Surgical Site Infection in a University Hospital in Northeast Brazil

We examined prevention of surgical site infection (SSI) in a tertiary teaching hospital in northeast Brazil, from January 1994 to December 2003. The survey included 5,742 patients subjected to thoracic, urologic, vascular and general surgery. The criteria for diagnosing SSI were those of the Centers for Disease Control, USA, and the variables of the National Nosocomial Infection Surveillance risk index were used. Data analysis revealed that anesthetic risk scores, wound class and duration of surgery were significantly associated with SSI. A total of 296 SSIs were detected among the 5,742 patients (5.1%). The overall incidence of SSI was 8.8% in 1994; it decreased to 3.3% in 2003. In conclusion, the use of educational strategies, based on guidelines for SSI prevention reduced SSI incidence. Appropriate management of preoperative, intraoperative, and postoperative incision care, and a surveillance system based on international criteria, were useful in reducing SSI rates in our hospital

Pain assessment in surgical patients with impaired cognition

Pain is considered the 5th vital sign and its measurement/assessment and records are required and must be systematic. Ineffective pain management involves complications in clinical status of patients, longer hospitalization times and higher costs with health. In the surgical patient with impaired cognition, hetero measurements should be made, based on behavioural and physiological indicators. We used to determine the efficacy and efficiency of the Observer Scale, the Abbey Pain Scale and Pain Assessment in Advanced Dementia (PAINAD). Our study is an applied, non-experimental, quantitative, descriptive and analytical research. The data collection instrument consisted of patients’ sociodemographic and clinical data, the Observer Scale, the Abbey Pain Scale (Rodrigues, 2013) and PAINAD (Batalha et al., 2012). We assessed pain at an early phase and 45 minutes after an intervention for its relief. The sample is non-probabilistic for convenience, consisting of 76 surgical patients with impaired cognition, admitted to the surgery services of a central hospital, aged between 38 and 96 years. There was a positive correlation between the results of the three scales, most evident in the initial evaluation. Pain intensity in the same patient is higher when assessed with PAINAD (OM = 2.16) and lower when assessed with the Observer Scale (OM = 1.78). The most effective and efficient scale is PAINAD. Due to the small sample size, we suggest confirmatory studies so that the results can be generalized.

„Die Musikschule im Klassenzimmer“. Streicherklassen aus der Perspektive von Prozess-Produkt-Didaktik

Instrumental or vocal teaching in music schools and general music education in compulsory schools represents primary elements of German music education. Both directions are combined on a professional basis by string, wind, singing or band classes. Music pedagogical theories describing instrumental teaching and school music, respectively, have evolved differently in the past - a fact that is scarcely addressed in the literature. In this article both problem-centered interview and video-assisted thought- reconstruction techniques are employed to use differences in the corresponding theories for building empirically grounded explanations of string classes. Major findings indicate that the instrumental teacher's background in traditional teaching structures strongly influences the realization of certain characteristics of aesthetic practice. (DIPF/Orig.)

Feasibility study to inform the design of a UK multi-centre randomised controlled trial of prophylactic antibiotics for the prevention of recurrent cellulitis of the leg

Background: This paper describes the results of a feasibility study for a randomised controlled trial (RCT). Methods: Twenty-nine members of the UK Dermatology Clinical Trials Network (UK DCTN) expressed an interest in recruiting for this study. Of these, 17 obtained full ethics and Research & Development (R&D) approval, and 15 successfully recruited patients into the study. A total of 70 participants with a diagnosis of cellulitis of the leg were enrolled over a 5-month period. These participants were largely recruited from medical admissions wards, although some were identified from dermatology, orthopaedic, geriatric and general surgery wards. Data were collected on patient demographics, clinical features and willingness to take part in a future RCT. Results: Despite being a relatively common condition, cellulitis patients were difficult to locate through our network of UK DCTN clinicians. This was largely because patients were rarely seen by dermatologists, and admissions were not co-ordinated centrally. In addition, the impact of the proposed exclusion criteria was high; only 26 (37%) of those enrolled in the study fulfilled all of the inclusion criteria for the subsequent RCT, and were willing to be randomised to treatment. Of the 70 participants identified during the study as having cellulitis of the leg (as confirmed by a dermatologist), only 59 (84%) had all 3 of the defining features of: i) erythema, ii) oedema, and iii) warmth with acute pain/tenderness upon examination. Twenty-two (32%) patients experienced a previous episode of cellulitis within the last 3 years. The median time to recurrence (estimated as the time since the most recent previous attack) was 205 days (95% CI 102 to 308). Service users were generally supportive of the trial, although several expressed concerns about taking antibiotics for lengthy periods, and felt that multiple morbidity/old age would limit entry into a 3-year study. Conclusion: This pilot study has been crucial in highlighting some key issues for the conduct of a future RCT. As a result of these findings, changes have been made to i) the planned recruitment strategy, ii) the proposed inclusion criteria and ii) the definition of cellulitis for use in the future trial.

Terminal interruption of relux source technique in the treatment of active venous ulcers

Introduction: The treatment for venous ulcers in most cases is unsatisfactory, with recurrences and poor healing. Objective: to evaluate adjuvant therapy in the treatment of active venous ulcers. Methods: We analyzed 20 patients with active venous ulcers attending the general Surgery outpatient clinic at the “Dr. José eleuterio gonzález” University Hospital from October 2012 to January 2013. they were randomly divided into 2 groups: group A (11 patients) underwent compression therapy and group B (9 patients) underwent compression therapy plus removal of the vein that gives terminal relux to the ulcer, guided by ultrasound (microphlebectomy). Patients were evaluated weekly (8 weeks). At each assessment, photographs and lesion measurements were taken and pain was evaluated using the visual analog scale. Results: No significant differences were found between the study groups in terms of age, weight, height, body mass index (BMi), ankle-brachial index, and baseline measurement of the ulcer (p>0.05). Group B showed a greater reduction in ulcer size and a statistically signiicant lower score on the visual analog pain scale (p<0.05) from the second and third week of treatment, respectively. Conclusions: the results obtained in patients with surgical procedure (group B) are consistent with the reported eficacy of chronic venous ulcer treatment with saphenectomy (conventional surgery), the difference is that in this study we used a minimally invasive procedure (microphlebectomy).

As orientações educacionais dos professores, o currículo e a promoção de estilos de vida ativos em educação física

O objetivo do estudo foi analisar e interpretar o currículo que é proporcionado nas escolas secundárias da Região de Lisboa e de como o currículo operacional está relacionado com as orientações educacionais (OE) dos professores. Assim, por um lado quisemos saber como as OE se relacionam com os diferentes níveis de currículo e por outro como é que a finalidade curricular de promover estilos de vida ativos nos alunos é percecionada pelos professores. Este objetivo geral deu origem a cinco objetivos específicos de pesquisa que foram estudados em diferentes etapas da investigação numa abordagem quantitativa/qualitativa com a utilização de diferentes técnicas estatísticas. Na etapa extensiva estudou-se as OE de 352 professores de EF de 79 escolas com o ensino secundário geral através do VOI-SF (value orientation inventory – short form) validado através de uma técnica transcultural permitindo encontrar valores de referência das OE para Portugal. Os professores revelaram alta prioridade em Integração ecológica e Auto-realização e baixa prioridade nas restantes OE. O currículo operacional de EF revelou-se essencialmente desportivo e existiram diferenças estatisticamente significativas em relação às variáveis independentes estudadas (idade e experiência profissional). Através de regressões lineares múltiplas comprovou-se que existe uma relação entre as OE e a oferta curricular. Na etapa intensiva estudou-se 14 professores com perfis representativos das suas OE, examinando-se dez dimensões de análise representativas da interpretação e operacionalização do CNEF (análise de conteúdo). Constata-se que as OE influenciam a leitura, interpretação e operacionalização do currículo (e.g., a coeducação no ensino da EF). Dos 14 professores investigados foram selecionados dois professores com perfis de OE opostos para percebermos o comportamento das OE em contexto de sala de aula. Depois das entrevistas, observação e análise do planeamento constatou-se que os dois professores operacionalizam o conhecimento e o ensino/aprendizagem de forma diferenciada e de acordo com as suas OE.

Estudio comparativo entre las metodologías de enseñanza–aprendizaje tradicional y el modelo constructivista fundamentado en el aprendizaje basado en problemas en las clases de educación física

El presente trabajo tiene por objetivo realizar un estudio comparativo entre las metodologías de enseñanza-aprendizaje tradicional y el modelo constructivista fundamentado en el Aprendizaje Basado en Problemas (ABP) en las clases de Educación Física, con los alumnos de los décimos años de Educación General Básica de la Escuela José Rafael Arízaga de la ciudad de Cuenca. El estudio se realizó con la finalidad de constatar la problemática, inicialmente se aplicaron fichas de observación a los docentes de Educación Física de la institución. Posteriormente, para el análisis comparativo se escogieron dos grupos. El décimo año de EGB paralelo A (grupo 1 denominado grupo control) y el décimo B (grupo 2 experimental). El primer grupo trabajó con el docente de la institución desarrollando los temas de los bloques curriculares: Movimientos Naturales, Juegos y Movimiento Formativo, Artístico y Expresivo, el segundo desarrolló los mismos temas pero el proceso de enseñanza aprendizaje se fundamentó en el ABP. Los resultados de la aplicación de las dos metodologías se evidenciaron en las evaluaciones a los estudiantes (Destrezas con criterio de desempeño). El análisis de los resultados obtenidos durante todo el proceso de evaluación, permitió comparar las metodologías evidenciando de ésta manera las ventajas y desventajas de su aplicación en las clases de Educación Física.

Análisis de la respuesta educativa desde la escuela a los menores en acogimiento residencial: un estudio de caso en la Comunidad de Madrid

The reality of children living in foster homes is clearly linked to the professionals that surround them both in the educational and residentialsphere. These are children who in all aspects of their livesat all hours, are exposed to the professionalism of those who work with them and not the affection of a family; their development is fully mediated by institutions. It is therefore a priority that teachers have specific training on children living infoster care, that general government (Education and Social Services) provide guidelines for action agreed to allow the coordination between the different professionals involved with children in foster care, considering the complexity of this coordination, as there are many institutions involved with these children: Social Services, schools, foster residences foster ... among others. Educational professionals have an important role in this intervention process, being their good professional work the one that favors a tight development of children in the educational field, but this intervention takes place generally from the ignorance of the specific situation faced by children living inresidential care and from the failure of the educational administration into sharing protocols, time and space, necessary for a proper coordination. In the event children incustody, and because of the uniqueness of their situation and the importance of a good intervention, there should be no space for improvisation.In addition intervention with children in residential care has to be based on a training and intervention from the complementary roles that is to be structured, systematic and evaluated in a continuously way by the professionals involved.We understand that the principle of equality in education requires to offer these minors an opportunity based on an appropriate intervention with formed professionals, knowledgeable and with the time and the necessary conditions...

MAPAS COGNITIVOS APRENDIZAJES DESDE LA VIVENCIA ESPACIAL

El artículo integra los marcos teóricos de la Geografía de la Percepción y el aprendizaje significativo mediante una secuencia didáctica para la enseñanza de la cartografía en el curso Didáctica de los Estudios Sociales para educación Básica, de la carrera Diplomado en pedagogía con acento en I y II ciclos de la Educación general Básica, Universidad Nacional.  El objetivo general se centró en analizar la utilidad del mapa cognitivo en la enseñanza de la cartografía, para contrastar con otos métodos tradicionales.  Los resultados revelan que las configuraciones espaciales representadas en los mapas cognitivos se asemejan muy poco a las representaciones cartográficas convencionales, no obstante la metodología implementada produce aprendizaje significativoPalabras claves: Geografía de la Percepción-Aprendizaje significativo-Secuencia didáctica-Mapa cognitivo-Enseñanza de la cartografía.Abstract:The article comprises the theoretical frameworks of the Geography of Perception and significant learning by means of a didactic sequence for the teaching of cartography in the Didactic course of Social Studies for Basic education, the Diploma course of study in pedagogy with emphasis on cycles I and II of general Basic Education,  Universidad Nacional.  The general objective is focused on analyzing the usefulness of the cognitive map in the teaching of cartography in order to contrast it other traditional methods. The results reveal that the spatial configurations represented in the cognitive maps bear little resemblance to the conventional cartographic representations. Nevertheless, the methodology implemented produces significant learning.Key Words: Geography of Perception, significant learning, didactic sequence, cognitive map, cartography education, cartography.

A virtual surgery in general practice: evaluation of a novel undergraduate virtual patient learning package

Background: A suite of 10 online virtual patients developed using the IVIMEDS ‘Riverside’ authoring tool has been introduced into our undergraduate general practice clerkship. These cases provide a multimedia-rich experience to students. Their interactive nature promotes the development of clinical reasoning skills such as discriminating key clinical features, integrating information from a variety of sources and forming diagnoses and management plans.

Aims: To evaluate the usefulness and usability of a set of online virtual patients in an undergraduate general practice clerkship.
Method: Online questionnaire completed by students after their general practice placement incorporating the System Usability Scale questionnaire.

Results: There was a 57% response rate. Ninety-five per cent of students agreed that the online package was a useful learning tool and ranked virtual patients third out of six learning modalities. Questions and answers and the use of images and videos were all rated highly by students as useful learning methods. The package was perceived to have a high level of usability among respondents.

Conclusion: Feedback from students suggest that this implementation of virtual patients, set in primary care, is user friendly and rated as a valuable adjunct to their learning. The cost of production of such learning resources demands close attention to design.

Older patients request more information : a survey of use of written patient education materials in general practice

Objectives: To determine GPs' reported use of written education materials with older patients and older patients' reported receipt of these materials. To determine GPs' and older patients' perceptions of written materials.---------- Method: Using self-report questionnaires, two populations were surveyed; a randomised sample of 50 GPs (29 males and 21 females) practising in Brisbane's southern suburbs and a convenience sample of 188 older community-dwelling people (aged over 64 years).----------- Results: All GPs reported using written materials with patients, although 28% had not given any to the Last 10 patients. This increased to 46% when patients were older. Twenty percent of patients wanted more written information from their GP, while some GPs believed that older patients preferred verbal information and gave out written information only when they perceived patient interest. All GPs reported giving written materials at the time of consultation and over two thirds discussed the content with patients. Just over 50% of patients reported receiving written information from GPs in the Last six months and only hall of these again discussed it directly with their GP. Overall, patients were more positive than GPs about the value of written education materials.---------- Conclusions: Older patients' desire for written information may be better met if they are more assertive in requesting this of GPs and GPs may better serve their patients' needs if they make written information more readily available to them. Better access to materials and more financial incentives to give them out might also increase GPs' use of written materials.

Bringing skills and general competences back into technological education

In this paper we show that industry-based student training is not limited to work experience; work integrated learning, internship or extended vacation work. It is also about bringing back the lost parts of technological education. We experience the unilateral focus on theoretical knowledge at the expense of skills and general competences as one important challenge in technological education. The lacking facilitation and training of practical skills and general competences in the curricula and programs are identified, but many institutions have failed to address the problem. Today’s curricula in many ways reduce technology to abstract concepts, calculations and models, and create a gap between the academic programs and the practical applications in the society. We explore two (Australia and Norway) initiatives on industry-based student training and discuss how these initiatives address and bridge the gap. We argue that these initiatives of industry-based student training contribute to bringing skills and general competences back into technological education, and that the effects are not limited to increased employability, but also include increased academic performance.

The Australian litigation landscape - Oral and Maxillofacial Surgery and general dentistry (oral surgery procedures): An analysis of litigation cases

Background: There are persistent concerns about litigation in the dental and medical professions. These concerns arise in a setting where general dentists are more frequently undertaking a wider range of oral surgery procedures, potentially increasing legal risk. Methods: Judicial cases dealing with medical negligence in the fields of general dentistry (oral surgery procedure) and Oral and Maxillofacial Surgery were located using the three main legal databases. Relevant cases were analysed to determine the procedures involved, the patients’ claims of injury, findings of negligence, and damages awarded. A thematic analysis of the cases was undertaken to determine trends. Results: Fifteen cases over a twenty-year period were located across almost all Australian jurisdictions (eight cases involved general dentists; seven cases involved Oral and Maxillofacial Surgeons). Eleven of the fifteen cases involved determinations of whether or not the practitioner had failed in their duty of care; negligence was found in six cases. Eleven of the fifteen cases related to molar extractions (eight specifically to third molar). Conclusions: Dental and medical practitioners wanting to manage legal risk should have regard to circumstances arising in judicial cases. Adequate warning of risks is critical, as is offering referral in appropriate cases. Pre-operative radiographs, good medical records, and processes to ensure appropriate follow-up are also important.

General practitioners learning qualitative research: A case study of postgraduate education

Background Qualitative research is increasingly being recognised as a vital aspect of primary healthcare research. Teaching and learning how to conduct qualitative research is especially important for general practitioners and other clinicians in the professional educational setting. This article examines a case study of postgraduate professional education in qualitative research for clinicians, for the purpose of enabling a robust discussion around teaching and learning in medicine and the health sciences. Method A series of three workshops was delivered for primary healthcare academics. The workshops were evaluated using a quantitative survey and qualitative free-text responses to enable descriptive analyses. Results Participants found qualitative philosophy and theory the most difficult areas to engage with, and learning qualitative coding and analysis was considered the easiest to learn. Discussion Key elements for successful teaching were identified, including the use of adult learning principles, the value of an experienced facilitator and an awareness of the impact of clinical subcultures on learning.