Guidelines on the standards for the training of specialised health professionals dealing with breast cancer.

According to EUSOMA position paper 'The requirements of a specialist breast unit', each breast unit should have a core team made up of health professionals who have undergone specialist training in breast cancer. In this paper, on behalf of EUSOMA, authors have identified the standards of training in breast cancer, to harmonise and foster breast care training in Europe. The aim of this paper is to contribute to the increase in the level of care in a breast unit, as the input of qualified health professionals increases the quality of breast cancer patient care.

Teaching neuraxial anesthesia techniques for obstetric care in a Ghanaian referral hospital: achievements and obstacles.

Anesthesia providers in low-income countries may infrequently provide regional anesthesia techniques for obstetrics due to insufficient training and supplies, limited manpower, and a lack of perceived need. In 2007, Kybele, Inc. began a 5-year collaboration in Ghana to improve obstetric anesthesia services. A program was designed to teach spinal anesthesia for cesarean delivery and spinal labor analgesia at Ridge Regional Hospital, Accra, the second largest obstetric unit in Ghana. The use of spinal anesthesia for cesarean delivery increased significantly from 6% in 2006 to 89% in 2009. By 2012, >90% of cesarean deliveries were conducted with spinal anesthesia, despite a doubling of the number performed. A trial of spinal labor analgesia was assessed in a small cohort of parturients with minimal complications; however, protocol deviations were observed. Although subsequent efforts to provide spinal analgesia in the labor ward were hampered by anesthesia provider shortages, spinal anesthesia for cesarean delivery proved to be practical and sustainable.

Exodus? The training paths and plans of postgraduate medical trainees, under the Royal College of Physicians of Ireland

Background: In 2006, the Buttimer report highlighted the paucity of demographic data on those applying for and entering postgraduate medical education and training (PGMET) in Ireland. Today, concerns that there is an "exodus" of graduates of Irish medical schools are at the forefront of national discussion, however, published data on PGMET remains inadequate.

Aims: The objectives of this study were to collate existing data relating to trainees and training programmes at three stages of training and to examine the career plans of junior trainees.

Methods: Data from application forms for training programmes, commencing July 2012, under the Royal College of Physicians of Ireland (n = 870), were integrated with data from other existing sources. Candidates entering basic specialist training were surveyed with regard to career plans. Descriptive and comparative analysis was performed in SPSS version 18.

Results: Graduates of Irish medical schools made up over 70 % of appointees. Over 80 % of BST trainees aspired to work as consultants in Ireland, but 92.5 % planned to spend time working abroad (response rate 77 %). Decisions to leave the Irish system were linked to lifestyle, but also to failure to be appointed to higher specialist training. Significant numbers of trainees return to Ireland after a period abroad.

Conclusions: The trainee "exodus" is more complex than is often portrayed. The desire to spend time working outside Ireland must be accounted for in workforce planning and configuration of training programmes. Expansion of HST is a potential solution to reduce the numbers of graduates leaving Ireland post-BST.

Standardizing the assessment of clinical competence: an overview of intensive care course design.

Rationale for the development of the Certificate in Health Studies: Intensive Care and High Dependency for Adults course developed at Queens University Belfast, Northern Ireland. Structure and content of clinical module reviewed. Clinical assessment strategy discussed. Focus on the utilization of a standardized portfolio, individualized learning contract and objective structured clinical examination (OSCE) to evaluate clinical competence. Evaluation of OSCE as an assessment tool and of the course provision.

Female genital mutilation in Switzerland: a survey among gynaecologists.

QUESTION UNDER STUDY: To evaluate the situation of Female Genital Mutilation (FGM) in Switzerland. METHODS: Through a questionnaire, Swiss gynaecologists were asked if they have been confronted to FGMs, if they have been asked to perform infibulations and FGMs. The health representatives (Kantonsärzte/médecins cantonaux) were interviewed on FGM activity at the Canton level. Swiss Medical Schools were asked if FGM was included in the pregraduate curriculum, and an estimated prevalence rate for FGMs in Switzerland was gathered. RESULTS: Among Swiss gynaecologists, 20% reported having been confronted with patients presenting with FGM and among them 40% had been asked about reinfibulation. Gynaecologists are occasionally asked about the possibility of performing FGMs in Switzerland. No activity concerning FGM is reported by health authorities in the Cantons. Teaching about FGM is not included in the curriculum of any of the Swiss medical schools. Approximately 6,700 girls at risk and women who have undergone FGM live in Switzerland. CONCLUSION: The extent to which gynaecologists are confronted to women with FGM may justify further action to try to better understand the situation in Switzerland. Improvement of care by better education of health care providers (guidelines) and prevention of new cases by women's education should also be considered.

Perceptions infirmières quant à la réalisation de la collecte des données auprès de la clientèle à l'urgence, étape préalable à la formulation du jugement clinique infirmier

Depuis l’adoption de la Loi 90 en 2002, la Loi sur les infirmières et infirmiers (LII, article 36) confère une autonomie élargie aux infirmières en reconnaissant, notamment, leur compétence et leur responsabilité à l’égard de l’évaluation clinique qui est représentée dans cette loi comme l’assise de l’exercice infirmier (Pellerin, 2009; OIIQ, 2010). La collecte des données constitue une étape fondamentale du processus d’évaluation clinique (Dillon, 2007; Doyon, Brûlé & Cloutier, 2002; Pellerin, 2009; Weber & Kelley, 2007). L’infirmière d’urgence a une responsabilité majeure à l’égard de la collecte des données. En effet, elle œuvre auprès de clientèles de tous âges qui présentent des problèmes de santé variés, aigus et parfois urgents et doit souvent intervenir, sur la base de son évaluation clinique, avant qu’un diagnostic n’ait été établi ou que le patient n’ait été vu par le médecin (Newberry & Criddle, 2005). Or, malgré toute l’importance que revêtent dorénavant l’évaluation clinique et la collecte des données au sens de la loi, ce rôle de l’infirmière semble tarder à s’actualiser dans la pratique clinique. Le but de cette étude qualitative descriptive consiste à explorer les perceptions d’infirmières, de gestionnaires en soins infirmiers et d’infirmières ressources cliniques d’urgence relativement à la réalisation de la collecte des données. La norme clinique « collecte des données » (assessment) de l’Emergency Nurses Association (1999) constitue le cadre de référence de l’étude. Cinq entrevues individuelles semi-dirigées de 60 minutes ainsi qu’un groupe de discussion de 90 minutes ont été réalisés auprès d’infirmières d’urgence. Un deuxième groupe de discussion a également réuni deux gestionnaires en soins infirmiers et deux infirmières ressources cliniques de l’urgence. Les données recueillies ont été analysées selon l’approche proposée par Miles et Huberman (2003). Les résultats obtenus démontrent que les infirmières considèrent la collecte des données comme un aspect fondamental de leur pratique à l’urgence, qui contribue à améliorer la qualité et la sécurité des soins dispensés. Or, les résultats révèlent également que leur compréhension de la collecte des données est variable, que leur pratique est aléatoire et largement influencée par le modèle biomédical. Plusieurs facteurs influencent la pratique des infirmières relativement à la collecte des données notamment : la conception individuelle de la collecte des données et du rôle infirmier, les relations et l’interaction avec les membres de l’équipe des soins infirmiers et les autres professionnels ainsi que le soutien de l’organisation et des gestionnaires en soins infirmiers. Ce dernier facteur semble prépondérant dans le contexte de l’urgence et démontre que le soutien des gestionnaires et des infirmières ressources cliniques influence de façon importante la pratique dans les milieux cliniques. Cette étude propose des pistes de réflexion sur la formation académique, la formation continue, l’administration des soins infirmiers et la collaboration interprofessionnelle qui pourraient faciliter l’actualisation du rôle des infirmières à l’égard de la collecte des données et de l’évaluation clinique afin d’améliorer la qualité des soins dispensés à l’urgence.

Concordancia en la interpretación de los gases arteriales entre residentes de medicina de emergencias y el intensivista

Se desconoce en la actualidad en Colombia la calidad de la interpretación de los gases arteriales por parte de los residentes de medicina de emergencias. Los gases arteriales es una de las ayudas diagnósticas de más rápida consecución en el servicio de urgencias y más utilizadas por ser indispensable en la valoración de patologías de alta prevalencia como son las enfermedades respiratorias y la sepsis. Su mala interpretación puede llevar a mal direccionamiento del manejo de pacientes en estado crítico por lo que es indefectible que los residentes logren un buen entrenamiento en la interpretación de los mismos. Por esta razón se realiza este estudio analítico de concordancia con recolección prospectiva, de corte transversal que busca determinar el grado de concordancia en la interpretación de gases arteriales de los residentes del programa de Medicina de Emergencias de la Universidad del Rosario y especialista en cuidado crítico, así como la interpretación entre ellos según su nivel de entrenamiento y describir cuáles son los hallazgos que encuentran en la interpretación de los mismos. Se recolectaron 60 gases arteriales realizados a paciente hospitalizados en la unidad de cuidados intensivos de la Fundación Santa Fe de Bogotá y se halló la concordancia entre la lectura de los residentes del programa de Medicina de Emergencias y un intensivista. Encontrando una concordancia moderada (r 0.445 y 0.442, ) en las respuestas identificadas en los residentes de segundo y tercer año de residencia(p:0,000y0,01).(MESH: Blood Gas Análisis, Emergency Medical Services, Education, Medical, Graduate)

Enfermagem, valores e aprendizagem

21 ENFERMAGEM, VALORES E APRENDIZAGEM ISILDA MARIA OLIVEIRA CARVALHO RIBEIRO Centro de Estudos em Educação e Formação (CEEF), Universidade Lusófona do Porto/ Centro de Estudos e Intervenção em Educação e Formação (CeiEF), ULHT Resumo Este trabalho enquadra-se na área da Aprendizagem dos Valores no Curso de Licenciatura em Enfermagem (CLE). Através desta reflexão, e em consonância com os objetivos traçados, privilegiamos o paradigma misto, ou seja, na investigação que pretendemos realizar, utilizaremos uma abordagem multimétodo, para que o estudo possa sair enriquecido. O estudo decorrerá numa Escola Superior de Enfermagem da Região Este trabalho enquadra-se na área da Aprendizagem dos Valores no Curso de Licenciatura em Enfermagem (CLE). A pertinência em estudar esta temática encontra-se na constatação da nossa prática profissional e na atividade como docente em ensino teórico-prático, espaço em que os valores e o sentido humano, no cuidar da pessoa como ser traduzem, muitas vezes, um certo esquecimento da sua dignidade. É aqui que o nosso interesse e motivação encontram a razão da preocupação e da responsabilidade pela formação do profissional competente, como autêntico cidadão de valores. A educação em enfermagem deverá ter uma conduta moral onde se pretende refletir, à luz dos princípios éticos e morais, o fundamento dos valores das nossas ações, de forma a tornarmos a prática mais consciente e refletida. Além de incidir necessariamente nos conhecimentos científicos e instrumentais, a formação deve privilegiar o desenvolvimento de capacidades como: capacidade de negociação, espírito crítico e equipa, criatividade, pensamento ético consolidado numa conduta de valores. Pretende-se, com esta comunicação, reproduzir o percurso realizado e refletir sobre a importância da aprendizagem dos valores no Curso de Norte e nas respetivas instituições hospitalares onde decorre o estágio de integração à vida profissional (IVP). Os participantes do estudo são os estudantes inscritos no 1º e 4º ano (sendo estes os que frequentam estágio IVP) e por docentes da referida escola que orientam ou tenham orientado estágios de IVP e responsáveis por órgãos como: o Conselho Técnico-Científico, o Conselho Pedagógico e Associação de Estudantes. Desenvolveremos o trabalho de campo recorrendo às seguintes fontes de colheita de dados: análise documental, observação participante, entrevistas, questionário e utilização da escala de valores: Rokeach Value Survy – RVS (Rokeach, 1973); Focus Group, constituído por peritos na área, cuja finalidade consiste numa discussão objetiva, conduzida ou moderada que introduz um assunto a um grupo de peritos e direciona a discussão sobre o tema, de uma maneira não estruturada e natural. Uma das vertentes fundamentais do estudo consistirá na concretização de triangulações múltiplas. Pretendemos que este projeto na sua concretização permita identificar novos valores a incluir ou excluir do Código Deontológico que orienta o exercício da profissão. Deseja-se enviar os resultados como proposta para o Conselho Jurisdicional, que apreciará e decidirá sobre a proposta de alteração.

In vitro antibacterial action of Tetraclean, MTAD and five experimental irrigation solutions

P>Aim To investigate the antibacterial effect of Tetraclean, MTAD and five experimental irrigants using both direct exposure test with planktonic cultures and mixed-species in vitro biofilm model. Methodology Tetraclean, MTAD and five experimental solutions that were modifications of existing formulae including MTAD + 0.01% cetrimide (CTR), MTAD + 0.1% CTR, MTAC-1 (Tween 80 replaced by 0.01% CTR in MTAD), MTAC-2 (Tween 80 replaced by 0.1% CTR) and MTAD-D (MTAD without the Tween 80 and no CTR added) were used as disinfectants in the experiments. In the direct exposure test, a suspension of Enterococcus faecalis was mixed with each of the solutions. After 0.5, 1, 3 and 10 min, an inactivator was added and the number of surviving bacteria was calculated. A mixed-species biofilm from subgingival plaque bacteria was grown in brain heart infusion broth in anaerobic conditions on synthetic hydroxyapatite discs. Two-week-old biofilms were exposed to the solutions for 0.5, 1 and 3 min. The samples were observed by confocal laser scanning microscopy after bacterial viability staining. The scans were quantitatively analysed, and the volume of killed cells of all cells was calculated for each medicament. Results Tetraclean and MTAC-2 (0.1% CTR) killed planktonic E. faecalis in < 30 s. Complete killing of bacteria required 1 min by MTAC-1, 3 min by MTAD + 0.1% CTR and 10 min by MTAD, MTAD-D and MTAD + 0.01% CTR. In the biofilm test, there were significant differences in microbial killing between the different solutions and times of exposure (P < 0.005). MTAC-2 showed the best performance, killing 71% of the biofilm bacteria in 3 min, followed by MTAC-1 and Tetraclean. MTAD and the three MTAD modifications demonstrated the lowest antibacterial activity. Conclusion Tetraclean was more effective than MTAD against E. faecalis in planktonic culture and in mixed-species in vitro biofilm. CTR improved the antimicrobial properties of the solutions, whereas Tween 80 seemed to have a neutral or negative impact on their antimicrobial effectiveness.

Pharmacophore-based 3D QSAR studies on a series of high affinity 5-HT(1A) receptor ligands

5-HT(1A) receptor antagonists have been employed to treat depression, but the lack of structural information on this receptor hampers the design of specific and selective ligands. In this study, we have performed CoMFA studies on a training set of arylpiperazines (high affinity 5-HT(1A) receptor ligands) and to produce an effective alignment of the data set, a pharmacophore model was produced using Galahad. A statistically significant model was obtained, indicating a good internal consistency and predictive ability for untested compounds. The information gathered from our receptor-independent pharmacophore hypothesis is in good agreement with results from independent studies using different approaches. Therefore, this work provides important insights on the chemical and structural basis involved in the molecular recognition of these compounds. (C) 2010 Elsevier Masson SAS. All rights reserved.

Representações sociais de discentes sobre universidade: um estudo psicossocial entre ingressantes do vestibular e da seleção ProUni

Demand for access to higher education to put in test the education Brazilian system in view of the surplus of selective processes of public universities, people without option to pay their studies at this education level. In this context, it has arisen the University for All(Universidade para Todos)Program, the ProUni, from Ministry of Education - MEC, created by the Federal Government in 2004, and that it aims the granting of full and partial scholarships in private higher education institutions, graduate courses in sequential specific training, low-income Brazilians students who do not have higher-level degree. Created by the Provisional Measure No 213/2004 and institutionalized by Law No. 11096 of January 13, 2005, the ProUni offers, however, the exemption of some taxes to those institutions that join the program. This is one of the privileged time for the study of Social Representations by offering the researcher, a living laboratory, natural environment, the confrontation between the established and new. In time like this people are challenged to incorporate the new system to the pre-existing one, aiming it through a strangeness of what was so familiar. It is through this game of social forces that we developed the present study with 196 entering higher education, of these are 116 of selective vestibular system and 80 of the ProUni selective system. We opt by the procedures for data collection in order to have access to the circulating senses, in addition to the streamlined responses. With foundation in Abric, we perform the test the Free Association of Words, then analysed by the software and by EVOC Content of the type theme as Bardin. Besides, we require of the subjects, a writing on the study object university later analysed by the software ALCESTE. The results point out to a representation strongly rooted in social factors such as more traditional socio-cultural elements: the beliefs, values, the symbols. It is unique in both groups of subjects: among those entering by the selective ProUni system, there was a stronger anchor in that it does not make inquiries about the program. At the same time, there is a stronger presence of objectivation, entering the selective vestibular system in order that they explained with a value judgement on the programme. It is suggested further studies considering the embryonic state of social representation, as recent as the social purpose that triggered. It would be relevant even the replication of the same research with other people in order to strengthen the power of the theorising of empiria available