What Are Effective Program Characteristics of Self-Management Interventions in Patients With Heart Failure? : An Individual Patient Data Meta-analysis

Background To identify those characteristics of self-management interventions in patients with heart failure (HF) that are effective in influencing health-related quality of life, mortality, and hospitalizations. Methods and Results Randomized trials on self-management interventions conducted between January 1985 and June 2013 were identified and individual patient data were requested for meta-analysis. Generalized mixed effects models and Cox proportional hazard models including frailty terms were used to assess the relation between characteristics of interventions and health-related outcomes. Twenty randomized trials (5624 patients) were included. Longer intervention duration reduced mortality risk (hazard ratio 0.99, 95% confidence interval [CI] 0.97–0.999 per month increase in duration), risk of HF-related hospitalization (hazard ratio 0.98, 95% CI 0.96–0.99), and HF-related hospitalization at 6 months (risk ratio 0.96, 95% CI 0.92–0.995). Although results were not consistent across outcomes, interventions comprising standardized training of interventionists, peer contact, log keeping, or goal-setting skills appeared less effective than interventions without these characteristics. Conclusion No specific program characteristics were consistently associated with better effects of self-management interventions, but longer duration seemed to improve the effect of self-management interventions on several outcomes. Future research using factorial trial designs and process evaluations is needed to understand the working mechanism of specific program characteristics of self-management interventions in HF patients.

Prevalencia y factores asociados al síndrome de agotamiento profesional en residentes de diferentes especialidades médicas : una revisión de la literatura de los últimos 15 años

El Síndrome de Agotamiento Profesional (SAP), es común en los trabajadores de la salud, particularmente en los expuestos a altos niveles de estrés en el trabajo e incluye el agotamiento emocional, despersonalización y baja realización personal. Se considera que los médicos residentes presentan una mayor prevalencia del síndrome que los médicos debido a que se encuentran en entrenamiento, período en el cual están sometidos a alta carga laboral debido a las largas horas de trabajo, horarios irregulares, privación de sueño, intensas demandas emocionales, así como la presión de dominar un gran conocimiento clínico. Objetivo. Determinar la prevalencia del Síndrome de Agotamiento Profesional o Burnout en la población de médicos residentes. Metodología. Se realizó una búsqueda de artículos en la base de datos electrónica Pubmed, seleccionando aquellos publicados entre los años 2001 al 2016, tanto en idioma inglés como en español, a texto completo y enfocados en estudios en médicos residentes. Resultados. Los hallazgos sugieren que el Síndrome de Agotamiento Profesional o Burnout es altamente prevalente, que varía de acuerdo a la residencia que se esté realizando, encontrando un promedio del 50% con un rango de 27% a 75% entre las diferentes especialidades de la población estudiada y, en consecuencia, puede constituir un problema de salud que amerita atención en cada Institución, esto a pesar de que la prevalencia pueda variar de un lugar a otro y en las diferentes especialidades. Conclusiones. El SAP o Burnout constituye un problema de salud entre la población de médicos residentes, lo que sugiere la conveniencia de diseñar medidas para su prevención como informar en la inducción al programa de residencia sobre el riesgo de la aparición del síndrome y sus síntomas, consultar tempranamente ante signos de alarma, adecuar el sistema de vigilancia epidemiológica para que incluya esta condición específica y ajustar o disminuir la carga laboral entre otras.

the health and well-being of nursing students in clinical practice . what prevents it? what promotes it?

Introduction: The training of nursing students in the context of clinical practice, is characterized by educational experiences, subject to various emotional stress (stress, ambivalence, frustration, conflict), sometimes making it very vulnerable student.However not all students use the same strategies minimizing their meanings and negative effects on the level of your health and well-being Objetiv:To analyze the perception that nursing students have about the determinants of their health status and well-being in clinical practice Methods: Exploratory research Results:The results reveal the complexity of the teaching / learning process in clinical practice, identified determinants that limit and / or promote health and well-being of students, or not contributing to their motivation, self-confidence and learning. All students value the presence of the following dimensions: affective-emotional (humanization in learning experiences); relational dynamics (interactions developed with all stakeholders); methods used (professional competence of the clinical supervisor and teacher); school curriculum (adaptation of learning in theory); socialization to the profession (become nurse).Conclusions: The results indicate, that although all students evidencing the dimensions described as fundamental to learning in clinical practice, the study results are dichotomous and ambivalent. Students 2nd and 3ºanos refer a low perception in clinical practice, the indicated dimensions, and for these source of concern and uncertainty in learning, such as limiting their health condition and well-being. For students of the 4th year, these dimensions are percecionadas as gifts, and sources of motivation, learning and catalysts such as promoting their health and well-being.

THE FORMATION OF THE READER: BETWEEN IMPOSITIONS AND FREEDOMS

In this article, we intend to focus on the theme of reading and the formation of reader, already so saturated universe of discourse, prioritizing the reader's perspective and their reading stories inside and outside school. To realize this goal, we will analyze reports of reading students letters course of Federal University of Paraíba. Data were collected from a textual production, in which the students should make an account of their stories reading, requested for the period 2013.1 The teacher of Reading and Textual Production I discipline, offered in the first sentence of that course. We aimed to analyze concepts, functions and values assigned to the reading underlying the speeches of these readers. As theoretical and methodological basis for the analysis of data, this work is guided mainly by authors who think of reading as a social and cultural practice - like Certeau (1994), Chartier (1999a, 1999b, 2009) Abreu (1999), Sousa (2009, 2011 and 2014). In this perspective, the reader is a figure that oscillates between what the institutions determine and actual read operations that denounce the existence of an action which does not overlies the passivity. The analysis showed that the training of reader walks between freedom of choice of reading objects and obligations mainly established within the school institution. Also, we realize that the lector assigns different values and functions to read, due mainly to the mode from which it appropriates reading objects.KEYWORDS: Reading. reading history. Formation of the reader. 

THE PIBID AS ITS STUDENTS: CONTRIBUTIONS IN INITIAL TEACHER TRAINING

On this qualitative and interpretative paper, we analyze what contributions of Scholarship Program Initiation to Teaching (PIBID), funded by CAPES, has given to the formation of their fellows in UNIOESTE, considering the enactment of Law 12,796, of 4 April 2013 amending the text of the Guidelines and Framework Law 9394/96 to include the PIBID, now considered in the country a program of Public Policy which aims to encourage the training of professional teachers to act in public basic education. We conducted semistructured interviews with academic students of the subproject Spanish PIBID UNIOESTE to verify the potential of the program and how they evaluate their participation in PIBID regarding your training. We’ve used as the theoretical studies regarding initial teacher training (GATTI (2010, 2012), GATTI; BARRETTO; ANDRÉ (2011)), studies evaluating subprojects PIBID program (MATTHEW; KADRI EL, Silva (2013)) and official documents such as National Curriculum Guidelines for Teacher Education (2002), the National Policy on Education Professionals Teaching of Basic Education (2009) and decrees that provide for the PIBID. The analysis reveals a very positive perception of the contributions PIBID in teacher training.

University library virtual reference services : best practices and continuous improvement

The inclusion or not of chat services within Virtual Reference (VR) is an important topic for university libraries. Increasingly, email supported by a Frequently Asked Questions (FAQ) database is suggested in the scholarly literature as the preferred, cost-effective means for providing university VR services. This paper examines these issues and identifies some best practices for university library VR services relating to chat and email service, collaborative service provision, services staffing, and staff training. Further studies are required to more completely identify best practices for the complete range of VR services.

Towards a cognitive-behavioural intervention for adult grief reactions

Published accounts of behavioural interventions for grief have relied on exposure and habituation to grief cues as the primary strategy. Such an approach is excessively narrow, since it does not adequately confront the challenges that are posed by a bereavement. Many people cope with a bereavement by themselves, and for those, intervention may well be counterproductive. A cognitive-behavioural intervention, following models for depression/anxiety, can assist vulnerable individuals obtain a more rapid or complete adjustment. The proposed approach differs from dynamic treatments by placing less emphasis on defensive behavior, insight, and interpretation and more emphasis on training of coping skills.

Decision support system for contractor pre-qualification : artificial neural network model

The selection criteria for contractor pre-qualification are characterized by the co-existence of both quantitative and qualitative data. The qualitative data is non-linear, uncertain and imprecise. An ideal decision support system for contractor pre-qualification should have the ability of handling both quantitative and qualitative data, and of mapping the complicated nonlinear relationship of the selection criteria, such that rational and consistent decisions can be made. In this research paper, an artificial neural network model was developed to assist public clients identifying suitable contractors for tendering. The pre-qualification criteria (variables) were identified for the model. One hundred and twelve real pre-qualification cases were collected from civil engineering projects in Hong Kong, and eighty-eight hypothetical pre-qualification cases were also generated according to the “If-then” rules used by professionals in the pre-qualification process. The results of the analysis totally comply with current practice (public developers in Hong Kong). Each pre-qualification case consisted of input ratings for candidate contractors’ attributes and their corresponding pre-qualification decisions. The training of the neural network model was accomplished by using the developed program, in which a conjugate gradient descent algorithm was incorporated for improving the learning performance of the network. Cross-validation was applied to estimate the generalization errors based on the “re-sampling” of training pairs. The case studies show that the artificial neural network model is suitable for mapping the complicated nonlinear relationship between contractors’ attributes and their corresponding pre-qualification (disqualification) decisions. The artificial neural network model can be concluded as an ideal alternative for performing the contractor pre-qualification task.

Industrial playwriting : forms, strategies, and methods for creative production

This study, in its exploration of the attached play scripts and their method of development, evaluates the forms, strategies, and methods of an organised model of formalised playwriting. Through the examination, reflection and reaction to a perceived crisis in playwriting in the Australian theatre sector, the notion of Industrial Playwriting is arrived at: a practice whereby plays are designed and constructed, and where the process of writing becomes central to the efficient creation of new work and the improvement of the writer’s skill and knowledge base. Using a practice-led methodology and action research the study examines a system of play construction appropriate to and addressing the challenges of the contemporary Australian theatre sector. Specifically, using the action research methodology known as design-based research a conceptual framework was constructed to form the basis of the notion of Industrial Playwriting. From this two plays were constructed using a case study method and the process recorded and used to create a practical, step-by-step system of Industrial Playwriting. In the creative practice of manufacturing a single authored play, and then a group-devised play, Industrial Playwriting was tested and found to also offer a valid alternative approach to playwriting in the training of new and even emerging playwrights. Finally, it offered insight into how Industrial Playwriting could be used to greatly facilitate theatre companies’ ongoing need to have access to new writers and new Australian works, and how it might form the basis of a cost effective writer development model. This study of the methods of formalised writing as a means to confront some of the challenges of the Australian theatre sector, the practice of playwriting and the history associated with it, makes an original and important contribution to contemporary playwriting practice.

Paving pathways : shaping the public health workforce through tertiary education

Public health educational pathways in Australia have traditionally been the province of Universities, with the Master of Public Health (MPH) recognised as the flagship professional entry program. Public health education also occurs within the fellowship training of the Faculty of Public Health Medicine, but within Australia this remains confined to medical graduates. In recent years, however, we have seen a proliferation of undergraduate degrees as well as an increasing public health presence in the Vocational Education and Training (VET) sector. ----- Following the 2007 Australian Federal election, the new Labour government brought with it a refreshing commitment to a more inclusive and strategic style of government. An important example of this was the 2020 visioning process that identified key issues of public health concern, including an acknowledgment that it was unacceptable to allocate less than 2% of the health budget towards disease prevention. This led to the recommendation for the establishment of a national preventive health agency (Australia: the healthiest country by 2020 National Preventative Health Strategy, Prepared by the Preventative Health Taskforce 2009). ----- The focus on disease prevention places a spotlight on the workforce that will be required to deliver the new investment in health prevention, and also on the role of public health education in developing and upskilling the workforce. It is therefore timely to reflect on trends, challenges and opportunities from a tertiary sector perspective. Is it more desirable to focus education efforts on selected lead issues such as the “obesity epidemic”, climate change, Indigenous health and so on, or on the underlying theory and skills that build a flexible workforce capable of responding to a range of health challenges? Or should we aspire to both? ----- This paper presents some of the key discussion points from 2008 – 2009 of the Public Health Educational Pathways workshops and working group of the Australian Network of Public Health Institutions. We highlight some of the competing tensions in public health tertiary education, their impact on public health training programs, and the educational pathways that are needed to grow, shape and prepare the public health workforce for future challenges.