Predictive factors of post-discharge surgical site infections among patients from a teaching hospital

Introduction Surgical site infections (SSIs) often manifest after patients are discharged and are missed by hospital-based surveillance. Methods We conducted a case-reference study nested in a prospective cohort of patients from six surgical specialties in a teaching hospital. The factors related to SSI were compared for cases identified during the hospital stay and after discharge. Results Among 3,427 patients, 222 (6.4%) acquired an SSI. In 138 of these patients, the onset of the SSI occurred after discharge. Neurological surgery and the use of steroids were independently associated with a greater likelihood of SSI diagnosis during the hospital stay. Conclusions Our results support the idea of a specialty-based strategy for post-discharge SSI surveillance.

Pharmacokinetic/pharmacodynamic target attainment of intravenous β-lactam regimens against Gram-negative bacteria isolated in a Brazilian teaching hospital

ABSTRACTINTRODUCTION: Monte Carlo simulations have been used for selecting optimal antibiotic regimens for treatment of bacterial infections. The aim of this study was to assess the pharmacokinetic and pharmacodynamic target attainment of intravenous β-lactam regimens commonly used to treat bloodstream infections (BSIs) caused by Gram-negative rod-shaped organisms in a Brazilian teaching hospital.METHODS: In total, 5,000 patients were included in the Monte Carlo simulations of distinct antimicrobial regimens to estimate the likelihood of achieving free drug concentrations above the minimum inhibitory concentration (MIC; fT > MIC) for the requisite periods to clear distinct target organisms. Microbiological data were obtained from blood culture isolates harvested in our hospital from 2008 to 2010.RESULTS: In total, 614 bacterial isolates, including Escherichia coli, Enterobacterspp., Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa, were analyzed Piperacillin/tazobactam failed to achieve a cumulative fraction of response (CFR) > 90% for any of the isolates. While standard dosing (short infusion) of β-lactams achieved target attainment for BSIs caused by E. coliand Enterobacterspp., pharmacodynamic target attainment against K. pneumoniaeisolates was only achieved with ceftazidime and meropenem (prolonged infusion). Lastly, only prolonged infusion of high-dose meropenem approached an ideal CFR against P. aeruginosa; however, no antimicrobial regimen achieved an ideal CFR against A. baumannii.CONCLUSIONS:These data reinforce the use of prolonged infusions of high-dose β-lactam antimicrobials as a reasonable strategy for the treatment of BSIs caused by multidrug resistant Gram-negative bacteria in Brazil.

Biographical narratives in teaching: a study of rofessors on postgraduate courses

Literature and research have shown that professional development constitutes an essential dimension in constructing both work and professional identity. An important aspect in such development is training. In the field of adult education, different authors (Pratt, 1993; Mezirow, 1985; Schön, 1996; Silva, 2007) emphasize the importance of placing trainees at the center of the learning and cognitive processes and within their corresponding social and historical contexts. Training is supported by a comprehensive adult learning theory. Therefore, the acquired knowledge is not only the result of an external and objective reality but also of a complex construction in which the appropriation of experience plays a relevant role. This paper reveals the findings obtained through biographical narratives in a five-year work program with teachers at different levels (from pre-school to higher education) on postgraduate courses. The core issue is the importance of biographical narratives, as an identification strategy for personal experience, knowledge construction and professional identity. This strategy provided the opportunity for recognition of practical experience, as a provider of learning, as well as his/her own authorship, which are important conditions in the understanding of professional identity.

20 Year Strategy for the Irish Language 2010 to 2030 Progress Report: July 2013 - Sept 2014

DES has commenced a review of education in the Gaeltacht with a view to identifying options for educational provision in primary and post-primary schools in Gaeltacht areas of varying linguistic profiles as well as clarifying the Department’s policy with regard to teaching through Irish in such schools. The review will also look at the impact of pre-school provision on primary education in Gaeltacht areas. Furthermore, the review will identify support measures for teachers’ practice that would be required to improve teaching through Irish in Gaeltacht schools. This review will complement the implementation of the Gaeltacht Act 2012.

Ireland's International Education Strategy 2010 - 2015: Investing in Global Relationships

Ireland, as a small, open European economy, relies fundamentally on international engagement. An internationalised education system in Ireland has a crucial role to play in maintaining Ireland’s international profile and attractiveness by educating the next generation of leaders, entrepreneurs and decision-makers in our partner-countries, by giving our own students the intercultural expertise demanded in the global economy, and by enhancing the direct link with Ireland for members of our global diaspora who choose to come home to study. The High-Level Group on International Education takes the view that, from a national perspective, the most compelling rationale for internationalisation is investment in future global relationships: with students educated in Ireland who will become our advocates overseas, with educational institutions that will be the research and teaching partners of the future, and with the countries that will be Ireland’s next trading and business partners

Ireland's International Education Strategy 2010 - 2015: Investing in Global Relationships Summary Report

Ireland, as a small, open European economy, relies fundamentally on international engagement. An internationalised education system in Ireland has a crucial role to play in maintaining Ireland’s international profile and attractiveness by educating the next generation of leaders, entrepreneurs and decision-makers in our partner-countries, by giving our own students the intercultural expertise demanded in the global economy, and by enhancing the direct link with Ireland for members of our global diaspora who choose to come home to study. The High-Level Group on International Education takes the view that, from a national perspective, the most compelling rationale for internationalisation is investment in future global relationships: with students educated in Ireland who will become our advocates overseas, with educational institutions that will be the research and teaching partners of the future, and with the countries that will be Ireland’s next trading and business partners. Internationalisation also provides a means of enhancing the quality of learning, teaching and research in Ireland and makes a significant contribution to our broader ambition as a global innovation hub.

Family Health Strategy professionals' view on the effects of Hansen's disease training

OBJECTIVEEvaluating how professionals of family health teams from three municipalities of Pernambuco perceive and interpret the effects of Hansen's disease training.METHODSA qualitative study using the perspective of Habermas. Six focus groups, totaling 33 nurses and 22 doctors were formed. The guide consisted of: reactions to training, learning, transfer of knowledge and organizational results.RESULTSThere were recurrent positive opinions on instructor performance, course materials, and an alert attitude to the occurrence of cases; the negative points were about lack of practical teaching, a lot of information in a short period of time and little emphasis on basic content. Low perceived self-efficacy and low locus of control, ambiguity, conflict of skills and the lack of support for the learning application. Nurses showed greater dissatisfaction with the organizational support.CONCLUSIONThe low effectiveness of training reveals the need to negotiate structured training from work problematization, considering performance conditions.

In vivo assessment of use-dependent brain plasticity--beyond the "one trick pony" imaging strategy.

This article has been written as a comment to Dr Thomas and Dr Baker's article "Teaching an adult brain new tricks: A critical review of evidence for training-dependent structural plasticity in humans". We deliberately expand on the key question about the biological substrates underlying use-dependent brain plasticity rather than reiterating the authors' main points of criticism already addressed in more general way by previous publications in the field. The focus here is on the following main issues: i) controversial brain plasticity findings in voxel-based morphometry studies are partially due to the strong dependency of the widely used T1-weighted imaging protocol on varying magnetic resonance contrast contributions; ii) novel concepts in statistical analysis allow one to directly infer topological specificity of structural brain changes associated with plasticity. We conclude that iii) voxel-based quantification of relaxometry derived parameter maps could provide a new perspective on use-dependent plasticity by characterisation of brain tissue property changes beyond the estimation of volume and cortical thickness changes. In the relevant sections we respond to the concerns raised by Dr Thomas and Dr Baker from the perspective of the proposed data acquisition and analysis strategy.

Case-based learning in VTLE: An effective strategy for improving learning design

This article presents preliminary research from an instructional design perspective on the design of the case method as an integral part of pedagogy and technology. Key features and benefitsusing this teaching and learning strategy in a Virtual Teaching and Learning Environment(VTLE) are identified, taking into account the requirements of the European Higher Education Area (EHEA) for a competence-based curricula design. The implications of these findings for alearning object approach exploring the possibilities of learning personalization, reusability and interoperability trough IMS LD, are also analyzed.

Teaching, sustainability and environment in UPC buildings

Universities must motivate future professionals so that they are able to apply their experience over and beyond the scientific and technological context. These professionals should also be trained so that they are aware of the current position as regards the economy and limited energy resources, and they must be creative, knowledgeable and committed if they are to rethink the current model.The Departments of Architectural Technology II and Applied Physics, in collaboration with the Interdisciplinary Centre of Technology, Innovation and Education for Sustainability (CITIES), believed that students could be given the opportunity to specialise in the area of sustainable development by means of their final theses [2]. With this objective in mind, a line of theses called Energy Assessments was created as part of the Plan for Resource Consumption Efficiency (PECR). The line was based on a learning strategy that focused on the student.The teaching staff was able to observe that, in terms of cognitive aspects, the students improved their knowledge of environmental issues and the associated skills, and that they were more able to solve problems in the area of sustainability and had greater concerns about this subject matter after having completed their theses.

Undergraduate palliative care teaching in Swiss medical faculties: a nationwide survey and improved learning objectives.

BACKGROUND: In 2007, a first survey on undergraduate palliative care teaching in Switzerland has revealed major heterogeneity of palliative care content, allocation of hours and distribution throughout the 6 year curriculum in Swiss medical faculties. This second survey in 2012/13 has been initiated as part of the current Swiss national strategy in palliative care (2010 - 2015) to serve as a longitudinal monitoring instrument and as a basis for redefinition of palliative care learning objectives and curriculum planning in our country. METHODS: As in 2007, a questionnaire was sent to the deans of all five medical faculties in Switzerland in 2012. It consisted of eight sections: basic background information, current content and hours in dedicated palliative care blocks, current palliative care content in other courses, topics related to palliative care presented in other courses, recent attempts at improving palliative care content, palliative care content in examinations, challenges, and overall summary. Content analysis was performed and the results matched with recommendations from the EAPC for undergraduate training in palliative medicine as well as with recommendations from overseas countries. RESULTS: There is a considerable increase in palliative care content, academic teaching staff and hours in all medical faculties compared to 2007. No Swiss medical faculty reaches the range of 40 h dedicated specifically to palliative care as recommended by the EAPC. Topics, teaching methods, distribution throughout different years and compulsory attendance still differ widely. Based on these results, the official Swiss Catalogue of Learning Objectives (SCLO) was complemented with 12 new learning objectives for palliative and end of life care (2013), and a national basic script for palliative care was published (2015). CONCLUSION: Performing periodic surveys of palliative care teaching at national medical faculties has proven to be a useful tool to adapt the national teaching framework and to improve the recognition of palliative medicine as an integral part of medical training.

A classroom-based investigation of reciprocal teaching at the grade seven level

This study assessed the effectiveness of a reciprocal teaching program as a method of teaching reading comprehension, using narrative text material in a t.ypical grade seven classroom. In order to determine the effectiveness of the reciprocal teaching program, this method was compared to two other reading instruction approaches that, unlike rcciprocal teaching, did not include social interaction components. Two intact grade scven classes, and a grade seven teacher, participated in this study. Students were appropriately assigned to three treatment groups by reading achievement level as determined from a norm-referenced test. Training proceeded for a five week intervention period during regularly scheduled English periods. Throughout the program curriculum-based tests were administered. These tests were designed to assess comprehension in two distinct ways; namely, character analysis components as they relate to narrative text, and strategy use components as they contribute to student understanding of narrative and expository text. Pre, post, and maintenance tests were administered to measure overall training effects. Moreover, during intervention, training probes were administered in the last period of each week to evaluate treatment group performance. AU curriculum-based tests were coded and comparisons of pre, post, maintenance tests and training probes were presented in graph form. Results showed that the reciprocal group achieved some improvement in reading comprehension scores in the strategy use component of the tests. No improvements were observed for the character analysis components of the curriculum-based tests and the norm-referenced tests. At pre and post intervention, interviews requiring students to respond to questions that addressed metacomprehension awareness of study strategies were administered. The intelviews were coded and comparisons were made between the two intelVicws. No significant improvements were observed regarding student awareness of ten identified study strategies . This study indicated that reciprocal teaching is a viable approach that can be utilized to help students acquire more effective comprehension strategies. However, the maximum utility of the technique when administered to a population of grade seven students performing at average to above average levels of reading achievement has yet to be determined. In order to explore this issue, the refinement of training materials and curriculum-based measurements need to be explored. As well, this study revealed that reciprocal teaching placed heavier demands on the classroom teacher when compared to other reading instruction methods. This may suggest that innovative and intensive teacher training techniques are required before it is feasible to use this method in the classroom.

Explicit versus implicit spelling strategy instruction and its effects on grade one children's invented spellings

The intent of this study was to investigate .the effectiveness of teaching thirty-five Grade One children a variety of effective spelling strategies in comparison to tradit~onal spelling instruction. Strategy instruction included training in phonology, imagery and analogy. In addition, the type of instruction pro~ided (implicit versus explicit) was also examined. Children were seen in small groups of four or five, for four, twenty-five minute sessions. All children were tested prior and immediately following the training sessions, as well as at 14-day follow-ups. Pretest and posttest measures included a dictated spelling test (based on words used in training), a developmental spelling test and a sample of each child's writing. In addition, children completed a metacognitive spelling test as a measure of their strategy awareness. Performance scores on the pretest and posttest measures were compared to determine if any differences existed between the three spelling instruction groups using the Dunn-Bonferroni and Dunnett procedures. Findings revealed that explicit strategy instruction was the most effective spelling program for improving Grade One children's invented spellings. Children who received this instruction were able to spell targeted words more accurately, even after a 14-day follow-up, and were able to recall more effective spelling strategies than children who received either implicit strategy instruction or traditional strategy instruction.

Improving grade eight students' spelling performance with a triad strategy approach

Thesis (M.Ed.)-- Brock University, 1996.

Spelling performance of third grade students : a comparison of whole-language-plus-strategy instruction, strategy instruction only, and the whole language approach

This study investigated three methods for teaching children how to spell. Third grade students were divided into three conditions for a one-week training period consisting of 15- to 20-minute lessons. One of the two experimental conditions used a whole language approach along with explicit strategy instruction. The second condition used strategy instruction within a traditional setting. The control used strictly a whole language approach to le~ing hO\\l to spell. The spelling perfonnance of all three conditions improved after the one-week training period. However, students in the strategy instruction groups did significantly better on the study "'7ords than the whole language only group. The students in whole-Ianguage-plusstrateg)! instruction outperformed both other groups. Significantly better spelling perfonnance was observed even at the nine-week posttest. This study frrst supported the hypothesis that children can make significantly greater improven1ents in their spelling when explicitly taught how to use spelling strategies. Secondl)', this study indicated that whole language provided a relevant context for the study words, clearly giving the students in the whole-Ianguage-plus-strategy condition an additional advantage.