The use of the Nursing Activities Score in clinical settings: an integrative review

ABSTRACT Objective analyze how studies have approached the results obtained from the application of the Nursing Activities Score (NAS) based on Donabedian’s model of healthcare organization and delivery. Method CINAHL and PubMed databases were searched for papers published between 2003 and March 2015. Results 36 articles that met the inclusion criteria were reviewed and double-coded by three independent coders and analyzed based on the three elements of Donabedian’s health care quality framework: structure, process and outcome. The most frequently addressed, but not always tested, variables were those that fell into the structure category. Conclusion variables that fell into the process category were used less frequently. Beside NAS, the most frequently used variables in the outcome category were mortality and length of stay. However, no study used a quality framework for healthcare or NAS to evaluate costs, and it is recommended that further research should explore this approach.

Opportunistic screening actions for breast cancer performed by nurses working in primary health care

Abstract OBJECTIVE To identify opportunistic screening actions for breast cancer performed by nurses working in primary health care units in Ribeirão Preto, São Paulo. METHOD Cross-sectional study with 60 nurses from 28 units, who had been working for at least one year in the public municipal health care network. Data were collected between December 2013 and March 2014, by means of a questionnaire, using descriptive analysis and the software IBM SPSS version 20 and Microsoft Excel 2010. RESULTS The results showed that 71.7% of the participants questioned their female patients as for risk factors for breast cancer, mainly during nursing consultation; 70.0% oriented users about the age to perform clinical breast exam, whereas 30.0% did not due to lack of knowledge and time; 60.0% explained about the age to perform mammogram; 73.3% did not refer patients with suspicious breast exam results to the referral department, citing scheduling as the main obstacle to referral. Educational activities were not performed by 78.3% of participants. CONCLUSION Investment is needed in professional training and management of breast cancer screening.

L'enseignement du patient diabétique et son évaluation par un questionnaire à choix multiple. [Education of the diabetic patient and its evaluation by a multiple-choice questionnaire].

37 insulin-dependent and non-insulin-dependent diabetics answered a multiple-choice questionnaire during inpatient educational sessions. 12 dietetic and 12 pathophysiologic questions had to be answered. Statistical analysis of factors influencing the number of errors can be summed up as follows: there is a direct correlation between age of the patient and number of errors; the older the patient, the greater the number of errors. However, insulin-dependent diabetics committed fewer errors than non-insulin-dependent subjects of the same age, which suggests greater motivation in the first group due to their treatment. The test likewise affords the patients an opportunity of reviewing unclear topics and enables the educational team to adapt their teaching to the patients.

Cost of nursing turnover in a Teaching Hospital

Abstract OBJECTIVE To map the sub processes related to turnover of nursing staff and to investigate and measure the nursing turnover cost. METHOD This is a descriptive-exploratory study, classified as case study, conducted in a teaching hospital in the southeastern, Brazil, in the period from May to November 2013. The population was composed by the nursing staff, using Nursing Turnover Cost Calculation Methodology. RESULTS The total cost of turnover was R$314.605,62, and ranged from R$2.221,42 to R$3.073,23 per employee. The costs of pre-hire totaled R$101.004,60 (32,1%), and the hiring process consumed R$92.743,60 (91.8%) The costs of post-hire totaled R$213.601,02 (67,9%), for the sub process decreased productivity, R$199.982,40 (93.6%). CONCLUSION The study identified the importance of managing the cost of staff turnover and the financial impact of the cost of the employee termination, which represented three times the average salary of the nursing staff.

Memoritzar avui dia a l’aula de música : nous recursos en base a la investigació contemporània de la memòria

Aquest projecte final vol ser un acostament senzill, però amb voluntat de rigorositat respecte a la capacitat mnemònica en el context de l’ensenyament i l’aprenentatge musical. Bàsicament està estructurat en dos grans blocs. D’una banda el marc teòric, el qual proporciona una visió general del funcionament de la memòria a nivell neurològic, psicològic i musical, i dels tipus de memòria existents dels quals ens podem servir per a memoritzar. De l’altra faig una recerca sobre quin paper juga la memòria musical tant en músics formats com en nens que comencen a aprendre música. Els musics formats són representats per una mostra d’alumnes de quart curs i graduats de quatre conservatoris superiors diferents, als que a través d’un qüestionari se’ls demana informació per conèixer de primera mà la seva opinió, vivències i coneixements sobre com utilitzen la memòria. Els nens en formació s’investiguen a través d’un estudi de cas amb la intenció de comprovar què suposa dissenyar activitats d’aprenentatge orientades a facilitar la capacitat de la memòria de les persones que estan començant a aprendre música.

The effect of university culture and stakeholders' perceptions on university-business linking activities

The present work discusses the effects of university culture and structure on university-business relations, focusing on knowledge transfer activities. It puts forward the thesis that when links between university and business are introduced into the university system as a turn-key proposition rather than as developmental process, the prevailing university culture and structure will exert resistance against change and will oppose the creation of appropriate structures to promote them, with deleterious effects for the university.

Frequent users of emergency departments present very high prevalence of mental health and substance use disorders, which are largery underdiagnosed by clinicians.

Background: The objective of this study was to determine if mental health and substance use diagnoses were equally detected in frequent users (FUs) compared to infrequent users (IUs) of emergency departments (EDs). Methods: In a sample of 399 adult patients (>= 18 years old) admitted to a teaching hospital ED, we compared the mental health and substance use disorders diagnoses established clinically and consigned in the medical files by the ED physicians to data obtained in face-to-face research interviews using the Primary Care Evaluation of Mental Disorders (PRIME-MD) and the Alcohol, Smoking and Involvement Screening Test (ASSIST). Between November 2009 and June 2010, 226 FUs (>4 visits within a year) who attended the ED were included, and 173 IUs (<= 4 visits within a year) were randomly selected from a pool of identified patients to comprise the comparison group. Results: For mental health disorders identified by the PRIME-MD, FUs were more likely than IUs to have an anxiety (34 vs. 16%, Chi2(1) = 16.74, p <0.001), depressive (47 vs. 25%, Chi2(1) = 19.11, p <0.001) or posttraumatic stress (PTSD) disorder (11 vs. 5%, Chi2(1) = 4.87, p = 0.027). Only 3/76 FUs (4%) with an anxiety disorder, 16/104 FUs (15%) with a depressive disorder and none of the 24 FUs with PTSD were detected by the ED medical staff. None of the 27 IUs with an anxiety disorder, 6/43 IUs (14%) with a depressive disorder and none of the 8 IUs with PTSD were detected. For substance use disorders identified by the ASSIST, FUs were more at risk than IUs for alcohol (24 vs. 7%, Chi2(1) = 21.12, p <0.001) and drug abuse/dependence (36 vs. 25%, Chi2(1) = 5.52, p = 0.019). Of the FUs, 14/54 (26%) using alcohol and 8/81 (10%) using drugs were detected by the ED physicians. Of the IUs, 5/12 (41%) using alcohol and none of the 43 using drugs were detected. Overall, there was no significant difference in the rate of detection of mental health and substance use disorders between FUs and IUs (Fisher's Exact Test: anxiety, p = 0.567; depression, p = 1.000; PTSD, p = 1.000; alcohol, p = 0.517; and drugs, p = 0.053). Conclusions: While the prevalence of mental health and substance use disorders was higher among FUs, the rates of detection were not significantly different for FUs vs. IUs. However, it may be that drug disorders among FUs were more likely to be detected.

Revising the Cannabis Use Disorders Identification Test (CUDIT) by means of Item Response Theory.

Cannabis use among adolescents and young adults has become a major public health challenge. Several European countries are currently developing short screening instruments to identify 'problematic' forms of cannabis use in general population surveys. One such instrument is the Cannabis Use Disorders Identification Test (CUDIT), a 10-item questionnaire based on the Alcohol Use Disorders Identification Test. Previous research found that some CUDIT items did not perform well psychometrically. In the interests of improving the psychometric properties of the CUDIT, this study replaces the poorly performing items with new items that specifically address cannabis use. Analyses are based on a sub-sample of 558 recent cannabis users from a representative population sample of 5722 individuals (aged 13-32) who were surveyed in the 2007 Swiss Cannabis Monitoring Study. Four new items were added to the original CUDIT. Psychometric properties of all 14 items, as well as the dimensionality of the supplemented CUDIT were then examined using Item Response Theory. Results indicate the unidimensionality of CUDIT and an improvement in its psychometric performance when three original items (usual hours being stoned; injuries; guilt) are replaced by new ones (motives for using cannabis; missing out leisure time activities; difficulties at work/school). However, improvements were limited to cannabis users with a high problem score. For epidemiological purposes, any further revision of CUDIT should therefore include a greater number of 'easier' items.

Aging and the lateralization of oscillatory activities related to external and internal motor preparation

Selection of action may rely on external guidance or be motivated internally, engaging partially distinct cerebral networks. With age, there is an increased allocation of sensorimotor processing resources, accompanied by a reduced differentiation between the two networks of action selection. The present study examines the age effects on the motor-related oscillatory patterns related to the preparation of externally and internally guided movements. Thirty-two older and 30 younger adults underwent three delayed motor tasks with S1 as preparatory and S2 as imperative cue: Full, laterality instructed by S1 (external guidance); Free, laterality freely selected (internal guidance); None, laterality instructed by S2 (no preparation). Electroencephalogram (EEG) was recorded using 64 surface electrodes. Motor-Related Amplitude Asymmetries (MRAA), indexing the lateralization of oscillatory activities, were analyzed within the S1-S2 interval in the mu (9-12 Hz) and low beta (15-20 Hz) motor-related frequency bands. Reaction times to S2 were slower in older than younger subjects, and slower in the Free than in the Full condition in older subjects only. In the Full condition, there were significant mu MRAA in both age groups, and significant low beta MRAA only in older adults. The Free condition was associated with large mu MRAA in younger adults and limited low beta MRAA in older adults. In younger subjects, the lateralization of mu activity in both Full and Free conditions indicated effective external and internal motor preparation. In older subjects, external motor preparation was associated with lateralization of low beta in addition with mu activity, compatible with an increase of motor-related resources. In contrast, absence of mu and limited low beta lateralization in internal motor preparation was concomitant with reaction time slowing and suggested less efficient cerebral processes subtending free movement selection in older adults, indicating reduced capacity for internally driven action with age.

Increasing Students Vocabulary in Efl Class

After reviewing the literature, this work tries to show the importance of teaching vocabulary fõr students’ literacy skills, especially, reading comprehension. Many researchers suggest that the greatest amount of vocabulary growth occurs through incidental word learning in wide reading, and, research indicates that vocabulary instruction is an important vehicle for vocabulary learning. (Anderson& Nagy, as cited in Harmon, 1992, p.306). Word knowledge is one of the best ways of successful reading and comprehension. “Reading enhancement correlates with reader’s vocabulary” (Im, 1994, p.12). Therefore, today’s language teachers and researchers have realized the important role of vocabulary in reading comprehension. A survey carried out on 10th, 11th and 12th grade students, regarding their reading comprehension, shows that unknown words is one of the factors which influences their ability to read and comprehend a passage. It also shows that students feel the need to be instructed on strategy when encountering new words and consequently improving their vocabulary. This inhibits their understanding of a reading selection. As a result it is crucial that teachers equip students with methodological tools to be employed when they encounter unknown words. There are a lot systematic approaches for discerning which skills and words a teacher should focus on and meaningful classroom activities to reinforce the words and strategies that teachers can use to help students increase their word knowledge. Finally research indicates that developing students’ vocabulary correlates with success in all areas of curriculum (Edger, 1999, p.14). The success of vocabulary development depends on students’ active process of learning and strategies used by teachers.

How are "teaching the teachers" courses in evidence based medicine evaluated? A systematic review.

BACKGROUND: Teaching of evidence-based medicine (EBM) has become widespread in medical education. Teaching the teachers (TTT) courses address the increased teaching demand and the need to improve effectiveness of EBM teaching. We conducted a systematic review of assessment tools for EBM TTT courses.To summarise and appraise existing assessment methods for teaching the teachers courses in EBM by a systematic review. METHODS: We searched PubMed, BioMed, EmBase, Cochrane and Eric databases without language restrictions and included articles that assessed its participants. Study selection and data extraction were conducted independently by two reviewers. RESULTS: Of 1230 potentially relevant studies, five papers met the selection criteria. There were no specific assessment tools for evaluating effectiveness of EBM TTT courses. Some of the material available might be useful in initiating the development of such an assessment tool. CONCLUSION: There is a need for the development of educationally sound assessment tools for teaching the teachers courses in EBM, without which it would be impossible to ascertain if such courses have the desired effect.

Teaching cardiac auscultation to trainees in internal medicine and family practice: does it work?

BACKGROUND: The general proficiency in physical diagnostic skills seems to be declining in relation to the development of new technologies. The few studies that have examined this question have invariably used recordings of cardiac events obtained from patients. However, this type of evaluation may not correlate particularly well with bedside skills. Our objectives were 1) To compare the cardiac auscultatory skills of physicians in training with those of experienced cardiologists by using real patients to test bedside diagnostic skills. 2) To evaluate the impact of a five-month bedside cardiac auscultation training program. METHODS: 1) In an academic primary care center, 20 physicians (trainees in internal medicine and family practice) and two skilled academic cardiologists listened to 33 cardiac events in 13 patients directly at bedside and identified the cardiac events by completing an open questionnaire. Heart sounds, murmurs and diagnosis were determined beforehand by an independent skilled cardiologist and were validated by echocardiography. Thirteen primary cardiologic diagnoses were possible.2) Ten of the physicians agreed to participate in a course of 45-minute sessions once a week for 5 months. After the course they listened again to the same patients (pre/post-interventional study). RESULTS: 1) The experts were the most skillful, achieving 69% recognition of heart sounds and murmurs and correct diagnoses in 62% of cases. They also heard all of the diastolic murmurs. The residents heard only 40% of the extra heart sounds and made a correct diagnosis in 24% of cases. 2) After the weekly training sessions, their mean percentage for correct diagnosis was 35% [an increase of 66% (p < 0.05)]. CONCLUSIONS: The level of bedside diagnostic skills in this relatively small group of physicians in training is indeed low, but can be improved by a course focusing on realistic bedside teaching.

Teaching metaheuristics in business schools

In this work we discuss some ideas and opinions related with teaching Metaheuristics in Business Schools. The main purpose of the work is to initiate a discussion and collaboration about this topic,with the final objective to improve the teaching and publicity of the area. The main topics to be discussed are the environment and focus of this teaching. We also present a SWOT analysis which lead us to the conclusion that the area of Metaheuristics only can win with the presentation and discussion of metaheuristics and related topics in Business Schools, since it consists in a excellent Decision Support tools for future potential users.

Projecto de sensibilização e educação ambiental na área da prevenção da produção dos resíduos urbanos : proposta de integração da temática nos currícula do ensino básico de Cabo Verde

This research project has as main objective the design of a project to raise awareness and environmental education in the area of prevention of the urban waste production by focusing on the presentation of a methodological proposal to incorporate this theme in the Course Curriculum of the Basic Education in Cape Verde. The study aimed beyond the project design, the preparation of a guide and a set of activities, instruments to be used by the educational community and more directly by the teachers of the Basic Education (EB) of Cape Verde for knowledge construction in study area and promove the development of skills of those teachers in terms of planning activities for waste prevention. The realized work included visits to various sources of information considered relevant, the application and validation of some activities in the population testing process using the technique of participant observation. This research involved the collaboration of the educational community of Praia namely the BE teachers, Pedagogical team teaching and Promoters of the new BE Curriculum. The study made a contribution in the view of the definition of the methodology of the work project and the assessment tool in order to reflect on the work process and its subsequent correction / improvement of future operations. We also present a proposal of monitoring and evaluation instrument of the project which will be applied during the implementation phase. Its use will enable the school community to improve their practices and will facilitate the involvement of the educational community taking into consideration an environmental sustainability

Projecto de sensibilização e educação ambiental na área da prevenção da produção dos resíduos urbanos : proposta de integração da temática nos currícula do ensino básico de Cabo Verde

O presente trabalho de projecto tem como principal objectivo a concepção de um projecto de sensibilização e educação ambiental na área da prevenção da produção dos resíduos urbanos com enfoque na apresentação de uma proposta metodológica de integração desta temática nos Currícula do Ensino Básico de Cabo Verde. Do estudo desenvolvido resultou, além da concepção do projecto, a elaboração de um guia, bem como um caderno de actividades, instrumentos a serem utilizados pela comunidade educativa e mais directamente pelos professores do Ensino Básico (EB) de Cabo Verde visando o reforço de conhecimentos na área de estudo identificada e o desenvolvimento de competências juntos dos referidos professores, para a planificação de actividades de prevenção da produção dos resíduos urbanos. O trabalho realizado compreendeu visitas a várias fontes de informação consideradas pertinentes assim como a aplicação e validação de algumas actividades numa população-teste com utilização da técnica de observação participante. Deste modo, o estudo contou com a colaboração da comunidade educativa da Cidade da Praia nomeadamente professores do EB, Equipa pedagógica e Promotores do novo Currículo do EB. O estudo permitiu dar um contributo na perspectiva da definição da metodologia do trabalho do projecto e instrumento de avaliação, visando uma reflexão sobre o trabalho desenvolvido e sua consequente correcção/melhoria de futuras acções. Apresentamos ainda uma proposta de instrumentos de acompanhamento e avaliação do projecto cuja aplicação se propõe no decorrer da implementação do mesmo. A sua utilização permitirá à comunidade escolar melhorar as suas práticas e facilitará o envolvimento da comunidade educativa tendo em vista a sustentabilidade ambiental.