The Need for Pedagogical Qualifications for Teaching Cardiology to Undergraduate Students

OBJECTIVE: To report a training program in cardiology emphasizing changes in its pedagogical practice. These changes were put into practice by some teachers at the Medical School of Porto Alegre of the University of Rio Grande do Sul (FAMED/UFRGS) aiming to make faculty and student activities more dynamic and to promote more efficacious learning. The training program is directed at 5th semester medical students and aims at a behavioral change in teachers and students to promote more interaction, to favor exchanges, and to make the teaching-learning process easier, always maintaining the patient in the center of the medical activity. METHODS: The program emphasizes the definition of general and specific objectives for each activity to be developed by the students, with training in the area of admission to the cardiology service, with special emphasis on behavioral change in the cognitive, motor, affective, and attitudinal areas. Knowledge was developed by means of interactive seminars with initial and final assessment tests to identify students' and teachers' performance. The students were evaluated in an immediate, continuous, and progressive way in their daily activities and through comparison of the results of 2 tests, one applied at the beginning of the training and the other at its end. These 2 tests contained the same questions. RESULTS: We systematically assessed 560 students over 4 years. The mean grades of the tests performed prior to and after the 244 seminars were 7.38±1.66 and 9.17± 0.82, respectively (p<0.0001). For the tests applied at the beginning and at the end of the training, the mean grades were 5.61±1.61 and 9.37±0.90, respectively (p<0.0001). CONCLUSION: The program proved to be efficient both for the students' learning and for assessing their performance in a systematic and objective way.

Acute Effects of Exercise on Blood Pressure: A Meta-Analytic Investigation

Abstract Hypertension affects 25% of the world's population and is considered a risk factor for cardiovascular disorders and other diseases. The aim of this study was to examine the evidence regarding the acute effect of exercise on blood pressure (BP) using meta-analytic measures. Sixty-five studies were compared using effect sizes (ES), and heterogeneity and Z tests to determine whether the ES were different from zero. The mean corrected global ES for exercise conditions were -0.56 (-4.80 mmHg) for systolic BP (sBP) and -0.44 (-3.19 mmHg) for diastolic BP (dBP; z ≠ 0 for all; p < 0.05). The reduction in BP was significant regardless of the participant's initial BP level, gender, physical activity level, antihypertensive drug intake, type of BP measurement, time of day in which the BP was measured, type of exercise performed, and exercise training program (p < 0.05 for all). ANOVA tests revealed that BP reductions were greater if participants were males, not receiving antihypertensive medication, physically active, and if the exercise performed was jogging. A significant inverse correlation was found between age and BP ES, body mass index (BMI) and sBP ES, duration of the exercise's session and sBP ES, and between the number of sets performed in the resistance exercise program and sBP ES (p < 0.05). Regardless of the characteristics of the participants and exercise, there was a reduction in BP in the hours following an exercise session. However, the hypotensive effect was greater when the exercise was performed as a preventive strategy in those physically active and without antihypertensive medication.

Universitat i discapacitat: construint un model d’aula inclusiva en el marc universitari

La present investigació es centre en crear un programa de formació i assessorament docent per atendre la diversitat d’estudiants en el marc universitari mitjançant els principis del disseny universal de la instrucció (DUI). D’aquesta manera es pretén donar resposta: a) a la necessitat d’implementar un model pedagògic en el marc universitari que doni resposta a la diversitat d’estudiants, b) de formar i canviar actituds docents vers la discapacitat i c) d’adaptar el nou marc legislatiu espanyol en matèria de discapacitat a les aules de les nostres universitats. A través d’un procés d’investigació-acció es detecten quins són les necessitats i dificulats pedagògiques, dels docents de les diferents universitats catalanes, per construir espais educatius que garanteixin la igultat d’oportunitats als estudiants amb discapacitat. Les dades obtingudes ens permeten crear una proposta de formació pels docents universitaris, basada en el paradigma educatiu del disseny universal de la instrucció.

Older people's views of falls-prevention interventions in six European countries.

PURPOSE: Our study identified factors common to a variety of populations and settings that may promote or inhibit uptake and adherence to falls-related interventions. DESIGN AND METHODS: Semistructured interviews to assess perceived advantages and barriers to taking part in falls-related interventions were carried out in six European countries with 69 people aged 68 to 97 years. The sample was selected to include people with very different experiences of participation or nonparticipation in falls-related interventions, but all individuals were asked about interventions that included strength and balance training. RESULTS: Attitudes were similar in all countries and contexts. People were motivated to participate in strength and balance training by a wide range of perceived benefits (interest and enjoyment, improved health, mood, and independence) and not just reduction of falling risk. Participation also was encouraged by a personal invitation from a health practitioner and social approval from family and friends. Barriers to participation included denial of falling risk, the belief that no additional falls-prevention measures were necessary, practical barriers to attendance at groups (e.g., transport, effort, and cost), and a dislike of group activities. IMPLICATIONS: Because many older people reject the idea that they are at risk of falling, the uptake of strength and balance training programs may be promoted more effectively by maximizing and emphasizing their multiple positive benefits for health and well-being. A personal invitation from a health professional to participate is important, and it also may be helpful to provide home-based programs for those who dislike or find it difficult to attend groups.

Avaluació de programes formatius de seguretat viària i la reincidència posterior

Els programes formatius d’educació viària són una mesura penal alternativa que s’imposa habitualment als autors dels delictes relacionats amb el trànsit (articles 379 i següents del Codi Penal) per suspendre o substituir la pena de presó. Aquests programes tenen un doble objectiu: aconseguir reduir a curt termini la sinistralitat viària i propiciar un canvi cultural permanent en la conducció. L’objectiu principal d’aquesta recerca va ser identificar les característiques comunes dels infractors de trànsit que fan aquest tipus d’intervenció, conèixer els factors de risc associats a aquests infractors i en quina mesura l’estat psicològic és un factor de risc en l’estil de conducció. També es volia determinar si hi havia diferències entre les entitats que impartien la formació, avaluar l’efectivitat d’aquests programes en l’estil de conducció dels participants en finalitzar el curs i conèixer la reincidència dels seus participants i la seva relació amb l’estat i el canvi de les variables de l’estudi. La mostra va comptar amb 278 participants voluntaris del total de 354 infractors de trànsit que van realitzar un programa formatiu entre l’1 d’abril de 2009 i el 13 de febrer de 2010. D’aquests, un total de 100 participants van autoritzar a ser contactats novament entre el desembre del 2011 i el gener del 2012, per mirar la reincidència. Les fonts d’informació van ser els qüestionaris passats als infractors i el buidatge de la base de dades d’execució penal del Departament de Justícia, amb informació judicial i personal i el seguiment dels usuaris fins a dos anys després d’haver finalitzat el curs formatiu, per saber si havien tornat a reincidir en el mateix delicte.

Evaluación de programas formativos de seguridad vial y su reincidencia posterior

Los programas formativos de educación vial son una medida penal alternativa que se impone habitualmente a los autores de delitos relacionados con el tráfico (artículos 379 y siguientes del Código Penal) para suspender o sustituir la pena de prisión. Estos programas tienen un doble objetivo: conseguir reducir a corto plazo la siniestralidad vial y propiciar un cambio cultural permanente en la conducción. El objetivo principal de esta investigación fue identificar las características comunes de los infractores de tráfico que han de hacer este tipo de intervención y conocer sus factores de riesgo. También se estudiaron las diferencias entre las entidades que imparten los cursos formativos, se evaluó su efectividad y se estudió la reincidencia de los conductores. En total participaron 278 infractores que realizaron un programa formativo entre el 1 de abril de 2009 y el 13 de febrero de 2010 y se les siguió hasta enero de 2012.

Influence of hip-flexion angle on hamstrings isokinetic activity in sprinters.

CONTEXT: Hamstrings strains are common and debilitating injuries in many sports. Most hamstrings exercises are performed at an inadequately low hip-flexion angle because this angle surpasses 70° at the end of the sprinting leg's swing phase, when most injuries occur. OBJECTIVE: To evaluate the influence of various hip-flexion angles on peak torques of knee flexors in isometric, concentric, and eccentric contractions and on the hamstrings-to-quadriceps ratio. DESIGN: Descriptive laboratory study. SETTING: Research laboratory. Patients and Other Participants: Ten national-level sprinters (5 men, 5 women; age = 21.2 ± 3.6 years, height = 175 ± 6 cm, mass = 63.8 ± 9.9 kg). Intervention(s): For each hip position (0°, 30°, 60°, and 90° of flexion), participants used the right leg to perform (1) 5 seconds of maximal isometric hamstrings contraction at 45° of knee flexion, (2) 5 maximal concentric knee flexion-extensions at 60° per second, (3) 5 maximal eccentric knee flexion-extensions at 60° per second, and (4) 5 maximal eccentric knee flexionextensions at 150° per second. Main Outcome Measure(s): Hamstrings and quadriceps peak torque, hamstrings-to-quadriceps ratio, lateral and medial hamstrings root mean square. RESULTS: We found no difference in quadriceps peak torque for any condition across all hip-flexion angles, whereas hamstrings peak torque was lower at 0° of hip flexion than at any other angle (P < .001) and greater at 90° of hip flexion than at 30° and 60° (P < .05), especially in eccentric conditions. As hip flexion increased, the hamstrings-to-quadriceps ratio increased. No difference in lateral or medial hamstrings root mean square was found for any condition across all hip-flexion angles (P > .05). CONCLUSIONS: Hip-flexion angle influenced hamstrings peak torque in all muscular contraction types; as hip flexion increased, hamstrings peak torque increased. Researchers should investigate further whether an eccentric resistance training program at sprint-specific hip-flexion angles (70° to 80°) could help prevent hamstrings injuries in sprinters. Moreover, hamstrings-to-quadriceps ratio assessment should be standardized at 80° of hip flexion.

Médecine de l'adolescence. La Guglera: une réponse nouvelle et originale aux adolescents gravement obèses et sans travail [Adolescent medicine in Guglera: a novel approach for unemployed, severely obese adolescents]

The Center "la Guglera", located in the canton of Fribourg (Switzerland) provides a novel approach to the care of severely obese adolescents who are currently unemployed. These young people, whose BMI is usually higher than 35 to 40 kg/m2 spend a 6 to 12 months long stay in an in-patient institution which also takes care of other unemployed non obese adolescents on an outpatient basis. Besides a nutritional education which is part of the everyday life of the institution, the program includes a generous amount of hours of physical activities and sports. The adolescents also participate in a rehabilitation training program which fosters the future integration in a professional milieu, such as an apprenticeship. The short term results of la Guglera seem very promising. The program is financially co-supported by the Swiss and cantonal administrations, the insurance companies and the parents.

Management options for accidental injection of epinephrine from an autoinjector: a case report.

INTRODUCTION: Epinephrine autoinjector devices are used with increasing frequency to treat severe anaphylactic reactions. Accidental injection, usually involving a finger, is a potential complication. CASE PRESENTATION: A physician in a Family Practice training program accidentally injected epinephrine into his left thumb while reading the operating instructions of an autoinjector (Epipen((R))). He developed swelling, pallor, and pain in the thumb. Treatment included topical nitroglycerin, oral vasodilators and warming of the thumb. As expected, none caused an immediate response; however, after 8 hours, the thumb was pink and warm. There was full recovery 2 months after the accident. We reviewed the treatment of accidental epinephrine injection, and found that the use of parenteral adrenergic alpha blocker phentolamine would have produced immediate recovery. CONCLUSIONS: All health professionals concerned with the use of epinephrine autoinjectors should receive adequate instruction on their use. A regimen for management of accidental epinephrine injection, in particular the use of phentolamine, should be emphasized.

Improved earthquake response via simulation and integrated space- and ground-based technologies: the TREMOR proposal

Earthquakes occurring around the world each year cause thousands ofdeaths, millions of dollars in damage to infrastructure, and incalculablehuman suffering. In recent years, satellite technology has been asignificant boon to response efforts following an earthquake and itsafter-effects by providing mobile communications between response teamsand remote sensing of damaged areas to disaster management organizations.In 2007, an international team of students and professionals assembledduring theInternational Space University’s Summer Session Program in Beijing, Chinato examine how satellite and ground-based technology could be betterintegrated to provide an optimised response in the event of an earthquake.The resulting Technology Resources for Earthquake MOnitoring and Response(TREMOR) proposal describes an integrative prototype response system thatwill implement mobile satellite communication hubs providing telephone anddata links between response teams, onsite telemedicine consultation foremergency first-responders, and satellite navigation systems that willlocate and track emergency vehicles and guide search-and-rescue crews. Aprototype earthquake simulation system is also proposed, integratinghistorical data, earthquake precursor data, and local geomatics andinfrastructure information to predict the damage that could occur in theevent of an earthquake. The backbone of these proposals is a comprehensiveeducation and training program to help individuals, communities andgovernments prepare in advance. The TREMOR team recommends thecoordination of these efforts through a centralised, non-governmentalorganization.

The 15-minute family interview: a family health strategy tool

The 15-minute family interview is a condensed form of the Calgary Family Assessment and Intervention Models (CFAM and CFIM) that aims to contribute to the establishment of a therapeutic relationship between nurses and family and to implement interventions to promote health and suffering relief, even during brief interactions. This study investigated the experience of nurses from the Family Health Strategy (FHS) who used the 15-minute interview on postpartum home. The qualitative research was conducted in three stages: participants' training program, utilization of the 15-minute family interview by participants, and interviews with nurses. The data were collected through semi-structured interviews with eight nurses. The thematic analysis revealed two main themes: dealing with the challenge of a new practice and evaluating the assignment. This work shows that this tool can be used to deepen relationships between nurses and families in the Family Health Strategy.

Prevalence, pathophysiology, health consequences and treatment options of obesity in the elderly: a guideline.

The prevalence of obesity is rising progressively, even among older age groups. By the year 2030-2035 over 20% of the adult US population and over 25% of the Europeans will be aged 65 years and older. The predicted prevalence of obesity in Americans, 60 years and older was 37% in 2010. The predicted prevalence of obesity in Europe in 2015 varies between 20 and 30% dependent on the model used. This means 20.9 million obese 60+ people in the USA in 2010 and 32 million obese elders in 2015 in the EU. Although cut-off values of BMI, waist circumference and percentages of fat mass have not been defined for the elderly (nor for the elderly of different ethnicity), it is clear from several meta-analyses that mortality and morbidity associated with overweight and obesity only increases at a BMI above 30 kg/m(2). Thus, treatment should only be offered to patients who are obese rather than overweight and who also have functional impairments, metabolic complications or obesity-related diseases, that can benefit from weight loss. The weight loss therapy should aim to minimize muscle and bone loss but also vigilance as regards the development of sarcopenic obesity - a combination of an unhealthy excess of body fat with a detrimental loss of muscle and fat-free mass including bone - is important in the elderly, who are vulnerable to this outcome. Life-style intervention should be the first step and consists of a diet with a 500 kcal (2.1 MJ) energy deficit and an adequate intake of protein of high biological quality together with calcium and vitamin D, behavioural therapy and multi-component exercise. Multi-component exercise includes flexibility training, balance training, aerobic exercise and resistance training. The adherence rate in most studies is around 75%. Knowledge of constraints and modulators of physical inactivity should be of help to engage the elderly in physical activity. The role of pharmacotherapy and bariatric surgery in the elderly is largely unknown as in most studies people aged 65 years and older have been excluded.

ASSIST With Windows Newsletter, Spring 2005

The purpose of Project ASSIST is to provide computer training to individuals who are blind, visually-impaired or deaf-blind. Our training materials address all levels of users, from beginners to advanced users. We have tutorials, keyboard guides and diagrams, and course packets. These materials can be used by individuals who want to learn popular computer programs on their own and by professional trainers for their organization's computer training program. We also offer instructor-led training through our ASSIST Online distance learning program.

Teaching cardiac auscultation to trainees in internal medicine and family practice: does it work?

BACKGROUND: The general proficiency in physical diagnostic skills seems to be declining in relation to the development of new technologies. The few studies that have examined this question have invariably used recordings of cardiac events obtained from patients. However, this type of evaluation may not correlate particularly well with bedside skills. Our objectives were 1) To compare the cardiac auscultatory skills of physicians in training with those of experienced cardiologists by using real patients to test bedside diagnostic skills. 2) To evaluate the impact of a five-month bedside cardiac auscultation training program. METHODS: 1) In an academic primary care center, 20 physicians (trainees in internal medicine and family practice) and two skilled academic cardiologists listened to 33 cardiac events in 13 patients directly at bedside and identified the cardiac events by completing an open questionnaire. Heart sounds, murmurs and diagnosis were determined beforehand by an independent skilled cardiologist and were validated by echocardiography. Thirteen primary cardiologic diagnoses were possible.2) Ten of the physicians agreed to participate in a course of 45-minute sessions once a week for 5 months. After the course they listened again to the same patients (pre/post-interventional study). RESULTS: 1) The experts were the most skillful, achieving 69% recognition of heart sounds and murmurs and correct diagnoses in 62% of cases. They also heard all of the diastolic murmurs. The residents heard only 40% of the extra heart sounds and made a correct diagnosis in 24% of cases. 2) After the weekly training sessions, their mean percentage for correct diagnosis was 35% [an increase of 66% (p < 0.05)]. CONCLUSIONS: The level of bedside diagnostic skills in this relatively small group of physicians in training is indeed low, but can be improved by a course focusing on realistic bedside teaching.

A Gestão da Formação na Sucursal da Mundiserviços em Cabo Verde

O presente Relatório de Estágio insere-se no âmbito da Unidade Curricular de Estágio, realizado na empresa MundiServiços, Consultoria de Gestão e Formação, Sucursal de Cabo Verde, conducente ao grau de Mestre em Ciências da Educação com especialização na área de Formação de Adultos. A Sucursal da MundiServiços em Cabo Verde centra a sua intervenção no mercado cabo-verdiano essencialmente em dois eixos: Consultoria na área de Gestão de Recursos Humanos e Formação Profissional. O meu Projecto de Estágio tem a sua incidência na área da Formação Profissional e visa responder a uma solicitação da ARFA - Agência de Regulação e Supervisão de Produtos Farmacêuticos e Alimentares - organização cliente da MundiServiços em Cabo Verde. Neste contexto, o Projecto de Estágio tem como finalidade a realização de um Estudo de Diagnóstico de Necessidades de Formação e a Elaboração de um Plano Estratégico de Formação que possa satisfazer as necessidades organizacionais, profissionais e pessoais da Agência e dos seus trabalhadores. Este trabalho enquadra-se numa medida estratégica da entidade, que passa pelo desenvolvimento de competências chave dos seus recursos humanos, como forma de responder a novos desafios estratégicos e organizacionais e de aumentar a motivação e satisfação interna dos seus trabalhadores. De acordo com os objectivos pré-estabelecidos para a execução deste estudo, tentou-se combinar as metodologias qualitativa e quantitativa, com recurso a diferentes técnicas de recolha, análise e tratamento de dados, com a principal finalidade de obter informações que permitam responder, de forma efectiva, à solicitação da agência, transformando as necessidades formativas dos trabalhadores em potencialidades.