Determinants of patients' expectations about total knee arthroplasty outcomes

Knee osteoarthritis (OA) is the most prevalent form of arthritis in the US, affecting approximately 37% of adults. Approximately 300,000 total knee arthroplasty (TKA) procedures take place in the United States each year. Total knee arthroplasty is an elective procedure available to patients as an irreversible treatment after failure of previous medical treatments. Some patients sacrifice quality of life and endure many years of pain before making the decision to undergo total knee replacement. In making their decision, it is therefore imperative for patients to understand the procedure, risks and surgical outcomes to create realistic expectations and increase outcome satisfaction. ^ From 2004-2007, 236 OA patients who underwent TKA participated in the PEAKS (Patient Expectations About Knee Surgery) study, an observational longitudinal cohort study, completed baseline and 6 month follow-up questionnaires after the surgery. We performed a secondary data analysis of the PEAKS study to: (1) determine the specific presurgical patient characteristics associated with patients’ presurgical expectations of time to functional recovery; and (2) determine the association between presurgical expectations of time to functional recovery and postsurgical patient capabilities (6 months after TKA). We utilized the WOMAC to measure knee pain and function, the SF-36 to measure health-related quality of life, and the DASS and MOS-SSS to measure psychosocial quality of life variables. Expectation and capability measures were generated from panel of experts. A list of 10 activities was used for this analysis to measure functional expectations and postoperative functional capabilities. ^ The final cohort consisted of 236 individuals, was predominately White with 154 women and 82 men. The mean age was 65 years. Patients were optimistic about their time to functional recovery. Expectation time of being able to perform the list activities per patient had a median of less than 3 months. Patients who expected to be able to perform the functional activities by 3 months had better knee function, less pain and better overall health-related quality of life. Despite expectation differences, all patients showed significant improvement 6 months after surgery. Participant expectation of time to functional recovery was not an independent predictor of capability to perform functional activities at 6 months. Better presurgical patient characteristics were, however, associated with a higher likelihood of being able to perform all activities at 6 months. ^ This study gave us initial insight on the relationship between presurgical patient characteristics and their expectations of functional recovery after total knee replacement. Future studies clarifying the relationship between patient presurgical characteristics and postsurgical functional capabilities are needed.^

Attitudes of dental students to hand hygiene practices at a dental school

Objectives. The purpose of this study was to elucidate behavioral determinants (prevailing attitudes and beliefs) of hand hygiene practices among undergraduate dental students in a dental school. ^ Methods. Statistical modeling using the Integrative Behavioral Model (IBM) prediction was utilized to develop a questionnaire for evaluating behavioral perceptions of hand hygiene practices by dental school students. Self-report questionnaires were given to second, third and fourth year undergraduate dental students. Models representing two distinct hand hygiene practices, termed "elective in-dental school hand hygiene practice" and "inherent in-dental school hand hygiene practice" were tested using linear regression analysis. ^ Results. 58 responses were received (24.5%); the sample mean age was 26.6 years old and females comprised 51%. In our models, elective in-dental school hand hygiene practice and inherent in-dental school hand hygiene practice, explained 40% and 28%, respectively, of the variance in behavioral intention. Translation of community hand hygiene practice to the dental school setting is the predominant driver of elective hand hygiene practice. Intended elective in-school hand hygiene practice is further significantly predicted by students' self-efficacy. Students' attitudes, peer pressure of other dental students and clinic administrators, and role modeling had minimal effects. Inherent hand hygiene intent was strongly predicted by students' beliefs in the benefits of the activity and, to a lesser extent, role modeling. Inherent and elective community behaviors were insignificant. ^ Conclusions. This study provided significant insights into dental student's hand hygiene behavior and can form the basis for an effective behavioral intervention program designed to improve hand hygiene compliance.^

Policy analysis of shifting to the state-run Texas women's health program

During the 82nd Texas legislature, state leaders passed a provision stating that healthcare providers, who perform, promote, or affiliate with providers who perform or promote elective abortion services may not be eligible to participate in the Texas Medicaid Women's Health Program (WHP). The federal government reacted to this new provision by vowing to eliminate its 90% share of program support on the grounds that the provision violated a patient's freedom to choose a provider; a right protected by the Social Security Act. Texas leaders stated that the Women's Health Program would continue without federal support, financed exclusively with state funds.^ The following policy analysis compares the projected impact of the current Medicaid Women's Health Program to the proposed state-run program using the criteria-alternative matrix framework. The criteria used to evaluate the program alternatives include population affected, unintended pregnancy and abortion impact, impact on cervical cancer rate, and state-level government expenditures. Each criterion was defined by selected measures. The population affected was measured by the number of women served in the programs. Government expenditures were measured in terms of payments for program costs, Medicaid delivery costs, and cervical cancer diagnostic costs. Unintended pregnancy impact was measured by the number of projected unplanned pregnancies and abortions under each alternative. The impact on cervical cancer was projected in terms of the number of new cervical cancer cases under each alternative. Differences in the projections with respect to each criterion were compared to assess the impact of shifting to the state-only policy.^ After examining program alternatives, it is highly recommended that Texas retain the Medicaid WHP. If the state does decide to move forward with the state-run WHP, it is recommended that the program run at its previous capacity. Furthermore, for the purpose of addressing the relatively high cervical cancer incidence rate in Texas, incorporating HPV vaccination coverage for women ages 18-26 as part of the Women's Health Program is recommended.^

Intensive care unit utilization among patients with cancer at the end of life

Over the last 2 decades, survival rates in critically ill cancer patients have improved. Despite the increase in survival, the intensive care unit (ICU) continues to be a location where end-of-life care takes place. More than 20% of deaths in the United States occur after admission to an ICU, and as baby boomers reach the seventh and eighth decades of their lives, the volume of patients in the ICU is predicted to rise. The aim of this study was to evaluate intensive care unit utilization among patients with cancer who were at the end of life. End of life was defined using decedent and high-risk cohort study designs. The decedent study evaluated characteristics and ICU utilization during the terminal hospital stay among patients who died at The University of Texas MD Anderson Cancer Center during 2003-2007. The high-risk cohort study evaluated characteristics and ICU utilization during the index hospital stay among patients admitted to MD Anderson during 2003-2007 with a high risk of in-hospital mortality. Factors associated with higher ICU utilization in the decedent study included non-local residence, hematologic and non-metastatic solid tumor malignancies, malignancy diagnosed within 2 months, and elective admission to surgical or pediatric services. Having a palliative care consultation on admission was associated with dying in the hospital without ICU services. In the cohort of patients with high risk of in-hospital mortality, patients who went to the ICU were more likely to be younger, male, with newly diagnosed non-metastatic solid tumor or hematologic malignancy, and admitted from the emergency center to one of the surgical services. A palliative care consultation on admission was associated with a decreased likelihood of having an ICU stay. There were no differences in ethnicity, marital status, comorbidities, or insurance status between patients who did and did not utilize ICU services. Inpatient mortality probability models developed for the general population are inadequate in predicting in-hospital mortality for patients with cancer. The following characteristics that differed between the decedent study and high-risk cohort study can be considered in future research to predict risk of in-hospital mortality for patients with cancer: ethnicity, type and stage of malignancy, time since diagnosis, and having advance directives. Identifying those at risk can precipitate discussions in advance to ensure care remains appropriate and in accordance with the wishes of the patient and family.^

A mulher na política do Brasil

O artigo discute a desigualdade de gênero entre homens e mulheres no Brasil na ocupaçao de cargos políticos eletivos. Trata-se de uma pesquisa bibliográfica e documental que utiliza os dados estatísticos do Tribunal Superior Eleitoral (TSE) das eleiçoes de 2006, 2008, 2010 e 2012 para avaliar se houve um aumento real de mulheres ocupando cargos políticos eletivos com a criaçao da lei No 12.034/2009 que obrigou partidos/coligaçoes a reservar, no mínimo, 30 das vagas para candidatura femininas. Os resultados mostram apesar do Brasil em 2010 ter eleito a primeira mulher Presidenta do país, das mulheres serem a maioria da populaçao segundo o IBGE (2010) e representarem 52 do eleitorado do país conforme o TSE (2010), elas ainda sao "subrepresentadas" nos cargos políticos eletivos, ocupados por maioria masculina. Visto que a média de mulheres eleitas no Brasil é, em torno, de 10 do total, mesmo com o maior número de candidaturas femininas em decorrência da exigência Legal

Historias de vida de deportistas paralímpicas argentinas : Redes de Relaciones

El creciente interés por los estudios de género manifiesta un vacío respecto de las mujeres con discapacidad que han desarrollado trayectorias exitosas en algún campo. Este trabajo, forma parte de dos investigaciones junto a mujeres deportistas con discapacidad motora que han alcanzado el más alto símbolo deportivo: la medalla paralímpica. Con el objetivo de develar sus Trayectorias Biográficas se diseñó un estudio flexible y multivocal, con un enfoque no estándar (cualitativo) centrado en el método biográfico. Se recolectaron trece relatos de vida con entrevistas en profundidad analizadas con el método Comparativo Constante de la Teoría Fundamentada de los Datos.
Las Trayectorias Biográficas constituyen los "grandes ámbitos de la experiencia social" que aportan testimonios de vivencias individuales dentro de un mismo objeto social (Bertaux, 2005: 41). Pero debido a las características del diseño, emergió una categoría imprevista: las redes de relaciones, constituidas por las influencias mutuas de las interacciones entre las personas, motivo de esta presentación. Lo interesante fue que estas redes no solo no respondían al rol de dependencia atribuido a las personas con discapacidad, sino que se halló un nuevo tipo y cuatro sub-categorías: compulsivas, electivas, omitidas e ignoradas. Principalmente en las redes electivas fue donde las entrevistadas manifestaron hallar nichos, en los que expresaron (descubrieron) roles y funciones (simultáneas y cambiantes) complementarias y cooperativas con otras personas, manteniendo al mismo tiempo, cierto grado de independencia interna (límites). El peso de las redes (importancia atribuida) fue variable tanto sincrónica como diacrónicamente, permitiendo que algunas deportistas se destacaran en más de una red en distintos momentos temporales

Historias de vida de deportistas paralímpicas argentinas : Redes de Relaciones

El creciente interés por los estudios de género manifiesta un vacío respecto de las mujeres con discapacidad que han desarrollado trayectorias exitosas en algún campo. Este trabajo, forma parte de dos investigaciones junto a mujeres deportistas con discapacidad motora que han alcanzado el más alto símbolo deportivo: la medalla paralímpica. Con el objetivo de develar sus Trayectorias Biográficas se diseñó un estudio flexible y multivocal, con un enfoque no estándar (cualitativo) centrado en el método biográfico. Se recolectaron trece relatos de vida con entrevistas en profundidad analizadas con el método Comparativo Constante de la Teoría Fundamentada de los Datos.
Las Trayectorias Biográficas constituyen los "grandes ámbitos de la experiencia social" que aportan testimonios de vivencias individuales dentro de un mismo objeto social (Bertaux, 2005: 41). Pero debido a las características del diseño, emergió una categoría imprevista: las redes de relaciones, constituidas por las influencias mutuas de las interacciones entre las personas, motivo de esta presentación. Lo interesante fue que estas redes no solo no respondían al rol de dependencia atribuido a las personas con discapacidad, sino que se halló un nuevo tipo y cuatro sub-categorías: compulsivas, electivas, omitidas e ignoradas. Principalmente en las redes electivas fue donde las entrevistadas manifestaron hallar nichos, en los que expresaron (descubrieron) roles y funciones (simultáneas y cambiantes) complementarias y cooperativas con otras personas, manteniendo al mismo tiempo, cierto grado de independencia interna (límites). El peso de las redes (importancia atribuida) fue variable tanto sincrónica como diacrónicamente, permitiendo que algunas deportistas se destacaran en más de una red en distintos momentos temporales

A mulher na política do Brasil

O artigo discute a desigualdade de gênero entre homens e mulheres no Brasil na ocupaçao de cargos políticos eletivos. Trata-se de uma pesquisa bibliográfica e documental que utiliza os dados estatísticos do Tribunal Superior Eleitoral (TSE) das eleiçoes de 2006, 2008, 2010 e 2012 para avaliar se houve um aumento real de mulheres ocupando cargos políticos eletivos com a criaçao da lei No 12.034/2009 que obrigou partidos/coligaçoes a reservar, no mínimo, 30 das vagas para candidatura femininas. Os resultados mostram apesar do Brasil em 2010 ter eleito a primeira mulher Presidenta do país, das mulheres serem a maioria da populaçao segundo o IBGE (2010) e representarem 52 do eleitorado do país conforme o TSE (2010), elas ainda sao "subrepresentadas" nos cargos políticos eletivos, ocupados por maioria masculina. Visto que a média de mulheres eleitas no Brasil é, em torno, de 10 do total, mesmo com o maior número de candidaturas femininas em decorrência da exigência Legal

Historias de vida de deportistas paralímpicas argentinas : Redes de Relaciones

El creciente interés por los estudios de género manifiesta un vacío respecto de las mujeres con discapacidad que han desarrollado trayectorias exitosas en algún campo. Este trabajo, forma parte de dos investigaciones junto a mujeres deportistas con discapacidad motora que han alcanzado el más alto símbolo deportivo: la medalla paralímpica. Con el objetivo de develar sus Trayectorias Biográficas se diseñó un estudio flexible y multivocal, con un enfoque no estándar (cualitativo) centrado en el método biográfico. Se recolectaron trece relatos de vida con entrevistas en profundidad analizadas con el método Comparativo Constante de la Teoría Fundamentada de los Datos.
Las Trayectorias Biográficas constituyen los "grandes ámbitos de la experiencia social" que aportan testimonios de vivencias individuales dentro de un mismo objeto social (Bertaux, 2005: 41). Pero debido a las características del diseño, emergió una categoría imprevista: las redes de relaciones, constituidas por las influencias mutuas de las interacciones entre las personas, motivo de esta presentación. Lo interesante fue que estas redes no solo no respondían al rol de dependencia atribuido a las personas con discapacidad, sino que se halló un nuevo tipo y cuatro sub-categorías: compulsivas, electivas, omitidas e ignoradas. Principalmente en las redes electivas fue donde las entrevistadas manifestaron hallar nichos, en los que expresaron (descubrieron) roles y funciones (simultáneas y cambiantes) complementarias y cooperativas con otras personas, manteniendo al mismo tiempo, cierto grado de independencia interna (límites). El peso de las redes (importancia atribuida) fue variable tanto sincrónica como diacrónicamente, permitiendo que algunas deportistas se destacaran en más de una red en distintos momentos temporales

A mulher na política do Brasil

O artigo discute a desigualdade de gênero entre homens e mulheres no Brasil na ocupaçao de cargos políticos eletivos. Trata-se de uma pesquisa bibliográfica e documental que utiliza os dados estatísticos do Tribunal Superior Eleitoral (TSE) das eleiçoes de 2006, 2008, 2010 e 2012 para avaliar se houve um aumento real de mulheres ocupando cargos políticos eletivos com a criaçao da lei No 12.034/2009 que obrigou partidos/coligaçoes a reservar, no mínimo, 30 das vagas para candidatura femininas. Os resultados mostram apesar do Brasil em 2010 ter eleito a primeira mulher Presidenta do país, das mulheres serem a maioria da populaçao segundo o IBGE (2010) e representarem 52 do eleitorado do país conforme o TSE (2010), elas ainda sao "subrepresentadas" nos cargos políticos eletivos, ocupados por maioria masculina. Visto que a média de mulheres eleitas no Brasil é, em torno, de 10 do total, mesmo com o maior número de candidaturas femininas em decorrência da exigência Legal

Análisis de la influencia de la estimulación con vibraciones en la respuesta neuromuscular en competidores de esgrima

La esgrima es un deporte de combate en el que todas las acciones están dirigidas a conseguir el objetivo de la competición, que es el de tocar al contrario sin ser tocado, y para ello los tiradores/as se sirven de todas las herramientas, técnicas, tácticas y de condición física posibles a su alcance. La calidad de las acciones de los esgrimistas en competición dependerá fundamentalmente de dos de los sistemas involucrados en el proceso. Por un lado, la activación del sistema nervioso, y por otro lado la respuesta del sistema muscular. Una de las herramientas utilizadas en los últimos años para estimular el sistema neuromuscular, y que ha reportado en muchas investigaciones resultados positivos, ha sido la plataforma de vibraciones vertical. Por esto, decidimos llevar a cabo un estudio con deportistas de esgrima de competición con un protocolo de exposición aguda a las vibraciones, y medir el efecto producido por esta herramienta sobre el sistema neuromuscular a través del estudio de los cambios experimentados en los tiempos de reacción simple, tiempos de respuesta electiva y tiempos de movimiento, así como los efectos en la eficacia del tocado de esgrima analizados antes y después de recibir el estímulo vibratorio. El estudio se desarrolló con tiradores/as de competición de nivel nacional y pertenecientes al Centro de Tecnificación de la Federación de Esgrima de Castilla y León (n=38; Edad: 22 ±9,08). La muestra estaba compuesta por 12 mujeres y 26 hombres, de categorías, cadetes (13), júnior (12), y absolutos (13). El protocolo elegido fue realizado por cada participante en tres ocasiones, una inicial, otra tras pasar por una carga de estimulación en la plataforma de vibraciones, y una fase final, pasado un tiempo de recuperación de 10 minutos para comprobar el grado de disipación del efecto vibratorio. El estímulo elegido para la estimulación sobre la plataforma de vibraciones fue de una frecuencia de 50 Hz, durante un periodo de 60 segundos y con una amplitud de 4 mm. Los resultados se analizaron en función de las variables dependientes tiempo de reacción, tiempo de respuesta electiva, tiempo de movimiento, y precisión y eficacia. Estos datos se cruzaron con las variables independientes sexo, categoría, nivel deportivo y años de experiencia. El propósito del presente estudio fue el de analizar los efectos producidos por una intervención de estimulación neuromuscular mecánica en fase aguda en un grupo de tiradores/as de esgrima de competición. Los resultados mostraron que la carga de estimulación neuromuscular mecánica (ENM) aplicada en nuestro estudio provocó un discreto efecto en la respuesta neuromuscular de los tiradores participantes en la investigación. Se encontraron efectos significativos provocados por el estímulo vibratorio en las siguientes variables: en el tiempo de reacción simple se registró una mejora del 8,1%, en el tiempo de respuesta electiva a pie parado un 10%, en la precisión a pie parado un 7%, y en la eficacia a pie parado un 18,5%. Igualmente se observaron ligeras diferencias por sexos, encontrando un efecto de mayor tamaño en el grupo femenino. Es necesario resaltar que las características particulares de la muestra parecen haber influido en los resultados encontrados de forma importante. Por último, debemos destacar que el efecto residual producido por la estimulación aplicada en nuestra investigación en algún caso superó los diez minutos, ya que se hallaron efectos positivos de la estimulación neuromuscular mecánica en varios de los registros finales como hemos visto. ABSTRACT Fencing is a combat sport in which all actions are aimed at achieving the objective of the competition, which is that of touching the opponent without being touched and for this the fencers make use of all the tools, techniques, tactics and physical condition possible at their disposal. The quality of the fencers´ actions in competition will depend primarily on two of the systems involved in the process: on the one hand, the activation of the nervous system and, on the other, the response of the muscular system. One of the tools recently used to stimulate the neuromuscular system, and which has produced positive results in many research studies, has been the vertical vibration platform. Therefore, we decided to conduct a study with competition fencers with a protocol of acute exposure to vibration and to measure the effect produced by this tool on the neuromuscular system by means of the study of changes experienced in simple reaction times, the elective response times and movement times, as well as the effects on the efficacy of the fencing touch analyzed before and after receiving the vibratory stimulus. The study was conducted with fencers in national competitions and belonging to the Technification Center of the Fencing Federation of Castilla y León (n = 38), with a mean age of 22 years (SD 9.08). The sample was composed of 12 women and 26 men, by categories cadets (13), juniors (12), and seniors (13). The protocol chosen was performed by each participant on three occasions: an initial one, another after going through a stimulation load on the vibration platform, and a final phase, after a 10 minute recovery time to assess the degree of dissipation of the vibratory effect. The stimulus chosen on the vibration platform was a frequency of 50 Hz, for a period of 60 seconds and an amplitude of 4 mm. The results were analyzed according to the following dependent variables: the reaction time, the response time, the accuracy and the efficiency. This data was crossed with the independent variables: gender, category, sporting level and the years of experience. The purpose of this study was analyze the effects of neuromuscular stimulation intervention in a group of fencing competition shooters. The results showed that the mechanical neuromuscular stimulation (MNS) load applied in our study led to a modest effect on the neuromuscular response of the fencers involved in the research. Significant effects were found caused by the vibratory stimulus on the simple reaction time 8,1%, elective response time 10%, as well as the accuracy 7%, and efficiency 18,5%. We should also point out that slight differences by gender were observed, finding a greater effect in females. It should be emphasized that the specific characteristics of the sample appear to have significantly influenced the results. Finally, we should note that the residual effect produced by the stimulation applied in our research in some cases exceeded ten minutes, given that positive effects of the mechanical neuromuscular stimulation were found in several of the final scores.

Design of online practical lessons in colorimetry

Applied colorimetry is an important module in the program of the elective subject "Colour Science: industrial applications”. This course is taught in the Optics and Optometry Degree and it has been used as a testing for the application of new teaching and assessment techniques consistent with the new European Higher Education Area. In particular, the main objective was to reduce the attendance to lessons and encourage the individual and collective work of students. The reason for this approach is based on the idea that students are able to work at their own learning pace. Within this dynamic work, we propose online lab practice based on Excel templates that our research group has developed ad-hoc for different aspects of colorimetry, such as conversion to different colour spaces, calculation of perceptual descriptors (hue, saturation, lightness), calculation of colour differences, colour matching dyes, etc. The practice presented in this paper is focused on the learning of colour differences. The session is based on a specific Excel template to compute the colour differences and to plot different graphs with these colour differences defined at different colour spaces: CIE ΔE, CIE ΔE94 and the CIELAB colour space. This template is implemented on a website what works by addressing the student work at a proper and organized way. The aim was to unify all the student work from a website, therefore the student is able to learn in an autonomous and sequential way and in his own pace. To achieve this purpose, all the tools, links and documents are collected for each different proposed activity to achieve guided specific objectives. In the context of educational innovation, this type of website is normally called WebQuest. The design of a WebQuest is established according to the criteria of usability and simplicity. There are great advantages of using WebQuests versus the toolbox “Campus Virtual” available in the University of Alicante. The Campus Virtual is an unfriendly environment for this specific purpose as the activities are organized in different sectors depending on whether the activity is a discussion, an activity, a self-assessment or the download of materials. With this separation, it is more difficult that the student follows an organized sequence. However, our WebQuest provides a more intuitive graphical environment, and besides, all the tasks and resources needed to complete them are grouped and organized according to a linear sequence. In this way, the student guided learning is optimized. Furthermore, with this simplification, the student focuses on learning and not to waste resources. Finally, this tool has a wide set of potential applications: online courses of colorimetry applied for postgraduate students, Open Course Ware, etc.

Evaluation of online tools as didactic resource in the university education

Recently, many efforts have been made in the academic world to adapt the new degrees to the new European Higher Education Area (EHEA). New technologies have been the most important factor to carry out this adaptation. In particular, the tools 2.0 have been spreading quickly, not just the Web 2.0, but even in all the educational levels. Nevertheless, it is now necessary to evaluate whether all these efforts and all the changes, carried out in order to obtain improved academic performance among students, have provided good results. Therefore, the aim of this paper is focused on studying the impact of the implementation of information and communication technologies (ICTs) in a subject belonging to a Master from the University of Alicante in the academic year (2010-2011). In special, it is an elective course called "Advanced Visual Ergonomics" from the Master of Clinical Optometry and Vision. The methodology used to teach this course differs from the traditional one in many respects. For example, one of the resources used for the development of this course is a blog developed specifically to coordinate a series of virtual works, whose purpose is that the student goes into specific aspects of the current topic. Next, the student participates in an active role by writing a personal assessment on the blog. However, in the course planning, there is an attendance to lessons, where the teacher presents certain issues in a more traditional way, that is, with a lecture supported with audiovisual materials, such as materials generated in powerpoint. To evaluate the quality of the results achieved with this methodology, in this work the personal assessment of the students, who have completed this course during this academic year, are collected. In particular, we want to know their opinion about the used resources, as well as the followed methodology. The tool used to collect this information was a questionnaire. This questionnaire evaluates different aspects of the course: a general opinion, quality of the received information, satisfaction about the followed methodology and the student´s critical awareness. The design of this questionnaire is very important to get conclusive information about the methodology followed in the course. The questionnaire has to have an adequate number of questions; whether it has many questions, it might be boring for the student who would pay no enough attention. The questions should be well-written, with a clear structure and message, to avoid confusion and an ambiguity. The questions should be objectives, without any suggestion for a desired answer. In addition, the questionnaire should be interesting to encourage the student´ s interest. In conclusion, this questionnaire developed for this subject provided good information to evaluate whether the methodology was a useful tool to teach "Advanced Visual Ergonomics". Furthermore, the student´s opinion collected by this questionnaire might be very helpful to improve this didactic resource.

Placenta acreta

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Caractérisation des unités de soins aigus chirurgicaux au sein des départements de chirurgie générale au Canada

Introduction : The acute care surgery (ACS) units are dedicated to the prompt management of surgical emergencies. It is a systemic way of organizing on-call services to diminish conflict between urgent care and elective obligations. The aim of this study was to define the characteristics of an ACS unit and to find common criteria in units with reported good functioning. Methods : As of July 1st 2014, 22 Canadian hospitals reported having an ACS unit. A survey with questions about the organization of the ACS units, the population it serves, the number of emergencies and trauma cases treated per year, and the satisfaction about the implementation of this ACS unit was sent to those hospitals. Results : The survey’s response rate was 73%. The majority of hospitals were tertiary or quaternary centers, served a population of more than 200 000 and had their ACS unit for more than three years. The median number of surgeons participating in an ACS unit was 8.5 and the majority were doing seven day rotations. The median number of operating room days was 2.5 per week. Most ACS units (85%) had an estimated annual volume of more than 2500 emergency consultations (including both trauma and non-trauma) and 80% operated over 1000 cases per year. Nearly all the respondents (94%) were satisfied with the implementation of the ACS unit in their hospital. Conclusion : Most surgeons felt that the implementation of an ACS unit resulted in positive outcomes. However, there should be a sizeable catchment population and number of surgical emergencies to justify the resulting financial and human resources.