Lessons learnt from comprehensive evaluation of community-based education in Uganda: a proposal for an ideal model community-based education for health professional training institutions

<p>Abstract</p> <p>Background</p> <p>Community-based education (CBE) can provide contextual learning that addresses manpower scarcity by enabling trainees acquire requisite experiences, competence, confidence and values. In Uganda, many health professional training institutions conduct some form of community-based education (CBE). However, there is scanty information on the nature of the training: whether a curriculum exists (objectives, intended outcomes, content, implementation strategy), administration and constraints faced. The objective was to make a comprehensive assessment of CBE as implemented by Ugandan health professional training institutions to document the nature of CBE conducted and propose an ideal model with minimum requirements for health professional training institutions in Uganda.</p> <p>Methods</p> <p>We employed several methods: documentary review of curricula of 22 institutions, so as to assess the nature, purpose, outcomes, and methods of instruction and assessment; s<it>ite visits </it>to these institutions and their CBE sites, to assess the learning environment (infrastructure and resources); in-depth interviews with key people involved in running CBE at the institutions and community, to evaluate CBE implementation, challenges experienced and perceived solutions.</p> <p>Results</p> <p>CBE was perceived differently ranging from a subject, a course, a program or a project. Despite having similar curricula, institutions differ in the administration, implementation and assessment of CBE. Objectives of CBE, the curricula content and implementation strategies differ in similar institutions. On collaborative and social learning, most trainees do not reside in the community, though they work on group projects and write group reports. Lectures and skills demonstrations were the main instruction methods. Assessment involved mainly continuous assessment, oral or written reports and summative examination.</p> <p>Conclusion</p> <p>This assessment identified deficiencies in the design and implementation of CBE at several health professional training institutions, with major flaws identified in curriculum content, supervision of trainees, inappropriate assessment, trainee welfare, and underutilization of opportunities for contextual and collaborative learning. Since CBE showed potential to benefit the trainees, community and institutions, we propose a model that delivers a minimum package of CBE and overcomes the wide variation in the concept, conduct and implementation of CBE.</p

Conservative treatment of a comminuted cervical fracture in a racehorse

The 'classical' or 'Hangman' neck fracture involves the odontoid peg (process) of the second cervical vertebra (C2), and is described as an axial, dens or odontoid peg fracture in both the veterinary and human literature. Possible surgical treatment in both foals and adult horses requires a technique that allows decompression, anatomical alignment and stabilisation of the odontoid fracture. A limited number of surgical cases in foals have been reported in literature, but never in an adult horse. A mature Irish Thoroughbred racehorse was diagnosed with a type 2a odontoid peg fracture. Clinical signs included reluctance to move the head and neck, a left hind limb lameness and a neurological status of grade 2. The horse was treated conservatively and raced successfully five months after the diagnosed injury

AMBULANSSISSA TYÖSKENTELEVÄN TYÖTURVALLISUUS, VÄKIVALTAINEN ASIAKAS / ITSEPUOLUSTUS OC-KAASULLA. KOULUTUSMALLIN SUUNNITTELU, TOTEUTUS SEKÄ ARVIOINTI KYMENLAAKSON PELAS-TUSLAITOKSELLE

Tämän opinnäytetyön tarkoituksena oli järjestää Kymenlaakson Pelastuslaitoksen ensihoitohenki-löstölle koulutuspäivä, jossa käsiteltiin väkivaltaisen potilaan kohtaamista ensihoitotehtävissä sekä OC -kaasun käyttöä itsepuolustuksena. Ensihoitohenkilöstö joutuu nykypäivänä kohtaamaan työteh-tävissään erilaisia uhka- ja väkivaltatilanteita, joissa väkivallan merkkien tunteminen ja oikeanlai-nen toiminta uhkaavassa tilanteessa voivat ehkäistä tilanteen eskaloitumista. OC -kaasua voidaan käyttää itsepuolustustarkoituksessa, mutta sen käyttö vaatii lain mukaan asianmukaisen koulutuk-sen. Opinnäytetyön tavoitteena oli laatia Kymenlaakson Pelastuslaitoksen ensihoitohenkilöstölle yhte-näinen toimintamalli väkivaltaisen potilaan kohtaamiseen ja tilanteessa toimimiseen. Koulutuspäi-vän tavoitteena oli myös kouluttaa ensihoitajille OC -kaasun turvallinen käyttö viimeisenä keinona hätävarjelutilanteessa. Tavoitteen saavuttamiseen käytettiin OC -kaasun koulutuksessa vaadittavaa koulutuskorttia, jonka pohjalta koulutus pidettiin. Tämä työ toteutettiin toiminnallisena opinnäytetyönä. Opinnäytetyöhön liittyvät koulutukset toteu-tettiin Kymenlaakson Pelastuslaitoksen tiloissa Haminassa, Kotkassa ja Kouvolassa. Koulutuksesta saadun palautteen perusteella 96 % koulutettavista (n=78) oli sitä mieltä, että koulutus oli onnistu-nut ja tarpeellinen. 69 % oli sitä mieltä, että koulutus antoi heille riittävät tiedot väkivaltaisuuteen johtavista ennakoivista merkeistä. 42 % koulutettavista koki, että koulutus opetti heille selkeän toi-mintamallin vaaratilanteisiin.The purpose of this thesis was to arrange an education and training day for the personnel who are working as paramedics in Kymenlaakso Rescue Department. Education and training consisted of confronting a violent patient in emergency medical care tasks and using OC-gas for the purpose of self-defense. Paramedics have to confront different kind of threatening and violent situations at their work. Then, recognizing signs of violence in a patient and the right kind of action in a threatening situation can prevent the situation from escalating to violence. OC- gas can be used as a self-defense, but law requires that a person who uses or operates an OC-sprayer must have proper training to use it. The aim of this thesis was to establish a uniform operation model to confront a violent patient and to operate in violent situations for paramedics who work in Kymenlaakso Rescue Department. The aim of the education and training day was also to teach the safe use of OC- gas in act of self-defense as a last resort. For the proper use of OC-sprayer training, we used a training-card as a basis to a achieve of the objective. This work was implemented as a functional thesis. The education and training part related to this thesis were conducted in Kymenlaakso Rescue Department´s premises in Kotka, Hamina and Kou-vola. Based on feedback from the training 96% of trainees (n = 78) were of the opinion that the training was successful and necessary. 69% were of the opinion that the training gave them suffi-cient information of proactive signs that could lead to violence. 42% of trainees felt that the training taught them an explicit approach to hazard situation

Keeping it Real: Encountering Mixed Reality in igloo’s SwanQuake: House

This paper employs the writings of early twentieth-century phenomenologists to examine physical/virtual dualism a century later. It considers the nature of embodied experience in mixed reality environments through an analysis of the author’s encounter with an art installation. The paper reflects on post-Cartesian approaches to the body and new media, noting the resistance of the language of philosophy to the articulation of mixed reality as a concept. If the language of the field constructs dualism, and the cyborgian unitization of human/technology invokes responses of horror or pity, are we prepared socially or culturally to inhabit mixed reality environments as embodied beings