Uso del método de observación: una propuesta de aplicación al análisis de estrategias de resolución de problemas en niños con discapacidad / Use of observational method: a proposal for application to the analysis of problem-solving strategies in children with disabilities

El presente trabajo se ocupa de evaluar posibilidades del método de observación aplicado al análisis de estrategias de resolución de problemas en niños con discapacidad mediante juegos y tareas estructuradas. El marco teórico de referencia de esta contribución está representado por la teoría de la resolución de problemas, que contiene los principales procesos que intervienen en la gestión de los problemas y que nosotros aplicamos al desarrollo cognitivo y metacognitivo atípico. Junto con tres tareas diferentes estructuradas(Torre de Hanoi, Tetris y Bloques de construcción), usamos dos listas de comportamientos para codificar estrategias de resolución de problemas adoptadas por niños y/o adolescentes con desarrollo atípico. La aplicación de este tipo de observación con el uso de listas de comportamientos podría ser útil para crear en relación entre la investigación cualitativa y cuantitativa para mejorar el conocimiento de las estrategias de resolución de problemas y competencias metacognitivas en niños desarrollados atípicos(AU)

This paper is concerned with evaluating the possibilities of the observational method applied to the analysis of problem-solving strategies in children with disabilities through structured tasks. The theoretical framework of reference for this contribution is represented by the theory of problem-solving, containing the main processes involved in problem management,which we apply to atypical cognitive and metacognitive development. Together with three different structured tasks (Tower of Hanoi, Tetris, and Building Blocks), we used two lists of behaviors to code problem-solving strategies adopted by children and/or adolescents with atypical development. The application of this type of observation with the use of lists of behaviors could be useful to create a link between qualitative and quantitative research to improve the knowledge of problem-solving strategies and metacognitive competencies in atypically developed children(AU)

La observación. Primer eslabón del método clínico / Observation. First step of the clinical method

Introducción: la observación es la base del conocimiento del mundo y de la actividad científica. Objetivo: destacar la importancia de la observación como parte del método clínico para arribar al diagnóstico en un proceso salud enfermedad y poder decidir la terapéutica adecuada. Desarrollo: el método de observación es un proceso de descomposición-recomposición de informaciones obtenidas mediante la percepción, según los fines científicos establecidos en los modos de observación construidos. Se señala que es un proceso activo y organizado en el tiempo, en el cual se considera, un conjunto de fenómenos que pueden ser analizados. Conclusiones: la observación es la primera etapa del método clínico porque es de donde parte la obtención de información, tanto por lo que dice el enfermo como por lo que se puede observar mediante la inspección. Quiere decir que, no solo la información se vincula con la comunicación verbal, sino con formas no verbales como la inspección, y de esa forma se llega a acopiar datos sobre lo que ya puede ser explícito o general o sobre aspectos más particulares o específicos(AU)

Introduction: observation is the basis of knowledge of the world and of scientific activity. Objective: to emphasize the importance of observation as part of the clinical method to arrive at the diagnosis in a disease health process and to be able to decide the appropriate treatment. Development: the observation method is a process of decomposition-recomposition of information obtained through perception, according to the scientific purposes established in the modes of observation constructed. It is pointed out that it is an active and organized process over time, in which it is considered, a set of phenomena that can be analyzed. Conclusions: observation is the first stage of the clinical method because it is from where the information is obtained, both by what the patient says and by what can be observed through inspection. It means that not only information is linked to verbal communication, but also to non-verbal forms such as inspection, and in this way it is possible to collect data on what can already be explicit or general or on more specific or specific aspects(AU)

Effectiveness of using an unskilled model in action observation combined with motor imagery training for early motor learning in elderly people: a preliminary study.

AIM OF THE STUDY: To investigate a more available model for the early phase of motor learning after action observation combined with motor imagery training in elderly people. To address the purpose, we focused on a slow, unskilled model demonstrating an occasional error. MATERIALS AND METHODS: A total of 36 elderly people participated in the current study and were assigned to either the unskilled or skilled model observation groups (n = 12, respectively), or the control group (n = 12). The participants in the observation groups observed the assigned a video clip of an unskilled or skilled model demonstrating a ball rotation task. During the observation, the participants were instructed to imagine themselves as the person in the video clip. The participants in the control group read a scientific paper during the equivalent period of action observation and motor imagery. We measured ball rotation performance (the time required for five rotations, the number of ball drops) in pre- and post-intervention (observation combined with motor imagery training for intervention groups or reading for control group). RESULTS: Ball rotation performance (ball rotation speed) significantly improved in the unskilled model observation group compared to the other two groups. CONCLUSIONS: Intervention for action observation using unskilled model combined with motor imagery was effective for improving motor performance during the early phase of motor learning.

How are decisions made in cancer care? A qualitative study using participant observation of current practice.

OBJECTIVES: Shared decision-making has continuously gained importance over the last years. However, few studies have investigated the current state of shared decision-making implementation in routine cancer care. This study aimed to investigate how treatment decisions are made in routine cancer care and to explore barriers and facilitators to shared decision-making using an observational approach (three independent observers). Furthermore, the study aimed to extend the understanding of current decision-making processes beyond the dyadic physician-patient interaction. DESIGN: Cross-sectional qualitative study using participant observation with semistructured field notes, which were analysed using qualitative content analysis as described by Hsieh and Shannon. SETTING AND PARTICIPANTS: Field notes from participant observations were collected at n=54 outpatient consultations and during two 1-week-long observations at two inpatient wards in different clinics of one comprehensive cancer centre in Germany. RESULTS: Most of the time, either one physician alone or a group of physicians made the treatment decisions. Patients were seldom actively involved. Patients who were 'active' (ie, asked questions, demanded participation, opposed treatment recommendations) facilitated shared decision-making. Time pressure, frequent alternation of responsible physicians and poor coordination of care were the main observed barriers for shared decision-making. We found high variation in decision-making behaviour between different physicians as well as the same physician with different patients. CONCLUSION: Most of the time physicians made the treatment decisions. Shared decision-making was very rarely implemented in current routine cancer care. The entire decision-making process was not observed to follow the principles of shared decision-making. However, some aspects of shared decision-making were occasionally incorporated. Individual as well as organisational factors were found to influence the degree of shared decision-making. If future routine cancer care wishes to follow the principles of shared decision-making, strategies are needed to foster shared decision-making in routine cancer care.

Neuroprotective strategies for patients with acute myocardial infarction combined with hypoxic ischemic encephalopathy in the ICU.

BACKGROUND: We investigated neuroprotective treatment strategies for patients with acute myocardial infarction (AMI) complicated with hypoxic ischemic encephalopathy (HIE) in the ICU. METHODS: The 83 cases diagnosed with secondary AMI were, for the first time, divided into an observation group (n = 43) and control group (n = 40). All of the patients underwent emergency or elective PCI. Patients in the control group were treated with mannitol to reduce intracranial pressure and cinepazide maleate to improve microcirculation in the brain as well as given a comprehensive treatment with oxygen inhalation, fluid infusion, acid-base imbalance correction and electrolyte disturbance. Patients in the observation group underwent conventional treatment combined with neuroprotective therapeutic strategies. The effects of the different treatment strategies were compared. RESULTS: Consciousness recovery time, reflex recovery time, muscle tension recovery time and duration of ICU stay were significantly shorter in the observation group compared with the control group (P < 0.05). After treatment, the jugular vein oxygen saturation (SjvO2) and blood lactate (JB-LA) levels of both groups were lower than before treatment and the cerebral oxygen utilization rate (O2UC) increased, with a significantly higher increase in the observation group (P < 0.05). After treatment, the activities of daily living (ADL) score was higher for both groups and the neural function defect (NIHS) score was lower. CONCLUSION: The neuroprotective strategies of hypothermia and ganglioside administration assisted with hyperbaric oxygen was effective for treating AMI patients with HIE and may be worth clinical promotion.

Aproximando Teatro e Naturologia: a formação do ator em Stanislavski e a formação do naturólogo / Approaching Theather and Naturology: the training of the actor in Stanislavski and the formation of the naturologist

Este artigo relata sobre a aproximação entre Teatro e Naturologia.Tem por objetivo identificar de que maneira a formação do ator poderá contribuir com a formação do naturólogo, a partir dos conceitos elaborados pelo ator e diretor Constantin Stanislavski. Trata--se de uma revisão bibliográfica qualitativa de caráter exploratório. O levantamento foi realizado nas bases de dados: BVS-Psicologia Brasil, LILACS e SciELO; com a delimitação temporal de 2000 até 2014 e selecionados artigos disponíveis com texto na Língua Portuguesa. Fontes primárias e secundárias referente à metodologia de Stanislavski também foram consultadas. Os aspectos discutidos foram no que diz respeito à preparação do corpo e expressão das emoções. Constatou-se que ocorre aproximação entre as duas formações visto que abordam conceitos semelhantes. Assim, foi possível apontar como a formação do ator poderá contribuir para a formação do naturólogo.(AU)

This article reports on the approximatin between Theater and Naturology. It aims to indentify how the formatin of the actor can contribute to the formation of the naturologist, from the concepts developed by the actor and director Constantin Stanilavski. This is a qualitative bibliographical review of an exploratory nature. The survey was carried out in the databases: VHL-Psychology Brazil, LILACS and SciELO; With the time delimitation from 2000 to 2014 and selected articles avaliable with text in the Portuguese language. Primary and secondary sources for Stanislavski´s methodology were also consulted. The aspects discussed were with regard to the preparation of the body and expression of emoctions. It was found that approximation occurs between the two formations since they approach similar concepts. Thus, it was possible to indicate how the formation of the actor could contribute to the formation of the naturologist.(AU)

Observational methods to assess the effectiveness of screening colonoscopy in reducing right colon cancer mortality risk: SCOLAR.

AIMS: Screening colonoscopy's effectiveness in reducing risk of death from right colon cancers remains unclear. Methodological challenges of existing observational studies addressing this issue motivated the design of 'Effectiveness of Screening for Colorectal Cancer in Average-Risk Adults (SCOLAR)'. METHODS: SCOLAR is a nested case-control study based on two large integrated health systems. This affords access to a large, well-defined historical cohort linked to integrated data on cancer outcomes, patient eligibility, test indications and important confounders. RESULTS: We found electronic data adequate for excluding ineligible patients (except family history), but not the detailed information needed for test indication assignment. CONCLUSION: The lessons of SCOLAR's design and implementation may be useful for future studies seeking to evaluate the effectiveness of screening tests in community settings.

Determination of feedback in judo by means of T-patterns / Determinação de feedback no judô por meio de T-patterns / Determinación del feedback en el judo a través de T-patterns

The aim of this research was to propose methodological changes in the teaching-learning process of the judo technique Deashi-harai, pointing out the most frequent technical errors committed during its performance and also its action sequences. We carried out an observational study with the participation of fifty novice judokas at the University of Vigo. We recorded them while performing the Deashi-harai technique after a previous training of four months. Data obtained were evaluated using descriptive statistics and T-patterns analysis. Thus, we indentified: a) some typical inaccuracies during the technique execution and b) a number of chained errors affecting the imbalance of the body, the position of the right foot, the sweeping action and the action of the arms. These findings allowed us to suggest some motor tasks to correct the identified inaccuracies, the sequential actions to ensure the success of the execution and several recommendations for the proper use of the feedback.

O objetivo de esta investigação baseia-se na proposta de mudanças metodológicas no ensino/aprendizagem da técnica de judo Deashi-harai, assinalando os erros técnicos mais comuns durante a sua execução, assim como as suas sequências. Realizou-se um estudo observacional, onde participaram 50 estudantes da Universidade de Vigo sem conhecimentos prévios de Judô, foram filmados executando a técnica em estudo depois de uma formação prévia de quatro meses. Os resultados obtidos foram avaliados através de estatística descritiva e análise de T-patterns. Identificamos: a) uma diversidade de defeitos na execução da técnica; b) umas sequências de erros em cadeia que afetam consideravelmente o desequilíbrio, a posição do pé direito, a ação de varrimento e a ação dos braços. Estes resultados permitem-nos propor tarefas motrizes baseadas nos erros detetados, em sequências de movimentos que garantam o êxito na projeção e recomendações sobre a utilização do feedback.

El objetivo de esta investigación es proponer cambios metodológicos en el proceso de enseñanza aprendizaje de la técnica de judo Deashi-harai, indicando los errores técnicos más comunes durante su ejecución, así como sus secuencias. Hemos realizado un estudio observacional en el que participaron 50 estudiantes de la Universidad de Vigo sin conocimiento previo de Judo, que fueron filmadas ejecutando la técnica de estudio después de un entrenamiento previo de cuatro meses. Los resultados se analizaron utilizando estadística descriptiva y análisis de T-patterns. Se ha identificado: a) una variedad de errores en la ejecución b) una secuencia de cadena de errores que afectan significativamente el desequilibrio, la posición del pie derecho, acción de barrido y la acción del brazo. Estos resultados nos permiten proponer tareas motrices basadas en los errores detectados, secuencias de movimientos que aseguran el éxito en la proyección, así como recomendaciones sobre el uso del feedback.

Nocebo hyperalgesia induced by social observational learning.

Nocebo effects can be acquired by verbal suggestion, but it is unknown whether they can be induced through observational learning and whether they are influenced by factors known to influence pain perception, such as pain anxiety or pain catastrophizing. Eighty-five female students (aged 22.5 ± 4.4 years) were randomly assigned to one of three conditions. Participants in the control condition (CC) received information that an ointment had no effect on pain perception. Participants in the verbal suggestion condition (VSC) received information that it increased pain sensitivity. Participants in the social observational learning condition (OLC) watched a video in which a model displayed more pain when ointment was applied. Subsequently, all participants received three pressure pain stimuli (60 seconds) on each hand. On one hand, the ointment was applied prior to the stimulation. Numerical pain ratings were collected at 20-second intervals during pain stimulation. The participants filled in questionnaires regarding pain-related attitudes (Pain Anxiety Symptoms Scale, Pain Catastrophizing Scale, and Somatosensory Amplification Scale). Participants in the OLC showed higher pain ratings with than without ointment. Pain ratings within the CC and the VSC were at the same level with and without ointment. In the VSC, the pain ratings were higher than in the CC with and without ointment. The nocebo response correlated with pain catastrophizing but not with pain anxiety or somatosensory amplification. A nocebo response to pressure pain was induced by observational learning but not by verbal suggestion. This finding highlights the importance of investigating the influence of observational learning on nocebo hyperalgesia.

What's on the mind of a jellyfish? A review of behavioural observations on Aurelia sp. jellyfish.

Aurelia sp. (scyphozoa; Moon Jellies) are one of the most common and widely distributed species of jellyfish. Their behaviours include swimming up in response to somatosensory stimulation, swimming down in response to low salinity, diving in response to turbulence, avoiding rock walls, forming aggregations, and horizontal directional swimming. These are not simple reflexes. They are species typical behaviours involving sequences of movements that are adjusted in response to the requirements of the situation and that require sensory feedback during their execution. They require the existence of specialized sensory receptors. The central nervous system of Aurelia sp. coordinates motor responses with sensory feedback, maintains a response long after the eliciting stimulus has disappeared, changes behaviour in response to sensory input from specialized receptors or from patterns of sensory input, organizes somatosensory input in a way that allows stimulus input from many parts of the body to elicit a similar response, and coordinates responding when stimuli are tending to elicit more than one response. While entirely different from that of most animals, the nervous system of Aurelia sp. includes a brain that creates numerous adaptive behaviours that are critical to the survival of these phylogenetically ancient species.

An observational study of timing versus appropriateness of acute plastic surgery referrals in the UK.

AIM: A commitment made by the UK government that all patients presenting to Accident and Emergency (A&E) should be treated within 4h of arrival has challenged both A&E departments and those to whom they refer. It has been suggested on one hand that referrals from A&E are not always seen promptly enough to meet waiting time targets, and on the other hand that referrals are sometimes made to help busy A&Es clear their waiting rooms rather than through clinical need. METHODS: To investigate these claims 'Referral Time' (the time between a patient arriving at A&E and being referred to Plastic Surgery), 'Review Time' (the time taken from referral to review by the Plastic Surgery Senior House Officer) and their relationship with referral appropriateness were prospectively examined in a UK teaching hospital. RESULTS: The mean Referral Time was 84 min (SD=57.3) and Review Time was 33 min (SD=27.4). Review Time did not vary significantly between 'appropriate' and 'inappropriate' referrals (31.3 vs 36.1 min, p=0.357) but Referral Time was significantly quicker for 'inappropriate' than 'appropriate' referrals (92.8 vs 62.7 min, p=0.028). CONCLUSION: This data suggests that Review Time did not significantly contribute to the risk of patients breaching the A&E waiting time target in this study, but a correlation between reduced Referral Time and decreased referral appropriateness is consistent with referrals sometimes being made for non-clinical reasons. It is felt that such tactics are an inevitable consequence of an unachievable target placed on A&E departments and that this target should be reconsidered.

Review of research methods used to investigate violence in the emergency department.

Violence in the emergency department (ED) is of constant concern to emergency practitioners. Much research has been conducted on this topic but it appears that there has been no attempt to systematically evaluate the methods that have been used to investigate this problem. Therefore, the purpose of this paper is to review the research methods in order to identify the most effective approach for future use and to reveal gaps in the understanding of this problem. Most studies that have been conducted to investigate violence in the ED are descriptive in nature with the most common type retrospective or prospective surveys. Few interview-based studies have been conducted but these have provided an in-depth understanding of the perspectives and feelings of staff involved in the patient violence. However, none of the methods used have provided insight into the perspectives of patients or perpetrators of violence in the ED. To date, it appears that no observational or predictive studies pertaining to this problem have been conducted. Combining questionnaire-based and interview-based prospective surveys with observations could be an ideal method to investigate violence in the ED, as it would permit the researcher to investigate this complex problem more thoroughly and holistically.

OSCEs--seven years on the bandwagon: the progress of an objective structured clinical evaluation programme.

The original purpose of Objective Structured Clinical Examination (OSCE), as first described in the medical literature [Harden, R.M., Stevenson, M., Downie, W.W., Wilson, G.M., 1975. Assessment of clinical competence using objective structured examination. British Medical Journal, 1, 447-451], provided a means of examining the skills acquisition of medical students. A review of the literature, since that time, provides the background to the development of OSCEs into pre-registration nursing curricula, with the OSCE programme at the University of Salford presented here as a case study. The original student sample was a mixture of 150-250 adult, child and mental health students in each of seven cohorts over a period of four years. Each student undertook a 30-min formative, simulated patient, holistic care OSCE in their second year of the programme. Later developments included one remote workstation connected to and as part of the holistic patient care encounter. In subsequent curricula, the larger cohorts of around 250-300 students were accommodated in a formative rotational three-workstation OSCE, based on clinical skills to be acquired prior to their first clinical placement. A summative patient-centred OSCE was undertaken in practice at a later date. The educational and practice value of OSCEs regarding their clinical content and context in nursing curricula now and in the future are explored, along with the practicalities of implementation.

Hand movement observation by individuals born without hands: phantom limb experience constrains visual limb perception.

Increasing evidence suggests that the visual analysis of other people's actions depends upon the observer's own body representation or schema. This raises the question of how differences in observers' body structure and schema impact their perception of human movement. We investigated the visual experiences of two persons born without arms, one with and the other without phantom sensations. These participants, plus six normally-limbed control observers, viewed depictions of upper limb movement under conditions of apparent motion. Consistent with previous results (Shiffrar M, Freyd JJ (1990) Psychol Sci 1:257), normally-limbed observers perceived rate-dependent paths of apparent human movement. Specifically, biologically impossible motion trajectories were reported at rapid display rates while biologically possible trajectories were reported at slow display rates. The aplasic individual with phantom experiences showed the same perceptual pattern as control participants, while the aplasic individual without phantom sensations did not. These preliminary results suggest that phantom experiences may constrain the visual analysis of the human body. These results further suggest that it may be time to move beyond the question of whether aplasic phantoms exist and instead focus on the question of why some people with limb aplasia experience phantom sensations while others do not. In this light, the current results suggest that somesthetic representations are not sufficient to define body schema. Instead, neural systems matching action observation, action execution and motor imagery likely contribute to the definition of body schema in profound ways. Additional research with aplasic individuals, having and lacking phantom sensations, is needed to resolve this issue.

Opinión de las gestantes, sus acompañantes y los profesionales de salud que les atienden sobre el acompañamiento en el parto / Opinion of expectant mothers, those accompanying them and the attending health care professionals of the presence of an accompanying person during delivery

Objetivo. Conocer la opinión de gestantes, sus acompañantes y las matronas y auxiliares de enfermería que les atienden, sobre el acompañamiento en el parto. Método. Estudio observacional, descriptivo y transversal. Los sujetos de estudio fueron las mujeres que acudieron al Servicio de Partos del Hospital Cabueñes de Gijón, entre febrero y junio del 2003, sus acompañantes y las matronas y auxiliares de enfermería del servicio. Se elaboraron tres cuestionarios que fueron autocumplimentados por las gestantes, sus acompañantes y los profesionales, en los que se recogían sus opiniones sobre el proceso del parto y sobre el acompañamiento a la gestante en dicho proceso. La técnica de muestreo utilizada fue consecutiva no aleatoria. Resultados. Se estudiaron 328 gestantes (63 por ciento de los cuestionarios entregados), 318 acompañantes (63 por ciento) y todas las matronas y auxiliares de enfermería del Servicio (19). Casi todas las gestantes (318; 97 por ciento) expresaron que necesitaban estar acompañadas, de éstas, el 95 por ciento (302) de su pareja y 310 (97 por ciento) lo decidieron antes del parto. El principal motivo expresado para. estar acompañadas ha sido "desahogar miedos y temores" (220; 67 por ciento). La mayoría de los acompañantes (299; 94 por ciento) pensaba que las gestantes necesitan compañía; el 91 por ciento (289) consideró que el acompañante ideal es la pareja. Los entrevistados consideraron que la tarea principal era la de "acompañar" (115; 36 por ciento).El 94 por ciento (18) del personal manifestó propiciar el acompañamiento y 18 también opinaron que la gestante quiere estar acompañada siempre o casi siempre. El 58 por ciento (11) reflejó que la presencia del acompañante es molesta para la realización del trabajo. Conclusiones. Las gestantes y sus parejas desean estar juntos durante el parto, siendo el acompañante ideal el marido o pareja. También las matronas y auxiliares de enfermería que los atienden consideran importante el acompañamiento de la gestante y lo favorecen (AU)

The starting point: pathography.

The issues which have dominated discussion of homeopathic medicine hitherto are the efficacy and effectiveness of the medicines themselves and the problem of their mechanism of action. The resolution of these is of profound clinical and scientific importance. But there is another aspect of homeopathic methodology that is of equal, and perhaps even more fundamental importance, and that does not depend on whether or how the medicines work. This is the detailed study, almost unique now in western medicine, of the disease process and the healing process; the evolution, manifestation and resolution of the illness in the individual patient. This paper reviews the epidemiology and the 'pathography' that are inherent in the homeopathic method, and discusses their implications for medical science and clinical practice, and their value to medical education; their importance to the identity of the medicine of the future and the doctor of the future.

Medicina tradicional china / Traditional Chinese medicine

Se profundiza conceptualmente en los principios de la Medicina Tradicional China (MTC), expresados en la teoría de "Los tres tesoros" (el Jing, el Qi, el Shen) y en la relación de sustento y de gestión que existe entre estos tres niveles. Tanto la alteración de sus sustancias o niveles fundamentales como el desorden de sus relaciones (la desarmonía) puede suponer la enfermedad. Dentro de estos tres tesoros debemos destacar el Qi (inexistente en la cultura judeo-cristiana) y que se entiende como la energía o el aliento vital. La MTC es una medicina integral por su filosofía (consideración del individuo como un todo interrelacionado) y porque sus métodos de diagnóstico y tratamiento se apoyan claramente en esta filosofía (AU)