Impact of medical practice guidelines on the assessment of patients with acute coronary syndrome without persistent ST segment elevation.

OBJECTIVE: To assess the impact of introducing clinical practice guidelines on acute coronary syndrome without persistent ST segment elevation (ACS) on patient initial assessment. DESIGN: Prospective before-after evaluation over a 3-month period. SETTING: The emergency ward of a tertiary teaching hospital. PATIENTS: All consecutive patients with ACS evaluated in the emergency ward over the two 3-month periods. INTERVENTION: Implementation of the practice guidelines, and the addition of a cardiology consultant to the emergency team. MAIN OUTCOME MEASURES: Diagnosis, electrocardiogram interpretation, and risk stratification after the initial evaluation. RESULTS: The clinical characteristics of the 328 and 364 patients evaluated in the emergency ward for suspicion of ACS before and after guideline implementation were similar. Significantly more patients were classified as suffering from atypical chest pain (39.6% versus 47.0%; P = 0.006) after guideline implementation. Guidelines availability was associated with significantly more formal diagnoses (79.9% versus 92.9%; P < 0.0001) and risk stratification (53.7% versus 65.4%, P < 0.0001) at the end of initial assessment. CONCLUSION: Guidelines implementation, along with availability of a cardiology consultant in the emergency room had a positive impact on initial assessment of patients evaluated for suspicion of ACS. It led to increased confidence in diagnosis and stratification by risk, which are the first steps in initiating effective treatment for this common condition.

Se former à l'entretien motivationnel pour aider ses patients à changer: Les étudiants en médecine le confirment [Learning motivational interviewing to help patients change their health-related behaviors: medical students confirm it].

At the Lausanne University, 5th year medical students were trained in Motivational interviewing (MI). Eight hours of training improved their competence in the use of this approach. This experience supports the implementation of MI training in medical schools. Motivational interviewing allows the health professional to actively involve the patient in this behavior change process (drinking, smoking, diet, exercise, medication adherence, etc.), by encouraging reflection and reinforcing personal motivation and resources.

Supporting interdisciplinary case studies: development and implementation of a joint learning environment for students in forensic science and criminal law

Scientific reporting and communication is a challenging topic for which traditional study programs do not offer structured learning activities on a regular basis. This paper reports on the development and implementation of a web application and associated learning activities that intend to raise the awareness of reporting and communication issues among students in forensic science and law. The project covers interdisciplinary case studies based on a library of written reports about forensic examinations. Special features of the web framework, in particular a report annotation tool, support the design of various individual and group learning activities that focus on the development of knowledge and competence in dealing with reporting and communication challenges in the students' future areas of professional activity.

Apprendre dans l'urgence

Nous avons effectué une étude dans le but d'investiger les stratégies utilisées par les ambulanciers pour préserver leur santé. Parmi les stratégies que nous avons identifiées, celles contribuant au maintien et au développement des compétences nous ont semblé particulièrement intéressantes car elles permettent de réduire le stress lié à la peur de l'erreur. Elles permettent aussi aux ambulanciers "d'apprivoiser l'urgence" en leur donnant la possibilité de jouer un rôle actif face aux difficultés rencontrées. Nous présentons quelques-unes de ces stratégies dans cet article.

Hégémonie du modèle de l'autisme: carrefour epistémologique entre médecine, familles et politique [Hegemonic model of autism: epistemological crossroads between medicine, family and politics].

The aim of this article is to make a contribution to the regional reflection with regard to autism spectrum disorders (ASDs) at a key moment in which the authorities are requested by the users, professionals in the fields of health, pedagogy and education to put forward a structured answer to a multitude of expressed needs. The question for the creation of a competence pole of an academic tertiary level is posed in order to advise in the best possible way the families who do not know how to orient themselves in the maze and contradictions of the proposed solutions and to help the professionals who are submerged by an ever increasing demand of services exceeding the means of the existing institutions and who cannot justify their choices among the various existing theoretical and scientific models.

Beliefs and practices in the assessment of workplace pollutants

OBJECTIVES: A survey was undertaken among Swiss occupational hygienists and other professionals to identify the different exposure assessment methods used, the contextual parameters observed and the uses, difficulties and possible developments of exposure models for field application. METHODS: A questionnaire was mailed to 121 occupational hygienists, all members of the Swiss Occupational Hygiene Society. A shorter questionnaire was also sent to registered occupational physicians and selected safety specialists. Descriptive statistics and multivariate analyses were performed. RESULTS: The response rate for occupational hygienists was 60%. The so-called expert judgement appeared to be the most widely used method, but its efficiency and reliability were both judged with very low scores. Long-term sampling was perceived as the most efficient and reliable method. Various determinants of exposure, such as emission rate and work activity, were often considered important, even though they were not included in the exposure assessment processes. Near field local phenomena determinants were also judged important for operator exposure estimation. CONCLUSION: Exposure models should be improved to integrate factors which are more easily accessible to practitioners. Descriptors of emission and local phenomena should also be included.

Assessing small non-zero perceptions of chance: The case of H1N1 (swine) flu risks

Feelings of invulnerability, seen in judgments of 0% risk, can reflect misunderstandings of risk and risk behaviors, suggesting increased need for risk communication. However, judgments of 0% risk may be given by individuals who feel invulnerable, and by individuals who are rounding from small non-zero probabilities. We examined the effect of allowing participants to give more precise responses in the 0-1% range on the validity of reported probability judgments. Participants assessed probabilities for getting H1N1 influenza and dying from it conditional on infection, using a 0-100% visual linear scale. Those responding in the 0-1% range received a follow-up question with more options in that range. This two-step procedure reduced the use of 0% and increased the resolution of responses in the 0-1% range. Moreover, revised probability responses improved predictions of attitudes and self-reported behaviors. Hence, our two-step procedure allows for more precise and more valid measurement of perceived invulnerability. [Authors]

Information literacy - historical and conceptual bases: constructing meanings

Recent years have witnessed the increasing interest in studies focused on information literacy, which is reflected mainly in the number of publications on the subject and goes beyond the fields of Librarianship and Information Science. The purpose of this paper is, therefore, to offer an outlook, historical and conceptual, of international researches on information literacy, trying to show some of the different ramifications which the discussion on the subject has exhibited in past few years in countries where its process of legitimation is already well established, in order to illuminate possible areas of research and action for the librarian professional. This research indicates that if the initial studies on this topic tended to be devoted to conceptualize it, discussing its relevance and determine the skills and knowledge related to information literacy, in the last decade can be noticed a proliferation of researches aimed at describing initiatives or proposing models in areas beyond the usual field such as Medical Sciences, Law, Politics or Computers, among others. The first results of this research refer to a philosophical and educational perspective of information literacy, which suggests the need for deeper understanding and characterization of information literacy in four dimensions: technical, aesthetic, ethical and political, serving both to competence as to information.

Non-formal education, overeducation and wages

Why do overeducated workers participate in non-formal education activities? Do not they suffer from an excess of education? Using microdata from the Spanish sample of the 2007 Adult Education Survey, we have found that overeducated workers participate more than the rest in non-formal education and that they earn higher wages than overeducated workers who did not participate. This result can be interpreted as evidence that non-formal education allows overeducated workers to acquire new abilities that improve their competence at the job they perform. From this point of view, our results support the European Commission"s view on the need to reinforce lifelong learning among adult population.

«S'ha de practicar, el problema és la solució» sense ús no hi ha prou aprenentatge: les pràctiques lingüístiques dels joves sabadellencs

El present article pretén conèixer les tries i els usos lingüístics dels joves de Sabadell. L'estudi se centra en els individus presents a l'escola secundària amb edats compreses entre 14 i 19 anys. En concret es basa a conèixer la importància de l'escola en l'adquisició de la segona llengua d'aquests joves, així com els factors que influencien en la tria i l'ús d'una llengua determinada en els diferents contextos. Donada la diversitat sociocultural actual de Catalunya els individus seleccionats representen les diverses tipologies principals existents segons el seu origen etnicolingüístic (català, castellà i bilingüe), combinat amb la composició del seu entorn bàsic de socialització (xarxes socials), i amb altres aspectes geogràfics, demogràfics i econòmics.

Didàctica de la competència comunicativa plurilingüe i intercultural: el paper de la motivació en l'aprenentatge

L'ensenyament d'una llengua determinada intenta aconseguir que s'aprengui aquesta llengua i saber una llengua pot significar: saber vocabulari (conèixer el significat dels mots), saber descodificar estructures, regles sintàctiques (tenir competència lingüística) i especialment tenir competència comunicativa, concepte que inclou els anteriors i els supera ja que vol dir saber utilitzar la llengua.

Onko osaamisella sukupuoli?

Summary: Is competence gendered?

Human melanoma-specific CD8(+) T-cells from metastases are capable of antigen-specific degranulation and cytolysis directly ex vivo.

The relatively low frequencies of tumor Ag-specific T-cells in PBMC and metastases from cancer patients have long precluded the analysis of their direct ex vivo cytolytic capacity. Using a new composite technique that works well with low cell numbers, we aimed at determining the functional competence of melanoma-specific CD8(+) T-cells. A multiparameter flow cytometry based technique was applied to assess the cytolytic function, degranulation and IFNγ production by tumor Ag-specific CD8(+) T-cells from PBMC and tumor-infiltrated lymph nodes (TILN) of melanoma patients. We found strong cytotoxicity by T-cells not only when they were isolated from PBMC but also from TILN. Cytotoxicity was observed against peptide-pulsed target cells and melanoma cells presenting the naturally processed endogenous antigen. However, unlike their PBMC-derived counterparts, T-cells from TILN produced only minimal amounts of IFNγ, while exhibiting similar levels of degranulation, revealing a critical functional dichotomy in metastatic lesions. Our finding of partial functional impairment fits well with the current knowledge that T-cells from cancer metastases are so-called exhausted, a state of T-cell hyporesponsiveness also found in chronic viral infections. The identification of responsible mechanisms in the tumor microenvironment is important for improving cancer therapies.