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Academic leaders instinctively replicate their own historical best practices or those that their peer institutions have adopted in response to a crisis. And here are some of the reasons why. Many of us, faculty and administrators alike, have not embraced the habitus of reflective practice. To effectively lead in times of crisis, we must (a) strive for better practices; (b) reimagine leadership as a shared and differentiated vocation; and (c) reframe systems that hinder us from becoming reflective communities for transformation. As practical theologians, our core mandate is to practice what we teach within and beyond our institutions. [ABSTRACT FROM AUTHOR]

The pathogenesis of bronchopulmonary dysplasia (BPD) is clearly multifactorial. Specific pathogenic risk factors are prematurity, respiratory distress, oxygen supplementation, mechanical ventilation (MV), inflammation, patent ductus arteriosus (PDA), etc. Aim: To evaluate BPD prevalence and to identify risk factors for BPD in five Portuguese Neonatal Intensive Care Units in order to develop better practices the management of these newborns. Material and methods: 256 very low birth weight infants with gestational age (GA) 0.30 (85 vs 5 days, respectively in BPD and no BPD patients, pA displasia broncopulmonar (DBP) é multifactorial. Prematuridade, doença da membrana hialina, oxigénio, ventilação mecânica, inflamação e canal arterial são alguns dos factores na sua patogénese. Objectivo: Avaliar a prevalência da DBP e seus factores de risco em cinco unidades portuguesas, para implementar boas práticas no tratamento deste doentes. Material e métodos: 256 recém-nascidos (RN) com idade gestacional (IG) 0,30 (85 vs 5 dias, respectivamente nos doentes com e sem DBP, p

With the advent of surfactant, prenatal corticosteroids (PNC) and advances in technology, the survival rate of extremely low birth weight (ELBW) infants has improved dramatically. Rates of bronchopulmonary dysplasia (BPD) vary widely among neonatal intensive care units (NICUs) and many studies using multiple interventions have shown some improvement in BPD rates. Implementing potentially better practices to reduce BPD has been an effort made over the last few decades. Aim: To compare five Portuguese NICUs in terms of clinical practices in very low birth weight (VLBW) infants, in order to developbetter practices to prevent BPD. Patients and methods: 256 preterm neonates, gestational age (GA) < 30 weeks and/or birthweight (BW) < 1250g admitted to five Portuguese NICUs (centers 1 to 5) between 1st January 2004 and 31st December 2006, were studied. VLBW infants with major malformations, grade IV intraventricular haemorrhage in the first week of life and metabolic or neuromuscular disease were excluded. BPD was defined as oxygen dependency at 36 weeks of postconceptional age. We considered a practice to be improved as clinically significant whenever a decrease greater than 10% in the prevalence of BPD adjusted for the practice, GA and BW was achieved compared to BPD prevalence adjusted only for GA and BW. Results: The overall prevalence of BPD was 12.9%. Our results revealed that PNC use should be improved in centers 2, 4 and 5; fluid policy in center 5; oxygen therapy in centers 1 and 3 and sepsis prevention in centers 1 and 2. Patent ductus arteriosus (PDA) treatment should be improved in center 2. Conclusion: The implementation of potentially better practices to reduce lung injury in neonates in Portuguese NICUs, according to each NICU, must be addressed to increase the prescription of PNC, to use a lower FiO2, to be careful with fluid administration in the first weeks of life and to prevent PDA and sepsis. It is necessary to follow guidelines, recommendations or protocols to improve quality in the prevention of BPD.Com o advento do surfactante, dos corticosteróides prénatais e dos avanços na tecnologia, a sobrevida dos recém-nascidos de extremo baixo peso tem melhorado dramaticamente. As taxas de displasia broncopulmonar (DBP) variam amplamente entre unidades, e vários estudos, avaliando resultados de múltiplas intervenções, têm mostrado alguma melhoria na prevalência da DBP. A implementação de potenciais boas práticas na DBP tem sido adoptada por muitos serviços nas últimas décadas. Objectivo: Comparar cinco unidades portuguesas de cuidados intensivos neonatais no que se refere as práticas clínicas no tratamento dos recém-nascidos de muito baixo peso, para desenvolver e melhorar as boas práticas na prevenção da DBP. População e métodos: Foram estudados 256 recém-nascidos com a idade gestacional inferior a 30 semanas e/ou peso ao nascer inferior a 1250 g, admitidos nas cinco unidades portuguesas (centros 1 a 5) entre 1 de Janeiro de 2004 e 31 de Dezembro de 2006. Foram excluídos os recém-nascidos com malformações major, hemorragia intraventricular grau IV na primeira semana de vida e com doença metabólica ou neuromuscular. Definimos DBP como a dependência do oxigénio às 36 semanas de idade pós-concepcional. A ecessidade de melhorar determinada prática foi considerada significativa sempre que se verificava uma melhoria superior a 10% na prevalência da DBP ajustada para a prática, idade gestacional e peso ao nascer, comparada com a prevalência ajustada só para a idade gestacional e peso ao nascer. Resultados: A prevalência global da DBP foi de 12,9%. Os resultados mostram que o uso de corticosteróides pré-natais deve ser melhorado nos centros 2, 4 e 5; a política de fluidos deve ser melhorada no centro 5; o uso de oxigénio deve ser melhorado nos centros 1 e 3; a prevenção da sépsis deve ser melhorada nos centros 1 e 2. O tratamento do canal arterial patente deve ser melhorado no centro 2. Conclusão: Neste estudo, a implementação de boas práticas para reduzir a lesão pulmonar nos recém-nascidos, de acordo com cada unidade, deve ser dirigida ao aumento da prescrição de corticosteróides pré-natais, ao uso de menor FiO2, ao uso criterioso de líquidos na primeiras semanas de vida, à prevenção do canal arterial patente e da sépsis. Guidelines, recomendações ou protocolos são necessários na melhoria da qualidade na prevenção da DBP.

doi:10.1111/j.1741-2358.2009.00280.x Oral health care in long-term care facilities for elderly people in southern Brazil: a conceptual framework Objective: To present a theoretical model for understanding oral health care for the elderly in the context of long-term care institutions (LTCI). Methods: Open-ended individual interviews were conducted with the elderly residing in LTCI, their carers, nursing technicians and nurses, directors of care, dental surgeons and managers of public health services. A grounded theory methodological approach was adopted for data collection and analysis. Results: The emerging core category revealed a basic social process: ‘Promoting oral health care for the elderly based on the context of LTCI’. This process was composed of two contradicting yet correlated aspects: the oral health care does not minimise the poor oral epidemiological condition, and at the same time, there was a continued improvement in the oral care expressed by better care practices. These aspects were related to the: attribution of meaning to oral health, social determination of oral health, the ageing process, interactions established in the oral health care practices, oral health care management in LTCI, inclusion of oral health care into the political–organisational dimension and possibility of conjecturing better oral health care practices. Conclusion: The core concept of ‘Promotion of oral health care for elderly people based on the context of LTCI’ is capable of explaining the variations in the structure and process of LTCI, as well as in helping to understand the meaning of the oral health care practices for the institutionalised elderly. [ABSTRACT FROM AUTHOR]

Exercise and sport scientists are increasingly faced with the need to demonstrate that their work is based on a sound evidence base and has an impact on professional practice and policy. This evidence is often derived from systematic reviews of rigorously designed studies such as randomized controlled trials. This paper addresses some of the limitations of the exclusive reliance on such trials and highlights the importance of addressing issues of effectiveness and practical concerns when synthesizing research evidence. The “Better Practices” model is then described in the context of a current project examining exercise and smoking cessation. This model provides one framework for integrating critical reviews of empirical evidence with contextual and practical considerations relevant to organizations interested in the translation of the synthesis into practice. Strengths and weaknesses of the model are discussed regarding its potential consideration and application by exercise and sport scientists. [ABSTRACT FROM AUTHOR]