Procedimentos do ensino da leitura no primeiro ano do ensino fundamental: concepções, estratégias e resultados

The theme of the reading in the first year of the literacy cycle has become recurrent in academic papers, research groups, discussion forums, conferences etc. and raised different positions depending on the theoretical framework with which it is studied. While it is granted that reading instruction this school year is to ensure the ability to encode and decode and learn and understand the meanings and the meanings of what we read. In this work, it formed a general objective to investigate how reading skills are being developed in the classroom and the strategies used to develop decoding and understanding of meanings. The question that formed the north to the survey was as follows: The strategies and procedures being used in the teaching of reading in the early literacy process develop the coding and decoding skills beyond the grasp and understanding of the meanings of ideas? The specific objectives were established: a) investigate how is the teaching of reading in the first grade of elementary school; b) identify the teaching strategies and the design of reading and reader that the teacher of the class has observed and relate it to the way he teaches; c) verify that the teaching of reading in the first year of the literacy process, develop the early reading skills, decoding, and favors the development of the apprehension and understanding of the meanings of what we read. The methodology included field research, from a qualitative interpretation approach and had as direct data source the natural environment in which the teaching of reading has been developed. The work then displays data results analyzed in the light of literacy concepts distinguished by Soares (2011), and reading by Silva (1983), Foucambert (1994), Solé (1998), among others. The results were extracted inferences and interpretations. It is hoped that this work raises in literacy teachers, reflections on the teaching of reading in the literacy cicle, in order to establish the...

A reumatologia em um curso de medicina com aprendizagem baseada em problemas

OBJETIVO: Apresentar a experiência de uma instituição brasileira no ensino da Reumatologia na graduação médica, cujo projeto pedagógico é estruturado em metodologias ativas de aprendizado. MÉTODOS: Realizou-se um estudo descritivo, com abordagem qualitativa dos conteúdos referentes à Reumatologia no curso de Medicina do Centro Universitário do Estado do Pará (Cesupa). RESULTADOS: O sistema musculoesquelético é abordado no segundo e sétimo semestres, nos módulos referentes ao sistema locomotor e Clínica Médica II, respectivamente, sendo que cada etapa e cada atividade apresentam objetivos específicos mínimos. Além do conteúdo teórico, no sétimo semestre, os alunos realizam atendimentos no ambulatório de Reumatologia, quando existe maior ênfase na elaboração correta de anamnese e exame físico. No internato, os alunos retornam ao ambulatório de Reumatologia e, neste momento, as habilidades de diagnóstico, de investigação e de terapêutica são as mais exigidas. CONCLUSÃO: Ainda há muito para evoluir em busca de um modelo ideal para o ensino da Reumatologia, porém, cumprindo as principais recomendações disponíveis para a boa prática do ensino na graduação, podemos proporcionar ao futuro médico conhecimento, habilidade e experiências capazes de ajudá-lo na condução desses pacientes.

Procedimentos do ensino da leitura no primeiro ano do ensino fundamental: concepções, estratégias e resultados

The theme of the reading in the first year of the literacy cycle has become recurrent in academic papers, research groups, discussion forums, conferences etc. and raised different positions depending on the theoretical framework with which it is studied. While it is granted that reading instruction this school year is to ensure the ability to encode and decode and learn and understand the meanings and the meanings of what we read. In this work, it formed a general objective to investigate how reading skills are being developed in the classroom and the strategies used to develop decoding and understanding of meanings. The question that formed the north to the survey was as follows: The strategies and procedures being used in the teaching of reading in the early literacy process develop the coding and decoding skills beyond the grasp and understanding of the meanings of ideas? The specific objectives were established: a) investigate how is the teaching of reading in the first grade of elementary school; b) identify the teaching strategies and the design of reading and reader that the teacher of the class has observed and relate it to the way he teaches; c) verify that the teaching of reading in the first year of the literacy process, develop the early reading skills, decoding, and favors the development of the apprehension and understanding of the meanings of what we read. The methodology included field research, from a qualitative interpretation approach and had as direct data source the natural environment in which the teaching of reading has been developed. The work then displays data results analyzed in the light of literacy concepts distinguished by Soares (2011), and reading by Silva (1983), Foucambert (1994), Solé (1998), among others. The results were extracted inferences and interpretations. It is hoped that this work raises in literacy teachers, reflections on the teaching of reading in the literacy cicle, in order to establish the...

Late evaluation of the relationship between morphological and functional renal changes and hypertension after non-operative treatment of high-grade renal injuries

Objective: To evaluate the anatomical and functional renal alterations and the association with post-traumatic arterial hypertension. Methods: The studied population included patients who sustained high grades renal injury (grades III to V) successfully non-operative management after staging by computed tomography over a 16-year period. Beyond the review of medical records, these patients were invited to the following protocol: clinical and laboratory evaluation, abdominal computed tomography, magnetic resonance angiography, DMSA renal scintigraphy, and ambulatory blood pressure monitoring. The hypertensive patients also were submitted to dynamic renal scintigraphy (Tc-99m EC), using captopril stimulation to verify renal vascular etiology. Results: Of the 31 patients, there were thirteen grade III, sixteen grade IV (nine lacerations, and seven vascular lesions), and two grade V injuries. All the patients were asymptomatic and an average follow up post-injury of 6.4 years. None had abnormal BUN or seric creatinine. The percentage of renal volume reduction correlates with the severity as defined by OIS. There was no evidence of renal artery stenosis in Magnetic Resonance angiography (MRA). DMSA scanning demonstrated a decline in percentage of total renal function corresponding to injury severity (42.2 +/- 5.5% for grade III, 35.3 +/- 12.8% for grade IV, 13.5 +/- 19.1 for grade V). Six patients (19.4%) had severe compromised function (< 30%). There was statistically significant difference in the decrease in renal function between parenchymal and vascular causes for grade IV injuries (p < 0.001). The 24-hour ambulatory blood pressure monitoring detected nine patients (29%) with post-traumatic hypertension. All the patients were male, mean 35.6 years, 77.8 % had a familial history of arterial hypertension, 66.7% had grade III renal injury, and average post-injury time was 7.8 years. Seven patients had negative captopril renography. Conclusions: Late results of renal function after conservative treatment of high grades renal injuries are favorable, except for patients with grades IV with vascular injuries and grade V renal injuries. Moreover, arterial hypertension does not correlate with the grade of renal injury or reduction of renal function.

Aging reduces complexity of heart rate variability assessed by conditional entropy and symbolic analysis

Increasing age is associated with a reduction in overall heart rate variability as well as changes in complexity of physiologic dynamics. The aim of this study was to verify if the alterations in autonomic modulation of heart rate caused by the aging process could be detected by Shannon entropy (SE), conditional entropy (CE) and symbolic analysis (SA). Complexity analysis was carried out in 44 healthy subjects divided into two groups: old (n = 23, 63 +/- A 3 years) and young group (n = 21, 23 +/- A 2). It was analyzed SE, CE [complexity index (CI) and normalized CI (NCI)] and SA (0V, 1V, 2LV and 2ULV patterns) during short heart period series (200 cardiac beats) derived from ECG recordings during 15 min of rest in a supine position. The sequences characterized by three heart periods with no significant variations (0V), and that with two significant unlike variations (2ULV) reflect changes in sympathetic and vagal modulation, respectively. The unpaired t test (or Mann-Whitney rank sum test when appropriate) was used in the statistical analysis. In the aging process, the distributions of patterns (SE) remain similar to young subjects. However, the regularity is significantly different; the patterns are more repetitive in the old group (a decrease of CI and NCI). The amounts of pattern types are different: 0V is increased and 2LV and 2ULV are reduced in the old group. These differences indicate marked change of autonomic regulation. The CE and SA are feasible techniques to detect alteration in autonomic control of heart rate in the old group.

Intervenção educativa sobre hipotermia: uma estratégia de ensino para aprendizagem em centro cirúrgico

Este trabalho trata-se de um estudo quase experimental aplicado em uma intervenção educativa de curta duração aos auxiliares de enfermagem do Centro Cirúrgico, cujos objetivos foram conhecer as características sociais e de formação dos auxiliares de enfermagem; identificar a diferença no conhecimento sobre hipotermia no auxiliar de enfermagem após a intervenção educativa e relacionar as ações de enfermagem às variáveis estudadas. A intervenção educativa foi efetiva, uma vez que a diferença na média das ações de enfermagem foi de 5,35 após a intervenção educativa. Entretanto, não se verificou diferença significativa das ações de enfermagem quando relacionadas às variáveis estudadas. Recomenda-se realizar estudos sobre educação nos profissionais de Enfermagem, baseado na aprendizagem significativa nas diferentes unidades.

Gestión de pacientes de un Servicio de Urgencias Hospitalarias

[ES] Un servicio de urgencias de una zona ofrece asistencia sanitaria y tiene como principal objetivo atender la patología urgente que acude al hospital y el nivel de compromiso que se asume consiste en diagnosticar, tratar y estabilizar, en la medida posible, dicha patología urgente. Otro objetivo es gestionar la demanda de atención urgente por parte del ciudadano a través de un sistema de selección prioritaria inicial (Triaje) que selecciona, prioriza, organiza y gestiona la demanda de atención. Para poder controlar y realizar el trabajo de la forma más eficaz se utilizan herramientas de gestión necesarias para el control de los pacientes, desde que se realiza su ingreso en el servicio de urgencias hasta el alta del mismo. Las aplicaciones desarrolladas son las siguientes: Gestión de Pacientes en Urgencias: Esta aplicación asignará un estado inicial al paciente y permitirá ir cambiando el estado del mismo usando el método del Triaje (valoración), el más difundido en la medicina de urgencias. Además, se podrán solicitar pruebas diagnósticas y la visualización de marcadores de analíticas para comprobar su evolución. Finalmente, se podrá desarrollar un informe de alta para el paciente. Informadores de Urgencias: La aplicación gestiona la localización física del paciente dentro del servicio de urgencias, permitiendo asimismo el cambio entre las distintas localizaciones y el control para la información a los familiares de los mismos, pudiendo almacenar los familiares y teléfonos de contactos para que estos puedan ser informados. El desarrollo se ha realizado utilizando el MVC (modelo - vista - controlador) que es patrón de arquitectura que separa los datos de una aplicación, la interfaz gráfica de usuario y la lógica de control de componentes. El software utilizado para el desarrollo de las aplicaciones es CACHÉ de Intersystems que permite la creación de una base de datos multidimensional. El modelo de objetos de Caché se basa en el estándar ODMG (Object Database Management Group, Grupo de gestión de bases de datos de objetos) y soporta muchas características avanzadas. CACHÉ dispone de Zen, una biblioteca completa de componentes de objetos preconstruidos y herramientas de desarrollo basadas en la tecnología CSP (Caché Server Pages) y de objetos de InterSystems. ZEN es especialmente apropiado para desarrollar una versión Web de las aplicaciones cliente/servidor creadas originalmente con herramientas como Visual Basic o PowerBuilder.

Educazione alla cittadinanza per cittadini immigrati adulti. Il contributo della formazione linguistico-giuridica all'acquisizione di competenze di cittadinanza in lingua seconda

The research examines which cultural and linguistic instruments can be offered to provide adult migrants with formative access to citizenship competences. Starting from the questions: How can individuals of all community groups present in a nation-state acquire high standards of linguistic, sociolinguistic and discourse competences in order to be fully integrated, that is to participate and be included in social activities in the public domain such as work and institutional environments? How are these competencies developed in an educational context? How do adult migrants behave linguistically in this context, according to their needs and motivations? The research hypothesis aimed at outlining a formative project of citizenship education targeted at adult foreign citizens, where a central role is assigned both to law education and linguistic education. Acoordingly, as the study considered if the introduction of a law programme in a second language course could be conceived as an opportunity to further the access to active citizenship and social participation, a corpus of audiodata was collected in law classes of an Italian adult professional course attended by a 50% of foreign students. The observation was conducted on teacher and learner talk and learner participation in classroom interaction when curriculum legal topics were introduced and discussed. In the classroom law discourse two dimensions were analyzed: the legal knowledge construction and the participants’ interpersonal and identity construction. From the analysis, the understanding is that drawn that law classes seem to represent an educational setting where foreign citizens have an opportunity to learn and practise citizenship. The social and pragmatic approach to legal contents plays a relevant role, in a subject which, in non-academic contexts, loses its technical specificity and refers to law as a product of social representation. In the observed educational environment, where students are adults who bring into the classroom multiple personal and social identities, legal topics have the advantage of increasing adult migrants’ motivation to ‘go back to school’ as they are likely to give hints, if not provide solutions, to problems relating to participation in socio-institutional activities. At the same time, these contents offer an ideal context where individuals can acquire high discourse competences and citizenship skills, such as agency and critical reflection. Besides, the analysis reveals that providing adult learners with materials that focus on rights, politics and the law, i.e. with materials which stimulate discussion on concerns affecting their daily lives, is welcomed by learners themselves, who might appreciate the integration of these same topics in a second language course.

Untersuchung zum Einfluss der ACD-CPR mit während der Dekompressionsphase blockiertem Gasfluss (ITD) im Vergleich zur Standard-Reanimationstechnik auf die Kurzzeit-Überlebensrate von Patienten mit präklinisch aufgetretenem Herzkreislaufstillstand

Untersuchung zum Einfluss der ACD-CPR (Aktive Kompressions- Dekompressions-Reanimation) mit während der Dekompressionsphase blockiertem Gasfluss (Impedance-Threshold-Device) im Vergleich zur Standardreanimationsrechnik auf die Kurzzeit-Überlebensrate von Patienten mit präklinisch aufgetretenem Herzkreislaufstillstand. Die Studie vergleicht die ACD-ITD-CPR gegen die Standard-CPR bei Patienten mit präklinischem Herkreislaufstillstand. Primär untersuchter Parameter war die Ein-Stunden-Überlebensrate nach Krankenhausaufnahme. Sekundär wurden die Tastbarkeit eines Pulses unter CPR, die Wiederkehr des Spontankreislaufs (ROSC), die Rate an Krankenhausaufnahmen, 24-Stunden-Überleben und Krankenhausentlassungen untersucht. Außerdem wurde das neurologische Outcome evaluiert. Die Studie fand in Mainz statt; Mainz bietet sich für die Durchführung notfallmedizinischer Studien in besonderem Maße an. Der Rettungsdienst der Stadt arbeitet nach dem in Deutschland üblichen zweigliedrigen System mit RA/RS auf RTWs und NA auf NAW/NEF. Die Studie wurde nach einer fünfmonatigen Pilotphase und extensivem Training beider Verfahren durchgeführt. Zusätzlich bestanden bei einigen der Beteiligten schon Erfahrungen mit ACD-CPR. Es ergaben sich signifikante Vorteile der ACD-ITD-CPR gegenüber der Standard-CPR hinsichtlich des primär untersuchten Parameters (51% vs. 32% p=0,006), außerdem statistisch auffällige Vorteile hinsichtlich der Pulstastbarkeit unter CPR (85% vs. 69%, p=0,008), der Wiederkehr des Spontankreislaufs (55% vs. 37%, p=0,016), der Rate der Krankenhausaufnahmen (52% vs. 36%, p=0.023) und des 24-Stunden-Überlebens (37% vs. 22%, p=0,033). Es ergaben sich keine statistisch auffälligen Unterschiede hinsichtlich der Rate an Krankenhausentlassungen und im neurologischen Outcome. Die Ergebnisse lassen den Schluss zu, dass die ACD-ITD die Kurzzeitüberlebensrate der Patienten mit außerklinischem Herzkreislaufstillstand verbessern kann. Eine Voraussetzung hierfür ist eine ausreichende und andauernde Ausbildung der beteiligten Helfer und/oder die Verfügbarkeit technisch verbesserter Lösungen. Weitere Untersuchungen zum Einfluss auf die Langzeitüberlebensraten und das neurologische Outcome scheinen angezeigt.

Do we really need 24-h observation for patients with minimal brain injury and small intracranial bleeding? The Bernese Trauma Unit Protocol

Traumatic brain injury is one of the most common reasons for admission to hospital emergency departments. However, optimal diagnosis and treatment protocols remain controversial. The aim of this study is to assess whether a specific group of patients can be discharged from the hospital without 24-h neurological observation.

Trauma-induced coagulopathy in severely injured patients: knowledge lost in translation?

Many guidelines exist on how to treat patients with multiple injuries correctly in an accident and emergency setting. The aim of the present work was to find out how well patients are treated focusing on trauma induced coagulopathy (TIC), and what anaesthetists involved in trauma care think about their own experiences with TIC.

Effects of cardiology review of the electrocardiogram in patients with suspected acute coronary syndromes

Misclassification of the electrocardiogram (ECG) contributes to treatment errors in patients with acute coronary syndrome. We hypothesized that cardiology ECG review could reduce these errors.

Can S-100B serum protein help to save cranial CT resources in a peripheral trauma centre? A study and consensus paper

Cranial CT (CCT) is the gold standard to rule out traumatic brain injury. The serum level of the protein S-100B has recently been proposed as promising marker of traumatic brain injury. We prospectively investigated whether it might be a reliable tool for CCT triage in mild brain injury at a peripheral trauma centre with limited CT resources.

Is computer-assisted telephone triage safe? A prospective surveillance study in walk-in patients with non-life-threatening medical conditions

Background Patients often establish initial contact with healthcare institutions by telephone. During this process they are frequently medically triaged. Purpose To investigate the safety of computer-assisted telephone triage for walk-in patients with non-life-threatening medical conditions at an emergency unit of a Swiss university hospital. Methods This prospective surveillance study compared the urgency assessments of three different types of personnel (call centre nurses, hospital physicians, primary care physicians) who were involved in the patients' care process. Based on the urgency recommendations of the hospital and primary care physicians, cases which could potentially have resulted in an avoidable hazardous situation (AHS) were identified. Subsequently, the records of patients with a potential AHS were assessed for risk to health or life by an expert panel. Results 208 patients were enrolled in the study, of whom 153 were assessed by all three types of personnel. Congruence between the three assessments was low. The weighted κ values were 0.115 (95% CI 0.038 to 0.192) (hospital physicians vs call centre), 0.159 (95% CI 0.073 to 0.242) (primary care physicians vs call centre) and 0.377 (95% CI 0.279 to 0.480) (hospital vs primary care physicians). Seven of 153 cases (4.57%; 95% CI 1.85% to 9.20%) were classified as a potentially AHS. A risk to health or life was adjudged in one case (0.65%; 95% CI 0.02% to 3.58%). Conclusion Medical telephone counselling is a demanding task requiring competent specialists with dedicated training in communication supported by suitable computer technology. Provided these conditions are in place, computer-assisted telephone triage can be considered to be a safe method of assessing the potential clinical risks of patients' medical conditions.

A nation-wide initiative against venous thromboembolism

There is a gap between knowledge and recommendations regarding venous thromboembolism (VTE) on the one hand and daily practice on the other. This fact has prompted a Swiss multidisciplinary group consisting of angiologists, haematologists, internists, and emergency medicine and pharmaceutical medicine specialists interested in VTE, the SAMEX group, to set up a series of surveys and studies that give useful insight into the situation in our country. Their projects encompassed prophylactic and therapeutic aspects of VTE, and enrolled over 7000 patients from five academic and 45 non-academic acute care hospitals and fifty-three private practices in Switzerland. This comprehensive Swiss Clinical Study Programme forms the largest database surveying current clinical patterns of VTE management in a representative sample of the Swiss patient population. Overall the programme shows a lack of thromboprophylaxis use in hospitalised at-risk medical patients, particularly in those with cancer, acute heart or respiratory failure and the elderly, as well as under-prescription of extended prophylaxis beyond hospital discharge in patients undergoing major cancer surgery. In regard to VTE treatment, planning of anticoagulation duration, administration of LMWH for cancer-associated thrombosis, and the use of compression therapy for prevention of post-thrombotic syndrome in patients with symptomatic proximal DVT require improvement. In conclusion, this programme highlights insufficient awareness of venous thromboembolic disease in Switzerland, underestimation of its burden and inconsistent application of international consensus statement guidelines regarding prophylaxis and treatment adopted by the Swiss Expert Group.