Avaliação e a Qualidade das Práticas de Inclusão para Alunos com PEA: Escala LAQI (Louisiana Autism Quality Indicators)

Dissertação apresentada à Escola Superior de Educação de Lisboa para obtenção de grau de mestre em Educação Especial, domínio Cognição e MultideficiênciaA Escola é um espaço promotor de diversas aprendizagens, um espaço rico de partilha de vivências, de constructo do ser humano, enquanto individualidade própria, e enquanto ser social. O sistema educativo português consubstancia o acesso à Educação para todos, nomeadamente a alunos com Perturbação do Espectro do Autismo (PEA). Neste estudo, centramo-nos no tema da Avaliação das Práticas de Inclusão para alunos com PEA. Este divide-se em duas fases: uma primeira, que procura conhecer as práticas implementadas para a Inclusão de alunos com PEA e o processo e instrumentos de avaliação utilizados pela equipa multidisciplinar para melhorar a intervenção; e uma segunda fase, que consiste na sugestão de análise do instrumento de avaliação LAQI, para depois se verificar a sua utilidade e viabilidade no contexto português. De modo a orientar o estudo, elaboramos um conjunto de questões: i) primeira fase: que práticas educativas são desenvolvidas pelos profissionais que intervém com alunos com PEA?; que concepções e que processos de avaliação da qualidade das práticas para a Inclusão de alunos com PEA são implementados? ii) segunda fase: o instrumento de avaliação é útil na avaliação da qualidade de práticas de Inclusão para alunos com PEA?; a LAQI adequa-se ao contexto português, no que concerne à avaliação de práticas educativas para alunos com PEA? Neste sentido, o estudo apresenta os seguintes objetivos gerais para a primeira fase: conhecer o modo como a equipa organiza as respostas educativas para alunos com PEA; conhecer o processo de avaliação das práticas para a inclusão de alunos com PEA; conhecer a opinião dos profissionais sobre a utilidade da avaliação das práticas educativas e as dificuldades sentidas nesse processo. Na segunda fase, procurou-se conhecer a opinião dos profissionais sobre a viabilidade de utilização de um instrumento de avaliação, tendo como sugestão a LAQI (traduzido como " Indicadores de Qualidade no Autismo para as Escolas - Louisiana). Em termos de instrumentos e técnicas de recolha e análise de dados foram utilizados duas entrevistas semidiretivas, a análise documental e a análise de conteúdo. Este estudo envolveu a participação de 5 docentes de educação especial a trabalhar em Escolas com UEE's, na área de Lisboa e Loures. O estudo apresenta cariz qualitativo,numa linha de índole descritiva-interpretativa. A análise de dados sugere-nos que são implementadas práticas de inclusão e que a família tem um papel ativo no percurso educativo do aluno com PEA. O trabalho em equipa é pouco consistente, embora se verifique uma tendência para se modificar esta realidade. Alguns constrangimentos interferem na dinâmica da equipa: falta de horário comum para reunir, pouco envolvimento de alguns agentes educativos e o fato de os terapeutas são serem afetos às escolas. Por outro lado, a avaliação de práticas realiza-se pela equipa, mas sobressai o seu caráter informal. Para a implementação do processo de avaliação, os resultados auferem a necessidade de um processo organizado e instituído, com linhas orientadoras, documentação de suporte e disponibilização de instrumentos de avaliação. Referem, ainda, a necessidade de formação específica na área da avaliação para a qualidade de práticas inclusivas. Relativamente ao uso do instrumento de avaliação LAQI, conclui-se que é adequado ao contexto português e exequível no seu preenchimento. Surgem algumas dúvidas quanto à formulação de alguns descritores e quantificadores, no entanto esta percepção pode estar eventualmente relacionada com aspectos da tradução da LAQI ou com a diferenciação de contextos. O instrumento surge como uma mais valia no apoio ao processo de avaliação, pois permite refletir em equipa e melhorar a qualidade das respostas para a Inclusão de alunos com PEA.ABSTRACT The School is a promoter of different learning space, a rich space for sharing experiences, construct of the human being, while individuality itself, and as a social being. The Portuguese education system consolidates access to education for all, including students with Autism Spectrum Disorder (ASD). In this study, we focus on the issue of Evaluation of Inclusion Practices for students with ASD. This is divided into two phases: the first, which is seeking the practices implemented for Inclusion of students with ASD and the process and assessment tools, which are used by the multidisciplinary team to improve the operation; and a second phase consisting of the analysis of suggestion LAQI assessment tool to later verify their usefulness and practicality in Portuguese context. In order to guide the study, we developed a set of questions: i) first phase: that educational practices are developed by professionals who intervene with students with ASD?; that concepts and procedures to assess the quality of practices for the inclusion of students with ASD are implemented? ii) second phase: the assessment tool is useful in assessing the quality of inclusion practices for students with ASD?; the LAQI fits the Portuguese context, regarding the evaluation of educational practices for students with ASD? In this sense, the study presents the following general objectives for the first phase: to know how the team organizes educational provision for pupils with ASD; know the process of assessing practices for the inclusion of students with ASD; know the opinion of professionals about the usefulness of educational practices and the difficulties encountered in this process. In the second phase, we tried to know the opinion of professionals about the feasibility of using an assessment tool, with the suggestion to LAQI (Quality Indicators of Autism for Schools - Louisiana). In terms of tools and techniques of data collection and analysis used two semi-directive interviews, document analysis and content analysis. This study involved the participation of 5 special education teachers working in schools with UEE's in the area of Lisbon and Loures. The study presents qualitative nature, a line of descriptiveinterpretative nature. Data analysis suggested that the inclusion practices are implemented and that the family plays an active role in the education of the students' progress with ASD.Teamwork is weak, although there is a tendency to change this reality. Some constraints interfere in team dynamics: lack of common time to gather, little involvement of some educators and the fact that therapists are being affections to schools. On the other hand, the evaluation practices carried out by the team, but excel their informal character. For the implementation of the evaluation process, the results earn the need for an organized and established process, with guidelines, supporting documentation and availability of assessment tools. They also report that the need for specific training in the field of evaluation for the quality of inclusive practices. Regarding the use of LAQI assessment tool, it is concluded that it is appropriate and feasible to Portuguese context of completion. Raises some doubts about the wording of some descriptors and quantifiers, however this perception may be possibly related to the translation aspects of LAQI or the differentiation of contexts. The instrument comes as an added value in supporting the evaluation process because it allows reflect a team and improve the quality of the answers to the inclusion of students with ASD

SARS-CoV-2 introductions and early dynamics of the epidemic in Portugal

Genomic surveillance of SARS-CoV-2 in Portugal was rapidly implemented by the National Institute of Health in the early stages of the COVID-19 epidemic, in collaboration with more than 50 laboratories distributed nationwide. Methods By applying recent phylodynamic models that allow integration of individual-based travel history, we reconstructed and characterized the spatio-temporal dynamics of SARSCoV-2 introductions and early dissemination in Portugal. Results We detected at least 277 independent SARS-CoV-2 introductions, mostly from European countries (namely the United Kingdom, Spain, France, Italy, and Switzerland), which were consistent with the countries with the highest connectivity with Portugal. Although most introductions were estimated to have occurred during early March 2020, it is likely that SARS-CoV-2 was silently circulating in Portugal throughout February, before the first cases were confirmed. Conclusions Here we conclude that the earlier implementation of measures could have minimized the number of introductions and subsequent virus expansion in Portugal. This study lays the foundation for genomic epidemiology of SARS-CoV-2 in Portugal, and highlights the need for systematic and geographically-representative genomic surveillance.We gratefully acknowledge to Sara Hill and Nuno Faria (University of Oxford) and Joshua Quick and Nick Loman (University of Birmingham) for kindly providing us with the initial sets of Artic Network primers for NGS; Rafael Mamede (MRamirez team, IMM, Lisbon) for developing and sharing a bioinformatics script for sequence curation (https://github.com/rfm-targa/BioinfUtils); Philippe Lemey (KU Leuven) for providing guidance on the implementation of the phylodynamic models; Joshua L. Cherry (National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health) for providing guidance with the subsampling strategies; and all authors, originating and submitting laboratories who have contributed genome data on GISAID (https://www.gisaid.org/) on which part of this research is based. The opinions expressed in this article are those of the authors and do not reflect the view of the National Institutes of Health, the Department of Health and Human Services, or the United States government. This study is co-funded by Fundação para a Ciência e Tecnologia and Agência de Investigação Clínica e Inovação Biomédica (234_596874175) on behalf of the Research 4 COVID-19 call. Some infrastructural resources used in this study come from the GenomePT project (POCI-01-0145-FEDER-022184), supported by COMPETE 2020 - Operational Programme for Competitiveness and Internationalisation (POCI), Lisboa Portugal Regional Operational Programme (Lisboa2020), Algarve Portugal Regional Operational Programme (CRESC Algarve2020), under the PORTUGAL 2020 Partnership Agreement, through the European Regional Development Fund (ERDF), and by Fundação para a Ciência e a Tecnologia (FCT).info:eu-repo/semantics/publishedVersio

Delayed colorectal cancer care during covid-19 pandemic (decor-19). Global perspective from an international survey

Background The widespread nature of coronavirus disease 2019 (COVID-19) has been unprecedented. We sought to analyze its global impact with a survey on colorectal cancer (CRC) care during the pandemic. Methods The impact of COVID-19 on preoperative assessment, elective surgery, and postoperative management of CRC patients was explored by a 35-item survey, which was distributed worldwide to members of surgical societies with an interest in CRC care. Respondents were divided into two comparator groups: 1) ‘delay’ group: CRC care affected by the pandemic; 2) ‘no delay’ group: unaltered CRC practice. Results A total of 1,051 respondents from 84 countries completed the survey. No substantial differences in demographics were found between the ‘delay’ (745, 70.9%) and ‘no delay’ (306, 29.1%) groups. Suspension of multidisciplinary team meetings, staff members quarantined or relocated to COVID-19 units, units fully dedicated to COVID-19 care, personal protective equipment not readily available were factors significantly associated to delays in endoscopy, radiology, surgery, histopathology and prolonged chemoradiation therapy-to-surgery intervals. In the ‘delay’ group, 48.9% of respondents reported a change in the initial surgical plan and 26.3% reported a shift from elective to urgent operations. Recovery of CRC care was associated with the status of the outbreak. Practicing in COVID-free units, no change in operative slots and staff members not relocated to COVID-19 units were statistically associated with unaltered CRC care in the ‘no delay’ group, while the geographical distribution was not. Conclusions Global changes in diagnostic and therapeutic CRC practices were evident. Changes were associated with differences in health-care delivery systems, hospital’s preparedness, resources availability, and local COVID-19 prevalence rather than geographical factors. Strategic planning is required to optimize CRC care

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine