle inhibition and elevated Prz1 activity. This work reveals that Cmk1 kinase activated by the newly identified Ckk2 counteracts calcineurin function by negatively regulating Prz1 activity which in turn is involved in activating cmk1 gene transcription. These results are the first insights into Cmk1 and Ckk2 function in Schizosaccharomyces pombe.

The internal wave field in Sau reservoir : Observation and modeling of a third vertical mode

Water withdrawal from Mediterranean reservoirs in summer is usually very high. Because of this, stratification is often continuous and far from the typical two-layered structure, favoring the excitation of higher vertical modes. The analysis of wind, temperature, and current data from Sau reservoir (Spain) shows that the third vertical mode of the internal seiche (baroclinic mode) dominated the internal wave field at the beginning of September 2003. We used a continuous stratification two-dimensional model to calculate the period and velocity distribution of the various modes of the internal seiche, and we calculated that the period of the third vertical mode is ;24 h, which coincides with the period of the dominating winds. As a result of the resonance between the third mode and the wind, the other oscillation modes were not excited during this period

The seasonal evolution of high vertical–mode internal waves in a deep reservoir

The causal mechanism and seasonal evolution of the internal wave field in a deep, warm, monomictic reservoirare examined through the analysis of field observations and numerical techniques. The study period extends fromthe onset of thermal stratification in the spring until midsummer in 2005. During this time, wind forcing wasperiodic, with a period of 24 h (typical of land–sea breezes), and the thermal structure in the lake wascharacterized by the presence of a shallow surface layer overlying a thick metalimnion, typical of small to mediumsized reservoirs with deep outtakes. Basin-scale internal seiches of high vertical mode (ranging from mode V3 toV5) were observed in the metalimnion. The structure of the dominant modes of oscillation changed asstratification evolved on seasonal timescales, but in all cases, their periods were close to that of the local windforcing (i.e., 24 h), suggesting a resonant response. Nonresonant oscillatory modes of type V1 and V2 becamedominant after large frontal events, which disrupted the diurnal periodicity of the wind forcing