Alignment in social interactions Gallotti, M.; Fairhurst, M.T.; Frith, C.D.
Consciousness and cognition,
February 2017, 2017-02-00, 20170201, Letnik:
48
Journal Article
Recenzirano
Odprti dostop
•A new approach to social cognition in terms of mental alignment is proposed.•The dynamic and graded exchange of information between agents creates alignment.•Not all forms of joint action in which ...the agents align will turn out to be social interactions.•Shared goals are not needed for mutual alignment to occur.•Two important theoretical developments follow from focusing on processes of mental alignment.
According to the prevailing paradigm in social-cognitive neuroscience, the mental states of individuals become shared when they adapt to each other in the pursuit of a shared goal. We challenge this view by proposing an alternative approach to the cognitive foundations of social interactions. The central claim of this paper is that social cognition concerns the graded and dynamic process of alignment of individual minds, even in the absence of a shared goal. When individuals reciprocally exchange information about each other's minds processes of alignment unfold over time and across space, creating a social interaction. Not all cases of joint action involve such reciprocal exchange of information. To understand the nature of social interactions, then, we propose that attention should be focused on the manner in which people align words and thoughts, bodily postures and movements, in order to take one another into account and to make full use of socially relevant information.
Nurse understaffing is frequently hypothesized as a potential risk factor for healthcare-associated infections (HAI). This study aimed to evaluate the role of nursing workload in the occurrence of ...HAI, using Nursing Activities Score (NAS).
This prospective cohort study enrolled all patients admitted to 3 Medical ICUs and one step-down unit during 3 months (2009). Patients were followed-up until HAI, discharge or death. Information was obtained from direct daily observation of medical and nursing rounds, chart review and monitoring of laboratory system. Nursing workload was determined using NAS. Non-compliance to the nurses' patient care plans (NPC) was identified. Demographic data, clinical severity, invasive procedures, hospital interventions, and the occurrence of other adverse events were also recorded. Patients who developed HAI were compared with those who did not.
195 patients were included and 43 (22%) developed HAI: 16 pneumonia, 12 urinary-tract, 8 bloodstream, 2 surgical site, 2 other respiratory infections and 3 other. Average NAS and average proportion of non compliance with NPC were significantly higher in HAI patients. They were also more likely to suffer other adverse events. Only excessive nursing workload (OR: 11.41; p: 0.019) and severity of patient's clinical condition (OR: 1.13; p: 0.015) remained as risk factors to HAI.
Excessive nursing workload was the main risk factor for HAI, when evaluated together with other invasive devices except mechanical ventilation. To our knowledge, this study is the first to evaluate prospectively the nursing workload as a potential risk factor for HAI, using NAS.
Empathy is a central characteristic of medical professionalism and has recently gained attention in medical education research. The Jefferson Scale of Empathy is the most commonly used measure of ...empathy worldwide, and to date it has been translated in 39 languages. This study aimed to adapt the Jefferson Scale of Empathy to the Brazilian culture and to test its reliability and validity among Brazilian medical students.
The Portuguese version of the Jefferson Scale of Empathy was adapted to Brazil using back-translation techniques. This version was pretested among 39 fifth-year medical students in September 2010. During the final fifth- and sixth-year Objective Structured Clinical Examination (October 2011), 319 students were invited to respond to the scale anonymously. Cronbach's alpha, exploratory factor analysis, item-total correlation, and gender comparisons were performed to check the reliability and validity of the scale.
The student response rate was 93.7% (299 students). Cronbach's coefficient for the scale was 0.84. A principal component analysis confirmed the construct validity of the scale for three main factors: Compassionate Care (first factor), Ability to Stand in the Patient's Shoes (second factor), and Perspective Taking (third factor). Gender comparisons did not reveal differences in the scores between female and male students.
The adapted Brazilian version of the Jefferson Scale of Empathy proved to be a valid, reliable instrument for use in national and cross-cultural studies in medical education.
Developing clearly defined competencies and identifying strategies for their measurement remain unfortunately a critical aspect of nursing training. In the current international context, which ...continues to be characterised by deep economic crisis, universities have a fundamental role to play in redefining the educational goals to respond to the expectations of certain geographical areas of interest, as underscored in the Bologna Process (Joint Declaration of the European Ministers of Education Convened in Bologna 19 June 1999).
The aim of this observational study was to examine the clinical learning context of nursing students using a tool developed by a team of teachers for the analysis of clinical learning.
Redefinition of the clinical learning objectives with reference to the competencies set out in the questionnaire validated by Venturini et al. (2012) and the subsequent use of the tool created by the team of teachers for students in the first, second and third-year courses of the 2013/14 academic year, covering all the internships called for in those years.
All nursing students enrolled in the first, second and third year of the nursing undergraduate degree program at the University of Pavia (no. 471) participated in this survey. A total of 1,758 clinical internships were carried out: 461 for the first year, 471 for the second year and 826 for the third year. Setting objectives, beginning with the educational offerings in the several clinical contexts, represents a strong point for this process. The results highlight a level of heterogeneity and complexity intrinsic to the University of Pavia educational system, characterized by clinical settings with different clinical levels (Research hospital and other traditional hospitals) that offering different levels of training.
The use of the self-evaluation form for clinical learning made it possible to perform real-time observations of the training activities of the entire student body. An educational model structured in this way allows the student to develop their capacity for critical thinking. For educational activities, such a self-evaluation form represents an ideal instrument for identifying areas in need of improvement. This explorative study, carried out by means of a self-evaluation form, is the first-step toward the development of an educational programme that is more uniform and easily traceable within the academic system.
Aim of the present investigation was to analyse the possible malignant transformation of oral lichen planus to carcinoma, especially in the atrophic erosive forms and those displaying plaques ...involving the top of the tongue. A review has been made of the literature, from 1986 to the present day. This search outlines the relationship between oral lichen planus, hepatitis C virus infection, Epstein-Barr virus infection and the importance of periodic follow-up in all patients with oral lichen planus. The case is described of malignant transformation of oral lichen planus to oral cancer in a female presenting asymptomatic hepatitis C virus infection. The clinical history confirms the most important aspects of the relationship between oral lichen planus and oral cancer. Oral lichen planus should be considered as a precancerous lesion, particularly in patients presenting hepatitis C virus infection, requiring follow-up, at close intervals, starting from 3 months after diagnosis.
Use of the Valsalva graft and long-term follow-up De Paulis, Ruggero, MD; Scaffa, Raffaele, MD; Nardella, Saverio, MD ...
Journal of thoracic and cardiovascular surgery (Print),
12/2010, Letnik:
140, Številka:
6
Journal Article, Conference Proceeding
Recenzirano
Odprti dostop
Objective The Valsalva graft is a specifically designed Dacron graft that, on implantation and pressurization, generates pseudosinuses of Valsalva. We reviewed a multicenter experience of the ...reimplantation procedure with the Valsalva graft in patients with aneurysms involving the aortic root. Methods A total of 278 patients underwent valve-sparing aortic root replacement using the Valsalva graft at 4 different Italian cardiac surgery centers and were studied by clinical assessment and echocardiography. Of the 278 patients, 220 were men (79%), with a mean age of 56 ± 15 years. Of the patients, 42 (15%) had Marfan syndrome, 31 (11%) had a bicuspid aortic valve, 13 (5%) had acute aortic dissection, and 136 (49%) had grade 3 or 4+ aortic insufficiency. Concomitant cardiac procedures were performed in 78 patients (28%). Additional aortic leaflet repair was necessary in 25 patients (9%). The mean crossclamp time was 120 ± 27 minutes. Results There were 5 (1.8%) operative and 5 (1.8%) late deaths. The mean follow-up was 52 ± 28 months (range, 2–112 months) and was 100% complete. The cumulative actuarial survival was 95.2% (268 patients). A total of 32 patients (11%) had grade 3 to 4+ aortic insufficiency, and 17 of these required late aortic valve replacement (range, 3–78 months). At 10 years of follow-up, the freedom from aortic valve reoperation rate was 91%, and the rate of freedom from residual aortic insufficiency not needing reoperation was 88%. Conclusions The reimplantation type of valve-sparing procedure can be facilitated by the use of the Valsalva graft and can be performed with satisfactory perioperative and midterm results. How an optimal root reconstruction will affect the second decade of follow-up has yet to be determined.
The Senning and Mustard operations for dextro-transposition of the great arteries are associated with an increased risk for supraventricular tachycardia. Catheter ablation has been shown to be ...acutely successful for achieving rhythm control in this population, but the mechanisms of recurrence are ill-defined.
We hypothesized that the type and degree of recurrence would vary by the surgical technique used.
All consecutive catheter ablation procedures for dextro-transposition of the great arteries after the Mustard or Senning operation between 2004 and 2016 at a single center were reviewed. Tachycardia mechanisms were determined by complete 3-dimensional mapping in addition to a standard electrophysiological technique for all cases.
Twenty-eight patients underwent 38 procedures during the study period. The most common mechanism at the index procedure was intra-atrial reentrant tachycardia using the cavotricuspid isthmus. Over a median follow-up period of 1.6 years, 9 patients experienced recurrent tachycardia (32%), all of whom underwent repeat catheter ablation. Tachycardia recurrence was more common after the Senning vs the Mustard operation (6 of 10 60% vs 3 of 18 17%; P = .034). In addition, substrates for recurrence were different from those encountered at the index procedure in 10 of 13 tachycardias (77%), with the single most common location being the posterior anastomosis after the Senning operation. Complete control was ultimately achieved in 27 patients (96%) when considering all procedures.
Recurrent tachycardia after catheter ablation appears to be more common after the Senning operation and to involve substrates unique to this repair. The posterior anastomosis is commonly implicated and should not be overlooked.
New hybrid approaches for atrial fibrillation (AF) ablation, combining surgical and percutaneous procedures, are emerging to enhance the long-term success rate of these 2 procedures severally ...considered. Recent guidelines underline the need for long-term follow-up to really assess the efficacy of AF ablation.
From 2000 to 2002, 33 patients with long-standing persistent AF and valvular heart disease underwent valve surgery and cryoablation (pulmonary veins isolation and mitral isthmus and roof line lesions). The surgically created ablation scheme was validated with electroanatomic mapping and percutaneous radiofrequency ablation was performed in case of lesion incompleteness.
In 19 of 33 patients (58%) the electroanatomic mapping showed a complete lesion scheme, which increased to 79% (26 of 33) with the addition of radiofrequency ablation. At the mean follow-up of 10.7 ± 3.1 years, 73% (24 of 33) of patients were in sinus rhythm (SR), whereas 27% had permanent AF. At the end of follow-up 81% of patients with a complete lesion scheme were in SR, while 43% with an incomplete one maintained SR (p = 0.048).
In patients with long-standing persistent AF and valvular heart disease, the hybrid approach with surgical cryoablation consisting of pulmonary veins isolation and left atrial linear lesions combined with transcatheter radiofrequency ablation was highly effective in maintaining SR for a very long-term follow-up. Electrophysiological evaluation, to validate the transmurality of the surgical lesions and to complete the lesion scheme applying radiofrequency energy, improved the long-term efficacy.
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