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Studies comparing large-scale assessment data among educational systems have been an important tool for understanding the differences in how education is delivered worldwide. Many of these studies do not go beyond reporting average student scores in a particular educational system. A more unbiased analysis would avoid the simple use of gross performance and consider educational system contexts. A common approach is to estimate effectiveness by the residuals of parametric linear models. These models rely upon strong assumptions regarding the data-generating process, and are limited to handling extensive datasets. To address this issue, our paper provides a new approach based on machine learning models. The new approach is flexible, allows paired comparison, and is model-independent. An analysis conducted in Brazil verifies the suitability of the method to explore differences in effectiveness between Brazilian educational administrative units at the regional and state levels from 2009 to 2019. Our results are consistent with the existing literature, but the methodology produced a number of new findings that were not observed in studies using more traditional approaches., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Cardoso Silva Filho et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Copyright of Brazilian Journal of Occupational Therapy / Cadernos Brasileiros de Terapia Ocupacional is the property of Cadernos de Terapia Ocupacional da UFSCar and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aims: This study aimed to investigate the influence of barriers to the use of research results in the practice of nurses on patient safety perception. Background: The use of research results in clinical practice promotes safe care, increases quality and reduces the possibility of adverse events. Design This is a cross‐sectional study. Methods: The sample consisted of 207 nurses from three public university hospitals in the state of Minas Gerais, Brazil from March 2017 to November 2018. They answered a questionnaire with professional characteristics, The Barriers Scale and Safety Attitudes Questionnaire. Descriptive analysis, Student's t test, Pearson correlation and multiple linear regression were used for data analysis. Results: The findings showed most nurses had unfavourable competencies for implementing research results in practice. As barrier scores for the use of research results in practice increase, safety climate scores decrease. Taking a training course on the use of research results in clinical practice and organization characteristics, limitations of the setting were statistically significant, constituting factors that influence the perception of the safety climate. Conclusion: Investments in education are needed for health professionals to be aware of evidence‐based practice and how to use evidence to impact decision‐making outcomes, strengthening safety outcomes in health services. Summary statement: What is already known about this topic? The use of research results in clinical practice promotes safe care, increases quality and reduces the possibility of adverse events.In the health literature, there is little evidence on the factors related to the use of research results in the clinical practice of nurses and the patient safety climate.The non‐use of research results in clinical practice is a relevant problem for patient safety. What is already known about this topic? The results of the study showed that nurses do not have favourable competencies in the use of research results in clinical practice.The most significant barrier to the use of research results in clinical practice was related to the characteristics of the organization, and the negative perception of the safety climate was related to working conditions, indicating a negative view of the work environment.The results of the research indicated that the more barriers were reported by nurses to the use of research results in clinical practice, the worse the perception of patient safety.The provision of training courses for nurses on the use of research results and the characteristics of the organization were factors that influenced the perception of patient safety. The implications of this paper: The results of the study highlighted the need to strengthen the partnership between universities and health services. Nurses trained to use research results in clinical practice promote safe and quality care.The use of research results in clinical practice can benefit the safety and quality of care around the world. Additional studies are needed to understand other factors related to the use of research that influences patient safety outcomes. [ABSTRACT FROM AUTHOR]

Health care challenges in remote rural municipalities (RRMs) emphasize the importance of primary health care (PHC) and require an expanded scope of practice. Doctors are key actors in this context. The aim of this study was to explore the level of integration of doctors in RRMs and working practices. We conducted a qualitative study involving semi-structured interviews with 46 PHC doctors working in 27 RRMs in Brazil. Content analysis was performed, resulting in the identification of categories of analysis grouped under three core dimensions: doctor training and experience; comprehensive care and timely access; and the community-based approach. Doctors working in RRMs were mainly recent graduates with limited experience who had undertaken their degree outside Brazil, and care was focused on the individual. The findings also revealed weak sociocultural adaptation and a harsh working environment and issues related to social status that reinforced prejudice against rurality and poverty. Practice was limited in scope and care tended to be oriented towards acute problems, disease-centered and focused on the biomedical model of medicine. Barriers to the delivery of comprehensive care include both structural constraints, such as poor facilities and centralization of services in administrative centers, and the lack of professional competencies necessary for PHC in these areas. The findings point to the need to promote an expanded scope of practice in PHC delivery in RRMs, with major public investment in the promotion of training and strengthening career pathways in these areas. [ABSTRACT FROM AUTHOR]

Objective: this paper aims to describe the first phase of a project whose general goal was to develop a consensus-based set of advanced practice nurse competencies applicable to Latin American countries and, based on these competencies, produce an advanced practice nurse curricular prototype adapted to Latin American countries. The project was framed in a competency-based approach to advanced practice nursing education. The specific aims of the first phase of the project described in this paper were: 1) to identify a set of potential advanced practice nurse competencies that would serve as the template for Core Advanced Practice Nurse Competencies in Latin American countries and 2) to establish consensus for Core Advanced Practice Nurse Competencies in Latin American countries. Method: advanced practice nurse competencies were derived from a comprehensive review of published competencies and informed the development of a survey designed to assess the relevance of advanced practice nurse competencies in Latin American countries. The survey was distributed to nurse leaders and nurse educators. Data were analyzed using descriptive statistics. Results: consensus for Core Competencies was established. Conclusion: the Core Advanced Practice Nurse Competencies presented can provide a structured framework to build educational programs aligned to the needs of the regional environment. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper is to present the academic requirements for the education of speech-language pathologists (SLPs) and to discuss some of the challenges in providing quality supervised practice and the solutions proposed by some programs in Brazil. Methods: Brazilian proposals regarding the training of SLPs are reviewed, with guidelines provided by the International Association of Logopedics and Phoniatrics (IALP) and the Comité Permanent de Liaison des Orthophonistes-Logopèdes de l'UE (CPLOL), and descriptions of the specific experience of the oldest Brazilian program are provided. Results: The bachelor's degree is the minimum level required for the independent practice of speech-language pathology and audiology in Brazil, where there are 75 undergraduate programs. In several programs, students are encouraged to enjoy the diversity at their university, enrolling in courses of different areas to broaden their experience. The basic areas of the undergraduate program are mandatory as per recommendation of the Ministry of Education and include competences related to the health system, decision making, communication, leadership and continued education. Since practice training is part of the undergraduate programs, it is incorporated into the pedagogical concept and has a major role in it. Conclusion: The structure of the programs allows the dissociation of theory from practice to be attenuated; both educational strategies are used together as part of the pedagogical concept. © 2015 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: This study evaluates the success of graduate students in psychiatry in an emerging country, in terms of the quantity and quality of their publication productivity (given by the number of papers and impact factors of the journals in which they publish). We investigated to what extent student proficiency in English and the scientific capabilities of academic advisors predict that success., Methods: Our sample comprised 43 master's and doctoral students in psychiatry (n = 28 and n = 15, respectively) at the University of São Paulo School of Medicine, in São Paulo, Brazil. We collected information about their knowledge of English and the ways in which they wrote their articles to be submitted to periodicals published in English. Multiple regression analyses were carried out in order to investigate the influence English proficiency, h-index of supervisors and use of language editing assistance had on the number and impact of student publications., Results: Although 60% of students scored ≥80 (out of 100) on English tests given at admission to the graduate program, 93.09% of the sample used some form of external editing assistance to produce their papers in English. The variables "number of publications" and "impact factor of journals" were significantly related to each other (r = 0.550, p < 0.001). Multiple regression analysis revealed that the impact factor of periodicals where students published their articles as first authors correlated significantly not only with student proficiency in English at admission (p = 0.035), but also with the degree of language editing assistance (p = 0.050) and the h-index of the academic advisor (p = 0.050)., Conclusions: Albeit relevant, knowledge of English was not the key factor for the publication success of the graduate students evaluated. Other variables (h-index of the advisor and third-party language editing assistance) appear to be also important predictors of success in publication.

Unlabelled: Physicians from all medical specialties are required to understand the principles of science and to interpret medical literature. Yet, the levels of theoretical and practical knowledge held by Brazilian otorhinolaryngologists has not been evaluated to date., Objective: To assess the background and level of scientific knowledge of Brazilian otorhinolaryngologists., Method: Participants of two national ENT meetings were invited to answer a questionnaire to assess scientific practice and knowledge., Results and Conclusion: This study included 73 medical doctors (52% otorhinolaryngologists and 38% residents) aged between 18 and 65 years. About two-thirds have been involved in some form of scientific activity during undergraduate education and/or reported to have written at least one scientific paper. Physicians who took part in research projects felt better prepared to interpret scientific papers and carry out research projects (p = 0.0103 and p = 0.0240, respectively). Respondents who claimed to have participated in research or to have written papers had higher scores on theoretical scientific concepts (p = 0.0101 and p = 0.0103, respectively). However, the overall rate of right answers on questions regarding scientific knowledge was 46.1%. Therefore, a deficiency was observed in the scientific education of Brazilian otorhinolaryngologists. Such deficiency may be mitigated through participation in research.

The transformations that have revolutionized the labor market in contemporary society make it necessary to think of new alternatives for training health care professionals, thereby establishing a new approach to the health problems of individuals and collectives. Based on these considerations, this paper sets out to discuss training in health--based on the concept of competence--with a focus on education for the Brazilian Unified Health System (SUS), using attempts to analyze and propose an alternative to the system entrenched in the logic of late capitalism as a theoretical benchmark. It is thus a reflection on the subject, correlating theory and praxis, in constant and relentless movement of construction, deconstruction and (re)construction of propositions.

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Context: Reflective practice has been suggested to be an important instrument in improving clinical judgement and developing medical expertise. Empirical evidence supporting this suggestion, however, is absent. This paper reports on an experiment conducted to study the effects of reflective practice on diagnostic accuracy., Methods: Participants were 42 internal medicine residents in hospitals in 2 states in the northeast of Brazil. They diagnosed 16 clinical cases. The experiment employed a repeated measures design, with 2 independent variables: the complexity of clinical cases (simple or complex), and the reasoning approach induced to diagnose the case (participants were instructed to diagnose each case either through pattern recognition or reflective reasoning). The dependent variable was the accuracy of the diagnosis provided for each case. All participants participated in each of the 2 levels of both independent variables., Results: A main effect of case complexity emerged. There was no statistically significant main effect of reflective practice. However, a significant interaction effect was found between case complexity and mode of processing (F[1,41] = 4.48, P < 0.05), indicating that although reflective practice did not make a difference to accuracy of diagnosis in simple cases, it had a positive effect when diagnosing complex cases., Conclusions: Reflective practice had a positive effect on diagnosis of complex, unusual cases. Non-analytical reasoning was shown to be as effective as reflective reasoning for diagnosing routine clinical cases. Findings support the idea that reflective practice may particularly improve diagnoses in situations of uncertainty and uniqueness, reducing diagnostic errors.

Context: Two modes of case processing have been shown to underlie diagnostic judgements: analytical and non-analytical reasoning. An optimal form of clinical reasoning is suggested to combine both modes. Conditions leading doctors to shift from the usual mode of non-analytical reasoning to reflective reasoning have not been identified. This paper reports a study aimed at exploring these conditions by investigating the effects of ambiguity of clinical cases on clinical reasoning., Methods: Participants were 16 internal medicine residents in the Brazilian state of Ceará. They were asked to diagnose 20 clinical cases and recall case information. The independent variable was the degree of ambiguity of clinical cases, with 2 levels: straightforward (i.e. non-ambiguous) and ambiguous. Dependent variables were processing time, diagnostic accuracy and proposition per category recalled. Data were analysed using a repeated measures design., Results: Participants processed straightforward cases faster and more accurately than ambiguous ones. The proportion of text propositions recalled was significantly lower (t[15] = 2.29, P = 0.037) in ambiguous cases, and an interaction effect between case version and proposition category was also found (F[5, 75] = 4.52, P = 0.001, d = 0.232, observed power = 0.962). Furthermore, participants recalled significantly more literal propositions from the ambiguous cases than from the straightforward cases (t[15] = 2.28, P = 0.037)., Conclusions: Ambiguity of clinical cases was shown to lead residents to switch from automatic to reflective reasoning, as indicated by longer processing time, and more literal propositions recalled in ambiguous cases.

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The first experience in hospital training may create tensions and anxieties. These feelings interfere negatively in the teaching-learning process. The aim of this paper was to investigate the expectations of Nursing Fundamentals II students regarding their initial hospital training. Second-year students of the Nursing Course offered by Universidade Estadual de Maringá (state of Paraná, Brazil) were chosen as subjects of this investigation. The students revealed a state of anxiety when confronting technical procedures, relationship with patients and evolution. By reflecting on these aspects instructor the may increase the teaching-learning efficiency and humanize the professional training.

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Copyright of Minas Gerais Medical Journal / Revista Médica de Minas Gerais is the property of Associacao Medica de Minas Gerais and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Analyzing the historical and social path of an occupation using the sociology of professions and the perspective of scientific knowledge promotes an understanding of the origin of physical therapy in Brazil and of discussions of the profession in its contemporary context. Objective: The aim of this paper was to discuss the professionalization process of physical therapy in São Paulo. The authors tried to analyze bath therapy, massage therapy, and physical therapy as occupations involving distinct expertise and as part of the group of occupations that evolved into the profession of physiotherapy in the first half of the twentieth century. Method: The analysis undertaken was a qualitative study based on an analysis of historical documents. Eighty-six professional records from the Service of Inspection of Professional Practice in the state of São Paulo and healthcare legislation from the 1930s and 1940s were analyzed. Results: The distinction between physical therapy practitioner and profession of physiotherapy can be seen by examining registration requirements for rank-and-file nurses with expertise in interactions; this distinction suggests the emergence of specialized expertise that was clearly a part of neither medicine nor nursing and contributed to expertise in physical therapy since the 1950s. Conclusion: The regulation of physiotherapy practices, the recognition of expertise, the accreditation of practical nurses by the State, and the institutionalization of a course for physical therapy practitioners in 1951 are key elements of the professionalization process for the physical therapy profession in Brazil [ABSTRACT FROM AUTHOR]

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This study identifies some undergraduate nursing students' imaginary manifestations concerning themselves and care delivered to patients with orthopedic and/or trauma disorders. The Social Poetics method was used and the research group was composed of 15 undergraduate students. Only the categories and subcategories exclusively related to the "student" are presented in this paper. Data revealed that care provided by orthopedic nursing students is the result of a care relationship that emerges from their sensitivity toward patients and their own knowledge, skills and attitudes. The orthopedic treatment, equipment and procedures, to which patients are submitted, cause important emotional distress for students, empathic behavior and encourage them to search for ways to minimize their patients' pain. All the aspects that permeate care provided by orthopedic nursing students should be identified in order to enable reassessment of the teaching-learning process. [ABSTRACT FROM AUTHOR]

Copyright of Revista Gaucha de Enfermagem is the property of Revista Gaucha de Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Context: Diagnostic competence in students is a major medical education goal. Adding instructional guidelines to prompt deliberate reflection fosters medical students' diagnostic proficiency. This study investigates the effects of this teaching strategy on diagnostic accuracy in solving clinical cases of different complexity levels by novice and senior students. Method: Eighty third‐year and 62 sixth‐year medical students participated in this three‐phase experimental study. First, participants were randomly assigned to one of three experimental conditions (free reflection, cued reflection and worked example) to diagnose 12 clinical text‐based cases, following different levels of deliberate reflection. In an immediate test and a delayed test, the participants diagnosed varied sets of 12 cases, six involving the same diseases (four routine and two rare). The main outcomes were the diagnostic accuracy scores achieved for the cases assessed by repeated measures of analysis of variance for each category. Results: There was a significant primary effect of experimental condition (P <.001), year of training (P <.001) and study phase (P <.001) on the diagnostic accuracy achieved. The use of deliberate reflection in addition to instructional guidelines resulted in improved results in the immediate test for all cases evaluated (P <.001), regardless of participants' seniority. In the delayed test, this benefit was maintained for simple cases (P <.001). For complex cases, the benefit was maintained only for senior students (P <.001). The cued reflection and worked example groups did not differ in performance (P >.05), but both groups surpassed the free reflection group (P <.001), regardless of the students' learning stage and case complexity. The authors demonstrate that guiding deliberate reflection improves diagnostic competence both in the solution of simple cases and in the solution of complex cases by novice and senior students. [ABSTRACT FROM AUTHOR]

Background: Dentists need training in the management of children's anxiety (DA), fear (DF) and behaviour management problems (DBMP) but little is known of their competence on this topic. Aim: To report dentists' opinions and attitudes about protective stabilisation and pharmacological techniques for the management of children with DA/DF/DBMP; to propose a postgraduate curriculum focussing on DA/DF/DBMP. Design: A survey of 301 Brazilian dentists and later a modified Delphi process to outline the curriculum in two phases: (a) face‐to‐face discussions with 33 early career researchers mentored by six researchers, both from UK and Brazil; (b) online discussions by eight early and senior researchers on the knowledge, experience, and competencies necessary for a specialist in paediatric dentistry in Brazil that should be included in the core curriculum of postgraduate courses. Results: Almost all (99.0%) of the survey respondents provide treatment to children with DA/DF/DBMP, and 91.2% do not systematically diagnose these conditions; 94.3% use protective stabilisation, and 20.0%‐30.0% have training in pharmacological techniques. The four‐domain framework supporting the proposed curriculum is as follows: DA/DF/DBMP assessment, non‐pharmacological and pharmacological approaches, and decision‐making. Conclusion: Dental curricula should be customised to solve the misconceptions and promote a comprehensive and positive attitude to DA/DF/DBMP by paediatric oral healthcare practitioners. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to evaluate the dentists' knowledge and practice regarding HIV positive individuals' oral care in Rio de Janeiro State. Methods: Dentists from Rio de Janeiro State (n = 242) answered an electronic questionnaire on biosafety procedures, oral manifestations of AIDS, and knowledge of HIV infection. Collected information was stratified by gender, and data were analyzed using Chi-square and t tests. Results: From the 14 oral manifestations investigated, oral candidiasis, necrotizing ulcerative gingivitis, and hairy leucoplakia were more associated with HIV, with no differences between the responses from men and women. Above 85% of the participants would be concerned about becoming infected with HIV after a needle/ sharp object injury and more than 80% of them were willing to be tested for HIV. However, significantly more women (98.8%), compared to men (91.3%), said they knew that HIV/ AIDS patients can contaminate dental care professionals, p = 0.007. There was a significant difference in the answers for the questions: "Are there special dental clinics for treatment of HIV/AIDS patients in Brazil?" (p = 0.044), and "Do the negative HIV tests surely indicate that the persons are free of viruses?" (p = 0.005). Significant differences between men and women were also observed regarding use of disposable mask (p = 0.01), and cap (p < 0.0001). Conclusion: Most dentists who participated in the study presented a good knowledge on the care of HIV/ AIDS individuals, including biosafety protocols and in terms of the oral manifestations commonly associated to AIDS. [ABSTRACT FROM AUTHOR]

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The religiosity/spirituality (R/S) dimension is recognised as an important component of the concept of health advocated by the World Health Organization; however, it does not appear in the undergraduate Psychology curricula in the Brazilian context, revealing a gap in the way this theme has been covered. In order to identify the professional reality of Brazilian psychotherapists in relation to this theme, this study aimed to identify what constitutes the best professional practices when approaching R/S in psychotherapy. We interviewed 24 psychotherapists of both sexes, with a mean age of 36.43, from two medium‐sized cities of two Brazilian states. According to the interviewees, the best practices considered when addressing R/S, that is, the most appropriate actions/attitudes, are as follows: (a) Respect; (b) Knowing how to separate what is from the psychotherapist and from the patient/client; (c) Recognising the theme as an integrative dimension of the human being; (d) Knowing how to listen; (e) Questioning the role of R/S in the life of the patients/clients; (f) Knowledge about the subject matter; and (g) Not imposing knowledge, practices or doctrine. These practices were revealed as the skills, competencies and knowledge needed to deal with the subject and highlight important references to think about the theme in psychotherapy, guiding the formation of new professionals and updating practising psychotherapists. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the influence of a number of variables regarding clinicians' gender, social class, length of time since graduation and the level of knowledge on their use of available preventive measures against hepatitis B and C.Materials and Methods: A cross-sectional questionnaire-based survey was carried out involving a random and representative sample (n = 319) of the clinicians working in Recife, Pernambuco, North-East Brazil. The participants were interviewed by means of a questionnaire, prepared and pretested by the researchers. Pearson's chi-square and Fisher's exact tests were used in the statistical analyses (significance level: 5%).Results: Female clinicians were found to make more frequent use of equipment such as lab coats, scrub caps and masks (P = 0.0357). With regard to lab coat use in relation to social class, it was seen that clinicians from social class B used it less (P = 0.0077). The length of time since graduation was seen to be connected with the use of scrub caps (P = 0.0003), coating of equipment with polyvinyl chloride plastic film (P = 0.037), use of alcohol for cleaning equipment (P = 0.0012), two-handed recapping of needles (P < 0.0001) and immunisation (P = 0.003), showing that those who graduated most recently were more likely to take adequate infection control steps. The fact that clinicians had been informed about hepatitis B and C, and also their knowledge about its contagion, was positively associated with their levels of vaccination against HBV (P = 0.0313 and 0.0108, respectively).Conclusions: The adherence to preventive practices against hepatitis B and C was shown to be connected with the clinicians' socio-demographic, professional and educational variables. [ABSTRACT FROM AUTHOR]

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Copyright of Investigacion & Educacion en Enfermeria is the property of Universidad de Antioquia, Facultad de Enfermeria and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Better communication among field health care teams and points of care, together with investments focused on improving teamwork, individual management, and clinical skills, are strategies for achieving better outcomes in patient-oriented care. This research aims to implement and evaluate interventions focused on improving communication and knowledge among health teams based on points of care in a regional public health outreach network, assessing the following hypotheses: 1) A better-working communication process between hospitals and primary health care providers can improve the sharing of information on patients as well as patients' outcomes. 2) A skill-upgrading education tool offered to health providers at their work sites can improve patients' care and outcomes.Methods/design: A quasi-experimental study protocol with a mixed-methods approach (quantitative and qualitative) was developed to evaluate communication tools for health care professionals based in primary care units and in a general hospital in the southern region of São Paulo City, Brazil. The usefulness and implementation processes of the integration strategies will be evaluated, considering: 1) An Internet-based communication platform that facilitates continuity and integrality of care to patients, and 2) A tailored updating distance-learning course on ambulatory care sensitive conditions for clinical skills improvements. The observational study will evaluate a non-randomized cohort of adult patients, with historical controls. Hospitalized patients diagnosed with an ambulatory care sensitive condition will be selected and followed for 1 year after hospital discharge. Data will be collected using validated questionnaires and from patients' medical records. Health care professionals will be evaluated related to their use of education and communication tools and their demographic and psychological profiles. The primary outcome measured will be the patients' 30-day hospital readmission rates. A sample size of 560 patients was calculated to fit a valid logistic model. In addition, qualitative approaches will be used to identify subjective perceptions of providers about the implementation process and of patients about health system use.Discussion: This research project will gather relevant information about implementation processes for education and communication tools and their impact on human resources training, rates of readmission, and patient-related outcomes. [ABSTRACT FROM AUTHOR]

The article focuses on a study regarding the technical skills acquisition among General Surgery (GS) of residents in Brazil. It mentions the risk of receiving inadequate training due to low number of operations performed by General Surgery (GS) in Brazil. It also mentions that current formatting of regular GS residency programs in Brazil are insufficient to train experts in general surgery.

Objectives: The aim of the study was to evaluate the association between physicians' understanding of the mechanism of action of the emergency contraceptive pill (ECP), their personal use of it, and their practice in informing their patients about the method and in prescribing it.Methods: The study was carried out in a sample of 3337 obstetrician-gynaecologists who responded to a mailed questionnaire. Bivariate analysis was used to test the association between physicians' personal use of the ECP, their understanding of its mechanism of action, and their practice in informing their patients about the method and in prescribing it. Multiple Poisson regression analysis was carried out to identify variables independently associated with the two dependent variables.Results: Multiple regression analysis showed that the percentage of physicians who had informed their patients about the ECP was significantly lower among those who had needed it themselves but had not used it and among those living in the northeast of Brazil. A significantly higher percentage of female than male physicians had provided information on the ECP. The percentage of physicians who had prescribed the ECP was significantly lower among those who had needed it themselves but had not used it and among those who believed that it caused a mini-abortion. The proportion of physicians who had ever-prescribed the ECP was greater among those who worked exclusively in private practice and among those who worked in a state capital.Conclusions: The misconception that emergency contraception could cause a mini-abortion was associated with its denial to potential users, while physicians' personal experience of needing to use it favoured the likelihood of their informing potential users about it and prescribing it. [ABSTRACT FROM AUTHOR]

Society expects physicians to always improve their competencies and to be up to date with developments in their field. Therefore, an important aim of medical schools is to educate future medical doctors to become self-regulated, lifelong learners. However, it is unclear if medical students become better self-regulated learners during the pre-clinical stage of medical school, and whether students develop self-regulated learning skills differently, dependent on the educational approach of their medical school. In a cross-sectional design, we investigated the development of 384 medical students' self-regulated learning skills with the use of the Self-Regulation of Learning Self-Report Scale. Next, we compared this development in students who enrolled in two distinct medical curricula: a problem-based curriculum and a lectured-based curriculum. Analysis showed that more skills decreased than increased during the pre-clinical stage of medical school, and that the difference between the curricula was mainly caused by a decrease in the skill evaluation in the lecture-based curriculum. These findings seem to suggest that, irrespective of the curriculum, self-regulated learning skills do not develop during medical school. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to evaluate the knowledge of Brazilian dentists (DEN) and dental students (DS) about bisphosphonates (BP) and bisphosphonate-related osteonecrosis of the jaw (BRONJ).Methods: A convenience sample of 104 DEN and 100 DS was randomly selected and invited to answer a questionnaire. The questionnaire was structured on the basis of the main information about BP and the risk factors associated with the development of BRONJ. The data obtained were analyzed by the chi-square and Fisher's exact tests, considering significance of 5%.Results: Seventy-five (72.1%) DEN and 75 (75%) DS did not know the BP cited in the questionnaire (p < 0.0001), and their commercial brand names were not recognized by 88 (84.6%) DEN and 86 (86%) DS (p < 0.0001). In the same way, 62 (59.6%) DEN (p = 0.04) and 58 (58%) DS (p < 0.0001) did not recognize BRONJ as an oral side effect of BP or point out oral conditions that were not associated with the use of BP.Conclusions: Practical initiatives, such as free lectures and workshops, must be taken to broaden the knowledge of DEN and DS about BP and thus contribute to the prevention of BRONJ. [ABSTRACT FROM AUTHOR]

Copyright of Acta Paulista de Enfermagem is the property of Universidade Federal de Sao Paulo, Escola Paulista de Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Paulista de Enfermagem is the property of Universidade Federal de Sao Paulo, Escola Paulista de Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Paulista de Enfermagem is the property of Universidade Federal de Sao Paulo, Escola Paulista de Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aims and objectives To identify the attributes of the concept 'clinical role of the nurse' in the literature. Background The concept of nurses' clinical role is frequently mentioned in literature, but hardly explored in conceptual terms. This has implications for nursing practice and education. Design Qualitative and descriptive study, which corresponds to the first phase in the concept development of the qualitative concept analysis method - identification of concept attributes. Methods The critical literature analysis method was used to identify the antecedents, defining attributes and consequences of the nurse's clinical role. A systematic literature search was undertaken in International Literature in Health Sciences, Cumulative Index to Nursing and Allied Health Literature and Latin American and Caribbean Health Sciences. Results The clinical role was shown to be a process of complex interaction between nurse and patient, with critical thinking, informed experience and a sense of clinical autonomy as its antecedents. Consequences of nurses' clinical role include transformations in the organisation and process of nursing practice. A theoretical proposal was elaborated for the concept of the clinical role of the nurse, identifying the defining attributes, antecedents and consequences. Conclusions The clinical role of the nurse concept that was developed represents innovative evidence on the theme. Nevertheless, a deeper understanding of nurses' clinical role is needed, as well as refinement of its conceptual components. This study should be integrated into a field research project, designed to illuminate how nurses manifest and articulate the concept in clinical practice. Relevance to clinical practice Knowledge of clinical role attributes, associated with nursing competencies, can contribute to reflection on the dimensions involved in nursing practice and inform not only teaching and professional practice, but also health policies. [ABSTRACT FROM AUTHOR]

Copyright of Acta Paulista de Enfermagem is the property of Universidade Federal de Sao Paulo, Escola Paulista de Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Medical Education 2012: 46: 464-472 Objectives Developing diagnostic competence in students is a major goal of medical education, but there is little empirical evidence on instructional strategies that foster the acquisition of this competence. The aim of this study was to investigate the effects of structured reflection compared with the generation of immediate or differential diagnosis while practising with clinical cases on learning clinical diagnosis. Methods This was a three-phase experimental study. During a learning phase, 46 Year 4 students diagnosed six clinical cases under different experimental conditions: structured reflection, immediate diagnosis, or differential diagnosis. This was followed by an immediate test and a delayed test administered 1 week later. Each test consisted of diagnosing four different cases of diseases presented in the learning phase. Performance in diagnosing these new cases was used as a measure of learning. Results Repeated-measures analysis of variance on the mean diagnostic accuracy scores (range: 0-1) showed a significant interaction between performance moment (i.e. performance in the learning phase and on each test) and instructions followed during the learning phase (p = 0.003). Follow-up analyses of this interaction showed that diagnostic performance did not differ between conditions in the learning phase. On the immediate test, scores in the reflection condition (mean = 0.48, 95% confidence interval [CI] 0.38-0.58) were significantly lower than scores in the differential diagnosis condition (mean = 0.62, 95% CI 0.54-0.70; p = 0.012) and marginally lower than those in the immediate diagnosis condition (mean = 0.61, 95% CI 0.52-0.70; p = 0.04). One week later, however, scores in the reflection condition (mean = 0.66, 95% CI 0.56-0.76) significantly outperformed those in the other conditions (differential diagnosis: mean = 0.48, 95% CI 0.37-0.58 [p < 0.01]; immediate diagnosis: mean = 0.52, 95% CI 0.43-0.60 [p = 0.01]). Comparisons within experimental conditions showed that performance from the immediate to the delayed test decreased in the immediate and differential diagnosis conditions (immediate diagnosis: p = 0.042; differential diagnosis: p = 0.012), but increased in the reflection condition (p = 0.003). Conclusions Structured reflection while practising with cases appears to foster the learning of clinical knowledge more effectively than the generation of immediate or differential diagnoses and therefore seems to be an effective instructional approach to developing diagnostic competence in students. [ABSTRACT FROM AUTHOR]

Objective: To assess knowledge related to the ICF before and after an ICF training and to identify items to compose a monocentric rehabilitation ICF code set for cerebral palsy (CP). Methods: (a) Design: A cross-sectional study with a descriptive-explorative design. (b) Participants: Professionals from the fields of physiotherapy, nutrition, dentistry, occupational therapy, psychology, social work, speech therapy and medicine. (c) Instrument: A questionnaire to assess ICF's knowledge (total score == 17). Results: A high effect size of the ICF training was found (Cohen's d == 4.10). Ninety-one and 43 ICF categories were selected for a comprehensive evaluation and triage, respectively, for CP. Conclusion: ICF categories were identified to compose a comprehensive evaluation and for triage through an ICF code sets for CP. Studies are needed to validate the instrument on the knowledge of the ICF and to test the impact of ICF's training for clinical rehabilitation of CP. [ABSTRACT FROM AUTHOR]

Background: Lack of skills on how to diagnose and manage obstetric emergencies contribute to substandard institutional care and preventable maternal deaths in Brazil. Simulation-based obstetric emergency team training can reduce adverse maternal outcomes. However, this type of training is expensive and not widely available, especially in low resource settings. We present the experience of a private-public partnership that offered a two-day obstetric emergency simulation-training course to hundreds of Brazilian professionals working in the public sector. We also present participants´ short-term learning outcomes (Kirkpatrick's level 2) and satisfaction (Kirkpatrick's level 1). Methods: This was a non-experimental before-and-after study. The free 16-h course was held over a 14 months period in a large private hospital's simulation center using multidisciplinary scenario and model-based training. The training sessions consisted of four (4-h) modules on pre-eclampsia/eclampsia, hemorrhage, sepsis and resuscitation. An anonymous questionnaire collected participants´ satisfaction at the end of each module. Learning outcomes were assessed by comparing differences in participants´ pre- versus immediate post-course test scores. Wilcoxon, Kruskal-Wallis and Friedman tests were used for statistical analyses. P < 0.05 was considered significant. Results: 340 professionals (117 doctors, 179 registered nurses-RN and 44 licensed practical nurses-LPN) working in 33 public Brazilian hospitals were trained. There was a significant increase in post-course test scores in all four modules. On average, scores increased 55% in the hypertension and 65–69% in the hemorrhage, sepsis and resuscitation modules (p = 0.019). Knowledge acquisition of RN and LPN was similar in the hypertension, hemorrhage and sepsis modules and significantly higher than doctors´ (p < 0.05). On a 0 to 10 scale, mean overall satisfaction ranged from 9.6 (for the hypertension module) to 9.8 (for the resuscitation module). Conclusions: This successful experience of a private-public partnership to offer obstetric emergency simulation training required strategic organization and a strong commitment from both sides. This promising private-public partnership model could be replicated in similar settings. The training course obtained high satisfaction scores and significantly improved the knowledge of public-sector health professionals on how to manage the main causes of maternal mortality. [ABSTRACT FROM AUTHOR]