Oligoanalgesia in the emergency department: short-term beneficial effects of an education program on acute pain.

STUDY OBJECTIVE: Acute pain is the most frequent complaint in emergency department (ED) admissions, but its management is often neglected, placing patients at risk of oligoanalgesia. We evaluate the effect of the implementation of guidelines for pain management in ED patients with pain at admission or anytime during their stay in our ED. METHODS: This prospective pre-post intervention cohort study included data collection both before and after guideline implementation. Consecutive adult patients admitted with acute pain from any cause or with pain at any time after admission were enrolled. The quality of pain management was evaluated according to information in the ED medical records by using a standardized collection form, and its impact on patients was recorded with a questionnaire at discharge. RESULTS: Two hundred forty-nine and 192 patients were included during pre- and postintervention periods. Pain was documented in 61% and 76% of nurse and physician notes, respectively, versus 78% and 85% after the intervention (difference 17%/9%; 95% confidence interval [CI] 8% to 26%/2% to 17%, respectively). Administration of analgesia increased from 40% to 63% (difference 23%; 95% CI 13% to 32%) and of morphine from 10% to 27% (difference 17%; 95% CI 10% to 24%). Mean doses of intravenous morphine increased from 2.4 mg (95% CI 1.9 to 2.9 mg) to 4.6 mg (95% CI 3.9 to 5.3 mg); administration of nonsteroidal antiinflammatory drugs and acetaminophen increased as well. There was a greater reduction of visual analogue scale score after intervention: 2.1 cm (95% CI 1.7 to 2.4 cm) versus 2.9 cm (95% CI 2.5 to 3.3 cm), which was associated with improved patient satisfaction. CONCLUSION: Education program and guidelines implementation for pain management lead to improved pain management, analgesia, and patient satisfaction in the ED.

Prevalence of frailty in middle-aged and older community-dwelling Europeans living in 10 countries.

BACKGROUND: Frailty is an indicator of health status in old age. Its frequency has been described mainly for North America; comparable data from other countries are lacking. Here we report on the prevalence of frailty in 10 European countries included in a population-based survey. METHODS: Cross-sectional analysis of 18,227 randomly selected community-dwelling individuals 50 years of age and older, enrolled in the Survey of Health, Aging and Retirement in Europe (SHARE) in 2004. Complete data for assessing a frailty phenotype (exhaustion, shrinking, weakness, slowness, and low physical activity) were available for 16,584 participants. Prevalences of frailty and prefrailty were estimated for individuals 50-64 years and 65 years of age and older from each country. The latter group was analyzed further after excluding disabled individuals. We estimated country effects in this subset using multivariate logistic regression models, controlling first for age, gender, and then demographics and education. RESULTS: The proportion of frailty (three to five criteria) or prefrailty (one to two criteria) was higher in southern than in northern Europe. International differences in the prevalences of frailty and prefrailty for 65 years and older group persisted after excluding the disabled. Demographic characteristics did not account for international differences; however, education was associated with frailty. Controlling for education, age and gender diminished the effects of residing in Italy and Spain. CONCLUSIONS: A higher prevalence of frailty in southern countries is consistent with previous findings of a north-south gradient for other health indicators in SHARE. Our data suggest that socioeconomic factors like education contribute to these differences in frailty and prefrailty.

Early Childhood Mathematics Education: Research, Curriculum and Educational Practice

This article reviews data obtained through research into early childhood mathematics education in Spain. It analyses the current curricular directions in mathematics education with early learners. It also provides an overview of mathematical practices in early childhood education classrooms to analyse the commonalities and differences between research, curriculum and educational practice. A review of the research presented at SEIEM symposia from 1997 until 2012 demonstrates: a) very little research has been done, a trend that is repeated in other areas, such as the JCR-Social Sciences Edition or the PME; b) the first steps have been taken to create a more and more cohesive body of research, although until now there has not been enough data to outline the curricular directions; and c) some discrepancies still exist between the mathematical practices in early childhood education classrooms and the official guidelines

Our future in geriatrics : an examination of the knowledge, attitudes and career choices of physical therapy students in Ontario : a pretest-posttest study /

There continues to be a shortage of health professionals interested in providing care for the older adult. Part of the problem seems to stem from the negative perceptions of geriatrics as a clinical speciality. This study examines the knowledge, attitudes and career decisions of physical therapy students in Ontario before and after an educational intervention. Surveys were conducted with 144 physical therapy students from five universities before and after their geriatrics course in order to measure their knowledge, attitudes and interest in working with older adults. The incoming class of physical therapy students (n = 1 86) acted as control subjects for the study. The Revised Palmore Facts On Aging Quiz measured the students' knowledge of aging (Miller & Dodder, 1980). The Revised Tuckman-Lorge (Axelrod & Eisdorfer, 1961) and the Kogan Old People Scales (Kogan, 1961) were used to examine attitude. An environmental scale was developed based on the work of Snape (1986) to measure the impact of the working conditions on the students' career choices. A 10-point Likert-type scale based on the work of Michlelutte & Diseker (1985) was modified and used to measure career interest in working with the elderly. On independent sample t-tests, positive attitudes were related to the demographic characteristic of gender; ethnicity was negatively related; and marital status was found to be unrelated to attitude (fi<.05). Having a relationship with an older adult and taking courses in gerontology were also found to be positively related to attitude (fi<.05). Results on a betweensubjects design which compared students before and after the course found that knowledge scores improved from pretest to posttest (fi<.05). In general, attitude scores improved from T1 to T2 on both measurement tools (b<.05). The environmental and vocational interest scales yielded statistically significant differences between the control and experimental groups during the intervention period (p<.05). The results of this research indicated that knowledge and attitudes improve after an educational intervention; however, there was little impact on the students' overall career decisions. Further research is indicated to examine the complex relationship between attitude and behaviour and its impact on students' career choices. In addition, the impact of geriatric clinical environment on students' attitudes and career decisions needs to be further explored.

Learning English as an adult: a narrative of women's improvised and empowered lives /

This thesis is a narrative inquiry of learning English as an adult. It stories the journey of 7 women, including me, and unravels lived experiences that serve as learning models. Learning English as an adult presents challenges and results in lifelong implications both in personal and professional life. Every learner's experience is imique and, when reflected upon, each experience is a valuable source of knowledge for constructing meanings and forging new identities. The stories are testimony to the participants' lives: interrupted yet improvised, silenced yet roused, dependent yet independent, intimidated yet courageous, vulnerable yet empowered. The personal experiences elucidate the passion, the inner voices, the dreams, and the rewards that compel persistence in learning a new language and releaming new social roles. The stories provide encouragement and hope to other women who are learning or will learn English in their adult years, and the lived experiences will offer insights for English language teachers. This thesis employs the phenomenology methodology of research with heuristic (discovery) and hermeneutical (interpretative) approaches using the reflective-responsivereflexive writing and interviewing methods for data gathering and unravelling. The narrative inquiry approach reaffirms that storytelling is an important tool in conducting research and constructing new knowledge. This thesis narrates a new story about sharing experiences, interconnecting, and continuing to learn.

Learning and healing: a wellness pedagogy for Aboriginal teacher education /

During the last 30 years Aboriginal peoples in Canada have made steady progress in reclaiming the responsibility for the education of their young people, especially in primary and secondary school. In comparison the education and or training of adult populations has not kept pace and many socioeconomic and sociocultural indicators demonstrate a ' , continued confinement of those populations to the margins of the dominant society of Canada. It is the adults, the mothers and the fathers, the grandmothers and grandfathers, the aunties and uncles that are the first teachers of the next generation and the nature of these relationships replicates the culture of unwellness in each subsequent generation through those teachers. There are few examples in the Aboriginal adult education literatures that give voice to the educational experience of the Learner. This study addresses that gap by exploring the perspectives embedded in the stories of a Circle of Learners who are, or were enrolled in the Bachelor of Education in Aboriginal Adult Education program at Brock University. That Circle of 1 participants included 9 women and 1 man, 6 of whom were from various i Anishinabek nations while 4 represented the Hotinonshd:ni nations in southern Ontario. They are an eclectic group, representing many professions, age groups, spiritual traditions, and backgrounds. This then is their story, the story of the heaming and Healing pedagogy and an expanded vision of Aboriginal education and research at Brock University.

For whom the cruiser rolls: a retrospective analysis of factors relating to recidivism in a sample of graduates from a court-ordered alcohol education and awareness program

This study investigated, retrospectively, whether recidivism in a sample of court-ordered'graduates of an alcohol education and awareness program could be predicted. This alcohol education program was based on adult education principles and was philosophically akin to the thoughts of Drs. Jack Mezirow, Stephen Brookfield, and Patricia Cranton. Data on the sample of 214 Halton IDEA (Impaired Driver Education and Awareness) graduates were entered into a spread sheet. Descriptive statistics were generated. Each of the 214 program graduates had taken several tests during the course of the IDEA program. These tests measured knowledge, attitude about impaired driving, and degree of alcohol involvement. Test scores were analyzed to determine whether those IDEA graduates who recidivated differed in any measurable way from those who had no further criminal convictions after a period of at least three years. Their criminal records were obtained from the Canadian Police Information Centre (CPIC). Those program graduates who reoffended were compared to the vast majority who did not reoffend. Results of the study indicated that there was no way to determine who would recidivate from the data that were collected. Further studies could use a qualitative model. Follow-up interviews could be used to determine what impact, if any, attendance at the IDEA program had on the life of the graduates.

Participation of registered nurses in continuing education

This correlational study investigated the psychological types, learning style preferences, readiness for self-directed learning, demographic and continuing education participation data of 154 registered nurses at two different Southern Ontario hospitals. One hospital was a large tertiary care university-affiliated teaching centre (Cityview) and the other was a smaller secondary care community hospital (Waterview). The instruments used in the study were the PET Type Check, Kolb's Learning Style Inventory, the Self-Directed Readiness Scale (SDLRS), and a Nursing Survey developed by the researcher. Descriptive statistics, crosstabulations and correlational analyses were calculated. The most common psychological types identified among this sample of nurses were extraverted thinking, introverted intuitive and extraverted intuitive. There were no significant differences between the two hospitals. The accommodator learning style was preferred overall, with more nurses at Waterview Hospital preferring the diverger learning style, and more nurses at Cityview Hospital preferring the accommodator learning style. The majority of nurses scored in the average and above average categories on the SDLRS, indicating that they perceive themselves as ready to engage in self-directed learning. At Cityview Hospital there were more nurses in the average and high readiness categories, whereas at Waterview Hospital more nurses scored in the below average category. No significant correlations were found for learning style with psychological type, or for learning style with SDLRS scores. A positive correlation was found to exist between SDLRS scores and each of the psychological types extraverted feelings, extraverted thinking, and introverted intuitive.The only significant correlation for psychological type and continuing education activity was a positive correlation between extraverted thinking types and participation in informal discussion or study groups. Positive correlations were found for SDLRS scores with each of the following continuing education activities; number of hours per month spent reading journals; journal reading; attendance at credit courses; watching videos; using reference texts. Further details of the results are included as well as a discussion of the findings and implications for future research.

Finding and Implementing Relevant Resources in Adapted Physical Activity (APA): It's easier said than done...

The purpose of this research was to explore challenges to operationalizing and implementing relevant resources for Adapted Physical Activity (APA) and to develop a framework on how resources should be developed and implemented to foster appropriate APA. An unobtrusive methodology was used to examine existing resources and training/learning opportunities for practitioners teaching APA. Data were collected via unobtrusive methods: documents, records, literature and feedback forms. After the findings were summarized, expert consultations were completed using a modified Delphi- technique to confirm the findings. A constructivist approach and phenomenological orientation was used to analyze the data and develop the “ideal” resource. Results indicate there are limited APA resources and teaching/learning opportunities for practitioners and there is a need for practitioner facilitation through professional development on finding and implementing resources. Future research should develop and evaluate the “ideal” resource and strive to improve the connection and consistency of resources in APA.

Socio-demographic factors, smoking, symptoms, morbidities and pulmonary function and quality of life in individuals with a heavy smoking history

Objective: To determine which socio-demographic, exposure, morbidity and symptom variables are associated with health-related quality of life among former and current heavy smokers. Methods: Cross sectional data from 2537 participants were studied. All participants were at ≥2% risk of developing lung cancer within 6 years. Linear and logistic regression models utilizing a multivariable fractional polynomial selection process identified variables associated with health-related quality of life, measured by the EQ-5D. Results: Upstream and downstream associations between smoking cessation and higher health-related quality of life were evident. Significant upstream associations, such as education level and current working status and were explained by the addition of morbidities and symptoms to regression models. Having arthritis, decreased forced expiratory volume in one second, fatigue, poor appetite or dyspnea were most highly and commonly associated with decreased HRQoL. Discussion: Upstream factors such as educational attainment, employment status and smoking cessation should be targeted to prevent decreased health-related quality of life. Practitioners should focus treatment on downstream factors, especially symptoms, to improve health-related quality of life.

Community remoteness and birth outcomes among First Nations in Quebec

OBJECTIF: Chez les Autochtones, la relation entre le degré d'éloignement et les issues de naissance est inconnue. L’objectif de cette étude est d’évaluer cet impact parmi les Premières Nations du Québec. MÉTHODE : Nous avons utilisé les données vitales de Statistique Canada pour la province du Québec pour la période 1991-2000. L’ensemble des naissances géocodées parmi les communautés des Premières Nations groupées en quatre zones en se basant sur le degré d'éloignement a été analysé. Nous avons utilisé la régression logistique multi-niveaux pour obtenir des rapports de cotes ajustés pour les caractéristiques maternelles. RESULTATS : Le taux de naissances prématurées varie en fonction de l’éloignement de la zone d’habitation (8,2% dans la zone la moins éloignée et 5,2% dans la Zone la plus éloignée, P<0,01). En revanche, plus la zone est éloignée, plus le taux de mortalité infantile est élevé (6,9 pour 1000 pour la Zone 1 et 16,8 pour 1000 pour la Zone 4, P<0,01). Le taux élevé de mortalité infantile dans la zone la plus éloignée pourrait être partiellement expliqué par le fort taux de mortalité post-natale. Le taux de mort subite du nourrisson est 3 fois plus élevé dans la zone 4 par rapport à la zone 1. Cependant la mortalité prénatale ne présente pas de différences significatives en fonction de la zone malgré une fréquence élevée dans la zone 4. La morbidité périnatale était semblable en fonction de la zone après avoir ajusté pour l’âge, l’éducation, la parité et le statut civil. CONCLUSIONS : Malgré de plus faibles taux d’enfants à haut risque (accouchements prématurés), les Premières Nations vivant dans les communautés les plus éloignées ont un risque plus élevé de mortalité infantile et plus spécialement de mortalité post-néonatale par rapport aux Premières Nations vivant dans des communautés moins éloignées. Il y existe un grand besoin d’investissement en services de santé et en promotion de la santé dans les communautés les plus éloignées afin de réduire le taux de mortalité infantile et surtout post-néonatale.

Private Higher Education in the Sultanate of Oman: Rationales, Development and Challenges

Diese Studie stellt die Entwicklung des privaten Hochschulbereichs im Oman dar und analysiert sie auf die damit verbundenen Erwartungen. Sie untersucht die wesentlichen Herausforderungen, denen sich dieser Sektor zu stellen hat, und formuliert einige Empfehlungen, um die Rolle der privaten Hochschulbildung im Oman zu fördern. Um die Situation in Oman einordnen zu konnen, wurde die Literatur zu Systemen der privaten Hochschulbildung in verschiedenen Ländern vergleichend aufgearbeitet. Der Autor dieser Dissertation hat zudem zahlreiche offizielle Dokumente, Statistiken der Regierung, Berichte, Korrespondenzen und auch unveröffentlichtes Material zum Thema Bildung, Wirtschaft und zur Personalentwicklung geprüft und analysiert. Halb-strukturierte Interviews wurden mit Präsidenten und Dekanen privater Hochschulen sowie mit einigen externen Akteuren durchgeführt, um die Stärken und Schwächen, Herausforderungen und Ziele des privaten Hochschulsektors in Oman zu analysieren.

Uso y efectividad de la relación estratégica comunitaria y el marketing en empresas del sector aeronáutico

La relación estratégica comunitaria busca la atracción y retención de clientes a través del entendimiento de los consumidores dentro del contexto social que los rodea, es decir, una estrategia de mercadeo que busca relaciones duraderas con sus clientes a través del desarrollo de las comunidades en las cuales están insertos, logrando así beneficios para ambas partes, empresa y comunidad, y una relación de negocios sostenible a través del tiempo. Este trabajo busca determinar cuál es el uso y la efectividad de la relación estratégica comunitaria y el marketing en el sector aeronáutico, pasando por la identificación de las estrategias de mercadeo, los conceptos comunitarios y el uso de las estrategias comunitarias al interior del sector. Para determinar esto, se tomó a Avianca como muestra en el período 2004-2014 y se buscó la relación de su mercadeo y sus acciones sociales con las estrategias comunitarias, sin embargo los resultados arrojaron que no existe una relación estratégica comunitaria en la compañía, a pesar de manejar conceptos comunitarios en sus proyectos sociales.

Métodos de análisis de las comunidades de clientes mediante la relación estratégica comunitaria y el marketing.

En este proyecto analizaremos como las organizaciones se relacionan con el medio y marketing. La idea es determinar cuáles son los métodos de análisis de las comunidades de clientes mediante la relación estratégica comunitaria y el marketing. Por medio del mercadeo se puede conocer el entorno y determinar qué métodos de análisis utilizar para conocer a la comunidad de clientes. Las personas de mercadeo se ocupan de todo lo que ocurre en el entorno, de estar al tanto para saber cuándo hay oportunidades que puedan ser provechosas para la organización o por otro lado cuando hay amenazas de las que debe tener cuidado. Dependiendo del entorno, la organización diseña sus actividades de mercadeo enfocadas en satisfacer las necesidades del consumidor. Las actividades del consumidor se conceptualizan en producto, precio, promoción y plaza que se definen y diseñan basados en la comunidad en la que este inmersa la organización. Es importante buscar información confiable sobre el grupo objetivo al cual se le va ofrecer el producto o servicio, ya que toca analizarlos y comprender a estas personas para diseñar una buena oferta que satisfaga sus necesidades y deseos. Esta persona que recibe el producto o servicio por parte de la organización es el cliente. Los clientes son las personas que llegan a una organización en búsqueda de satisfacer necesidades a través de los bienes y servicios que las empresas ofrecen. Es esencial determinar que los clientes viven en comunidad, es decir comparten ideas por la comunicación tan estrecha que tienen y viven en conjunto bajo las mismas costumbres. Debido a estos es que hoy en día, los consumidores se conglomeran en comunidades de clientes, y para saberles llegar a estos clientes, toca analizarlos por medio de diversos métodos. El uso de las estrategias comunitarias es necesario ya que por medio del marketing se analiza el entorno y se buscan los métodos para analizar a la comunidad de clientes, que comparten características y se analizan en conjunto no por individuo. Es necesario identificar los métodos para relacionarse con la comunidad de clientes, para poder acercarnos a estos y conocerlos bien, saber sus necesidades y deseos y ofrecerles productos y servicios de acuerdo a éstos. En la actualidad estos métodos no son muy comunes ni conocidos, es por esto que nuestro propósito es indagar e identificar estos métodos para saber analizar a las comunidades. En este proyecto se utilizara una metodología de estudio tipo teórico-conceptual buscando las fuentes de información necesarias para llevar a cabo nuestra investigación. Se considera trabajar con El Grupo de Investigación en Perdurabilidad Empresarial y se escogió la línea de gerencia ya que permite entrar en la sociedad del conocimiento, siendo capaces de identificar oportunidades gerenciales en el entorno. Es interesante investigar sobre estos métodos, ya que los clientes esperan un servicio excelente, atento y que se preocupe por ellos y sus necesidades.

Incremento de la salud financiera mediante la utilización de la relación estratégica comunitaria y marketing.

Debido a las crisis mundiales, la perdurabilidad empresarial se ha convertido en la primera preocupación de las organizaciones, puesto que los problemas económicos en otros países pueden generar un efecto negativo en las condiciones del mercado doméstico, que junto con el entorno empresarial complejo y dinámico en el que se deben desempeñar las empresas hoy en día gracias a la globalización, sumado al aumento en la competitividad nacional e internacional, la perdurabilidad de las empresas se está viendo seriamente comprometida. Lo anterior, ha llevado a las empresas a buscar nuevas formas de mejorar su salud financiera. Para medir la salud financiera empresarial, se pueden usar distintos indicadores como lo es el flujo de caja que está asociado con la rentabilidad, el patrimonio que está asociado a las dificultades financieras, entre otros, o a través de varios modelos de bancarrota, los cuales, por medio de un conjunto de ratios financieros, reflejan el estado actual de la organización y su probabilidad de fracaso en el futuro. Las estrategias comunitarias y el marketing permiten incrementar la salud financiera de las empresas a través de la orientación al cliente y el establecimiento de relaciones gana-gana a largo plazo con las diferentes comunidades con las que se relaciona la organización.