Apuntes metodológicos para una etnografía reflexiva sobre la “discapacidad intelectual”

A propósito de una investigación antropológica desarrollada en un Centro de Día de la Ciudad de la Plata-Argentina, que buscaba comprender los mecanismos de producción social de la discapacidad intelectual, tuvo lugar un intercambio prolongado con una joven que asistía a dicho Centro. A través del relato etnográfico que tiene como protagonista a esta joven, pude visibilizar cuestiones de método: Las particularidades y ajustes metodológicos en el trabajo de campo con personas que han sido etiquetadas como portadorasde discapacidades intelectuales; las formas que toma la reflexividad y capacidad de agencia en los sujetos investigados; los cuestionamientos sobre mi rol como investigadora y terapeuta; la necesidad de desnaturalizar el escenario de entrevista; comprender el lugar y peso del cuerpo en el escenario de trabajo de campo; y las dinámicas que rodean la producción del dato etnográfico. Esta reflexión acerca del método, constituye un aporte a las investigaciones de carácter antropológico centradas en la comprensión de la discapacidad intelectual como hecho social y cultural. Para abordar estas cuestiones es necesario preguntarse: ¿Cuáles fueron las características singulares del proceso etnográfico al desarrollar una investigación centrada en personas con discapacidades intelectuales?, ¿Qué ocurre cuando el investigador hace parte del campo social que desea investigar?, y ¿Qué dicen las personas con discapacidad intelectual acerca de los métodos de investigación decampo

¿PEDAGOGÍA DE LA INCLUSIÓN? Una mirada hacia las prácticas educativas en personas con discapacidad

La pedagogía de la inclusión busca reconstruir un análisis histórico sobre los principios de normalidad/ anormalidad en occidente, describir cómo éstos han influido en la consolidación de prácticas de exclusión e inclusión que han invadido todas las esferas de la vida cotidiana, incluyendo la dimensión educativa y los procesos de escolarización. Estas reflexiones se dirigen principalmente hacia un tipo especial de sujeto que configura, en gran medida, una categoría que Foucault ha dado en denominar “de lo anormal”. Si bien, en este rango de anormalidad fueron incluidos homosexuales, criminales, locos, se hará un especial énfasis en sujetos con discapacidades. Entendiendo la pedagogía como una práctica para formar sujetos, se realizará un indagación sobre las características de este tipo de práctica pedagógica, que denominaremos “pedagogía de la inclusión”: cómo las razones para incluir-excluir a cierto tipo de sujetos y para prestar especial vigilancia sobre ellos; develando así, qué tipo de sujetos se están constituyendo por medio de estas prácticas, y cómo se ha constituido históricamente a un tipo especial de sujeto… al sujeto moderno de las minorías, al sujeto perteneciente a grupos humanos que han atravesado situaciones históricas de exclusión y condicionamiento

Shared learning from national to international contexts: A Research and Innovation Collaboration to Enhance Education for Patient Safety

Background: Patient safety is key for healthcare across the world and education is critical in improving practice. We drew on existing links to develop the Shared LearnIng from Practice to improve Patient Safety (SLIPPS) group. The group incorporates expertise in education, research, healthcare, healthcare organisation and computing from Norway, Spain, Italy, the UK and Finland. In 2016 we received co-funding from the Erasmus þ programme of the European Union for a 3-year project. Aim: SLIPPS aims to develop a tool to gather learning events related to patient safety from students in each country, and to use these both for further research to understand practice, and to develop educational activities (virtual seminars, simulation scenarios and a game premise). Study outline: The SLIPPS project is well underway. It is underpinned by three main theoretical bodies of work: the notion of diverse knowledge contexts existing in academia, practice and at an organisational level; the theory of reflective practice; and experiential learning theory. The project is based on recognition of the unique position of students as they navigate between contexts, experience and reflect on important learning events related to patient safety. To date, we have undertaken the development of the SLIPPS Learning Event Recording Tool (SLERT) and have begun to gather event descriptions and reflections. Conclusions: Key to the ongoing success of SLIPPS are relationships and reciprocal openness to view things from diverse perspectives and cultures

Action after Adverse Events in Healthcare: An Integrative Literature Review

Adverse events are common in healthcare. Three types of victims of patient-related adverse events can be identified. The first type includes patients and their families, the second type includes healthcare professionals involved in an adverse event and the third type includes healthcare organisations in which an adverse event occurs. The purpose of this integrative review is to synthesise knowledge, theory and evidence regarding action after adverse events, based on literature published in the last ten years (2009–2018). In the studies critically evaluated (n = 25), key themes emerged relating to the first, second and third victim elements. The first victim elements comprise attention to revealing an adverse event, communication after an event, first victim support and complete apology. The second victim elements include second victim support types and services, coping strategies, professional changes after adverse events and learning about adverse event phenomena. The third victim elements consist of organisational action after adverse events, strategy, infrastructure and training and open communication about adverse events. There is a lack of comprehensive models for action after adverse events. This requires understanding of the phenomenon along with ambition to manage adverse events as a whole. When an adverse event is identified and a concern expressed, systematic damage preventing and ameliorating actions should be immediately launched. System-wide development is needed.</p

Unsupervised machine learning predicts future sexual behaviour and sexually transmitted infections among HIV-positive men who have sex with men

Machine learning is increasingly introduced into medical fields, yet there is limited evidence for its benefit over more commonly used statistical methods in epidemiological studies. We introduce an unsupervised machine learning framework for longitudinal features and evaluate it using sexual behaviour data from the last 20 years from over 3'700 participants in the Swiss HIV Cohort Study (SHCS). We use hierarchical clustering to find subgroups of men who have sex with men in the SHCS with similar sexual behaviour up to May 2017, and apply regression to test whether these clusters enhance predictions of sexual behaviour or sexually transmitted diseases (STIs) after May 2017 beyond what can be predicted with conventional parameters. We find that behavioural clusters enhance model performance according to likelihood ratio test, Akaike information criterion and area under the receiver operator characteristic curve for all outcomes studied, and according to Bayesian information criterion for five out of ten outcomes, with particularly good performance for predicting future sexual behaviour and recurrent STIs. We thus assess a methodology that can be used as an alternative means for creating exposure categories from longitudinal data in epidemiological models, and can contribute to the understanding of time-varying risk factors

Unsupervised machine learning predicts future sexual behaviour and sexually transmitted infections among HIV-positive men who have sex with men.

Machine learning is increasingly introduced into medical fields, yet there is limited evidence for its benefit over more commonly used statistical methods in epidemiological studies. We introduce an unsupervised machine learning framework for longitudinal features and evaluate it using sexual behaviour data from the last 20 years from over 3'700 participants in the Swiss HIV Cohort Study (SHCS). We use hierarchical clustering to find subgroups of men who have sex with men in the SHCS with similar sexual behaviour up to May 2017, and apply regression to test whether these clusters enhance predictions of sexual behaviour or sexually transmitted diseases (STIs) after May 2017 beyond what can be predicted with conventional parameters. We find that behavioural clusters enhance model performance according to likelihood ratio test, Akaike information criterion and area under the receiver operator characteristic curve for all outcomes studied, and according to Bayesian information criterion for five out of ten outcomes, with particularly good performance for predicting future sexual behaviour and recurrent STIs. We thus assess a methodology that can be used as an alternative means for creating exposure categories from longitudinal data in epidemiological models, and can contribute to the understanding of time-varying risk factors

Unsupervised machine learning predicts future sexual behaviour and sexually transmitted infections among HIV-positive men who have sex with men

Machine learning is increasingly introduced into medical fields, yet there is limited evidence for its benefit over more commonly used statistical methods in epidemiological studies. We introduce an unsupervised machine learning framework for longitudinal features and evaluate it using sexual behaviour data from the last 20 years from over 3'700 participants in the Swiss HIV Cohort Study (SHCS). We use hierarchical clustering to find subgroups of men who have sex with men in the SHCS with similar sexual behaviour up to May 2017, and apply regression to test whether these clusters enhance predictions of sexual behaviour or sexually transmitted diseases (STIs) after May 2017 beyond what can be predicted with conventional parameters. We find that behavioural clusters enhance model performance according to likelihood ratio test, Akaike information criterion and area under the receiver operator characteristic curve for all outcomes studied, and according to Bayesian information criterion for five out of ten outcomes, with particularly good performance for predicting future sexual behaviour and recurrent STIs. We thus assess a methodology that can be used as an alternative means for creating exposure categories from longitudinal data in epidemiological models, and can contribute to the understanding of time-varying risk factors

Action after Adverse Events in Healthcare: An Integrative Literature Review

Adverse events are common in healthcare. Three types of victims of patient-related adverse events can be identified. The first type includes patients and their families, the second type includes healthcare professionals involved in an adverse event and the third type includes healthcare organisations in which an adverse event occurs. The purpose of this integrative review is to synthesise knowledge, theory and evidence regarding action after adverse events, based on literature published in the last ten years (2009–2018). In the studies critically evaluated (n = 25), key themes emerged relating to the first, second and third victim elements. The first victim elements comprise attention to revealing an adverse event, communication after an event, first victim support and complete apology. The second victim elements include second victim support types and services, coping strategies, professional changes after adverse events and learning about adverse event phenomena. The third victim elements consist of organisational action after adverse events, strategy, infrastructure and training and open communication about adverse events. There is a lack of comprehensive models for action after adverse events. This requires understanding of the phenomenon along with ambition to manage adverse events as a whole. When an adverse event is identified and a concern expressed, systematic damage preventing and ameliorating actions should be immediately launched. System-wide development is needed.The sixth author would like to thank INVEST Research Flagship funded by the Academy of Finland Flagship Programme (decision number: 320162)

Critical Incident Techniques and Reflection in Nursing and Health Professions Education

Background: The terms critical incident technique and reflection are widely used but often not fully explained, resulting in ambiguity. Purpose: The aims of this review were to map and describe existing approaches to recording or using critical incidents and reflection in nursing and health professions literature over the last decade; identify challenges, facilitating factors, strengths, and weaknesses; and discuss relevance for nursing education. Methods: A systematic narrative review was undertaken. MEDLINE and the Cumulative Index to Nursing and Allied Health Literature were searched using MeSH terms, returning 223 articles (2006-2017). After exclusions, 41 were reviewed. Results: Articles were categorized into 3 areas: descriptions of the development of an original tool or model, critical incidents or reflection on events used as a learning tool, and personal reflections on critical incidents. Conclusions: Benefits have been identified in all areas. More attention is needed to the pedagogy of reflection and the role of educators in reflection