ABSTRACT
The year of 2020 was very important to (re)think Education in Brazil, since it was the year when the educational community had to resignify itself in the face of the new challenges imposed by the Covid-19 pandemic, requiring training to train teachers in the so-called "new" teaching modality. In this sense, this work aims to make a cut of what happened and is happening in the academic environment after the pandemic was decreed. The research in question investigates, under the bias of qualitative analysis, using questionnaires, the main difficulties encountered by teachers from inclusive high school classrooms and professionals from multifunctional resource classrooms, in the learning process of deaf students, with the use of technologies and the real need to train these teachers in terms of hybrid teaching. The theoretical bases guiding this textual construct were: Giroto (2012), Moran (2015), Moreira (2020), and Quadros (2003). The results point to efforts in the context of teaching deaf students, as changes in educational paradigms have re-signified and are resignifying agents, modes/means, instruments, and educational purposes, in addition to pointing out the need for innovations in educational practices.
ABSTRACT
Background: For patients of reproductive age with cancer, counseling regarding reproductive risks associated with systemic therapy and facilitating access to fertility services are essential to quality care. We conducted a quality improvement study to improve rates of fertility preservation counseling at the Johns Hopkins Sidney Kimmel Comprehensive Cancer Center (SKCCC) in Baltimore, MD. Methods: We formed a multidisciplinary team as part of the ASCO Quality Training Program. We aimed to increase the rate of fertility preservation counseling for patients of reproductive age (18-40 years) with newly diagnosed cancer who were initiating systemic therapy from a baseline (June 2019-January 2020) of 36.7% (25/68) to 70.0% by February, 2021. Data sources included the electronic medical record and direct verification with patients by phone. We surveyed patients, oncologists, and experts in reproductive endocrinology and urology to identify barriers to optimal care. After considering a prioritization matrix, we implemented Plan-DoStudy-Act (PDSA) cycles. Results: We identified the following improvement opportunities: (1) oncologist under confidence about counseling, (2) oncologist lack of knowledge about local fertility preservation options/processes, and (3) lack of a standardized referral mechanism to reproductive endocrinology/urology. The first PDSA cycle was disrupted due to COVID-19;from February 2020-August 2020, we introduced the initiative at oncology disease site meetings (e.g., leukemia). In September 2020, we implemented a second PDSA cycle. Our interventions included (1) presenting the baseline data and fellow-led initiative at Oncology Grand Rounds (attended by 150 staff members), (2) creating and distributing paper and electronic informative pamphlets to oncologists and patients, and (3) implementing an electronic medical record order set. This order set included instructions for providers and patients, necessary laboratory studies, and a referral to reproductive endocrinology or orders for cryopreservation of sperm. It also added the following to a patient's after visit summary: Contact information for a dedicated fertility coordinator, estimated costs of services, and financial assistance programs. Postimplementation (September 2020-February 2021), the percentage of patients who reported receiving fertility preservation counseling increased from 36.7% to 80.9% (38/47). A sustained shift in the process was apparent on a control chart. Conclusions: Despite disruptions caused by the COVID-19 pandemic, we demonstrate how a trainee-led, patientcentered initiative improved fertility care services for people with cancer. Ongoing work focuses on ensuring sustainability of change, assessing the quality of counseling, and evaluating the impact on utilization of fertility care services.