Estratégia de capacitação pedagógica do residente: uma perspectiva para melhoria do ensino na Universidade Federal do Rio Grande do Norte

Studies have shown that resident informally plays the role of teacher. It is estimated that up to 25% of the residents of the time is devoted to teaching, mainly contributing as a facilitator, however, almost the entire medical residency programs in Brazil did not offer teacher training during residency education. This paper aims to introduce educational content initiation to teaching as part of the training of resident physician inserted in residency program of the University Hospital Onofre Lopes (HUOL). It is an exploratory, descriptive and prospective study in HUOL the Federal University of Rio Grande do Norte. Three steps were developed: preparation and planning of a pedagogic course, associated with a motivating technical content (basic and advanced life support); second stage, testing of pedagogical model for medical students; and finally, replication to residents. The interventions were made two practice stations life support with performance evaluation in practical activity through OSPE (Objective Structured Practical Examination). The techniques presented teachings were one-minute preceptor and feedback. Data collection was conducted through a structured evaluation form during the life support stations and at the end of the course, and analyzed using descriptive statistics. The results showed that the feedback and one minute preceptor were considered important for teaching and learning for more than 85% of participants. The feedback from evaluators practices stations added information about the performance and were held appreciatively way, according to 100% of the participants. Positive aspects highlighted by the participants were related to educational content, especially the participants of the first intervention. The time of the lectures of motivating technical content was the most repeated negative. Based on the good acceptance of pedagogical contents, this pioneer teacher training strategy was included in the formal residency program in Cardiology of our institution. It is considered therefore that the educational training model with motivating technical content was feasible and had a good evaluation and acceptance by most participants in both interventions. Thus, we believe that the educational content can be inserted in the formal curriculum of medical residency of other programs at HUOL through the training model developed in this study.

Instrumento de avaliação de processos cognitivos para a aprendizagem de subestações de energia em ambientes 2D e realidade virtual

This study describes the development of a prototype to evaluate the potential of environments based on two-dimensional modeling and virtual reality as power substations learning objects into training environments from a central operation and control of power utility Cemig. Initially, there was an identification modeling features and cognitive processes in 2D and RV, from which it was possible to create frames that serve to guide the preparation of a checklist with assigning a metric weight for measuring cognitive potential learning in the study sites. From these contents twenty-four questions were prepared and each was assigned a weight that was used in the calculation of the metric; the questions were grouped into skill sets and similar cognitive processes called categories. Were then developed two distinct environments: the first, the prototype features an interactive checklist and your individual results. And, second, a system of data management environment for the configuration and editing of the prototype, and the observation and analysis of the survey results. For prototype validation, were invited to access the virtual checklist and answer it, five professionals linked to Cemig's training area. The results confirmed the validity of this instrument application to assess the possible potential of modeling in 2D and RV as learning objects in power substations, as well as provide feedback to developers of virtual environments to improve the system.

Exposición infantil a violencia doméstica en una muestra comunitaria en España y consecuencias psicopatológicas asociadas

En los últimos años ha aumentado el interés científico y social sobre los niños que conviven en situaciones de violencia doméstica y han proliferado diversas investigaciones que analizan los efectos de la exposición infantil a la violencia doméstica. No obstante, son escasas las investigaciones realizadas en España, y la mayoría se centran en población clínica. Objetivos: Esta investigación tiene como principal objetivo valorar la presencia de exposición infantil a violencia doméstica en muestra comunitaria que permita capturar una imagen de la realidad en nuestra sociedad. También valora las consecuencias psicopatológicas asociadas: en concreto, se estudia la asociación entre exposición infantil a violencia doméstica y el desarrollo de sintomatología internalizante, externalizante y traumática. El segundo objetivo es estudiar si se producen cambios en cuanto a exposición infantil a violencia doméstica en el tiempo, en concreto entre 2010 y 2014. Metodología: Se contó con una muestra comunitaria seleccionada de forma incidental, formada por 925 sujetos (572 niños en el año 2010 y 353 en el año 2014) con edades comprendidas entre los 11 y 17 años. Para medir la exposición infantil a violencia doméstica se empleó el instrumento Child Exposure to Domestic Violence Scale, CEDV (Edleson, Johnson y Shin, 2007). Este cuestionario es una prueba autoadministrada que evalúa frecuencia y grado de exposición a violencia doméstica y, además, valora otros aspectos tales como implicación, otros tipos de victimización, factores de riesgo o exposición a violencia comunitaria. Con el objetivo de valorar sintomatología internalizante y externalizante se empleó el cuestionario Child Behavior Checklist (CBCL) de Achenbach y Edelbrock (1991), en concreto se aplicó el formato para jóvenes Youth Self Report (YSR). Este cuestionario ha sido uno de los más empleados a lo largo de la literatura para valorar diferentes problemas en la infancia y adolescencia. Para medir sintomatología traumática se empleó el Child PTSD Symptom Scale (CPSS) de Foa, Johnson, Feeny y Tredwell (2001)...

Avaliação da eficácia da implementação de um pacote de medidas na prevenção de pneumonia associada à ventilação mecânica em unidade de terapia intensiva adulta

Background: Ventilator-associated pneumonia (VAP) is a health care related infection and the second leading cause of nosocomial infections linked to morbidity and mortality rates. Therefore, the implementation of care guideline protocols has become necessary for critically ill patients in ICUs in order to provide adequate treatment. Objective: To assess the impact of a package called FAST HUG in PAV ; analyze the risk factors for occurrence of VAP in adult patients at an ICU of a private hospital ; analyze the clinical characteristics of patients who were or were not submitted to the FAST HUG ; analyze the etiology of microorganisms related to EPI ; determine the cost of hospitalization in patients with pneumonia and in patients who received the FAST HUG.Methods: The study was performed in a private hospital that has an 8-bed ICU. It was divided into two phases: before implementing FAST HUG, from August 2011 to August 2012 and after the implementation of FAST HUG, from September 2012 to December 2013. An individual form for each patient in the study was filled out by using information taken electronically from the hospital medical records. The following data for each patient was obtained: age, gender, reason for hospitalization, the use of three or more types of antibiotics, length of stay, intubation time and progress. Findings: After the implementation of FAST HUG, there was an observable decrease in the occurrence of VAP (p <0.01), as well as a reduction in mortality rates (p <0.01). It also shows that the intervention performed in the study resulted in a significant reduction in ICU hospital costs (p <0.05).Conclusion: The implementation of FAST HUG reduced the cases of VAP. Thus, decreasing costs, reducing mortality rates and length of stay, which therefore resulted in an improvement to the overall quality of care.

Using parent report to assess early lexical production in children exposed to more than one language

Limited expressive vocabulary skills in young children are considered to be the first warning signs of a potential Specific Language Impairment (SLI) (Ellis & Thal, 2008). In bilingual language learning environments, the expressive vocabulary size in each of the child’s developing languages is usually smaller compared to the number of words produced by monolingual peers (e.g. De Houwer, 2009). Nonetheless, evidence shows children’s total productive lexicon size across both languages to be comparable to monolingual peers’ vocabularies (e.g. Pearson et al., 1993; Pearson & Fernandez, 1994). Since there is limited knowledge as to which level of bilingual vocabulary size should be considered as a risk factor for SLI, the effects of bilingualism and language-learning difficulties on early lexical production are often confounded. The compilation of profiles for early vocabulary production in children exposed to more than one language, and their comparison across language pairs, should enable more accurate identification of vocabulary delays that signal a risk for SLI in bilingual populations. These considerations prompted the design of a methodology for assessing early expressive vocabulary in children exposed to more than one language, which is described in the present chapter. The implementation of this methodological framework is then outlined by presenting the design of a study that measured the productive lexicons of children aged 24-36 months who were exposed to different language pairs, namely Maltese and English, Irish and English, Polish and English, French and Portuguese, Turkish and German as well as English and Hebrew. These studies were designed and coordinated in COST Action IS0804 Working Group 3 (WG3) and will be described in detail in a series of subsequent publications. Expressive vocabulary size was measured through parental report, by employing the vocabulary checklist of the MacArthur-Bates Communicative Development Inventory: Words and Sentences (CDI: WS) (Fenson et al., 1993, 2007) and its adaptations to the participants’ languages. Here we describe the novelty of the study’s methodological design, which lies in its attempt to harmonize the use of vocabulary checklist adaptations, together with parental questionnaires addressing language exposure and developmental history, across participant groups characterized by different language exposure variables. This chapter outlines the various methodological considerations that paved the way for meaningful cross-linguistic comparison of the participants’ expressive lexicon sizes. In so doing, it hopes to provide a template for and encourage further research directed at establishing a threshold for SLI risk in children exposed to more than one language.

Early detection of delirium in older medical inpatients: prodrome, predictors and motor subtyping

Background Delirium is highly prevalent, especially in older patients. It independently leads to adverse outcomes, but remains under-detected, particularly hypoactive forms. Although early identification and intervention is important, delirium prevention is key to improving outcomes. The delirium prodrome concept has been mooted for decades, but remains poorly characterised. Greater understanding of this prodrome would promote prompt identification of delirium-prone patients, and facilitate improved strategies for delirium prevention and management. Methods Medical inpatients of ≥70 years were screened for prevalent delirium using the Revised Delirium Rating Scale (DRS--‐R98). Those without prevalent delirium were assessed daily for delirium development, prodromal features and motor subtype. Survival analysis models identified which prodromal features predicted the emergence of incident delirium in the cohort in the first week of admission. The Delirium Motor Subtype Scale-4 was used to ascertain motor subtype. Results Of 555 patients approached, 191 patients were included in the prospective study. The median age was 80 (IQR 10) and 101 (52.9%) were male. Sixty-one patients developed incident delirium within a week of admission. Several prodromal features predicted delirium emergence in the cohort. Firstly, using a novel Prodromal Checklist based on the existing literature, and controlling for confounders, seven predictive behavioural features were identified in the prodromal period (for example, increasing confusion; and being easily distractible). Additionally, using serial cognitive tests and the DRS-R98 daily, multiple cognitive and other core delirium features were detected in the prodrome (for example inattention; and sleep-wake cycle disturbance). Examining longitudinal motor subtypes in delirium cases, subtypes were found to be predominantly stable over time, the most prevalent being hypoactive subtype (62.3%). Discussion This thesis explored multiple aspects of delirium in older medical inpatients, with particular focus on the characterisation of the delirium prodrome. These findings should help to inform future delirium educational programmes, and detection and prevention strategies.

The knowledge, attitudes and beliefs of patients and their healthcare professionals around oral dosage form modification: a systematic review of the qualitative literature

Objectives: The objective of this systematic review was to synthesize the available qualitative evidence on the knowledge, attitudes and beliefs of adult patients, healthcare professionals and carers about oral dosage form modification. Design: A systematic review and synthesis of qualitative studies was undertaken, utilising the thematic synthesis approach. Data sources: The following databases were searched from inception to September 2015: PubMed, Medline (EBSCO), EMBASE, CINAHL, PsycINFO, Web of Science, ProQuest Databases, Scopus, Turning Research Into Practice (TRIP), Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Database of Systematic Reviews (CDSR). Citation tracking and searching the references lists of included studies was also undertaken. Grey literature was searched using the OpenGrey database, internet searching and personal knowledge. An updated search was undertaken in June 2016. Review methods: Studies meeting the following criteria were eligible for inclusion; (i) used qualitative data collection and analysis methods; (ii) full-text was available in English; (iii) included adult patients who require oral dosage forms to be modified to meet their needs or; (iv) carers or healthcare professionals of patients who require oral dosage forms to be modified. Two reviewers independently appraised the quality of the included studies using the Critical Appraisal Skills Programme Checklist. A thematic synthesis was conducted and analytical themes were generated. Results: Of 5455 records screened, seven studies were eligible for inclusion; three involved healthcare professionals and the remaining four studies involved patients. Four analytical themes emerged from the thematic synthesis: (i) patient-centred individuality and variability; (ii) communication; (iii) knowledge and uncertainty and; (iv) complexity. The variability of individual patient’s requirements, poor communication practices and lack of knowledge about oral dosage form modification, when combined with the complex and multi-faceted healthcare environment complicate decision making regarding oral dosage form modification and administration. Conclusions: This systematic review has highlighted the key factors influencing the knowledge, attitudes and beliefs of patients and healthcare professionals about oral dosage form modifications. The findings suggest that in order to optimise oral medicine modification practices the needs of individual patients should be routinely and systematically assessed and decision-making should be supported by evidence based recommendations with multidisciplinary input. Further research is needed to optimise oral dosage form modification practices and the factors identified in this review should be considered in the development of future interventions.

Instructional Gaming

This action research will investigate instructional games as a strategy to increase third grade students’ engagement and motivation. A researcher-created behavior checklist and survey will document students’ behavior and attitudes during baseline, intervention, and post intervention. Analysis will investigate changes in engagement, motivation, and grades due to the gaming intervention.

Challenges, Strengths and Opportunities Related to Implementing Comprehensive Evidence-Based Guidelines on Breast Cancer Survivorship Care by Primary Care Physicians and Nurse Practitioners in Southeastern Ontario

Background Many breast cancer survivors continue to have a broad range of physical and psychosocial problems after breast cancer treatment. As cancer centres move forward with earlier discharge of stable breast cancer survivors to primary care follow-up it is important that comprehensive evidence-based breast cancer survivorship care is implemented to effectively address these needs. Research suggests primary care providers are willing to provide breast cancer survivorship care but many lack the knowledge and confidence to provide evidence-based care. Purpose The overall purpose of this thesis was to determine the challenges, strengths and opportunities related to implementing comprehensive evidence-based breast cancer survivorship guidelines by primary care physicians and nurse practitioners in southeastern Ontario. Methods This mixed-methods research was conducted in three phases: (1) synthesis and appraisal of clinical practice guidelines relevant to provision of breast cancer survivorship care within the primary care practice setting; (2) a brief quantitative survey of primary care providers to determine actual practices related to provision of evidence-based breast cancer survivorship care; and (3) individual interviews with primary care providers about the challenges, strengths and opportunities related to provision of comprehensive evidence-based breast cancer survivorship care. Results and Conclusions In the first phase, a comprehensive clinical practice framework was created to guide provision of breast cancer survivorship care and consisted of a one-page checklist outlining breast cancer survivorship issues relevant to primary care, a three-page summary of key recommendations, and a one-page list of guideline sources. The second phase identified several knowledge and practice gaps, and it was determined that guideline implementation rates were higher for recommendations related to prevention and surveillance aspects of survivorship care and lowest related to screening for and management of long-term effects. The third phase identified three major challenges to providing breast cancer survivorship care: inconsistent educational preparation, provider anxieties, and primary care burden; and three major strengths or opportunities to facilitate implementation of survivorship care guidelines: tools and technology, empowering survivors, and optimizing nursing roles. A better understanding of these challenges, strengths and opportunities will inform development of targeted knowledge translation interventions to provide support and education to primary care providers.

Complete Public Law Text, Cases and Materials, 3rd edition

Complete Public Law: Text, Cases, and Materials combines extracts from key primary and secondary materials with clear explanatory text to provide a complete resource for students of constitutional and administrative law. Clear, concise explanation of key legal principles is combined with a wide range of extracts, from statutes, case law and academic materials to provide a complete resource for students The authors use straightforward and uncomplicated language to ensure legal concepts and the complexities of the British constitution are easily understood Learning features such as thinking points, diagrams, useful notes, summary points and reflective questions provide valuable support for students and encourage them to engage with the subject A helpful 'case study' chapter on human rights, terrorism and the courts illustrates how the Human Rights Act has been used in practice across the legal system, providing extra insight into the importance of both human rights law and the process of judicial review The 'Judicial review: putting it all together in problem answers' chapter pulls together strands from previous chapters to provide a checklist of issues to be considered in order to diagnose a judicial review problem and advise a client

Anatomy and variability of "Cuvierichelys parisiensis", a geoemydid turtle that crosses the Eocene-Oligocene boundary in Belgium

Abundant material of turtles from the early Oligocene site of Boutersem-TGV (Boutersem, Belgium), is presented here. No information on the turtles found there was so far available. All the turtle specimens presented here are attributable to a single freshwater taxon that is identified as a member of Geoemydidae, Cuvierichelys. It is the first representative of the ‘Palaeochelys s. l.–Mauremys’ group recognized in the Belgian Paleogene record. This material, which allows to know all the elements of both the carapace and the plastron of the taxon, cannot be attributed to the only species of the genus Cuvierichelys so far identified in the Oligocene, the Spanish form Cuvierichelys iberica. The taxon from Boutersem is recognized as Cuvierichelys parisiensis. Thus, both the paleobiogeographic and the biostratigraphic distributions of Cuvierichelys parisiensis are extended, its presence being confirmed for the first time outside the French Eocene record. The validity of some European forms is refuted, and several characters previously proposed as different between Cuvierichelys iberica and Cuvierichelys parisiensis are recognized as subjected to intraspecific variability.

The relationship between vegetation and modern pollen assemblages on Mount Paggeo (NE Greece)

In this study, we investigated the relationship between vegetation and modern-pollen rain along the elevational gradient of Mount Paggeo. We apply multivariate data analysis to assess the relationship between vegetation and modern-pollen rain and quantify the representativeness of forest zones. This study represents the first statistical analysis of pollen-vegetation relationship along an elevational gradient in Greece. Hence, this paper improves confidence in interpretation of palynological records from north-eastern Greece and may refine past climate reconstructions for a more accurate comparison of data and modelling. Numerical classification and ordination were performed on pollen data to assess differences among plant communities that beech (Fagus sylvatica) dominates or co-dominates. The results show a strong relationship between altitude, arboreal cover, human impact and variations in pollen and nonpollen palynomorph taxa percentages.

Psychologische Inflexibiliteit bij Kinderen: Invloed op de Relatie tussen en de Samenhang met Gepest worden en (Sociale) Angst

Pesten komt voor op alle scholen en kan psychosociale gevolgen hebben zoals (sociale) angst klachten. Op cognitieve gedragstherapie gebaseerde interventies hebben dikwijls de voorkeur bij behandeling van de klachten. De cognitieve vaardigheden van kinderen van 8 tot 11 jaar schieten echter soms tekort om optimaal te kunnen profiteren van cognitieve therapie. Acceptance and Commitment Therapy (ACT) zet in op het vergroten van de psychologische flexibiliteit en is mogelijk een geschikte alternatieve therapie voor kinderen. In de huidige studie werd onderzocht of psychologische inflexibiliteit een onderliggend probleem vormt bij kinderen die angsten hebben of dat gepest worden de kwetsbaarheid voor psychologische inflexibiliteit vergroot. Er werd een positieve samenhang tussen de variabelen psychologische inflexibiliteit, (sociale) angst en gepest worden verwacht. Tevens werd verwacht dat de positieve samenhang tussen gepest worden en (sociale) angst wordt gemodereerd door psychologische inflexibiliteit. Aan 126 kinderen, 66 jongens en 60 meisjes in de leeftijd van 8 tot 11 jaar, afkomstig van basisscholen in Zuid-Nederland werd door de ouders toestemming verleend voor deelname. Eenmalig werden een drietal zelfrapportage vragenlijsten klassikaal aan de kinderen voorgelegd. (Sociale) angst werd gemeten met de Screen for Child Anxiety Related Emotional Disorders-71 (SCARED-71), gepest worden werd gemeten met de Personal Experience Checklist-32 (PECK-32) en psychologische inflexibiliteit werd gemeten met de Avoidance and Fusion Questionnaire for Youth (AFQ-Y). Er werd een positieve samenhang gevonden tussen psychologische inflexibiliteit, (sociale) angst en gepest worden. Een moderatie effect van psychologische inflexibiliteit op de relatie tussen gepest worden en (sociale) angstklachten werd niet gevonden. De huidige studie bevestigt dat psychologische inflexibiliteit een onderliggend probleem vormt voor kinderen met angsten of kinderen die gepest worden. De gevonden verbanden bleken sterker voor angst als algemene trek dan voor sociale angst. Geslacht werd ter controle meegenomen in de analyses, maar verschillen tussen jongens en meisjes werden niet gevonden. ACT vermindert de psychologische inflexibiliteit door het versterken van de psychologische flexibiliteit. De verwachting dat de inzet van ACT de angstklachten en de gevolgen van het gepest worden bij kinderen kan verminderen wordt middels deze studie ondersteund. Verklaringen, beperkingen en relevantie worden besproken evenals suggesties voor verder onderzoek.

De Relatie tussen Angst- en Stemmingsklachten en Self-disclosure: het Effect van Emotie-inhibitie en Mindfulness

Angst- en stemmingsklachten worden geassocieerd met verminderde self-disclosure. Met self-disclosure wordt zelfonthulling van ervaren emoties bedoeld. Dit speelt een rol bij zelfacceptatie en zelfinzicht, en is belangrijk bij gesprekstherapie. Deze studie onderzocht of emotie-inhibitie de negatieve relatie tussen angst- en stemmingsklachten en self-diclosure verklaart, en of de relatie gunstig te beïnvloeden is door mindfulness. Het effect van mindfulness op deze relatie was nog niet eerder onderzocht. Deelnemers waren 99 vrouwen van 24 t/m 74 jaar (M = 44.60, SD = 10.55) en 26 mannen van 26 t/m 77 jaar (M = 48.27, SD = 12.68), afkomstig uit de normale Nederlands populatie. Het onderzoeksontwerp betrof een cross-sectioneel online vragenlijstonderzoek, waarbij gebruik gemaakt werd van de Symptom Checklist (Arrindel & Ettema, 1986), Emotional Self-Disclosure Scale (Snell, Miller, & Belk, 1988), Emotion Regulation Questionnaire (Gross & John, 2003) en Five Factor Mindfulness Questionnaire – Short Form (Bohlmeijer, Ten Klooster, Fledderus, Veehof, & Baer, 2011). Resultaten tonen, conform bestaande literatuur, dat angst- en stemmingsklachten negatief samenhangen met self-disclosure. Emotie-inhibitie heeft echter géén mediatie-effect en mindfulness heeft géén moderatie-effect op de negatieve relatie tussen angst- en stemmingsklachten en self-disclosure. Mindfulness heeft wel mediatie-effect op deze relatie. Mindfulness hangt hierbij positief samen met self-disclosure. De relevantie van de bevindingen is vooral praktisch: om mensen met angst- en stemmingsklachten te stimuleren over hun emoties te praten zou mindfulness aangewend kunnen worden.

Sistema de informação contábil para a gestão pública em conformidade com as normas internacionais: um estudo do modelo vigente

Tese apresentada ao Programa de Pós-Graduação em Administração da Universidade Municipal de São Caetano do Sul para a obtenção do título de doutor em Administração.