879 resultados para fidelity encouragement
Resumo:
BACKGROUND: Successful management of chronic cough has varied in the primary research studies in the reported literature. One of the potential reasons relates to a lack of intervention fidelity to the core elements of the diagnostic and/or therapeutic interventions that were meant to be used by the investigators.
METHODS: We conducted a systematic review to summarize the evidence supporting intervention fidelity as an important methodologic consideration in assessing the effectiveness of clinical practice guidelines used for the diagnosis and management of chronic cough. We developed and used a tool to assess for five areas of intervention fidelity. Medline (PubMed), Scopus, and the Cochrane Database of Systematic Reviews were searched from January 1998 to May 2014. Guideline recommendations and suggestions for those conducting research using guidelines or protocols to diagnose and manage chronic cough in the adult were developed and voted upon using CHEST Organization methodology.
RESULTS: A total of 23 studies (17 uncontrolled prospective observational, two randomized controlled, and four retrospective observational) met our inclusion criteria. These articles included 3,636 patients. Data could not be pooled for meta-analysis because of heterogeneity. Findings related to the five areas of intervention fidelity included three areas primarily related to the provider and two primarily related to the patients. In the area of study design, 11 of 23 studies appeared to be underpinned by a single guideline/protocol; for training of providers, two of 23 studies reported training, and zero of 23 reported the use of an intervention manual; and for the area of delivery of treatment, when assessing the treatment of gastroesophageal reflux disease, three of 23 studies appeared consistent with the most recent guideline/protocol referenced by the authors. For receipt of treatment, zero of 23 studies mentioned measuring concordance of patient-interventionist understanding of the treatment recommended, and zero of 23 mentioned measuring enactment of treatment, with three of 23 measuring side effects and two of 23 measuring adherence. The overall average intervention fidelity score for all 23 studies was poor (20.74 out of 48).
CONCLUSIONS: Only low-quality evidence supports that intervention fidelity strategies were used when conducting primary research in diagnosing and managing chronic cough in adults. This supports the contention that some of the variability in the reporting of patients with unexplained or unresolved chronic cough may be due to lack of intervention fidelity. By following the recommendations and suggestions in this article, researchers will likely be better able to incorporate strategies to address intervention fidelity, thereby strengthening the validity and generalizability of their results that provide the basis for the development of trustworthy guidelines.
Resumo:
BACKGROUND: High-fidelity simulation is becoming increasingly important in the delivery of teaching and learning to health care professionals within a safe environment. Its use in an interprofessional context and at undergraduate level has the potential to facilitate the learning of good communication and teamworking, in addition to clinical knowledge and skills.
METHODS: Interprofessional teaching and learning workshops using high-fidelity paediatric simulation were developed and delivered to undergraduate medical and nursing students at Queen's University Belfast. Learning outcomes common to both professions, and essential in the clinical management of sick children, included basic competencies, communication and teamworking skills. Quantitative and qualitative evaluation was undertaken using published questionnaires.
RESULTS: Quantitative results - the 32-item questionnaire was analysed for reliability using spss. Responses were positive for both groups of students across four domains - acquisition of knowledge and skills, communication and teamworking, professional identity and role awareness, and attitudes to shared learning. Qualitative results - thematic content analysis was used to analyse open-ended responses. Students from both groups commented that an interprofessional education (IPE) approach to paediatric simulation improved clinical and practice-based skills, and provided a safe learning environment. Students commented that there should be more interprofessional and simulation learning opportunities.
DISCUSSION: High-fidelity paediatric simulation, used in an interprofessional context, has the potential to meet the requirements of undergraduate medical and nursing curricula. Further research is needed into the long-term benefits for patient care, and its generalisability to other areas within health care teaching and learning.
Resumo:
Estudos recentes estabelecem uma ligação entre erros na tradução do mRNA e cancro, envelhecimento e neurodegeneração. RNAs de transferência mutantes que introduzem aminoácidos em locais errados nas proteínas aumentam a produção de espécies reactivas de oxigénio e a expressão de genes que regulam autofagia, ribofagia, degradação de proteínas não-funcionais e protecção contra o stress oxidativo. Erros na tradução do mRNA estão portanto relacionados com stress proteotóxico. Sabe-se agora que o mecanismo de toxicidade do crómio está associado à diminuição da fidelidade de tradução e à agregação de proteínas com malformações que destabilizam a sua estrutura terciária. Desta forma, é possível que os efeitos do stress ambiental ao nível da degeneração celular possam estar relacionados com a alteração da integridade da maquinaria da tradução. Neste estudo procedeu-se a uma avaliação alargada do impacto do stress ambiental na fidelidade da síntese de proteínas, utilizando S. cerevisiae como um sistema modelo. Para isso recorreu-se a repórteres policistrónicos de luciferase que permitiram quantificar especificamente a supressão de codões de terminação e o erro na leitura do codão AUG em células exposta a concentações não letais de metais pesados, etanol, cafeína e H2O2. Os resultados sugerem que a maquinaria de tradução é na generalidade muito resistente ao stress ambiental, devido a uma conjugação de mecanismos de homeostase que muito eficientemente antagonizam o impacto negativo dos erros de tradução. A nossa abordagem quantitativa permitiu-nos a identificar genes regulados por uma resposta programada ao stress ambiental que são também essenciais para mitigar a ocorrência de erros de tradução, nomeadamente, HSP12, HSP104 e RPN4. A exposição prolongada ao stress ambiental conduz à saturação dos mecanismos de homeostase, contribuindo para a acumulação de proteínas contendo erros de tradução e diminuindo a disponibilidade de proteínas funcionais directamente envolvidas na manutenção da fidelidade de tradução e integridade celular. Ao contrário de outras Hsps, a Hsp12p adopta normalmente uma localização membranar em condições de stress, que pode modular a fluidez e estabilidade membranar, sugerindo que a membrana plasmática é um alvo preferencial da perda de fidelidade da tradução. Para melhor compreender as respostas celulares aos erros de tradução, células contendo deleções em genes codificadores das Hsps foram transformadas com tRNAs mutantes que introduzem alterações no proteoma. Os nossos resultados demonstram que para além da resposta geral ao stress, estes tRNAs induzem alterações a nível do metabolismo celular e um aumento de aminoacilação com Metionina em vários tRNAs, sugerindo um mecanismo de protecção contra espécies reactivas de oxigénio. Em conclusão, este estudo sugere um papel para os erros de tradução na gestão de recursos energéticos e na adaptação das células a ambientes desfavoráveis.
Resumo:
1878/01 (N8).
Resumo:
1886/07 (N3).
Resumo:
1887/07 (N7).
Resumo:
1887/10 (N8).
Resumo:
1886/10 (N4).
Resumo:
1888/07 (N11).
Resumo:
1876/08 (N6).
Resumo:
1875/04 (N3).
Resumo:
1888/10 (N12).
Resumo:
1889/01 (N13)-1889/04.
Resumo:
1877/03 (N7).
