Ethical issues in nutrition support of severely disabled elderly persons: a guide for health professionals.

Providing or withholding nutrition in severely disabled elderly persons is a challenging dilemma for families, health professionals, and institutions. Despite limited evidence that nutrition support improves functional status in vulnerable older persons, especially those suffering from dementia, the issue of nutrition support in this population is strongly debated. Nutrition might be considered a basic need that not only sustains life but provides comfort as well by patients and their families. Consequently, the decision to provide or withhold nutrition support during medical care is often complex and involves clinical, legal, and ethical considerations. This article proposes a guide for health professionals to appraise ethical issues related to nutrition support in severely disabled older persons. This guide is based on an 8-step process to identify the components of a situation, analyze conflicting values that result in the ethical dilemma, and eventually reach a consensus for the most relevant plan of care to implement in a specific clinical situation. A vignette is presented to illustrate the use of this guide when analyzing a clinical situation.

Teaching Motivational Interviewing to Medical Students to Improve Behavior Change Counseling Skills - Results of a Pilot Test

BACKGROUND: Patient behavior accounts for half or more of the variance in health, disease, mortality and treatment outcome and costs. Counseling using motivational interviewing (MI) effectively improves the substance use and medical compliance behavior of patients. Medical training should include substantial focus on this key issue of health promotion. The objective of the study is to test the efficacy of teaching MI to medical students. METHODS: Thirteen fourth-year medical students volunteered to participate. Seven days before and after an 8-hour interactive MI training workshop, each student performed a video-recorded interview with two standardized patients: a 60 year-old alcohol dependent female consulting a primary care physician for the first time about fatigue and depression symptoms; and a 50 year-old male cigarette smoker hospitalized for myocardial infarction. All 52 videos (13 students×2 interviews before and after training) were independently coded by two blinded clinicians using the Motivational Interviewing Training Integrity (MITI, 3.0). MITI scores consist of global spirit (Evocation, Collaboration, Autonomy/Support), global Empathy and Direction, and behavior count summary scores (% Open questions, Reflection to question ratio, % Complex reflections, % MI-adherent behaviors). A "beginning proficiency" threshold (BPT) is defined for each of these 9 scores. The proportion of students reaching BPT before and after training was compared using McNemar exact tests. Inter-rater reliability was evaluated by comparing double coding, and test-retest analyses were conducted on a sub-sample of 10 consecutive interviews by each coder. Weighted Kappas were used for global rating scales and intra-class correlations (ICC) were computed for behavior count summary scores. RESULTS: The percent of counselors reaching BPT before and after MI training increased significantly for Evocation (15% to 65%, p<.001), Collaboration (27% to 77%, p=.001), Autonomy/Support (15% to 54%, p=.006), and % Open questions (4% to 38%, p=.004). Proportions increased, but were not statistically significant for Empathy (38% to 58%, p=.18), Reflection to question ratio (0% to 15%, p=.12), % Complex reflection (35% to 54%, p=.23), and % MI-adherent behaviors (8% to 15%, p=.69). There was virtually no change for the Direction scale (92% to 88%, p=1.00). The reliability analyses produced mixed results. Weighted kappas for inter-rater reliability ranged from .14 for Direction to .51 for Collaboration, and from .27 for Direction to .80 for Empathy for test-retest. ICCs ranged from .20 for Complex reflections to .89 for Open questions (inter-rater), and from .67 for Complex reflections to .99 for Reflection to question ratio (test-retest). CONCLUSION: This pilot study indicates that a single 8-hour training in motivational interviewing for voluntary fourth-year medical students results in significant improvement of some MI skills. A larger sample of randomly selected medical students observed over longer periods should be studied to test if MI training generalizes to medical students. Inter-rater reliability and test-retest findings indicate a need for caution when interpreting the present results, as well as for more intensive training to help appropriately capture more dimensions of the process in future studies.

Nous perfils professionals i polivalència del periodista a Catalunya: mapa de situació

Aquesta investigació –finançada pel Consell de l’Audiovisual de Catalunya (CAC)– presenta un mapa dels nous perfils professionals en el panorama periodístic català actual com a conseqüència de la digitalització de les eines i els processos de treball en els mitjans de comunicació. L’article analitza també l’extinció i la transformació de figures professionals en els mitjans audiovisuals i multimèdia. A banda d’això, la recerca presenta un panorama de les competències professionals que ha de tenir un o una periodista en la nova realitat creada pels processos de digitalització de la producció informativa.

Grau de satisfacció d'un col·lectiu de persones grans en relació a l'atenció rebuda dels professionals d'infermeria durant la seva hospitalització

Introducció: La preocupació per la qualitat assistencial, i concretament per la qualitat de les cures infermeres, la satisfacció percebuda pel pacient com element fonamental com a indicador de la qualitat dels serveis sanitaris i clau en la millora de la qualitat assistencial, i el fet que a l’estat espanyol hi ha pocs estudis de satisfacció específics de la població anciana hospitalitzada, ens va portar a plantejar un estudi amb l’objectiu de valorar el grau de satisfacció de les persones grans hospitalitzades en relació a l’atenció rebuda dels professionals d’infermeria. Metodologia: S’ha realitzat un estudi descriptiu i transversal en un col.lectiu de 42 persones hospitalitzades d’edat ≥ 60 anys. El grau de satisfacció es va determinar amb “La Monica Oberst Patient Satisfaction Scale 12” (LOPSS 12), versió reduïda en castellà. La personalització de les cures es va valorar amb un qüestionari que valora la relació infermera-usuari extret de l’Índex de Personalització de les Cures. L'anàlisi estadística es va dur a terme amb el programa informàtic SPSS® vs 21.0. Resultats: Es va evidenciar un elevat grau de satisfacció global amb les cures d’infermeria (8,8  1,5 / 10), però el nivell global de personalització d’aquestes cures no va ser molt satisfactori (3,4  2,1 / 7). Els homes van valorar millor a les infermeres respecte a que consideraven les seves opinions i preferències (p=0,03) i contestaven amb rapidesa les seves trucades (p=0,009). La personalització de les cures millorava conforme incrementava el grau de satisfacció global (r = 0,582; p = 0,000) i amb el temps d’hospitalització (r = 0,344; p = 0,026). Conclusions: El grau de satisfacció global respecte la satisfacció en l’atenció rebuda per part d’infermeria, va ser elevat però amb baix grau de personalització, mostrant major satisfacció els homes respecte les dones. Conèixer l’opinió dels usuaris representa una oportunitat pels professionals de reflexionar sobre la pràctica clínica i ser crítics per avançar en el desenvolupament de la professió, identificant aspectes susceptibles de millora 5 amb la finalitat d’augmentar la qualitat de les cures que es presten, així com la qualitat de vida de les persones.

Teaching Video NeuroImages: Micronystagmus of oculopalatal tremor.

Three months after brainstem hemorrhage, MRI revealed a hyperintense lesion of the left inferior olivary nucleus of a 45-year-old man (figure). The patient was completely asymptomatic, but exhibited oculopalatal tremor (OPT), rhythmic palatal oscillations, and small-amplitude vertical pendular nystagmus of the right eye, best visualized on fundus examination (see video).

Awareness of HIV Testing Guidelines Is Low among Swiss Emergency Doctors: A Survey of Five Teaching Hospitals in French-Speaking Switzerland.

BACKGROUND: In Switzerland, 30% of HIV-infected individuals are diagnosed late. To optimize HIV testing, the Swiss Federal Office of Public Health (FOPH) updated 'Provider Induced Counseling and Testing' (PICT) recommendations in 2010. These permit doctors to test patients if HIV infection is suspected, without explicit consent or pre-test counseling; patients should nonetheless be informed that testing will be performed. We examined awareness of these updated recommendations among emergency department (ED) doctors. METHODS: We conducted a questionnaire-based survey among 167 ED doctors at five teaching hospitals in French-Speaking Switzerland between 1(st) May and 31(st) July 2011. For 25 clinical scenarios, participants had to state whether HIV testing was indicated or whether patient consent or pre-test counseling was required. We asked how many HIV tests participants had requested in the previous month, and whether they were aware of the FOPH testing recommendations. RESULTS: 144/167 doctors (88%) returned the questionnaire. Median postgraduate experience was 6.5 years (interquartile range [IQR] 3; 12). Mean percentage of correct answers was 59 ± 11%, senior doctors scoring higher (P=0.001). Lowest-scoring questions pertained to acute HIV infection and scenarios where patient consent was not required. Median number of test requests was 1 (IQR 0-2, range 0-10). Only 26/144 (18%) of participants were aware of the updated FOPH recommendations. Those aware had higher scores (P=0.001) but did not perform more HIV tests. CONCLUSIONS: Swiss ED doctors are not aware of the national HIV testing recommendations and rarely perform HIV tests. Improved recommendation dissemination and adherence is required if ED doctors are to contribute to earlier HIV diagnoses.

Trayectorias docentes e investigadoras en la universidad. 24 historias de vida profesional. Los efectos de los cambios en el trabajo y la vida profesional de los docentes universitarios

[spa] Este texto forma parte de un proyecto de investigación Los efectos de los cambios sociales en el trabajo y la vida profesional de los docentes universitarios, parcialmente financiado por el Ministerio de Ciencia e Innovación (SEJ2006-01876), en el que nos planteamos explorar los cambios los ámbitos de la legislación, laorganización institucional, la investigación, la gestión y la docencia en los últimos treinta años. El principal objetivo del estudio era profundizar en nuestra comprensión sobre el impacto del cambio económico, social, cultural, tecnológico y laboral que están experimentando las universidades españolas en la vida y la identidad profesional del personal docente e investigador, teniendo en cuenta el contexto nacional y europeo. Estapublicación recoge la 24 historias de vida profesional realizas con o sobre otros tantos docentes universitarios. Sus relatos analizados y contextualizados, significan una contribución significativa al conocimiento basado en la investigación sobre el saber profesional y la experiencia laboral en las universidades españolas, y en consecuencia, a nuestra comprensión sobre cómo los académicos se están enfrentando con los cambios actuales.

Trayectorias docentes e investigadoras en la universidad. 24 historias de vida profesional. Los efectos de los cambios en el trabajo y la vida profesional de los docentes universitarios

[spa] Este texto forma parte de un proyecto de investigación Los efectos de los cambios sociales en el trabajo y la vida profesional de los docentes universitarios, parcialmente financiado por el Ministerio de Ciencia e Innovación (SEJ2006-01876), en el que nos planteamos explorar los cambios los ámbitos de la legislación, laorganización institucional, la investigación, la gestión y la docencia en los últimos treinta años. El principal objetivo del estudio era profundizar en nuestra comprensión sobre el impacto del cambio económico, social, cultural, tecnológico y laboral que están experimentando las universidades españolas en la vida y la identidad profesional del personal docente e investigador, teniendo en cuenta el contexto nacional y europeo. Estapublicación recoge la 24 historias de vida profesional realizas con o sobre otros tantos docentes universitarios. Sus relatos analizados y contextualizados, significan una contribución significativa al conocimiento basado en la investigación sobre el saber profesional y la experiencia laboral en las universidades españolas, y en consecuencia, a nuestra comprensión sobre cómo los académicos se están enfrentando con los cambios actuales.

Trayectorias docentes e investigadoras en la universidad. 24 historias de vida profesional. Los efectos de los cambios en el trabajo y la vida profesional de los docentes universitarios

[spa] Este texto forma parte de un proyecto de investigación Los efectos de los cambios sociales en el trabajo y la vida profesional de los docentes universitarios, parcialmente financiado por el Ministerio de Ciencia e Innovación (SEJ2006-01876), en el que nos planteamos explorar los cambios los ámbitos de la legislación, laorganización institucional, la investigación, la gestión y la docencia en los últimos treinta años. El principal objetivo del estudio era profundizar en nuestra comprensión sobre el impacto del cambio económico, social, cultural, tecnológico y laboral que están experimentando las universidades españolas en la vida y la identidad profesional del personal docente e investigador, teniendo en cuenta el contexto nacional y europeo. Estapublicación recoge la 24 historias de vida profesional realizas con o sobre otros tantos docentes universitarios. Sus relatos analizados y contextualizados, significan una contribución significativa al conocimiento basado en la investigación sobre el saber profesional y la experiencia laboral en las universidades españolas, y en consecuencia, a nuestra comprensión sobre cómo los académicos se están enfrentando con los cambios actuales.

Trayectorias docentes e investigadoras en la universidad. 24 historias de vida profesional. Los efectos de los cambios en el trabajo y la vida profesional de los docentes universitarios

[spa] Este texto forma parte de un proyecto de investigación Los efectos de los cambios sociales en el trabajo y la vida profesional de los docentes universitarios, parcialmente financiado por el Ministerio de Ciencia e Innovación (SEJ2006-01876), en el que nos planteamos explorar los cambios los ámbitos de la legislación, laorganización institucional, la investigación, la gestión y la docencia en los últimos treinta años. El principal objetivo del estudio era profundizar en nuestra comprensión sobre el impacto del cambio económico, social, cultural, tecnológico y laboral que están experimentando las universidades españolas en la vida y la identidad profesional del personal docente e investigador, teniendo en cuenta el contexto nacional y europeo. Estapublicación recoge la 24 historias de vida profesional realizas con o sobre otros tantos docentes universitarios. Sus relatos analizados y contextualizados, significan una contribución significativa al conocimiento basado en la investigación sobre el saber profesional y la experiencia laboral en las universidades españolas, y en consecuencia, a nuestra comprensión sobre cómo los académicos se están enfrentando con los cambios actuales.

Referents de l'educació intercultural

La societat en què vivim cada cop és més diversa i complexa. Per això és essencial trobar uns paràmetres comuns que permetin la convivència i la comunicació intercultural entre les diverses cultures que conformen el teixit social actual en el territori de la Unió Europea. En la mesura en què aquestes persones provinents d'altres països tinguin garantits els drets civils essencials, com a ciutadans de ple dret, estarem posant les bases d'una futura convivència productiva per a tothom i estarem deixant un llegat de pau social imprescindible per al progrés de la nostra societat. Un dels pilars bàsics d'aquest accés a la plena ciutadania per part de tots els habitants dels estats europeus és l'educació. Sovint trasbalsada per múltiples canvis legislatius, l'educació ara per ara no té cap altre sortida que ser intercultural, com a reflex fidel d'allò que està passant en la societat. El repte és preparar els professionals i implicar-hi a tots els agents educatius i promoure el desenvolupament ple de totes les capacitats dels alumnes, alhora que els prepara per a una transició al món laboral el més fàcil possible.

An international university network for online teaching of pathology in Frenchspeaking countries

Introduction: Building online courses is a highly time consuming task for teachers of a single university. Universities working alone create high-quality courses but often cannot cover all pathological fields. Moreover this often leads to duplication of contents among universities, representing a big waste of teacher time and energy. We initiated in 2011 a French university network for building mutualized online teaching pathology cases, and this network has been extended in 2012 to Quebec and Switzerland. Method: Twenty French universities (see & for details), University Laval in Quebec and University of Lausanne in Switzerland are associated to this project. One e-learning Moodle platform (http://moodle.sorbonne-paris-cite.fr/) contains texts with URL pointing toward virtual slides that are decentralized in several universities. Each university has the responsibility of its own slide scanning, slide storage and online display with virtual slide viewers. The Moodle website is hosted by PRES Sorbonne Paris Cité, and financial supports for hardware have been obtained from UNF3S (http://www.unf3s.org/) and from PRES Sorbonne Paris Cité. Financial support for international fellowships has been obtained from CFQCU (http://www.cfqcu.org/). Results: The Moodle interface has been explained to pathology teachers using web-based conferences with screen sharing. The teachers added then contents such as clinical cases, selfevaluations and other media organized in several sections by student levels and pathological fields. Contents can be used as online learning or online preparation of subsequent courses in classrooms. In autumn 2013, one resident from Quebec spent 6 weeks in France and Switzerland and created original contents in inflammatory skin pathology. These contents are currently being validated by senior teachers and will be opened to pathology residents in spring 2014. All contents of the website can be accessed for free. Most contents just require anonymous connection but some specific fields, especially those containing pictures obtained from patients who agreed for a teaching use only, require personal identification of the students. Also, students have to register to access Moodle tests. All contents are written in French but one case has been translated into English to illustrate this communication (http://moodle.sorbonne-pariscite.fr/mod/page/view.php?id=261) (use "login as a guest"). The Moodle test module allows many types of shared questions, making it easy to create personalized tests. Contents that are opened to students have been validated by an editorial committee composed of colleagues from the participating institutions. Conclusions: Future developments include other international fellowships, the next one being scheduled for one French resident from May to October 2014 in Quebec, with a study program centered on lung and breast pathology. It must be kept in mind that these e-learning programs highly depend on teachers' time, not only at these early steps but also later to update the contents. We believe that funding resident fellowships for developing online pathological teaching contents is a win-win situation, highly beneficial for the resident who will improve his knowledge and way of thinking, highly beneficial for the teachers who will less worry about access rights or image formats, and finally highly beneficial for the students who will get courses fully adapted to their practice.

The promotion and assessment of generic skills from interdisciplinary teaching teams

The paper explains a teaching project financed by the University of Barcelona (UB). It focuses on ageneric skill of the University of Barcelona, which is defined as "the learning capability andresponsibility”, and in which analytical and synthesis skills are included. It follows a multidisciplinaryapproach including teachers of Mathematics, World Economics and Economic History. All of us sharethe same students during the first and the second course of the grade in Economics at the Faculty ofEconomics and Business. The project has been developed in three stages. The first one has beendone during the first semester of the course 2012/13, being applied to first year students on thesubjects of Mathematics and Economic History. The second phase is being to be done during thesecond semester only on the Economic History subject. A third stage is going to be done next course2013/14 to second year students on the subject of World Economics. Each different teaching teamhas developed specific materials and assessment tools for each one of the subjects included in theproject. The project emphasizes two teaching dimensions: the elaboration of teaching materials topromote the acquisition of generic skills from an interdisciplinary point of view, and the design ofspecific tools to assess such skills. The first results of the first phase of the project shows cleardeficiencies in the analytical skill regarding to first year students.

The promotion and assessment of generic skills from interdisciplinary teaching teams

The paper explains a teaching project financed by the University of Barcelona (UB). It focuses on ageneric skill of the University of Barcelona, which is defined as "the learning capability andresponsibility”, and in which analytical and synthesis skills are included. It follows a multidisciplinaryapproach including teachers of Mathematics, World Economics and Economic History. All of us sharethe same students during the first and the second course of the grade in Economics at the Faculty ofEconomics and Business. The project has been developed in three stages. The first one has beendone during the first semester of the course 2012/13, being applied to first year students on thesubjects of Mathematics and Economic History. The second phase is being to be done during thesecond semester only on the Economic History subject. A third stage is going to be done next course2013/14 to second year students on the subject of World Economics. Each different teaching teamhas developed specific materials and assessment tools for each one of the subjects included in theproject. The project emphasizes two teaching dimensions: the elaboration of teaching materials topromote the acquisition of generic skills from an interdisciplinary point of view, and the design ofspecific tools to assess such skills. The first results of the first phase of the project shows cleardeficiencies in the analytical skill regarding to first year students.