Salud, bienestar y convivencia de los ancianos. La situación portuguesa, española y europea / Health, wellbeing and conviviality of the elderly. The portuguese, spanish and european situation

Objetivo. Describir las características del envejecimiento en Portugal y España, en contraste con la realidad de los diecinueve países de la Unión Europea. Metodología. La visión del mayor se ve desde diferentes dimensiones: el estado de salud, el nivel de bienestar, las relaciones de convivencia y el sentimiento de soledad. El análisis se ha basado en los resultados obtenidos en el European Social Survey, round 5. Resultados. En Portugal, en comparación con España, se han identificado en la población anciana: mayores dificultades financieras, una peor percepción del estado de salud y del nivel de bienestar, pero, simultáneamente, menos limitación en la realización de las actividades de la vida diaria. Con respecto a las relaciones de convivencia en la población anciana, Portugal y España se diferencian del resto de la realidad europea analizada, con una frecuencia elevada de actividades de convivencia. Conclusión. Se ha podido constatar la existencia de especificidades nacionales que sugieren la existencia de factores sociales y culturales en la experiencia de la vejez (AU)

Objective. To characterize the specificities of aging in Portugal and Spain, in contrast to the reality of nineteen countries of the European Union. Methodology. The senior condition is characterized in different dimensions: health status, the level of wellbeing, conviviality and sense of loneliness. For that we have analyzed the results of the European Social Survey, round 5. Results. In Portugal, compared to Spain, it has been identified in the elderly population: greater financial difficulties, poorer perceived health status and wellbeing but, simultaneously, less limitation in performing activities of daily life. Respecting to conviviality, Portugal and Spain are distinct from other populations of the European reality analyzed, with a high frequency of convivial activities. Conclusion. In conclusion it was found the existence of national characteristics that suggest the existence of social and cultural factors that determine the experience of aging (AU)

Adaptación al español de la Escala de Desempeño Cívico de Coleman y Borman (2000) y análisis de la estructura empírica del constructo / Spanish adaptation of the Citizenship Performance Questionnaire by Coleman & Borman (2000) and an analysis of the empiric structure of the construct

Este artículo presenta una adaptación del cuestionario de desempeño cívico de Coleman y Borman (2000) y un análisis de su estructura empírica. Una vez traducido y adaptado, el cuestionario se aplicó a una muestra de 135 empleados públicos de una unidad completa del Gobierno Autonómico de Canarias. Los resultados indican que el cuestionario tiene una alta consistencia interna, aunque parece medir tres dimensiones relacionadas entre sí. Dos de estas dimensiones son altamente estables y coinciden con las propuestas por LePine, Erez y Johnson (2002), Cumplimiento Generalizado y Altruismo, mientras que la tercera es de difícil interpretación. Un análisis factorial de segundo orden indica que existe una única dimensión subyacente de desempeño cívico. Estos resultados tienen implicaciones teóricas y prácticas que ayudan a la interpretación y diagnóstico del dominio (AU)

This article presents a Spanish adaption of the citizenship performance questionnaire of Coleman and Borman (2000) an analysis of its empirical structure. Once the original questionnaire was translated and adapted to a Spanish public administration context, it was administered to a sample of 135 public employees representing the complete staff ofa ’ Autonomic Government unit. Results show a high internal consistency of the questionnaire, although it seems to measure three related dimensions. Two of these dimensions are highly stable and coincide with those proposed by LePine, Erez, and Johnson (2002), Generalized Compliance and Altruism, while the third dimension is difficult to interpret. A second order factor analysis supports the existence of a unique underlying dimension of citizenship performance. These results have theoretical as well as practical implications that may help the interpretation and diagnosis in this domain(AU)

Effectiveness of web-based teaching modules: test-enhanced learning in dental education.

The purpose of our study was to evaluate the effectiveness of self-tests as a component of web-based self-instruction in predoctoral orthodontics and pediatric dentistry. To this end, the usage patterns of online teaching modules and self-tests by students enrolled in three courses at the University of North Carolina at Chapel Hill School of Dentistry were monitored and correlated to final exam grade and course average. We recorded the frequency of access to thirty relevant teaching modules and twenty-nine relevant self-tests for 157 second- and third-year D.D.S. students during the course of our data collection. There was a statistically significant positive correlation between frequency of accessing self-tests and course performance in one course that was totally based on self-instruction with seminars and multiple-choice examination (Level IV): Spearman correlation between frequency of self-test access and final exam grade, rho=0.23, p=0.044; correlation between frequency of self-test access and course average: rho=0.39, p=0.0004. In the other two courses we monitored, which included content beyond self-instruction with self-tests, the correlations were positive but not statistically significant. The students' use of online learning resources varied significantly from one course (Level I) to the next (Level II): Wilcoxon matched pairs signed-rank tests, S=-515.5, p=.0057 and S=1086, p<0.0001. The data from this study suggest that increased use of web-based self-tests may be correlated with more effective learning in predoctoral dental education by virtue of the testing effect and that dental students' usage of resources for learning changes significantly over the course of their education.

Percepción de los residentes de primer año de sus competencias en soporte vital básico y desfibrilación automática externa / First-year medical residents’ self-assessment of skill in basic life support and automatic external defibrillation

OBJETIVOS: Evaluar la opinión de residentes de primeraño sobre sus competencias en soporte vital básico(SVB) y desfibrilación automática externa (DAE).MATERIAL Y MÉTODOS: Curso acreditado de SVB yDAE según el European Resuscitation Council. Encuestaantes, inmediatamente después del curso y a los 8 meses.Datos registrados: a) formación y experiencia previas; b)autoevaluación de habilidades para SVB y DAE (9ítems; puntuación: 1-5); c) habilidad considerada másdifícil; d) encuesta de satisfacción (13 ítems; puntuación:0-10).RESULTADOS: El estudio inicial incluyó 71 residentesde los cuales 31 cumplimentaron también la encuesta alos 8 meses. La autoevaluación mejoró después del curso(p = 0,0001). A los 8 meses las puntuaciones empeoraron(p = 0,0001) pero se mantuvieron significativamentesuperiores a las iniciales (p < 0,017). Más del 95% de losresidentes se consideraron competentes después del cursoy más del 80% a los 8 meses, excepto para la ventilacióncon bolsa-mascarilla (74,2%) y la liberación decuerpo extraño (61,3%). La habilidad considerada másdifícil fue la ventilación con bolsa-mascarilla. La valoraciónde las competencias para SVB y DAE en situaciónreal fue 8,48 (±1,33) y 9,19 (±0,94) después del curso y7,32 (±1,4) y 7,29 (±1,32) a los 8 meses (p = 0,0001). Lasatisfacción global fue alta.CONCLUSIONES: Los residentes consideraron que erancompetentes para aplicar SVB y DAE inmediatamentedespués del curso y a los 8 meses de su formación, aunqueen menor grado. La habilidad considerada más difícilfue la ventilación con bolsa-mascarilla(AU)

OBJECTIVE: To determine first-year medical residents’perception of their competence in basic life support (BLS)and the use of automatic external defibrillation (AED).MATERIAL AND METHODS: Course in BLS and AEDaccredited by the European Resuscitation Council withpre- and post-course self-assessment. The post-trainingquestionnaire was administered immediately after thecourse and 8 months later. The data recorded covered a)prior training and experience, b) self-assessment of BLSand AED skills (9 items, scored 1-5), c) the skill consideredmost difficult, and d) satisfaction (13 items, scored 0-10).RESULTS: The questionnaire was initially completed by71 residents;, 31 also responded 8 months later. Selfassessmentscores improved immediately after the course(P=.0001). Scores had fallen 8 months later (P=.0001) butwere still significantly higher than pre-course perceptionof skill (P=.017). More than 95% of the residentsconsidered themselves to be competent after the courseand more than 80% felt competent 8 months later, withthe exception of skills in bag-mask ventilation (74.2%)and removal of a foreign body (61.3%). The skillconsidered most difficult was bag-mask ventilation.Mean (SD) BLS and AED scores for real-life situationswere 8.48 (1.33) and 9.19 (0.94), respectively, after thecourse and 7.32 (1.4) and 7.29 (1.32) at 8 months(P=.0001). Overall satisfaction was high.CONCLUSIONS: The residents perceived themselves ascompetent to give BLS and AED immediately after thecourse and 8 months after training, although fewer feltas competent at the second assessment. Bag-maskventilation was considered the most difficult skill(AU)

American Board of Family Medicine (ABFM) maintenance of certification: variations in self-assessment modules uptake within the 2006 cohort.

INTRODUCTION: In its recent shift to a Maintenance of Certification for Family Physicians (MC-FP) paradigm, the American Board of Family Medicine provides diplomates completing 3 self-assessment modules (SAMs) in the first 3 years (or first stage of MC-FP) a pathway to extend their recertification cycle to 10 years provided additional requirements are met, versus a 7-year cycle for "non-completers." We use geographic information systems to report on variations in SAM participation and completion in a single cohort of diplomates followed during their first stage of MC-FP to better understand the communities impacted, barriers to uptake, and urban-rural differences. METHODS: We merged data from 2006 MC-FP files, association workforce files, and the US Census and completed cross-sectional spatial, descriptive, and regression analyses of the uptake and timely completion of SAMs during a 3-year period. Specifically, we explored characteristics of diplomates who did not meet first-stage MC-FP requirements within 3 years versus those who did. RESULTS: The cohort comprised 10,812 participants who passed their certification or recertification examination in 2005, of which 30.5% did not complete their MC-FP requirements by the end of 2008. Noncompleters were more likely to be older (P < .01), men (P < .0001), and from areas of dense poverty (P < .01) and underserved areas (P < .05). There were no significant differences in MC-FP completion across the rural-urban continuum (P = .7108). CONCLUSIONS: More than two-thirds of eligible, certified family physicians completed stage-one MC-FP requirements. Concerns that technical aspects of the new MC-FP paradigm would leave parts of a widely distributed, poorly resourced primary care workforce disadvantaged may hold true for providers in some underserved areas, but differential completion among rural and remote physicians was not found. Understanding barriers to uptake is essential if the specialty boards are to meet their obligations to the public to promote quality of care through Maintenance of Certification for all physicians.

Shift analysis versus dichotomization of the modified Rankin scale outcome scores in the NINDS and ECASS-II trials.

BACKGROUND AND PURPOSE: The SAINT I trial that showed a significant benefit of the neuroprotectant NXY-059 used a novel outcome for acute ischemic stroke trials: a shift toward good functional outcome on the 7-category modified Rankin scale (mRS). METHODS: We used the Cochran-Mantel-Haenszel shift test to analyze the distribution of the 90-day mRS outcomes in the NINDS and ECASS-II databases and compared the results with a dichotomized mRS outcome by logistic regression (0 to 2 vs 3 to 6, or 0 to 1 vs 2 to 6). We also stratified each dataset based on National Institutes of Health Stroke Scale baseline severity. RESULTS: Each dataset showed a statistically significant shift in the 90-day mRS distributions favoring tissue plasminogen activator (odds ratio, 1.6 for NINDS, 1.3 for ECASS-II). For ECASS-II, larger shift effects appeared in National Institutes of Health Stroke Scale 0 to 6 and 16 to 40 strata. Similarly, the mRS 0 to 2 analysis but not mRS 0 to 1 found similar treatment effects in both datasets (odds ratio, 1.6 for NINDS, 1.5 for ECASS-II) and similar variations in the low and high strata in the ECASS-II trial. NINDS found no significant treatment effects across the strata. After removing the strata at the fringes, the shift test lost significance in both datasets. CONCLUSIONS: Tissue plasminogen activator causes a beneficial shift toward wellness on the mRS in both the NINDS and ECASS-II trials, and ECASS-II would have been a positive trial according to the shift approach. However, the shift effect is not global for all treated patients and does not outperform the dichotomized 0 to 2 outcome. Patients with mild and severe deficits also shifted favorably on the mRS in the ECASS-II trial.

Autopercepción del trabajo asistencial y docente de los tutores de medicina de familia / Self-perception of the care and teaching work of family medicine mentors

Objetivo. Determinar las características del trabajo asistencial y docente del tutor de medicina de familia. Diseño. Transversal, observacional. Emplazamiento. Centros de salud docentes de la provincia de Valencia. Participantes. Participaron 91 tutores acreditados y con residentes de tercer año. Mediciones principales. Cuestionario autoadministrado que recoge los datos generales del tutor, las características del trabajo asistencial, la organización de la consulta entre el tutor y el residente, la dedicación a la docencia, la satisfacción y la motivación, y las propuestas de mejora. Resultados. Se analiza el 66% de los cuestionarios remitidos. Son tutores con una media de 7,1 años de experiencia y Atienden a una media de 43,2 consultas/día. Dedican 4,4 h/semana a la docencia en exclusiva y el 68,8% lo juzga insuficiente. El 24% de los tutores pasa consulta de forma simultánea con el residente. El grado de satisfacción y de motivación es alto, citándose más ventajas que inconvenientes. Conclusiones. Mayoritariamente, se utilizan estrategias organizativas que permiten la autonomía del residente. Los tutores se muestras satisfechos y motivados a pesar de que juzgan insuficiente su dedicación

Objective. To determine the characteristics of Family Medicine mentors' care and teaching work. Design. Transversal, observational study. Setting. Teaching Health Centres in Valencia province, Spain. Participants. Ninety-one accredited mentors with third-year residents. Main Measurements. Self-administered questionnaire collecting general data of mentors, characteristics of their care work, organisation of consultations between mentor and residents, teaching dedication, satisfaction and motivation, and proposals for improvement. Results. Sixty-six per cent of the questionnaires sent out were analysed. Mentors had an average 7.1 years experience and 43.2 consultations/day. They devoted 4.4 hours a week solely to teaching, which 68.8% judged insufficient. 24% of mentors did a consultation at the same time as the resident. The satisfaction and motivation levels were high, with more advantages than disadvantages cited. Conclusions. On the whole, organisational strategies ensuring residents' autonomy were used. Mentors were satisfied and motivated, even though they thought the time devoted was insufficient

Evaluación del grado de implantación de las intervenciones para el control del tabaquismo en la Red Catalana de Hospitales sin Humo / Evaluation of the degree of implementation of tobacco control interventions in the Catalan Network of Smoke-Free Hospitals

Objetivo. Evaluar el grado de implementación de las intervenciones dirigidas al control del tabaquismo y determinar la relación con las fases de despliegue del proyecto "Hospital sin humo". Así como conocer la prevalencia de consumo de tabaco en los hospitales de la Red en función de su fase de adscripción. Método. Estudio observacional, descriptivo y transversal, realizado en 16 hospitales miembros de la Red, que se encontraban en distintas fases de despliegue en el año 2005. Las intervenciones de control del tabaquismo se estudiaron con el cuestionario de autoevaluación de la European Network for Smoke-free Hospitals, que consta de 9 indicadores. El consumo de tabaco se estudió mediante entrevistas a 3.896 trabajadores, con variables sociodemográficas, consumo de tabaco, categoría profesional, indicadores para el control del tabaquismo, fase de adhesión al proyecto y grado de implementación de éste. Resultados. La prevalencia de consumo de tabaco en los hospitales estudiados fue del 35%. El grado de implementación del proyecto en el conjunto de los hospitales resultó del 53,3%. Los indicadores con un grado de implementación elevado (> 70%) fueron: compromiso, comunicación, control del consumo, control del ambiente y seguimiento. Se observó un incremento en el grado de implementación del proyecto global en los hospitales que pasaban de la fase de registro (x­ = 26,6; desviación estándar [DE] = 16,7) a fases posteriores (x­ = 59,7; DE = 14,1), y resultó estadísticamente significativo (p = 0,05). Conclusiones. La prevalencia del consumo de tabaco se mantuvo elevada en los "Hospitales sin Humo", aunque entre los profesionales de colectivos ejemplares (médicos y enfermeras) fue menor a la de la población general. El grado de implementación del proyecto aumentó en función del tiempo de adscripción a la Red, principalmente en el primer año de adopción del proyecto

Objectives. To evaluate the degree of implementation of tobacco prevention and control interventions and to determine the prevalence of smoking in the Catalan Network of Smoke-Free Hospitals according to the stage of adhesion to the project. Method. We performed an observational, descriptive, cross sectional study in 16 hospitals actively involved in the Catalan Network of Smoke-Free Hospitals (April 2005). Data were collected using the results of the self-audit, 9-item questionnaire of the European Network for Smoke Free Hospitals. To study tobacco consumption, we interviewed 3,896 employees. Data on sociodemographic characteristics, tobacco consumption, job category, tobacco control indicators, the project's stage of implementation, and adherence to the project were gathered. Results. The prevalence of smoking was 35%. The implementation stage among all the hospitals studied was 53.3%. The items with high implementation scores (above 70%) were commitment, communication, consumption control, environmental control, and follow-up. Higher scores in implemented activities were observed in hospitals that had passed from the registration phase (x­ = 26.6; standard deviation [SD] = 16.7) to subsequent phases (x­ = 59.7; SD = 14.1), with a statistically significant difference in the overall score (p = 0.05). Conclusions. The prevalence of smoking in the Catalan Network of Smoke-Free Hospitals remains high. However, the prevalence was lower among professionals serving as role models (physicians and nurses) than among the general population. The project's implementation increased according to the time since enrollment in the network, especially in the first year

Assessment of functional outcome in a national quality register for acute stroke: can simple self-reported items be transformed into the modified Rankin Scale?

BACKGROUND AND PURPOSE: To enable self-reporting of functional outcome in quality registers, the corresponding questions have to be easy to interpret. In scientific research, the modified Rankin Scale (mRS) is a standard assessment method. Such methods, with an outsider observer, are not feasible to use in quality registers. For several aspects, eg, comparisons between outcome in clinical studies and observational studies, we determined to see whether the functional outcome, as assessed in a quality register, can be transformed into mRS grades. METHODS: The agreement between self-reported functional outcome (including dependency, living situation, mobility, dressing and toileting) and mRS were analyzed using 555 stroke patients registered in Riks-Stroke, the Swedish quality register for acute stroke, during a 5-month period in 4 hospitals. The self-reported outcome and the mRS grades were concurrently assessed by a telephone interview performed by an experienced nurse 3 months after stroke. RESULTS: A translation using 5 of the questions from Riks-Stroke classified 76% of the patients to the correct mRS grade. The correlation between Riks-Stroke and mRS was 0.821 and Cohen's kappa (weighted) was 0.853. CONCLUSIONS: The study shows that self-reported functional outcome can be transformed into mRS grades with a high precision, making the translation useful for future comparative purposes in stroke outcome studies.

Competencias adquiridas en la carrera de Medicina. Comparación entre egresados de dos universidades, una pública y otra privada / Professional competencies learned at public and private medical schools

Se entiende por competencia, la capacidad de hacer alguna cosa o la capacidad de cumplir una tarea. El propósito de este trabajo es conocer qué competencias profesionales han logrado los egresados; comprobar si existen diferencias entre dos grupos de egresados y establecer si existe alguna relación éntrela cantidad de competencias que dicen haber logrado la valoración global que hacen de la formación universitaria recibida. Se diseñó un cuestionario con 34 conductas profesionales (marcar sí cuando se siente capaz de realizarla en forma autónoma) y una pregunta para valorar globalmente la formación recibida. El cuestionario se aplicó a dos grupos: egresados de una universidad pública (G1) y de una privada (G2).Los resultados se expresaron como porcentajes y medias de respuestas sí. Las 34 actividades representan agrupadas en 7 categorías. Se analizaron las diferencias entre ambos grupos. Respondieron 181 médicos, el promedio de respuestas positivas es de 28,18; diferencia significativa a favor del G1. El 100% de los egresados se sienten capaces de hacer una buena anamnesis y un examen físico completo. Los porcentajes más bajos de respuesta afirmativas se concentran en las conductas vinculadas decisiones terapéuticas, a intervenciones en salud comunitaria y a habilidades para el autoaprendizaje. Sólo en 8 de las 34 conductas profesionales se hallaron diferencias significativas a favor de G1.El 53% de los egresados evalúa como Buen ala formación recibida, no hay diferencia significativa entre ambos grupos. Se observa una correspondencia entre cantidad de respuestas sí y valoración de la formación recibida : a mejor valoración mayor número de respuestas positivas. Los resultados son similares en ambos grupos; los hallazgos están en consonancia con los de otros estudios publicados. Este tipo de cuestionario de autoevaluación puede ser uno de los instrumentos utilizar en la evaluación de resultados den programa de formación (AU)

This study was designed to determine whether medical graduates consider themselves proficient enough to perform a set of 34 professional competencies, and the perceived quality of their medical education. A self-assessment questionnaire was completed by 181 graduates, from a public medical school (Group 1) and a private medical school (Group 2). The form included 34 items related to medical competencies (yes/no) and one question concerning the quality of their medical education (excellent/very good/good/poor/very poor). Positive (yes) answers revealed a mean of 28.18 and a statistically significant difference supporting public education (Group 1). History taking and physical examination abilities showed the higher scores, while therapeutic decisions, community health issues, and continuous medical education had the lowest scores. Statistically significant differences were noted in eight of the 34 items, all in Group 1 physicians, Quality of medical education was considered "good" in 53% of cases, with no statistically significant differences among groups. A relationship between better medical education and more positive (yes) answers was found. Self-assessment questionnaires are useful to evaluate educational program outcomes (AU)

AdeQhos, un instrumento para la evaluación de la adecuación de la hospitalización en el pase de visita / AdeQhos, a tool to guague the appropriateness of hospitalization during the war round

Objetivos: Describir las características y propiedades clinimétricas del adeQhos®, un instrumento diseñado para la identificación de la inadecuación de la estancia hospitalaria por los propios clínicos durante el pase de visita.Material y métodos: A partir de dos instrumentos preexistentes se construyó adeQhos®, un instrumento con cuatro apartados (datos identificativos, siete criterios de evaluación de la adecuación de la estancia, juicio clínico y listado de causas de inadecuación). Se valoró la concordancia adeQhos® respecto al Appropriateness Evaluation Protocol (AEP) en 499 estancias en dos servicios de cirugía.Resultados: El tiempo promedio de revisión de una estancia con adeQhos® fue de un minuto. La evaluación externa con AEP identificó 34 estancias inadecuadas (6,8 por ciento), y la realizada con adeQhos® 79 (el 15,8 por ciento; intervalo de confianza [IC] del 95 por ciento, 12,7-19,3), de las que sólo 12 (2,3 por ciento) fueron consideradas inadecuadas conforme a los juicios subjetivos de los clínicos. El índice de concordancia global entre ambos instrumentos fue del 83 por ciento ( = 0,28; IC del 95 por ciento, 0,17-0,39) si se considera sólo el cumplimiento de criterios del adeQhos® y del 94,4 por ciento ( = 0,37; IC del 95 por ciento, 0,19-0,55) si consideran también los juicios clínicos. El valor predictivo para los casos etiquetados como adecuados fue del 95,2 por ciento.Conclusiones: Pese a la rapidez de su uso, adeQhos® evidenció un elevado grado de concordancia global con el AEP, una elevada especificidad y una baja sensibilidad, características que lo configuran como un instrumento útil para la evaluacion de la utilización inadecuada de la hospitalización y, sobre todo, como instrumento de intervención. (AU)

Reflective practice skills in undergraduates.

Critical self-appraisal skills are fundamental to professional competence. This study evaluated the educational contribution of self-assessment during individual students' projects.

Changes in learning-resource use across physicians' learning episodes.

INTRODUCTION: This study explores the numbers of learning resources physicians use at each stage in self-directed learning episodes addressing general problems. MATERIALS AND METHODS: A survey of a statewide random sample of doctors estimated the number of resources used at each stage in solving various general problems. RESULTS: The 50% response rate for faculty allowed generalization of findings to the population of these physicians; the rate for nonfaculty physicians was too low to allow generalization. Faculty findings showed (1) broader resource use in learning about diseases than diagnosis or therapeutics (2) comparable numbers of resources used in deciding whether to take on the learning problem and learning the required skills and knowledge, (3) greater numbers of resources selected to evaluate the problem and to learn the required skills and knowledge than to gain experience with the newly learned skills and knowledge, and (4) support for assertions that doctors value learning resources that are accessible, applicable, familiar, and time effective. DISCUSSION: The findings were interpreted in light of theory describing physicians' self-directed learning episodes, and implications are presented for physicians-in-training, physicians, and medical librarians.

Proceso de autoevaluación de la Fundación Hospital Manacor mediante el Modelo Europeo de Gestión de Calidad Total / Self-assessment process at Fundación Hospital Manacor using the European Model of Total Quality Management

Introducción: en 1998 la Fundación Hospital Manacor (FHM) inició la puesta en marcha de su Plan de Calidad Total. Método: se llevaron a cabo actividades de formación de los directivos asistenciales y no asistenciales en el Modelo Europeo y posteriormente se llevó a cabo un ejercicio de Autoevaluación. Resultados: el ejercicio de Autoevaluación es una herramienta útil para la implantación de estrategias de gestión basadas en los principios de calidad total. (AU)

Collecting cancer risk factor data from hospital outpatients: use of touch-screen computers.

The aim of this study was to assess the prevalence of selected cancer risk factor data from hospital outpatients and the proportion of "at risk" patients who would like help from hospital staff to reduce risk factors. A touch-screen computer collected data from outpatients in Newcastle, NSW, Australia. Eight hundred and nineteen outpatients completed the computerized interview. Of these, 35% were smokers, of whom 25% said that they would like help to stop smoking; 47% were overweight, with 48% indicating that they wanted assistance; 17% consumed harmful levels of alcohol, with 2% wanting help; 30% of eligible women were overdue for a Pap test, of whom 75% said that they wanted a referral to be screened, and 25% were overdue for a mammogram, of whom 83% said that they would like a referral for an examination. Touch-screen computerized health risk assessments are practical for collecting and monitoring valid cancer risk factor data for hospital outpatients.

Using videotaped benchmarks to improve the self-assessment ability of family practice residents.

PURPOSE: To address methodologic and statistical problems of previous studies of self-assessment by exposing participants to relevant standards, anchoring rating scales, and providing practice in the use of the assessment tool. METHOD: Fifty first- and second-year family practice residents performed a ten-minute patient interview with a difficult communication problem. Following each interview, the resident and two experts independently evaluated the resident's communication skills. The resident was then shown a videotape of four performances (ranging in quality from poor to good) of the same scenario. The resident evaluated the communication skills displayed in each performance and then reevaluated his or her own performance. RESULTS: The correlation between experts' evaluations and residents' self-evaluations was moderate immediately after the interview (r = 0.38) but increased significantly after the residents viewed the videotape (r = 0.52). This effect was more pronounced for first-year residents (0.22 to 0.45) than for second-year residents (0.53 to 0.65), although the difference was not significant. Post-hoc analysis revealed that neither initial nor post-benchmark self-assessment ability was related to the ability to accurately evaluate the benchmarks in a manner consistent with the experts. CONCLUSIONS: The ability to self-assess does not seem strongly tied to the ability to assess the performances of others on the same task. Nonetheless, providing a set of benchmarks against which trainees can compare their own performances improves their ability to self-evaluate even if the qualities of the benchmarks are not explicitly identified.

Stability of the Professional Development Assessment.

The Professional Development Assessment was constructed and pilot-tested with 76 students in three occupational therapy programs. A comparison of pretest and posttest scores yielded a significant correlation of .48, supporting the stability of responding over 1 to 2 years and suggesting usefulness of further development for evaluation of professional behaviors in students.

Evaluación de las actividades de detección y seguimiento del cáncer cervicouterino en población bajo cobertura de la Secretaría de Salud. México, 1992 / Evaluation of the activities of screening and follow-up of cervical uterine carcinoma from the population under coverage of the Ministry of Health in Mexico, 1992

Se presentan los resultados del programa de Detección Oportuna del Cáncer Cervicouterino para el año de 1992 que se conduce en las unidades de la Secretaría de Salud (SSA) basados en los informes anuales de Papanicolau de las unidades aplicativas y los laboratorios de diagnóstico en todo el país. En éstas se tomaron en total 1'022,862 Papanicolaus que representaron el 59.7 por ciento de logro con respecto a la meta programada. Existe un rango de la cobertura alcanzada de laminillas tomadas/usuarias, que va de 7.9 por ciento a 42.89 por ciento en las entidades. Las metas propuests sólo estaban estimando cubrir al 21 por ciento de la población bajo cobertura de la SSA. La incidencia determinada para displasia fue de 218.08 casos por cada 100,000 mujeres del grupo de edad de 15 a 69 años bajo cobertura de la SSA, y de cáncer cervicouterino fue de 64 casos por cada 100,000 mujeres del grupo de edad de 15 a 69 años bajo cobertura de la SSA. Se presentan estos resultados para que sirvan como marco de referencia a las estrategias del programa de Detección Oportuna de Cáncer Cervicouterino