Implementation of an Outpatient HD-MTX Initiative.

INTRODUCTION: Methotrexate (MTX) a folate antagonist is often given in high doses (≥500 mg/m2) to treat a variety of disease processes. While inpatient administration has been the norm, outpatient administration, has been shown to be safe, effective, and patient centered. Here in we describe development of an outpatient HDMTX protocol and our initial experience. METHODS: All patients were to receive their first cycle of HDMTX in the hospital to ensure they tolerate it well and also to use this time to assist in training for home administration. The outpatient protocol involved continuous IV sodium bicarbonate, along with oral leucovorin and acetazolamide. Patients were required to visit the infusion center daily for labs and methotrexate levels. Clear criteria for admission were developed in the case of delayed clearance or methotrexate toxicity. RESULTS: Two patients completed the safety run-in phase. Both patients tolerated treatment well. There were no associated toxicity. Methotrexate cleared within 3 days for all cycles. Both patients were able to follow the preadmission instructions for sodium bicarbonate and acetazolamide. The patients reported adequate teaching on the protocol and were able to maintain frequency of urine dipstick checks. CONCLUSION: We developed and implemented an outpatient protocol for high dose methotrexate. This study largely details the development of this protocol and its initial safety evaluation. More work needs to be done to assess its feasibility on a larger number of patients who receive more cycles in the outpatient setting.

A school-based public health model to reduce oral health disparities.

OBJECTIVES: Although dental decay is preventable, it remains the most common pediatric chronic disease. We describe a public health approach to implementing a scalable and sustainable school-based oral health program for low-income urban children. METHODS: The Los Angeles Trust for Children's Health, a nonprofit affiliated with the Los Angeles Unified School District, applied a public health model and developed a broad-based community-coalition to a) establish a District Oral Health Nurse position to coordinate oral health services, and b) implement a universal school-based oral health screening and fluoride varnishing program, with referral to a dental home. Key informant interviews and focus groups informed program development. Parent surveys assessed preventative oral health behaviors and access to oral health services. Results from screening exams, program costs and rates of reimbursement were recorded. RESULTS: From 2012 to 2015, six elementary schools and three dental provider groups participated. Four hundred ninety-one parents received oral health education and 89 served as community oral health volunteers; 3,399 screenings and fluoride applications were performed on 2,776 children. Sixty-six percent of children had active dental disease, 27 percent had visible tooth decay, and 6 percent required emergent care. Of the 623 students who participated for two consecutive years, 56 percent had fewer or no visible caries at follow-up, while only 17 percent had additional disease. Annual program cost was $69.57 per child. CONCLUSIONS: Using a broad based, oral health coalition, a school-based universal screening and fluoride varnishing program can improve the oral health of children with a high burden of untreated dental diseases.

FORMACIÓN AMBIENTAL Y RECONOCIMIENTO DE LA REALIDAD: DOS ASPECTOS ESENCIALES PARA LA INCLUSIÓN DE LA EDUCACIÓN AMBIENTAL EN LA ESCUELA / ENVIRONMENTAL EDUCATION AND RECOGNITION OF REALITY: TWO ESSENTIAL ASPECTS FOR THE INCLUSION OF ENVIRONMENTAL EDUCATION IN THE SCHOOL

Este artículo es el resultado de una investigación enmarcada en la didáctica de la educación ambiental y, de manera específica, en los procesos de enseñanza de dicho campo de conocimiento, encaminada al reconocimiento de realidades ambientales a partir de las cuales se generaron estrategias para su inclusión en la escuela, con la participación de diferentes actores de la comunidad de la Institución Educativa de Occidente, ubicada en el municipio de Anserma, departamento de Caldas en Colombia. Este trabajo de investigación fue realizado con la participación activa de maestros investigadores en formación del Programa Licenciatura en Educación Ambiental de la Universidad de Caldas, como parte de su práctica educativa llevada a cabo entre los años 2012 y 2013. Metodológicamente, esta investigación es cualitativa con un enfoque de investigación acción y se parte de una revisión documental del estado actual del Proyecto Ambiental Escolar (PRAE). Se concluye que para la enseñanza de la educación ambiental en la escuela, se requiere de procesos formativos de maestros y comunidades, quienes a partir del reconocimiento de su realidad, sus necesidades e intereses generen estrategias de acción.

This article is the result of an investigation framed in the didactics of environmental education and, specifically, in the teaching processes of this field of knowledge, aimed at recognizing environmental realities from which strategies for inclusion at school were generated, with the participation of different actors in the community of the Institución Educativa de Occidente located in the municipality of Anserma, department of Caldas, Colombia. This research project was conducted with the active participation of training teacher researchers from the Environmental Education Bachelor Program at Universidad de Caldas, as part of their educational practice carried out between 2012 and 2013. Methodologically this research is qualitative with action research approach, arising from a documentary review of the status of the School Environmental Project (SEP). It is concluded that, for teaching environmental education in the school, educational processes are required for teachers and communities who, from the recognition of their reality, their needs and interests, generate action strategies..