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Sample records for advanced practice providers

  1. Integration of advanced practice providers into the Israeli healthcare system.

    PubMed

    Aaron, Eliana Marcus; Andrews, Caryn Scheinberg

    2016-01-01

    Many countries around the world have integrated various types of Advanced Practice Providers (APPs) into their healthcare systems. The main motivating factors for recognizing and developing APPs worldwide include physician shortages and the need for improved access or delivery (US, France, Belgium, Scotland, Switzerland), reduced residency hours (US, UK), shortages in underserved regions (US, Canada, Finland, Australia), and cost containment (Germany, Netherlands, UK, US). Israel is experiencing a shortage of physicians in peripheral geographic regions and in critical medical specialties. Recent by-laws approved by the Knesset (Parliament), combined with Israel Ministry of Health (MOH) policies, have thus far been unable to fully address the shortages. To understand the potential contribution of APPs in Israel, we evaluated the international historical foundations and development of APP roles. We assessed how APPs have impacted healthcare in other countries by analyzing public data and published international research about APP education, safety, quality of care, motivators, barriers, and impact. We found that APPs are recognized in dozens of countries, and have similar scopes of practice, graduate level education requirements (in developed countries), and clinical training. At the same time, there is wide variability among countries in the actual function and independence of the advanced practice nurse (APN), particularly the nurse practitioner (NP). APPs have been established as cost effective, safe healthcare providers who improve healthcare access. Israel has begun to introduce APPs, specifically NPs, in a variety of fields, including geriatrics, palliative care and diabetic care. We recommend a rapid expansion of existing and new APP roles into the Israeli healthcare system based on evidence and the recommendations of international evaluations by non-government organizations. By shifting the education to a university setting, mirroring successful, evidence

  2. Use of Advanced Practice Providers as Part of the Urologic Healthcare Team.

    PubMed

    Mitchell, Kenneth A; Spitz, Aaron

    2015-09-01

    Advanced practice providers (APPs) are advanced practice nurses (APN)/nurse practitioners (NP) or physician assistants. Over half of urologists currently employ APPs to extend and enhance their practice. Because APPs can fulfill a variety of roles from surgical assisting to running their own subspecialty clinic, they have emerged as a vital solution to alleviating the looming workforce shortage in urology practice. About 40 % of practicing urologists have not yet incorporated APPs into their practices. Some may still be unfamiliar with the concept of utilizing advanced practice providers, some have concerns about liability or scope of practice, and some are just getting started. Recently, the American Urological Association (AUA) published a consensus statement on advanced practice providers that provides urologists a comprehensive review regarding the education, training, Medicare reimbursement policies, applicable state laws, liability concerns, and examples of utilization of advanced practice providers within a urology practice. The consensus statement represented one of the most comprehensive compendiums of information specific to advanced practice providers in a urologic practice. This review will touch on the AUA Consensus Statement on Advanced Practice Providers, background information that informed that statement, as well as recent responses to the publication.

  3. The role of Advanced Practice Providers in interdisciplinary oncology care in the United States.

    PubMed

    Reynolds, Rae Brana; McCoy, Kimberly

    2016-06-01

    Advanced Practice Registered Nurses (APRNs) and Physician Assistants (PAs), generally referred to as Advanced Practice Providers (APPs), are fundamental to interdisciplinary oncology care. As the projected demand for oncology services is anticipated to outpace the supply of oncologists, APPs will become increasingly vital in the delivery of oncology care and services. The training, education, and scope of practice for APPs gives the interdisciplinary care team professionals that deliver high-quality clinical services and provide valuable contributions and leadership to health care quality improvement initiatives. Optimizing the integration of APPs in oncology care offers immense advantages towards improvement of clinical outcomes. PMID:27197514

  4. Training Advanced Practice Providers to Collect Functional Outcomes After Fragility Fractures

    PubMed Central

    Wang, Tiffany L.; Ames, Tyler D.; Le, Khoi M.; Wee, Corinne; Phieffer, Laura S.

    2015-01-01

    Objective: The objective of this study was to determine whether advanced practice providers could learn to collect objective functional assessment data accurately and efficiently with commercially available devices that measure kinematics and kinetics (Nintendo Wii Balance Board [WBB] and Level Belt [LB]) to aid in the assessment of fall risk and outcomes after fragility fractures. Methods: Nine advanced practice providers participated in a 1-hour clinical assessment tools (CATs) training session on equipment use, providing standardized instructions, and practice of the testing procedures. Afterward, they participated in a skills demonstration evaluation and completed a postsession survey. Results: Participants successfully achieved a mean of 18.22 (standard deviation 1.56) of 20 performance measures. Of the incomplete or omitted tasks, the majority (10 of 16) occurred within the first of 3 CATs activities. Postsession survey results revealed that 9 of 9 participants reported that the 1 hour provided for training on the CATs was sufficient. All participants reported that after the training, they felt confident they could reliably carry out the tasks to test patients on both the WBB and the LB. The majority of participants reported that they believed that the WBB (7 of 9) and LB (8 out of 9) would be good assets to clinics in assessing patient functionality after fragility fractures. Conclusion: These results indicate that advanced practice providers can confidently learn and effectively test patients with the WBB and LB within 1 hour of training. In the future, adoption of CATs in the clinical setting may allow for objective, easy-to-use, portable, noninvasive, and relatively inexpensive measures to assess functional outcomes in patients with fragility fracture. PMID:26328225

  5. An Incentive Pay Plan for Advanced Practice Registered Nurses: Impact On Provider and Organizational Outcomes.

    PubMed

    Rhodes, Catherine A; Bechtle, Mavis; McNett, Molly

    2015-01-01

    Advanced practice registered nurses (APRNs) are integral to the provision of quality, cost-effective health care throughout the continuum of care. To promote job satisfaction and ultimately decrease turnover, an APRN incentive plan based on productivity and quality was formulated. Clinical productivity in the incentive plan was measured by national benchmarks for work relative value units for nonphysician providers. After the first year of implementation, APRNs were paid more for additional productivity and quality and the institution had an increase in patient visits and charges. The incentive plan is a win-win for hospitals that employ APRNs. PMID:26259336

  6. Assessing the productivity of advanced practice providers using a time and motion study.

    PubMed

    Ogunfiditimi, Folusho; Takis, Lisa; Paige, Virginia J; Wyman, Janet F; Marlow, Elissa

    2013-01-01

    The Resource-Based Relative Value Scale is widely used to measure healthcare provider productivity and to set payment standards. The scale, however, is limited in its assessment of pre- and postservice work and other potentially non-revenue-generating healthcare services, what we have termed service-valued activity (SVA). In an attempt to quantify SVA, we conducted a time and motion study of providers to assess their productivity in inpatient and outpatient settings. Using the Standard Time and Motion Procedures checklist as a methodological guide, we provided personal digital assistants (PDAs) that were prepopulated with 2010 Current Procedural Terminology codes to 19 advanced practice providers (APPs). The APPs were instructed to identify their location and activity each time the PDA randomly alarmed. The providers collected data for 3 to 5 workdays, and those data were separated into revenue-generating services (RGSs) and SVAs. Multiple inpatient and outpatient departments were assessed. The inpatient APPs spent 61.6 percent of their time on RGSs and 35.1 percent on SVAs. Providers in the outpatient settings spent 59.0 percent of their time on RGSs and 38.2 percent on SVAs. This time and motion study demonstrated an innovative method and tool for the quantification and analysis of time spent on revenue- and non-revenue-generating services provided by healthcare professionals. The new information derived from this study can be used to accurately document productivity, determine clinical practice patterns, and improve deployment strategies of healthcare providers.

  7. Comparison of Quality Oncology Practice Initiative (QOPI) Measure Adherence Between Oncology Fellows, Advanced Practice Providers, and Attending Physicians.

    PubMed

    Zhu, Jason; Zhang, Tian; Shah, Radhika; Kamal, Arif H; Kelley, Michael J

    2015-12-01

    Quality improvement measures are uniformly applied to all oncology providers, regardless of their roles. Little is known about differences in adherence to these measures between oncology fellows, advance practice providers (APP), and attending physicians. We investigated conformance across Quality Oncology Practice Initiative (QOPI) measures for oncology fellows, advance practice providers, and attending physicians at the Durham Veterans Affairs Medical Center (DVAMC). Using data collected from the Spring 2012 and 2013 QOPI cycles, we abstracted charts of patients and separated them based on their primary provider. Descriptive statistics and the chi-square test were calculated for each QOPI measure between fellows, advanced practice providers (APPs), and attending physicians. A total of 169 patients were reviewed. Of these, 31 patients had a fellow, 39 had an APP, and 99 had an attending as their primary oncology provider. Fellows and attending physicians performed similarly on 90 of 94 QOPI metrics. High-performing metrics included several core QOPI measures including documenting consent for chemotherapy, recommending adjuvant chemotherapy when appropriate, and prescribing serotonin antagonists when prescribing emetogenic chemotherapies. Low-performing metrics included documentation of treatment summary and taking action to address problems with emotional well-being by the second office visit. Attendings documented the plan for oral chemotherapy more often (92 vs. 63%, P=0.049). However, after the chart audit, we found that fellows actually documented the plan for oral chemotherapy 88% of the time (p=0.73). APPs and attendings performed similarly on 88 of 90 QOPI measures. The quality of oncology care tends to be similar between attendings and fellows overall; some of the significant differences do not remain significant after a second manual chart review, highlighting that the use of manual data collection for QOPI analysis is an imperfect system, and there may

  8. Providing a navigable route for acute medicine nurses to advance their practice: a framework of ascending levels of practice.

    PubMed

    Lees-Deutsch, Liz; Christian, Jan; Setchfield, Ian

    2016-01-01

    This article conveys concerns raised by delegates at the International SAM Conference (Manchester, 2015) regarding how to advance nursing practice in acute medicine. It endeavors to capture the essence of 'how to advance practice' and 'how to integrate advanced practice' within the workforce structures of an acute medicine unit (AMU). It addresses the production of tacit knowledge and the recognition and integration of this to developing the nursing workforce. The current context of NHS efficiencies and recruitment issues emphasize the value of retaining tacit knowledge. Uniquely, this article offers an early conceptual framework through which levels of advancement and potential transition points to advance nursing practice in acute medicine are articulated. Determining how to advance requires identification of prior accomplishments such as, tacit knowledge, experiential learning, CPD, specialist courses and management experience. This requires nurses to make judicious decisions to advance their practice and the distinction between 'amassing experience' and 'career progression'. It aims to stimulate thinking around the practicalities of advancement, the value of tacit knowledge and potential realization through the framework trajectory. PMID:27441313

  9. Providing general practice needs-based care for carers of people with advanced cancer: a randomised controlled trial

    PubMed Central

    Mitchell, Geoffrey K; Girgis, Afaf; Jiwa, Moyez; Sibbritt, David; Burridge, Letitia H; Senior, Hugh E

    2013-01-01

    Background Carers of patients with advanced cancer often have health and psychosocial needs, which are frequently overlooked. Aim To meet the needs of carers through a GP consultation directed by a self-completed carer needs checklist. Design and setting Randomised controlled trial in general practice with recruitment through specialist oncology clinics, in Brisbane, Australia. Method Intervention was (a) carer–GP consultations directed by a self-completed checklist of needs at baseline and 3 months; and (b) a GP-Toolkit to assist GPs to address carer-identified needs. Control group received usual care. Outcome measures were intensity of needs, anxiety and depression, and quality of life. Results Total recruitment 392. Overall, no significant differences were detected in the number or intensity of need between groups. Compared to controls, intervention participants with baseline clinical anxiety showed improvements in mental wellbeing (P = 0.027), and those with baseline clinical depression had slower development of anxiety (P = 0.044) at 6 months. For those not anxious, physical wellbeing improved at 1 month (P = 0.040). Carers looking after patients with poor functional status had more physical needs (P = 0.037) at 1 month and more psychological and emotional needs at 3 months (P = 0.034). Those caring for less unwell patients showed improved mental wellbeing at 3 months (P = 0.022). Conclusion The intervention did not influence the number or intensity of needs reported by carers of people with advanced cancer. There was limited impact in people with pre-existing clinical anxiety and depression. For the carer of those most severely affected by advanced cancer, it drew attention to the needs arising from the caregiving role. PMID:24152483

  10. Advanced midwifery practice or advancing midwifery practice?

    PubMed

    Smith, Rachel; Leap, Nicky; Homer, Caroline

    2010-09-01

    Advanced midwifery practice is a controversial notion in midwifery, particularly at present in Australia. The proposed changes in legislation around access to the publicly funded Medical Benefits Scheme (MBS) and the Pharmaceutical Benefits Scheme (PBS) in 2009-2010 have meant that the issue of advanced midwifery practice has again taken prominence. Linking midwifery access to MBS and PBS to a safety and quality framework that includes an 'advanced midwifery credentialling framework' is particularly challenging. The Haxton and Fahy paper in the December 2009 edition of Women and Birth is timely as it enables a reflection upon these issues and encourages debate and discussion about exactly what is midwifery, what are we educating our students for and is working to the full scope of practice practising at advanced level? This paper seeks to address some of these questions and open up the topic for further debate.

  11. 2015 ACC Health Policy Statement on Cardiovascular Team-Based Care and the Role of Advanced Practice Providers.

    PubMed

    Brush, John E; Handberg, Eileen M; Biga, Cathleen; Birtcher, Kim K; Bove, Alfred A; Casale, Paul N; Clark, Michael G; Garson, Arthur; Hines, Jerome L; Linderbaum, Jane A; Rodgers, George P; Shor, Robert A; Thourani, Vinod H; Wyman, Janet F

    2015-05-19

    The mission of the American College of Cardiology is "to transform cardiovascular care and improve heart health." Cardiovascular team-based care is a paradigm for practice that can transform care, improve heart health, and help meet the demands of the future. One strategic goal of the College is to help members successfully transition their clinical practices to the future, with all its complexity, challenges, and opportunities. The ACC's strategic plan is aligned with the triple aim of improved care, improved population health, and lower costs per capita. The traditional understanding of quality, access, and cost is that you cannot improve one component without diminishing the others. With cardiovascular team-based care, it is possible to achieve the triple aim of improving quality, access, and cost simultaneously to also improve cardiovascular health. Striving to serve the best interests of patients is the true north of our guiding principles. Cardiovascular team-based care is a model that can improve care coordination and communication and allow each team member to focus more on the quality of care. In addition, the cardiovascular team-based care model increases access to cardiovascular care and allows expansion of services to populations and geographic areas that are currently underserved. This document will increase awareness of the important components of cardiovascular team-based care and create an opportunity for more discussion about the most creative and effective means of implementing it. We hope that this document will stimulate further discussions and activities within the ACC and beyond about team-based care. We have identified areas that need improvement, specifically in APP education and state regulation. The document encourages the exploration of collaborative care models that should enable team members to optimize their education, training, experience, and talent. Improved team leadership, coordination, collaboration, engagement, and efficiency

  12. Process and Outcome Measures among COPD Patients with a Hospitalization Cared for by an Advance Practice Provider or Primary Care Physician

    PubMed Central

    Agarwal, Amitesh; Zhang, Wei; Kuo, YongFang; Sharma, Gulshan

    2016-01-01

    Objectives To examine the process and outcomes of care of COPD patients by Advanced Practice Providers (APPs) and primary care physicians. Methods We conducted a cross sectional retrospective cohort study of Medicare beneficiaries with COPD who had at least one hospitalization in 2010. We examined the process measures of receipt of spirometry evaluation, influenza and pneumococcal vaccine, use of COPD medications, and referral to a pulmonary specialist visit. Outcome measures were emergency department (ER) visit, number of hospitalizations and 30-day readmission in 2010. Results A total of 7,257 Medicare beneficiaries with COPD were included. Of these, 1,999 and 5,258 received primary care from APPs and primary care physicians, respectively. Patients in the APP group were more likely to be white, younger, male, residing in non-metropolitan areas and have fewer comorbidities. In terms of process of care measures, APPs were more likely to prescribe short acting bronchodilators (adjusted odds ratio [aOR] = 1.18, 95%Confidence Interval [CI] 1.05–1.32), oxygen therapy (aOR = 1.25, 95% CI 1.12–1.40) and consult a pulmonary specialist (aOR = 1.39, 95% CI 1.23–1.56), but less likely to give influenza and pneumococcal vaccinations. Patients receiving care from APPs had lower rates of ER visits for COPD (aOR = 0.84, 95%CI 0.71–0.98) and had a higher follow-up rate with pulmonary specialist within 30 days of hospitalization for COPD (aOR = 1.25, 95%CI 1.07–1.48) than those cared for by physicians. Conclusions Compared to patients cared for by physicians, patients cared for by APPs were more likely to receive short acting bronchodilator, oxygen therapy and been referred to pulmonologist, however they had lower rates of vaccination probably due to lower age group. Patients cared for by APPs were less like to visit an ER for COPD compared to patients care for by physicians, conversely there was no differences in hospitalization or readmission for COPD between MDs and

  13. Education of advanced practice nurses in Canada.

    PubMed

    Martin-Misener, Ruth; Bryant-Lukosius, Denise; Harbman, Patricia; Donald, Faith; Kaasalainen, Sharon; Carter, Nancy; Kilpatrick, Kelley; DiCenso, Alba

    2010-12-01

    In Canada, education programs for the clinical nurse specialist (CNS) and nurse practitioner (NP) roles began 40 years ago. NP programs are offered in almost all provinces. Education for the CNS role has occurred through graduate nursing programs generically defined as providing preparation for advanced nursing practice. For this paper, we drew on pertinent sections of a scoping review of the literature and key informant interviews conducted for a decision support synthesis on advanced practice nursing to describe the following: (1) history of advanced practice nursing education in Canada, (2) current status of advanced practice nursing education in Canada, (3) curriculum issues, (4) interprofessional education, (5) resources for education and (6) continuing education. Although national frameworks defining advanced nursing practice and NP competencies provide some direction for education programs, Canada does not have countrywide standards of education for either the NP or CNS role. Inconsistency in the educational requirements for primary healthcare NPs continues to cause significant problems and interferes with inter-jurisdictional licensing portability. For both CNSs and NPs, there can be a mismatch between a generalized education and specialized practice. The value of interprofessional education in facilitating effective teamwork is emphasized. Recommendations for future directions for advanced practice nursing education are offered.

  14. Organizing a Community Advanced Pharmacy Practice Experience

    PubMed Central

    Koenigsfeld, Carrie Foust; Tice, Angela L

    2006-01-01

    Setting up a community advanced pharmacy practice experience can be an overwhelming task for many pharmacy preceptors. This article provides guidance to pharmacist preceptors in developing a complete and effective community advanced pharmacy practice experience (APPE). When preparing for the APPE, initial discussions with the college or school of pharmacy are key. Benefits, training, and requirements should be addressed. Site preparation, including staff education, will assist in the development process. The preceptor should plan orientation day activities and determine appropriate evaluation and feedback methods. With thorough preparation, the APPE will be rewarding for both the student and the pharmacy site. PMID:17136163

  15. [Advanced nursing practice: vision in Switzerland].

    PubMed

    Morin, Diane; Ramelet, Anne-Sylvie; Shaha, Maya

    2013-12-01

    To meet the challenges related to the development of health problems taking into account the development of knowledge, several innovations in care are being implemented. Among these, advanced nursing roles and increased interprofessional collaboration are considered as important features in Switzerland. Although the international literature provides benchmarks for advanced roles, it was considered essential to contextualize these in order to promote their application value in Switzerland. Thus, from 79 statements drawn from the literature, 172 participants involved in a two-sequential phases study only kept 29 statements because they considered they were relevant, important and applicable in daily practice. However, it is important to point out that statements which have not been selected at this stage to describe advanced practice cannot be considered irrelevant permanently. Indeed, given the emergence of advanced practice in western Switzerland, it is possible that a statement judged not so relevant at this moment of the development of advanced practice, will be considered as such later on. The master's program in nursing embedded at the University of Lausanne and the University of Applied Sciences Western Switzerland was also examined in the light of these statements. It was concluded that all the objectives of the program are aligned with the competencies statements that were kept.

  16. The Future of Neonatal Advanced Practice Registered Nurse Practice: White Paper.

    PubMed

    Staebler, Suzanne; Meier, Susan R; Bagwell, Gail; Conway-Orgel, Margaret

    2016-02-01

    In recent years, the National Association of Neonatal Nurses and the National Association of Neonatal Nurse Practitioners have been monitoring aspects of neonatal advanced practice nursing and providing leadership and advocacy to address concerns related to workforce, education, competency, fatigue, safety, and scope of practice. This white paper discusses current barriers within neonatal advanced practice registered nurse practice as well as strategies to promote the longevity of the neonatal advanced practice registered nurse roles. PMID:26742097

  17. Provider practice models in ambulatory oncology practice: analysis of productivity, revenue, and provider and patient satisfaction.

    PubMed

    Buswell, Lori A; Ponte, Patricia Reid; Shulman, Lawrence N

    2009-07-01

    Physicians, nurse practitioners, and physician assistants often work in teams to deliver cancer care in ambulatory oncology practices. This is likely to become more prevalent as the demand for oncology services rises, and the number of providers increases only slightly.

  18. Positioning advanced practice nurses for financial success in clinical practice.

    PubMed

    Kennerly, Susan

    2006-01-01

    Advanced practice nurses (APNs) are well prepared for patient care, but not for the financial aspects of clinical practice. A lack of reimbursement knowledge and skills limits the prospects for APNs to be key players in business and practice ventures. Faculty are challenged to strengthen the advanced practice reimbursement component of the financial management core to promote the reimbursement competency of APNs. The author discusses 4 primary content categories that are critical to financial success in clinical practice.

  19. Advancing practice relating to SEA alternatives

    SciTech Connect

    González, Ainhoa; Thérivel, Riki; Fry, John; Foley, Walter

    2015-07-15

    Developing and assessing alternatives is a key and central stage to Strategic Environmental Assessment (SEA). However, research has repeatedly reported this stage as one of the most poorly undertaken aspects of the SEA process. Current practice limitations include belated consideration of reasonable alternatives, narrow scope of alternatives that often include unrealistic or retrofitted options, limited stakeholder and public involvement in their identification, assessment and selection, lack of systematic approaches to their assessment and comparison, and inadequate reporting of the ‘storyline’ on how they were identified, what the potential impacts are and why the preferred alternative was selected. These issues have resulted in objections and judicial reviews. On the positive side, a number of good practice case studies enable extraction of key lessons and formulation of a set of general recommendations to advance practice in SEA alternatives. In this paper, practical guidance on the identification and development of alternatives, their assessment and comparison, selection of the preferred option, and documentation of the process and the reasons for selection is provided and discussed to frame good practice approaches. - Highlights: • Alternatives are one of the most poorly completed aspects of Strategic Environmental Assessment. • Current practice limitations need to be addressed to enhance SEA effectiveness. • A set of recommendations are extracted from good practice case studies. • These recommendations can be applied across jurisdictions and sectors and tailored as necessary.

  20. Providing paediatric palliative care: collaboration in practice.

    PubMed

    Farrell, M; Sutherland, P

    One of the main aims of palliative care is to enable clients to receive and access services in a way that maximizes their choice in relation to where, when and how they receive care. To achieve this end, it is essential that statutory and voluntary care agencies collaborate to provide an effective range of services. This article offers for consideration the experience of a children's hospice service and a paediatric oncology outreach service who collaborated to provide a service for children requiring paediatric and terminal care. It identifies a number of elements which are important for positive and effective collaboration.

  1. Training Advanced Practice Palliative Care Nurses.

    ERIC Educational Resources Information Center

    Sherman, Deborah Witt

    1999-01-01

    Describes the role and responsibilities of advanced-practice nurses in palliative care and nursing's initiative in promoting high-quality care through the educational preparation of these nurses. (JOW)

  2. Faculty Practice: Criterion for Academic Advancement.

    ERIC Educational Resources Information Center

    Wright, Dolores J.

    1993-01-01

    Although nursing educators must use academic criteria for faculty advancement, they should customized them to reflect the need of nursing faculty not only to be good teachers and researchers but also to maintain expertise in nursing practice. (SK)

  3. A framework for advanced clinical practice.

    PubMed

    Kaur, Sukvinder; Radford, Mark; Arblaster, Gillian

    The NHS needs a skilled, knowledgeable workforce of advanced clinical practitioners, who require multidisciplinary approach to their postgraduate development. To meet these demands we set up a regional programme to help clinical practitioners move into these new and demanding roles. As a result, health professionals who want to progress their career and advance their practice have an opportunity in the West Midlands to qualify as advanced clinical practitioners. PMID:27328598

  4. Practical Advances in Petroleum Processing

    NASA Astrophysics Data System (ADS)

    Hsu, Chang S.; Robinson, Paul R.

    "This comprehensive book by Robinson and Hsu will certainly become the standard text book for the oil refining business...[A] must read for all who are associated with oil refining." - Dr. Walter Fritsch, Senior Vice President Refining, OMV "This book covers a very advanced horizon of petroleum processing technology. For all refiners facing regional and global environmental concerns, and for those who seek a more sophisticated understanding of the refining of petroleum resources, this book has been long in coming." - Mr. Naomasa Kondo, Cosmo Oil Company, Ltd.

  5. Providing capital for physician group practices: new opportunities for hospitals.

    PubMed

    Coddington, D C; Moore, K D; Clarke, R L

    1999-12-01

    As physician group practices grow and consolidate, they have an increasing interest in developing close capital partnerships to ensure access to capital. Yet as many healthcare organizations have sought to divest poorly performing acquired physician practices, physicians have seen their pool of potential capital partners shrink. Under these conditions, hospitals have a new opportunity to present themselves to physician group practices as attractive capital partners. To understand the nature of this opportunity, one needs to know why group practices seek capital, how groups approach their investment strategies, and what criteria they use to compare prospective capital partners. To build stronger relationships with physicians, hospitals should focus on turning around their poorly performing acquired physician practices and pursue strategies such as collaborating with physician practice management companies and developing new models for partnering with physicians (e.g., special purchase agreements and more advanced management services organizations). PMID:11066695

  6. Autism Screening Practices among Early Intervention Providers in Indiana

    ERIC Educational Resources Information Center

    Tomlin, Angela; Koch, Steven M; Raches, Christine; Minshawi, Noha F.; Swiezy, Naomi B.

    2013-01-01

    The purpose of this study was to identify current practices in autism spectrum disorder (ASD) screening among early intervention and care providers in Indiana. Participants were asked about their ASD screening practices within the context of overall screening for developmental delays. Results indicated that providers conduct ASD screening less…

  7. Steve Jobs provides lessons for any medical practice.

    PubMed

    Ornstein, Hal; Baum, Neil

    2013-01-01

    Steve Jobs is inarguably the greatest inventor and creative genius since Thomas Edison. He provided technology that enhances communication on a global level. Jobs also provided ideas and suggestions that could work in any medical practice regardless of the size of the practice, the location of the practice, or the employment model. His advice can be transferred from a high-tech business that employs thousands to a high-touch medical practice that has only a few employees. This article will list a few of Jobs leadership characteristics and how they might apply to physicians, their teams, and their practices. Wouldn't you like to be the Steve Jobs of healthcare? If so, read on!

  8. Steve Jobs provides lessons for any medical practice.

    PubMed

    Ornstein, Hal; Baum, Neil

    2013-01-01

    Steve Jobs is inarguably the greatest inventor and creative genius since Thomas Edison. He provided technology that enhances communication on a global level. Jobs also provided ideas and suggestions that could work in any medical practice regardless of the size of the practice, the location of the practice, or the employment model. His advice can be transferred from a high-tech business that employs thousands to a high-touch medical practice that has only a few employees. This article will list a few of Jobs leadership characteristics and how they might apply to physicians, their teams, and their practices. Wouldn't you like to be the Steve Jobs of healthcare? If so, read on! PMID:23547502

  9. Disentangling consumer and provider predictors of advance care planning.

    PubMed

    Baughman, Kristin R; Ludwick, Ruth; Merolla, David; Palmisano, Barbara; Hazelett, Susan; Allen, Kyle R; Sanders, Margaret

    2013-11-01

    Factorial surveys were used to examine community-based long-term care providers' judgments about consumers' need for advance care planning (ACP) and comfort levels in discussing ACP. Providers (448 registered nurses and social workers) judged vignettes based on hypothetical consumers. Hierarchical linear models indicated providers judged consumers who were older, had end-stage diagnoses, multiple emergency department visits, and uninvolved caregivers as most in need of ACP. These variables explained 10% of the variance in judgments. Providers' beliefs about ACP predicted judgments of need for ACP and comfort level in discussing ACP. Provider characteristics explained more variance in comfort levels (44%) than in judgments of need (20%). This study demonstrates the need for tailored educational programs to increase comfort levels and address ACP misconceptions.

  10. Penn Macy Initiative To Advance Academic Nursing Practice.

    ERIC Educational Resources Information Center

    Lang, Norma M.; Evans, Lois K.; Swan, Beth Ann

    2002-01-01

    The Penn School of Nursing and the Macy Foundation established a comprehensive institute and technical assistance program to help nursing schools advance academic nursing practice. The Penn School consulted with 21 participating schools, providing institutes, conferences, a listserv and a web-based knowledge center focused on integrating research,…

  11. Advanced nursing practice: old hat, new design.

    PubMed

    De Grasse, C; Nicklin, W

    2001-01-01

    Advanced practice nurses positively impact the delivery of healthcare and client outcomes. However, in the past these positions have been seen to have variable value and were often vulnerable during budget cuts. Lack of a clear advanced nursing practice (ANP) framework probably contributed to the compromised effectiveness of these roles and evolution of roles with different titles, scopes of practice and reporting structures. To build the foundation for developing an ANP framework, a task force at The Ottawa Hospital (TOH) conducted a literature review related to ANP roles and completed a review of all clinical nursing roles at TOH. In addition, focus groups with nurses and other health professionals elicited ANP perceptions. The ANP framework includes a standardized job description that details competencies under five role components: clinical practice; consultation; research; education; and, leadership. Recommendations for assessment, implementation and evaluation of ANP roles are identified. The process undertaken by our ANP task force proved to be thorough and sound in developing a framework within which to move forward with ANP role implementation throughout TOH. This article, describing the process, may assist other organizations in defining ANP roles to better meet patient needs in changing health care environments. PMID:11803945

  12. Adolescent confidentiality: Understanding and practices of health care providers

    PubMed Central

    Wadman, Ruth; Thul, Deborah; Elliott, April S; Kennedy, Andrea Pritchard; Mitchell, Ian; Pinzon, Jorge L

    2014-01-01

    BACKGROUND: Adolescent confidentiality may present practice challenges for health care providers related to family, medical, ethical, legal, social and bureaucratic processes. It is unclear how health care providers understand and practice confidentiality with adolescents in Canada. OBJECTIVE: To investigate the knowledge and practice of health care providers at Alberta Children’s Hospital (Calgary, Alberta), and to inform practice about the adolescent’s right to confidentiality. METHODS: The present study was a voluntary, anonymous online survey. Invitations to participate were sent through the paediatric facility’s electronic mailing list to all currently employed health care providers who potentially engaged in caregiving interactions with adolescents. The survey consisted of 15 closed items and seven open comment items. Closed items were analyzed using descriptive statistics and open comments were analyzed using manifest thematic coding. RESULTS: A total of 389 responses were received, representing health care providers in many disciplines. A variety of practices related to adolescent confidentiality and widespread misunderstanding of this issue were apparent. Respondents’ comments revealed individual and team knowledge gaps regarding adolescent and parent/guardian rights, and the difference between the constructs of consent to treatment and the provision of confidential health care for adolescents. CONCLUSIONS: While health care providers regard confidentiality as paramount, the present survey revealed a wide variation in understanding and practices regarding confidential care for adolescents. This was revealed in both the qualitative and quantitative data. The authors’ recommended strategies to improve the understanding and practice of adolescent confidentiality include: encouraging individuals’ examination of beliefs; postsecondary instruction; knowledge-translation strategies within programs; and institution-directed guidelines and policy. PMID

  13. Writing an employer-focused resume for advanced practice nurses.

    PubMed

    Welton, Robert H

    2013-01-01

    The most important new trend in resumes is the employer-focused resume. Writing one is not difficult, but it requires a change in focus. The focus of this type of resume is on the needs of prospective employers. This new resume format allows applicants to describe to prospective employers what they can provide related to the employer's needs as opposed to a simple listing of their academic and work experiences without relation to the prospective new job. This article provides advanced practice nurses with sources to guide construction of informative text about their advanced practice nursing skills and competencies using language familiar to employers. Resumes and curriculum vitae formats are compared, and advice is provided on developing content for either format. Guidelines are provided about listing credentials, identifying clinical proficiencies from student clinical practicum, using qualification summaries rather than an objective statement, choosing references, and including essential components in a cover letter.

  14. Effects of providing advance cues during a soccer penalty kick on the kicker's rate of success.

    PubMed

    Núñez, F Javier; Oño, Antonio; Raya, Antonio; Bilbao, Alfonso

    2010-12-01

    The effect of explicitly providing goalkeeper's movement advanced cue to the kicker during a real penalty kick task was assessed. 32 expert soccer players (M age= 23.2 yr.), who were divided into four groups: an experimental group, a discovery group, a placebo group, and a control group, participated. Rate of success in the task was assessed, as well as goals, decision times, and ball flight times. Providing an advance cue significantly improved the players' rate of success relative to players without the advance cue; this difference was still present after 1 and 7 days without training. The experimental group adapted better to the time range within which the response could be effective, while the discovery group showed adaptations. Explicit instructions about the advance cues available from goalkeepers' actions before the dive during practice can improve penalty kick performance.

  15. VET Providers Planning to Deliver Degrees: Good Practice Guide

    ERIC Educational Resources Information Center

    National Centre for Vocational Education Research (NCVER), 2015

    2015-01-01

    This good practice guide is intended to assist public and private registered training organisations (RTOs) planning to commence higher education (HE) delivery. The guide is based on research undertaken by Victor Callan and Kaye Bowman, who completed case studies with six providers currently delivering higher education qualifications in addition to…

  16. Theory in Practice: Helping Providers Address Depression in Diabetes Care

    ERIC Educational Resources Information Center

    Osborn, Chandra Y.; Kozak, Cindy; Wagner, Julie

    2010-01-01

    Introduction: A continuing education (CE) program based on the theory of planned behavior was designed to understand and improve health care providers' practice patterns in screening, assessing, and treating and/or referring patients with diabetes for depression treatment. Methods: Participants completed assessments of attitudes, confidence,…

  17. The "nuts & bolts" of becoming an aesthetic provider: part 2-building your aesthetic practice.

    PubMed

    Brennan, Connie

    2014-01-01

    Part 2 of this three-part series of articles on becoming an aesthetic provider centers on the steps necessary to build an aesthetic practice. We will discuss the legal (e.g., licensure, scope of practice, malpractice, and documentation) and the business aspects (e.g., "your brand," staff development, networking, marketing, and revenue possibilities) of building a successful aesthetic practice. On the basis of years of experience, "pearls and pitfalls" will be discussed so novice, intermediate, and advanced aesthetic providers can minimize mistakes and maximize their success in this exciting and growing profession.

  18. Providers' Attitudes Toward Evidence-Based Practices: Is it Just About Providers, or do Practices Matter, Too?

    PubMed Central

    Reding, Michael E. J.; Chorpita, Bruce F.; Lau, Anna S.; Innes-Gomberg, Debbie

    2014-01-01

    Evidence-based practice (EBP) attitudes were measured in a sample of Los Angeles County mental health service providers. Three types of data were collected: provider demographic characteristics, attitudes toward EBP in general, and attitudes toward specific EBPs being implemented in the county. Providers could reliably rate characteristics of specific EBPs, and these ratings differed across interventions. Preliminary implementation data indicate that appealing features of an EBP relate to the degree to which providers use it. These findings suggest that assessing EBP-specific attitudes is feasible and may offer implementation-relevant information beyond that gained solely from providers' general attitudes toward EBP. PMID:24166077

  19. Obstetric Provider Trainees in Georgia: Characteristics and Attitudes About Practice in Obstetric Provider Shortage Areas.

    PubMed

    Smulian, Elizabeth A; Zahedi, Leilah; Hurvitz, Julie; Talbot, Abigail; Williams, Audra; Julian, Zoë; Zertuche, Adrienne D; Rochat, Roger

    2016-07-01

    Objectives In Georgia, 52 % of the primary care service areas outside metropolitan Atlanta have a deficit of obstetric providers. This study was designed to identify factors associated with the likelihood of Georgia's obstetric trainees (obstetrics and gynecology (OB/GYN) residents and certified nurse midwifery (CNM) students) to practice in areas of Georgia that lack obstetric providers and services, i.e. rural Georgia. Methods Pilot-tested electronic and paper surveys were distributed to all of Georgia's OB/GYN residents (N = 95) and CNM students (N = 28). Mixed-methods survey questions assessed characteristics, attitudes, and incentives that might be associated with trainee desire to practice in areas of Georgia that lack obstetric providers and services. Surveys also gathered information about concerns that may prevent trainees from practicing in shortage areas. Univariate and bivariate analyses were performed, and qualitative themes were abstracted from open-ended questions. Results The survey response rate was 87.8 % (108/123). Overall, 24.4 % (19/78) of residents and 53.6 % (15/28) of CNM students expressed interest in practicing in rural Georgia, and both residents and CNM students were more likely to desire to practice in rural Georgia with the offer of any of six financial incentives (P < 0.001). Qualitative themes highlighted trainees' strong concerns about Georgia's political environment as it relates to reproductive healthcare. Conclusions Increasing state-level, rurally-focused financial incentive programs and emphasizing the role of CNMs may alleviate obstetric provider shortages in Georgia.

  20. Enhancing provider engagement in practice improvement: a conceptual framework.

    PubMed

    Hess, Donald W; Reed, Virginia A; Turco, Mary G; Parboosingh, John T; Bernstein, Henry H

    2015-01-01

    Engaging individual members of clinical teams in practice improvement initiatives is a challenge. In this commentary, we first summarize evidence supporting enhanced practitioner engagement through the creation of a work environment that builds on mutually respectful relationships and valued interdependencies. We then propose a phased, collaborative process that employs practice talk, a term that describes naturally occurring, collegial conversations among members of clinical teams. Planned interactions among team members, facilitated by individuals trained in dialogic techniques, enable health care providers and support staff to share their experiences and expertise, agree on what improvements they would like to make, and test the success of these changes. Participants would be encouraged to express their own suggestions for better practice and disclose strategies that are already working. Dissent would be regarded as an opportunity rather than a barrier. Iterative, sense-making conversations would generate a shared vision, enabling team members to engage in the entire process. Given that practice improvement ultimately depends on frontline providers, we encourage the exploration of innovative engagement strategies that will enable entire clinical teams to develop the collaborative learning skills needed to accomplish their goals. PMID:25799975

  1. Enhancing provider engagement in practice improvement: a conceptual framework.

    PubMed

    Hess, Donald W; Reed, Virginia A; Turco, Mary G; Parboosingh, John T; Bernstein, Henry H

    2015-01-01

    Engaging individual members of clinical teams in practice improvement initiatives is a challenge. In this commentary, we first summarize evidence supporting enhanced practitioner engagement through the creation of a work environment that builds on mutually respectful relationships and valued interdependencies. We then propose a phased, collaborative process that employs practice talk, a term that describes naturally occurring, collegial conversations among members of clinical teams. Planned interactions among team members, facilitated by individuals trained in dialogic techniques, enable health care providers and support staff to share their experiences and expertise, agree on what improvements they would like to make, and test the success of these changes. Participants would be encouraged to express their own suggestions for better practice and disclose strategies that are already working. Dissent would be regarded as an opportunity rather than a barrier. Iterative, sense-making conversations would generate a shared vision, enabling team members to engage in the entire process. Given that practice improvement ultimately depends on frontline providers, we encourage the exploration of innovative engagement strategies that will enable entire clinical teams to develop the collaborative learning skills needed to accomplish their goals.

  2. Scientific advances provide opportunities to improve pediatric environmental health

    USGS Publications Warehouse

    Reddy, Michael M.; Reddy, Micaela B.; Reddy, Carol F.

    2004-01-01

    The health consequences of contaminants in the environment, with respect to the health of children and infants, recently have been dramatically brought to public attention by the motion pictures Erin Brockovich and A Civil Action. These productions focused public attention on the potential link between water contaminants and pediatric health, a continuing subject of public concern. As a consequence of the increasing production of new commercial chemicals, many chemicals have appeared in the scientific and public awareness as potential threats to health. These new or novel compounds eventually distribute in the environment and often are termed emerging contaminants. Gitterman and Bearer stated, "Children may serve as unwitting sentinels for society; they are often the youngest exposed to many environmental toxicants and may become the youngest in age to manifest adverse responses." The discipline of pediatric environmental health is still in its adolescence, but it will be increasingly important as new chemicals are generated and as more is learned about the health effects of chemicals already in commerce. Here, we provide an overview of recent advances in biomonitoring and environmental monitoring of environmental contaminants including emerging contaminants. Our purpose in writing this commentary is to make pediatricians aware of the current resources available for learning about pediatric environmental health and of ongoing research initiatives that provide opportunities to improve pediatric environmental health.

  3. Consultant pharmacists, advanced practice nurses, and the interdisciplinary team.

    PubMed

    Resnick, Barbara

    2014-03-01

    Although in geriatrics we are better than many other clinical disciplines in terms of providing interdisciplinary care to older adults, I hope that we will continue to recognize how much more could actually be done. Before addressing the relationship between advanced practice nurses (APNs) and consultant pharmacists in real world settings, I want to review teamwork in geriatrics in general. It is critical to define what we mean by team, what type of team, and what the goals are of this teamwork.

  4. Advanced X-Ray Telescope Mirrors Provide Sharpest Focus Ever

    NASA Astrophysics Data System (ADS)

    1997-03-01

    's science mission. "We will observe X-rays generated when stars are torn apart by the incredibly strong gravity around massive black holes in the centers of galaxies," added Tananbaum. On a larger scale, the telescope will play a vital role in answering fundamental questions about the universe. "The superior quality of the mirrors will allow us to see and measure the details of hot gas clouds in clusters of galaxies, giving us a much better idea of the age and size of the universe," said Dr. Leon Van Speybroeck, Telescope Scientist at the Smithsonian Observatory. "These same observations also will measure the amount of dark matter present, providing unique insight into one of nature's great puzzles," said Van Speybroeck. A second phase of testing is now underway at Marshall. Calibration of the observatory's science instruments began in mid-February. "This phase of testing," said Weisskopf, "includes two focal plane instruments and two sets of gratings used to analyze images and energy distributions from cosmic sources seen by the telescope." Working around the clock, test teams are taking measurements and studying results. "It is very exciting," said Weisskopf. "With more than 1,200 measurements taken, there is already a tremendous amount of information for study." The calibration process will end around late April. The mirror assembly then will be shipped to TRW Space and Electronics Group, Redondo Beach, CA -- NASA's prime contractor for the program -- for integration into the spacecraft. The science instruments will remain at Marshall for several more weeks of testing before being shipped to Ball Aerospace and Technologies Corporation in Boulder, CO, where they will be integrated into the science instrument module before being shipped to TRW. The Advanced X-ray Astrophysics Facility is scheduled for launch in August 1998 and will join NASA's Hubble Space Telescope and Compton Gamma-ray Observatory in exploring the universe. Marshall manages development of the observatory

  5. Hand Washing Practices Among Emergency Medical Services Providers

    PubMed Central

    Bucher, Joshua; Donovan, Colleen; Ohman-Strickland, Pamela; McCoy, Jonathan

    2015-01-01

    Introduction Hand hygiene is an important component of infection control efforts. Our primary and secondary goals were to determine the reported rates of hand washing and stethoscope cleaning in emergency medical services (EMS) workers, respectively. Methods We designed a survey about hand hygiene practices. The survey was distributed to various national EMS organizations through e-mail. Descriptive statistics were calculated for survey items (responses on a Likert scale) and subpopulations of survey respondents to identify relationships between variables. We used analysis of variance to test differences in means between the subgroups. Results There were 1,494 responses. Overall, reported hand hygiene practices were poor among pre-hospital providers in all clinical situations. Women reported that they washed their hands more frequently than men overall, although the differences were unlikely to be clinically significant. Hygiene after invasive procedures was reported to be poor. The presence of available hand sanitizer in the ambulance did not improve reported hygiene rates but improved reported rates of cleaning the stethoscope (absolute difference 0.4, p=0.0003). Providers who brought their own sanitizer were more likely to clean their hands. Conclusion Reported hand hygiene is poor amongst pre-hospital providers. There is a need for future intervention to improve reported performance in pre-hospital provider hand washing. PMID:26587098

  6. Strangulation forensic examination: best practice for health care providers.

    PubMed

    Faugno, Diana; Waszak, Daria; Strack, Gael B; Brooks, Melodie Ann; Gwinn, Casey G

    2013-01-01

    Strangulation is one of the most dangerous forms of interpersonal violence (IVP), yet it is often not reported and missed by the health care provider because of lack of visible injury. The victim of strangulation can have critical injuries and a late onset symptoms. Victims of IVP should be directly asked whether they were choked or whether during the assault they felt like they could not breathe because of pressure on their neck. The objective of this article is to summarize "best practice" for health care providers so that they are better prepared to care for victims who report a history of strangulation. A summary of how to perform a forensic examination of the strangled patient is provided along with important documentation takeaways and useful forms to ensure that the severity of the strangulation is assessed, that critical injuries are identified, and that all injuries and findings are accurately documented for legal proceedings. PMID:24176831

  7. Advanced practice roles in the managed care environment.

    PubMed

    Madden, M J; Ponte, P R

    1994-01-01

    The role of the advanced practice nurse is based on expert clinical knowledge and skill and is practiced in multiple settings. As healthcare reform emerges, the context in which healthcare is delivered changes. The authors describe a creative approach to packaging and marketing the services of advanced practice nurses to the customers of the managed care system. PMID:8308561

  8. Medical abortion practices among private providers in Vietnam

    PubMed Central

    Park, Min Hae; Nguyen, Thang Huu; Dang, Anh Thi Ngoc; Ngo, Thoai Dinh

    2013-01-01

    Objective To describe medical abortion (MA) practices among private providers in Vietnam. Methods The study subjects were women (n = 258) undergoing early MA through 12 private providers in Hanoi during February–June 2012. The women were interviewed on the day of their procedure and were followed up by telephone 14 days after mifepristone administration. Results Of the 258 women in the study, 97% used a regimen of mifepristone plus misoprostol; 80% were instructed to administer misoprostol at home. MA resulted in a complete termination in 90.8% of cases. All women were provided with information on potential complications and were instructed to return for a follow-up visit. We successfully followed up 77.5% (n = 200) of participants by telephone, while nearly two-thirds of women returned to the clinic for a follow-up visit. At follow-up, 39.5% of women reported having used a Help line service, while 7% had sought help from a health provider. A high unmet need for postabortion family planning was identified. Conclusion Follow-up of women, postabortion care, and the provision of family planning have been identified as important areas to address for strengthening MA services in the private sector in Vietnam. PMID:24082795

  9. What Is "Advanced" in Generalist Practice? A Conceptual Discussion

    ERIC Educational Resources Information Center

    Lavitt, Melissa R.

    2009-01-01

    Advanced generalist practice is the fastest growing area of concentration for Master of Social Work (MSW) programs in the United States, yet a definition remains elusive. This article proposes that three key elements should be included within a conceptual schema of advanced generalist practice. Multidimensional problem-setting, self-reflective…

  10. Pediatric nursing practice: keeping pace with technological advances.

    PubMed

    Bowden, V R

    2000-01-01

    Over the past 25 years, extensive technological and medical advances have had a major impact on the way pediatric nursing is practiced. Pediatric nurses have expanded their nursing roles, established professional organizations and certification standards to ensure clinical competence at the bedside, and tirelessly advocated for the health care needs of children and their families. In addition, pediatric nurses have collaborated with other health care providers to institute family-centered and developmentally appropriate philosophies of care. All of these changes will assist pediatric nurses to remain focused on the most important aspect of their work: Supporting the unique needs of children and their families.

  11. Electronic retrieval of health information by healthcare providers to improve practice and patient care

    PubMed Central

    McGowan, Jessie; Grad, Roland; Pluye, Pierre; Hannes, Karin; Deane, Katherine; Labrecque, Michel; Welch, Vivian; Tugwell, Peter

    2014-01-01

    Background The movement towards evidence-based practice makes explicit the need for access to current best evidence to improve health. Advances in electronic technologies have made health information more available, but does availability affect the rate of use of evidence in practice? Objectives To assess the effectiveness of interventions intended to provide electronic retrieval (access to information) to health information by healthcare providers to improve practice and patient care. Search methods We obtained studies from computerized searches of multiple electronic bibliographic databases, supplemented by checking reference lists, and consultation with experts. Selection criteria Randomized controlled trials (RCTs) including cluster randomized trials (CRCTs), controlled clinical trials (CCT), and interrupted time series analyses (ITS) of any language publication status examining interventions of effectiveness of electronic retrieval of health information by healthcare providers. Data collection and analysis Duplicate relevancy screening of searches, data abstraction and risk of bias assessment was undertaken. Main results We found two studies that examined this question. Neither study found any changes in professional behavior following an intervention that facilitated electronic retrieval of health information. There was some evidence of improvements in knowledge about the electronic sources of information reported in one study. Neither study assessed changes in patient outcomes or the costs of provision of the electronic resource and the implementation of the recommended evidence-based practices. Authors’ conclusions Overall there was insufficient evidence to support or refute the use of electronic retrieval of healthcare information by healthcare providers to improve practice and patient care. PMID:19588361

  12. Private Practice: Benefits, Barriers and Strategies of Providing Fieldwork Placements.

    ERIC Educational Resources Information Center

    Sloggett, Kym; Kim, Nancy; Cameron, Debra

    2003-01-01

    An increasing number of occupational therapists enter private practice. Six practicing occupational therapists were surveyed regarding the benefits of fieldwork to occupational therapy students. Findings indicate benefits to the profession, to the clinician, and to the facility. Potential barriers were time, costs, travel, and legalities.…

  13. Advanced practice nursing in Latin America and the Caribbean: regulation, education and practice

    PubMed Central

    Zug, Keri Elizabeth; Cassiani, Silvia Helena De Bortoli; Pulcini, Joyce; Garcia, Alessandra Bassalobre; Aguirre-Boza, Francisca; Park, Jeongyoung

    2016-01-01

    Abstract Objective: to identify the current state of advanced practice nursing regulation, education and practice in Latin America and the Caribbean and the perception of nursing leaders in the region toward an advanced practice nursing role in primary health care to support Universal Access to Health and Universal Health Coverage initiatives. Method: a descriptive cross-sectional design utilizing a web-based survey of 173 nursing leaders about their perceptions of the state of nursing practice and potential development of advanced practice nursing in their countries, including definition, work environment, regulation, education, nursing practice, nursing culture, and perceived receptiveness to an expanded role in primary health care. Result: the participants were largely familiar with the advanced practice nursing role, but most were unaware of or reported no current existing legislation for the advanced practice nursing role in their countries. Participants reported the need for increased faculty preparation and promotion of curricula reforms to emphasize primary health care programs to train advanced practice nurses. The vast majority of participants believed their countries' populations could benefit from an advanced practice nursing role in primary health care. Conclusion: strong legislative support and a solid educational framework are critical to the successful development of advanced practice nursing programs and practitioners to support Universal Access to Health and Universal Health Coverage initiatives. PMID:27508923

  14. Tennessee advanced practice nurse compensation survey results 2006-2007.

    PubMed

    Arnold, Kimberly

    2007-01-01

    In 2006, representatives from Middle Tennessee Advanced Practice Nurses (MTAPN), Greater Memphis Area Advanced Practice Nurses (GMAAPN), and Northeast Tennessee Nurse Practitioners Association (NETNPA) decided to poll APNs in Tennessee to compare data with the most recent results from the Advance for Nurse Practitioners national NP survey. Every other year, Advance for Nurse Practitioners publishes salary survey results from their survey. Most recently, in January 2006, an average nationwide salary for all APNs was reported at $74,812, with Tennessee's average at $71,068.

  15. Courage as integral to advancing nursing practice.

    PubMed

    Spence, Deb; Smythe, Liz

    2007-11-01

    Courage is an elusive but fundamental component of nursing. Yet it is seldom mentioned in professional texts and other literature nor is it often recognised and supported in practice. This paper focuses on the illumination of courage in nursing. Data from a hermeneutic analysis of nurses' practice stories is integrated with literature to assist deeper understanding of the meaning of courage in contemporary nursing practice. The purpose is to make visible a phenomenon that needs to be actively fostered or 'en-courage-d' if nursing is to effectively contribute to an improved health service. PMID:18293656

  16. Mindfulness-Based Stress Reduction in Advanced Nursing Practice

    PubMed Central

    Williams, Hants; Simmons, Leigh Ann; Tanabe, Paula

    2015-01-01

    The aim of this article is to discuss how advanced practice nurses (APNs) can incorporate mindfulness-based stress reduction (MBSR) as a nonpharmacologic clinical tool in their practice. Over the last 30 years, patients and providers have increasingly used complementary and holistic therapies for the nonpharmacologic management of acute and chronic diseases. Mindfulness-based interventions, specifically MBSR, have been tested and applied within a variety of patient populations. There is strong evidence to support that the use of MBSR can improve a range of biological and psychological outcomes in a variety of medical illnesses, including acute and chronic pain, hypertension, and disease prevention. This article will review the many ways APNs can incorporate MBSR approaches for health promotion and disease/symptom management into their practice. We conclude with a discussion of how nurses can obtain training and certification in MBSR. Given the significant and growing literature supporting the use of MBSR in the prevention and treatment of chronic disease, increased attention on how APNs can incorporate MBSR into clinical practice is necessary. PMID:25673578

  17. Advancing the Practice of Systems Engineering at JPL

    NASA Technical Reports Server (NTRS)

    Jones, Ross; Jansma, Patti A.; Derro, Mary Ellen; Burns, Margaret J.; Blom, Kris

    2007-01-01

    Systems Engineering Advancement (SEA) practices at the Jet Propulsion Laboratory is presented. The topics include: 1) SEA background; 2) Three Key Components of change; and 3) Three Support Components of Change.

  18. Advancing practice inquiry: research foundations of the practice doctorate in nursing.

    PubMed

    Magyary, Diane; Whitney, Joanne D; Brown, Marie Annette

    2006-01-01

    The University of Washington Doctor of Nursing Practice program entails 3 curricular dimensions: advanced practice, leadership, and practice inquiry. In this article, the practice inquiry dimension is discussed and defined as a type of clinical investigation that closely aligns with the realities and complexities of everyday practice by advanced practice nurses (APNs). The advancement of APNs' practice inquiry competencies is timely for its interfaces with the national scientific agenda's emphasis on translating science to clinical practice, health care delivery systems and policy. A framework for conceptualizing a practice inquiry curriculum and competencies is proposed. In addition, the divergent and convergent comparisons with Doctor of Philosophy (PhD) nursing programs are discussed, with emphasis placed on potential collaborative clinical research endeavors.

  19. Child Welfare, Juvenile Justice, Mental Health, and Education Providers' Conceptualizations of Trauma-Informed Practice.

    PubMed

    Donisch, Katelyn; Bray, Chris; Gewirtz, Abigail

    2016-05-01

    This study systematically examined child-service providers' conceptualizations of trauma-informed practice (TIP) across service systems, including child welfare, juvenile justice, mental health, and education. Eleven focus groups and nine individual interviews were conducted, totaling 126 child-service providers. Conventional content analysis was used to analyze the qualitative data with interrater reliability analyses indicating near perfect agreement between coders. Qualitative analysis revealed that child-service providers identified traumatic stress as an important common theme among children and families served as well as the interest in TIP in their service systems. At the same time, child-service providers generally felt knowledgeable about what they define TIP to be, although they articulated wide variations in the degree to which they are taught skills and strategies to respond to their traumatized clients. The results of this study suggest a need for a common lexicon and metric with which to advance TIP within and across child-service systems.

  20. How Physicians Integrate Advances into Clinical Practices.

    ERIC Educational Resources Information Center

    Lockyer, Jocelyn M.; And Others

    1985-01-01

    Family physicians and specialists were asked to identify the sources of information they used in the process of making changes in their clinical practices. An average of 3.08 sources of information were utilized for each change and over 50 percent of the changes were complete in less than one year. (CT)

  1. Workplace Learning Provider's Manual. Practical Steps for Developing Programs.

    ERIC Educational Resources Information Center

    Pacific Management and Research Associates, Sacramento, CA.

    This handbook provides a broad overview of the stages and activities to be undertaken to establish workplace learning (WPL) programs. It is designed to lead WPL service providers and employers through the process of developing a WPL program. Each chapter begins by stating the purpose and the outcomes expected upon completion. Throughout the manual…

  2. Educational Changes to Support Advanced Practice Nursing Education

    PubMed Central

    LeFlore, Judy L.; Thomas, Patricia E.

    2016-01-01

    Educational factors limit the number of advanced practice registered nurse (APRN) graduates to meet the growing workforce demands. Healthcare dynamics are necessitating a shift in how nursing education envisions, creates, and implements clinical learning opportunities. The current clinical education model in APRN programs continues to be the same as it was 45 years ago when the student numbers were much smaller. New approaches in graduate nursing education are needed to address the shortage of APRNs in primary and acute care areas. Determining competency based on the number of clinical hours can be inefficient, ineffective, and costly and limits the ability to increase capacity. Little research exists in graduate nursing education to support the effectiveness and efficiency of current hours of clinical required for nurse practitioner students. Simulation and academic-practice partnership models can offer innovative approaches to nurse practitioner education for clinical training, with the goal of producing graduates who can provide safe, quality care within the complex practice-based environment of the nation's evolving healthcare system. PMID:27465446

  3. Advanced nursing practice--the influences and accountabilities.

    PubMed

    Wiseman, Heather

    The past two decades have seen a proliferation of new, advanced clinical roles for nurses in the UK which has resulted in much debate about the nature of advanced practice as these new roles involve many tasks that were traditionally considered the remit of doctors. This article critically analyses the professional accountabilities of working at an advanced level and the influences which are driving the NHS modernization agenda with particular reference to the role of the Community Matron. It concludes that advanced nursing practice presents an opportunity for the combination of the art of nursing and advanced tasks, but emphasizes that new roles must develop within a recognized framework which takes account of the educational, ethical and legal accountability issues and clarifies the scope and remit of roles for health professionals, patients and indemnifying agents.

  4. A Collaborative and Reflective Academic Advanced Pharmacy Practice Experience

    PubMed Central

    Limpach, Aimee L.

    2011-01-01

    Objectives. To implement a co-precepted advanced pharmacy practice experience (APPE) focused on traditional pharmacy faculty and administrative responsibilities and reflection opportunities. Design. A multi-faceted, reflection-infused academic APPE was designed that exposed students to activities related to teaching, curriculum revision, scholarly writing, committee service, faculty role-modeling, mentorship and development, and school-level administrative decision-making. Assessment. Two students completed the APPE in the first 2 semesters it was offered (1 in spring 2010 and 1 in fall 2010). Formative and summative evaluations confirmed that the students achieved the APPE goals and viewed the experience as valuable, informative, and enjoyable as expressed both in reflective journal submissions and survey comments. Conclusion. Co-precepting by pharmacy faculty members primarily engaged in traditional faculty- and administration-related responsibilities can provide students with a robust learning experience that surpasses that which could be achieved by a single mentor. PMID:21931458

  5. Back strength and flexibility of EMS providers in practicing prehospital providers.

    PubMed

    Crill, Matthew T; Hostler, David

    2005-06-01

    In the execution of prehospital care duties, an EMS provider may be required to carry equipment and patients over long distances or over multiple flights of stairs at any time of the day. At a minimum, a prehospital provider must have sufficient lower back strength and hamstring flexibility to prevent musculoskeletal injury while lifting. This study administered fitness assessments related to the occupational activities of the prehospital provider with the purpose of describing the incidence of occupational back injury and percentage of providers with known risk factors for back injury. Ninety subjects were tested during a regional EMS conference. Men were significantly taller and heavier than women and had significantly less hamstring flexibility. Body Mass Index was 30.7 +/- 7.2 in men and 28 +/- 5.7 in women. However, no significant differences were noted in an extension test of back strength. When surveyed, 47.8% of subjects reported a back injury in the previous 6 months but only 39.1% of these injuries were sustained while performing EMS duties. While only 13% of these injuries resulted in missed work, 52.2% reported their injury interfered with their daily activities. In spite of the physical nature of the profession, EMS providers in our sample were significantly overweight according to their Body Mass Index and may lack sufficient back strength and flexibilityfor safe execution of their duties. This group of professionals may be at risk for occupational injury and should be targeted for interventions to improve strength and flexibility.

  6. Practical aspects of advanced paediatric cardiopulmonary resuscitation.

    PubMed

    Tibballs, J

    1988-08-01

    Successful cardiopulmonary resuscitation in the paediatric age group necessitates the acquisition of technical skills for rapid tracheal intubation, external cardiac compression and access to the circulation. Skills and equipment must be adapted to each age group. For optimal mechanical ventilation and the avoidance of complications, correct selection of endotracheal tube diameter and length is necessary. New techniques in resuscitation incorporate an understanding of the mechanism of blood flow during cardiac compression, the use of the intratracheal route for drug administration, and a revision of the use of catecholamines, sodium bicarbonate and calcium solutions in the treatment of asystole-bradycardia, electromechanical dissociation, ventricular fibrillation and tachycardia. Early intubation, adequate ventilation with oxygen, well performed external cardiac compression, prompt defibrillation and administration of adrenaline remain the cornerstones of advanced cardiopulmonary resuscitation. PMID:3064747

  7. Research and Practice Communications Between Oral Health Providers and Prenatal Health Providers: A Bibliometric Analysis.

    PubMed

    Skvoretz, John; Dyer, Karen; Daley, Ellen; Debate, Rita; Vamos, Cheryl; Kline, Nolan; Thompson, Erika

    2016-08-01

    Objectives We aimed to examine scholarly collaboration between oral health and prenatal providers. Oral disease is a silent epidemic with significant public health implications for pregnant women. Evidence linking poor oral health during pregnancy to adverse pregnancy and birth outcomes requires oral health and prenatal providers to communicate on the prevention, treatment and co-management matters pertaining to oral health issues among their pregnant patients. The need for inter-professional collaboration is highlighted by guidelines co-endorsed by the American College of Obstetricians and Gynecologists and the American Dental Association, stressing the importance of oral health care during pregnancy. Methods To assess if interdisciplinary communication occurs between oral health and prenatal disciplines, we conducted a network analysis of research on pregnancy-related periodontal disease. Results Social Network analysis allowed us to identify communication patterns between communities of oral health and prenatal professionals via scientific journals. Analysis of networks of citations linking journals in different fields reveals a core-periphery pattern dominated by oral health journals with some participation from medicine journals. However, an analysis of dyadic ties of citation reveals statistically significant "inbreeding" tendencies in the citation patterns: both medical and oral health journals tend to cite their own kind at greater-than-chance levels. Conclusions Despite evidence suggesting that professional collaboration benefits patients' overall health, findings from this research imply that little collaboration occurs between these two professional groups. More collaboration may be useful in addressing women's oral-systemic health concerns that result in adverse pregnancy outcomes.

  8. Research and Practice Communications Between Oral Health Providers and Prenatal Health Providers: A Bibliometric Analysis.

    PubMed

    Skvoretz, John; Dyer, Karen; Daley, Ellen; Debate, Rita; Vamos, Cheryl; Kline, Nolan; Thompson, Erika

    2016-08-01

    Objectives We aimed to examine scholarly collaboration between oral health and prenatal providers. Oral disease is a silent epidemic with significant public health implications for pregnant women. Evidence linking poor oral health during pregnancy to adverse pregnancy and birth outcomes requires oral health and prenatal providers to communicate on the prevention, treatment and co-management matters pertaining to oral health issues among their pregnant patients. The need for inter-professional collaboration is highlighted by guidelines co-endorsed by the American College of Obstetricians and Gynecologists and the American Dental Association, stressing the importance of oral health care during pregnancy. Methods To assess if interdisciplinary communication occurs between oral health and prenatal disciplines, we conducted a network analysis of research on pregnancy-related periodontal disease. Results Social Network analysis allowed us to identify communication patterns between communities of oral health and prenatal professionals via scientific journals. Analysis of networks of citations linking journals in different fields reveals a core-periphery pattern dominated by oral health journals with some participation from medicine journals. However, an analysis of dyadic ties of citation reveals statistically significant "inbreeding" tendencies in the citation patterns: both medical and oral health journals tend to cite their own kind at greater-than-chance levels. Conclusions Despite evidence suggesting that professional collaboration benefits patients' overall health, findings from this research imply that little collaboration occurs between these two professional groups. More collaboration may be useful in addressing women's oral-systemic health concerns that result in adverse pregnancy outcomes. PMID:27029538

  9. Advanced nursing practice and Newton's three laws of motion.

    PubMed

    Sturgeon, David

    This article considers the reasons for the development of advanced practice roles among nurses and other healthcare professions. It explores the implications of financial constraints, consumer preferences and the development of new healthcare services on the reorganization of professional boundaries. It makes use of Sir Isaac Newton's three laws of motion to demonstrate how professional development in nursing has taken place in response to a number of external influences and demands. It also considers the significance of skill mix for the nursing profession, in particular the development and likely expansion of the physician assistant role. The application of different professionals and grades within a healthcare team or organization is central to the Government's Agenda for Change proposals and nurses have successfully adopted a number of roles traditionally performed by doctors. Nurses have demonstrated that they are capable of providing high quality care and contributing directly to positive patient outcome. Advanced nursing roles should not only reflect the changing nature of healthcare work, they should also be actively engaged in reconstructing healthcare boundaries.

  10. Implementation of Advanced Access in a Family Medicine Residency Practice.

    PubMed

    Tseng, Ann; Wiser, Eric; Barclay, Emily; Aiello, Karen

    2015-01-01

    Several models of scheduling have been documented in the literature, including the traditional model, the carve-out model, and the advanced access model. We describe the implementation of the advanced access model in our clinic, which has been very successful. Advanced access has decreased third next available appointments to less than seven days for many of our providers and has increased individual primary care physician continuity for 40% of our providers. Interestingly, we had no gains in patient satisfaction, which is consistent with other previously published studies on advanced access. PMID:26665471

  11. An overview of Medicare reimbursement regulations for advanced practice nurses.

    PubMed

    Frakes, Michael A; Evans, Tracylain

    2006-01-01

    The federal government spends nearly 15% of the budget on Medicare services annually, and advanced practice nurses are eligible for reimbursement from that pool. The regulations governing reimbursement are complex because of the social, political, and financial pressures involved in their development. Although economic viability and due diligence considerations make it incumbent on advanced practice nurses to understand the rules, the profession, as a whole, has knowledge deficits in this area. The essentials of regulatory development and structure are reviewed and considerations for optimizing reimbursement are described. PMID:16676748

  12. Energy Therapies in Advanced Practice Oncology: An Evidence-Informed Practice Approach

    PubMed Central

    Potter, Pamela J.

    2013-01-01

    Advanced practitioners in oncology want patients to receive state-of-the-art care and support for their healing process. Evidence-informed practice (EIP), an approach to evaluating evidence for clinical practice, considers the varieties of evidence in the context of patient preference and condition as well as practitioner knowledge and experience. This article offers an EIP approach to energy therapies, namely, Therapeutic Touch (TT), Healing Touch (HT), and Reiki, as supportive interventions in cancer care; a description of the author’s professional experience with TT, HT, and Reiki in practice and research; an overview of the three energy healing modalities; a review of nine clinical studies related to oncology; and recommendations for EIP. These studies demonstrate a response to previous research design critiques. Findings indicate a positive benefit for oncology patients in the realms of pain, quality of life, fatigue, health function, and mood. Directionality of healing in immune response and cell line studies affirms the usual explanation that these therapies bring harmony and balance to the system in the direction of health. Foremost, the research literature demonstrates the safety of these therapies. In order to consider the varieties of evidence for TT, HT, and Reiki, EIP requires a qualitative examination of patient experiences with these modalities, exploration of where these modalities have been integrated into cancer care and how the practice works in the oncology setting, and discovery of the impact of implementation on provider practice and self-care. Next steps toward EIP require fleshing out the experience of these modalities by patients and health-care providers in the oncology care setting. PMID:25031994

  13. Energy therapies in advanced practice oncology: an evidence-informed practice approach.

    PubMed

    Potter, Pamela J

    2013-05-01

    Advanced practitioners in oncology want patients to receive state-of-the-art care and support for their healing process. Evidence-informed practice (EIP), an approach to evaluating evidence for clinical practice, considers the varieties of evidence in the context of patient preference and condition as well as practitioner knowledge and experience. This article offers an EIP approach to energy therapies, namely, Therapeutic Touch (TT), Healing Touch (HT), and Reiki, as supportive interventions in cancer care; a description of the author's professional experience with TT, HT, and Reiki in practice and research; an overview of the three energy healing modalities; a review of nine clinical studies related to oncology; and recommendations for EIP. These studies demonstrate a response to previous research design critiques. Findings indicate a positive benefit for oncology patients in the realms of pain, quality of life, fatigue, health function, and mood. Directionality of healing in immune response and cell line studies affirms the usual explanation that these therapies bring harmony and balance to the system in the direction of health. Foremost, the research literature demonstrates the safety of these therapies. In order to consider the varieties of evidence for TT, HT, and Reiki, EIP requires a qualitative examination of patient experiences with these modalities, exploration of where these modalities have been integrated into cancer care and how the practice works in the oncology setting, and discovery of the impact of implementation on provider practice and self-care. Next steps toward EIP require fleshing out the experience of these modalities by patients and health-care providers in the oncology care setting. PMID:25031994

  14. Advanced practice nursing: leadership to effect policy change.

    PubMed

    Cummings, Greta; McLennan, Marianne

    2005-02-01

    Nursing leaders used evidence-based thinking to engage key stakeholders when implementing advanced practice nursing roles in a traditional medically oriented tertiary oncology center. A strategic orientation to the policy change initiative was guided by a theoretical framework for connecting research and policy. Policy approaches that addressed stakeholder values and beliefs, while attending to questions of competence, standards of practice, fiscal savings, medical and nursing workload, and ongoing multidisciplinary teamwork were essential to facilitate change. PMID:15714096

  15. What clinical activities do advanced-practice registered dietitian nutritionists perform? Results of a Delphi study.

    PubMed

    Brody, Rebecca A; Byham-Gray, Laura; Touger-Decker, Riva; Passannante, Marian R; Rothpletz Puglia, Pamela; O'Sullivan Maillet, Julie

    2014-05-01

    Activities performed by advanced-practice registered dietitian nutritionists (RDNs) have yet to be clearly elucidated. The study aimed to gain consensus on the practice activities of advanced-practice RDNs who provide direct clinical nutrition care. A three-round Delphi study was conducted. Purposive sampling identified 117 RDN experts working as clinicians and/or managers in direct care settings that met inclusion criteria for advanced-level practice. In Round 1, 85 experts provided open-ended advanced-level practice activities linked to the Nutrition Care Process sections. Using content analysis, the responses were coded into activity statements. In Round 2, experts rated the essentiality of these activities. In Round 3, experts re-rated statements not reaching consensus while viewing their previous rating, the group median, and comments. Median ratings of 1.0 to 3.0 were defined as essential, 4.0 were neither essential nor nonessential, and 5.0 to 7.0 were nonessential. Consensus was reached when the interquartile range of responses to each question was <2.0. Seventy-six (89.4%) experts completed all rounds. From 770 comments, 129 activity statements were generated. All statements reached consensus: 97.7% as essential; 0.8% as nonessential; and 1.5% as neither. Of essential activities, 67.5% were highly essential with limited variability (median=1.0; interquartile range≤2.0). Advanced-practice RDNs' tasks are patient-centered and reflect complex care; involve a comprehensive and discriminating approach; are grounded in advanced knowledge and expertise in clinical nutrition; include use of advanced interviewing, education, and counseling strategies; and require communication with patient, families, and the health care team. The high-level of consensus from experts suggest advanced-level clinical nutrition practice exists and can be defined.

  16. Advanced practice nursing students in the patient-centered medical home: preparing for a new reality.

    PubMed

    Swartwout, Kathryn; Murphy, Marcia Pencak; Dreher, Melanie C; Behal, Raj; Haines, Alison; Ryan, Mary; Ryan, Norman; Saba, Mary

    2014-01-01

    Driven by reimbursement incentives for increased access, improved quality and reduced cost, the patient-centered medical home model of health care delivery is being adopted in primary care practices across the nation. The transition from traditional primary care models to patient-centered medical homes presents many challenges, including the assembly of a well-prepared, interprofessional provider team to achieve effective, well-coordinated care. In turn, advanced practice nursing education programs are challenged to prepare graduates who are qualified for practice in the new reality of health care reform. This article reviews the patient-centered medical home model and describes how one college of nursing joined 7 primary care physician practices to prepare advanced practice nursing students for the new realities of health care reform while supporting each practice in its transition to the patient-centered medical home. PMID:24720942

  17. Training Advanced Writing Skills: The Case for Deliberate Practice

    ERIC Educational Resources Information Center

    Kellogg, Ronald T.; Whiteford, Alison P.

    2009-01-01

    The development of advanced writing skills has been neglected in schools of the United States, with even some college graduates lacking the level of ability required in the workplace (National Commission on Writing, 2003, 2004). The core problem, we argue, is an insufficient degree of appropriate task practice distributed throughout the secondary…

  18. Residency and Fellowship Programs for RNs and Advanced Practice RNs.

    PubMed

    Cosme, Sheryl

    2015-09-01

    In this month's column, the Senior Accreditation Operations Manager of the American Nurses Credentialing Center (ANCC) discusses the value of nursing residency programs and current discussion in the profession, along with criteria offered by the ANCC to support this imperative for both RNs and advanced practice RNs including new graduates and those transitioning between clinical settings.

  19. Establishing radiation therapy advanced practice in New Zealand

    SciTech Connect

    Coleman, Karen; Jasperse, Marieke; Herst, Patries; Yielder, Jill

    2014-02-15

    Introduction: Advanced practice (AP) is of increasing interest to many radiation therapists (RTs) both nationally and internationally. In New Zealand, initial research (2005–2008) showed strong support for the development of an AP role for medical radiation technologists (MRTs). Here, we report on a nationwide survey in which RTs validated and prioritised nine AP profiles for future development. Methods: All registered RTs in New Zealand (n = 260) were invited to take part in a survey in December 2011; 73 of whom returned a complete response. Results: RTs supported the implementation of AP roles in New Zealand and the requirement of a Master's degree qualification to underpin clinical knowledge. Most RTs endorsed the criteria attributed to each of the nine proposed AP profiles. The study identified that activities may qualify as either advanced practice or standard practice depending on the department. All participants agreed that an advanced practitioner should be a leader in the field, able to initiate and facilitate future developments within as well as outside this specific role. Acceptance of the AP roles by RTs and other health professionals as well as the availability of resources for successful implementation, were concerns expressed by some RTs. Conclusion: The authors recommend (1) the development of one scope of practice titled ‘advanced practitioner’ with generic and specialist criteria for each profile as the future career pathway, (2) promotion and support for the AP pathway by the New Zealand Institute of Medical Radiation Technology and the New Zealand Medical Radiation Technologists Board.

  20. Advancing Empirical Scholarship to Further Develop Evaluation Theory and Practice

    ERIC Educational Resources Information Center

    Christie, Christina A.

    2011-01-01

    Good theory development is grounded in empirical inquiry. In the context of educational evaluation, the development of empirically grounded theory has important benefits for the field and the practitioner. In particular, a shift to empirically derived theory will assist in advancing more systematic and contextually relevant evaluation practice, as…

  1. Canadian Educational Approaches for the Advancement of Pharmacy Practice

    PubMed Central

    Louizos, Christopher; Austin, Zubin

    2014-01-01

    Canadian faculties (schools) of pharmacy are actively engaged in the advancement and restructuring of their programs in response to the shift in pharmacy to pharmacists having/assuming an advanced practitioner role. Unfortunately, there is a paucity of evidence outlining optimal strategies for accomplishing this task. This review explores several educational changes proposed in the literature to aid in the advancement of pharmacy education such as program admission requirements, critical-thinking assessment and teaching methods, improvement of course content delivery, value of interprofessional education, advancement of practical experiential education, and mentorship strategies. Collectively, implementation of these improvements to pharmacy education will be crucial in determining the direction the profession will take. PMID:25258448

  2. Providing massage therapy for people with advanced cancer: what to expect.

    PubMed

    Smith, Marlaine C; Yamashita, Traci E; Bryant, Lucinda L; Hemphill, Linnea; Kutner, Jean S

    2009-04-01

    There is very little information in the literature to prepare massage therapists for what they might expect when they provide treatment to people with advanced cancer in hospice or palliative care. We report an analysis of a subset of data collected from a large multi-site clinical trial of the efficacy of massage therapy for people with advanced cancer. This is the first analysis of empirical data of patient presentation, massage treatment environment, and the characteristics of massage provided for this population.

  3. Establishing advanced practice for medical imaging in New Zealand

    SciTech Connect

    Yielder, Jill; Young, Adrienne; Park, Shelley; Coleman, Karen

    2014-02-15

    Introduction: This article presents the outcome and recommendations following the second stage of a role development project conducted on behalf of the New Zealand Institute of Medical Radiation Technology (NZIMRT). The study sought to support the development of profiles and criteria that may be used to formulate Advanced Scopes of Practice for the profession. It commenced in 2011, following on from initial research that occurred between 2005 and 2008 investigating role development and a possible career structure for medical radiation technologists (MRTs) in New Zealand (NZ). Methods: The study sought to support the development of profiles and criteria that could be used to develop Advanced Scopes of Practice for the profession through inviting 12 specialist medical imaging groups in NZ to participate in a survey. Results: Findings showed strong agreement on potential profiles and on generic criteria within them; however, there was less agreement on specific skills criteria within specialist areas. Conclusions: The authors recommend that one Advanced Scope of Practice be developed for Medical Imaging, with the establishment of generic and specialist criteria. Systems for approval of the overall criteria package for any individual Advanced Practitioner (AP) profile, audit and continuing professional development requirements need to be established by the Medical Radiation Technologists Board (MRTB) to meet the local needs of clinical departments. It is further recommended that the NZIMRT and MRTB promote and support the need for an AP pathway for medical imaging in NZ.

  4. Establishing advanced practice for medical imaging in New Zealand

    PubMed Central

    Yielder, Jill; Young, Adrienne; Park, Shelley; Coleman, Karen

    2014-01-01

    IntroductionThis article presents the outcome and recommendations following the second stage of a role development project conducted on behalf of the New Zealand Institute of Medical Radiation Technology (NZIMRT). The study sought to support the development of profiles and criteria that may be used to formulate Advanced Scopes of Practice for the profession. It commenced in 2011, following on from initial research that occurred between 2005 and 2008 investigating role development and a possible career structure for medical radiation technologists (MRTs) in New Zealand (NZ). MethodsThe study sought to support the development of profiles and criteria that could be used to develop Advanced Scopes of Practice for the profession through inviting 12 specialist medical imaging groups in NZ to participate in a survey. ResultsFindings showed strong agreement on potential profiles and on generic criteria within them; however, there was less agreement on specific skills criteria within specialist areas. ConclusionsThe authors recommend that one Advanced Scope of Practice be developed for Medical Imaging, with the establishment of generic and specialist criteria. Systems for approval of the overall criteria package for any individual Advanced Practitioner (AP) profile, audit and continuing professional development requirements need to be established by the Medical Radiation Technologists Board (MRTB) to meet the local needs of clinical departments. It is further recommended that the NZIMRT and MRTB promote and support the need for an AP pathway for medical imaging in NZ. PMID:26229631

  5. Advances, practice, and clinical perspectives in high-throughput sequencing.

    PubMed

    Park, S-J; Saito-Adachi, M; Komiyama, Y; Nakai, K

    2016-07-01

    Remarkable advances in high-throughput sequencing technologies have fundamentally changed our understanding of the genetic and epigenetic molecular bases underlying human health and diseases. As these technologies continue to revolutionize molecular biology leading to fresh perspectives, it is imperative to thoroughly consider the enormous excitement surrounding the technologies by highlighting the characteristics of platforms and their global trends as well as potential benefits and limitations. To date, with a variety of platforms, the technologies provide an impressive range of applications, including sequencing of whole genomes and transcriptomes, identifying of genome modifications, and profiling of protein interactions. Because these applications produce a flood of data, simultaneous development of bioinformatics tools is required to efficiently deal with the big data and to comprehensively analyze them. This review covers the major achievements and performances of the high-throughput sequencing and further summarizes the characteristics of their applications along with introducing applicable bioinformatics tools. Moreover, a step-by-step procedure for a practical transcriptome analysis is described employing an analytical pipeline. Clinical perspectives with special consideration to human oral health and diseases are also covered. PMID:26602181

  6. Advances in computer technology: impact on the practice of medicine.

    PubMed

    Groth-Vasselli, B; Singh, K; Farnsworth, P N

    1995-01-01

    Advances in computer technology provide a wide range of applications which are revolutionizing the practice of medicine. The development of new software for the office creates a web of communication among physicians, staff members, health care facilities and associated agencies. This provides the physician with the prospect of a paperless office. At the other end of the spectrum, the development of 3D work stations and software based on computational chemistry permits visualization of protein molecules involved in disease. Computer assisted molecular modeling has been used to construct working 3D models of lens alpha-crystallin. The 3D structure of alpha-crystallin is basic to our understanding of the molecular mechanisms involved in lens fiber cell maturation, stabilization of the inner nuclear region, the maintenance of lens transparency and cataractogenesis. The major component of the high molecular weight aggregates that occur during cataractogenesis is alpha-crystallin subunits. Subunits of alpha-crystallin occur in other tissues of the body. In the central nervous system accumulation of these subunits in the form of dense inclusion bodies occurs in pathological conditions such as Alzheimer's disease, Huntington's disease, multiple sclerosis and toxoplasmosis (Iwaki, Wisniewski et al., 1992), as well as neoplasms of astrocyte origin (Iwaki, Iwaki, et al., 1991). Also cardiac ischemia is associated with an increased alpha B synthesis (Chiesi, Longoni et al., 1990). On a more global level, the molecular structure of alpha-crystallin may provide information pertaining to the function of small heat shock proteins, hsp, in maintaining cell stability under the stress of disease.

  7. Family-centered care for children with cerebral palsy: conceptual and practical considerations to advance care and practice.

    PubMed

    King, Gillian; Chiarello, Lisa

    2014-08-01

    This article focuses on conceptual and practical considerations in family-centered care for children with cerebral palsy and their families. In the last 5 years, there have been important advances in our understanding of the components of family-centered care, and initial attempts to understand the client change processes at play. Recent research elaborates on family-centered care by delving into aspects of family-provider partnership, and applying family-centered principles to organizational service delivery to bring about organizational cultures of family-centered care. Recent research has also begun to consider mediators of client change, and new practice models have been proposed that embrace family-centered principles and illustrate the "art" of practice. Future research directions are discussed, including explorations of causal relationships between family-centered care principles, elements of caregiving practice, client change processes, and child and family outcomes. The meaning of the recent literature for pediatric neurology practice is considered. PMID:24810084

  8. Advanced practice nursing in performing arts health care.

    PubMed

    Weslin, Anna T; Silva-Smith, Amy

    2010-06-01

    Performing arts medicine is a growing health care profession specializing in the needs of performing artists. As part of the performing arts venue, the dancer, a combination of athlete and artist, presents with unique health care needs requiring a more collaborative and holistic health care program. Currently there are relatively few advanced practice nurses (APNs) who specialize in performing arts health care. APNs, with focus on collaborative and holistic health care, are ideally suited to join other health care professionals in developing and implementing comprehensive health care programs for the performing artist. This article focuses on the dancer as the client in an APN practice that specializes in performing arts health care.

  9. Providing Students with Foundational Field Instruction within a 50 Minute Class Period: A Practical Example

    NASA Astrophysics Data System (ADS)

    Percy, M.

    2014-12-01

    There is a growing recognition among secondary educators and administrators that students need to have a science education that provides connections between familiar classes like biology, chemistry, and physics. Because of this waxing interest in an integrative approach to the sciences, there is a broader push for school districts to offer classes geared towards the earth sciences, a field that incorporates knowledge and skills gleaned from the three core science subjects. Within the contexts of a regular secondary school day on a traditional schedule (45- to 50-minute long classes), it is challenging to engage students in rigorous field-based learning, critical for students to develop a deeper understanding of geosciences content, without requiring extra time outside of the regular schedule. We suggest instruction using common, manmade features like drainage retention ponds to model good field practices and provide students with the opportunity to calculate basic hydrologic budgets, take pH readings, and, if in an area with seasonal rainfall, make observations regarding soils by way of trenching, and near-surface processes, including mass wasting and the effects of vegetation on geomorphology. Gains in student understanding are discussed by analyzing the difference in test scores between exams provided to the students after they had received only in-class instruction, and after they had received field instruction in addition to the in-class lectures. In an advanced setting, students made measurements regarding ion contents and pollution that allowed the classes to practice lab skills while developing a data set that was analyzed after field work was completed. It is posited that similar fieldwork could be an effective approach at an introductory level in post-secondary institutions.

  10. Advanced-practice pharmacists: practice characteristics and reimbursement of pharmacists certified for collaborative clinical practice in New Mexico and North Carolina.

    PubMed

    Murawski, Matthew; Villa, Kristin R; Dole, Ernest J; Ives, Timothy J; Tinker, Dale; Colucci, Vincent J; Perdiew, Jeffrey

    2011-12-15

    PURPOSE The results of a survey assessing the practice settings, clinical activities, and reimbursement experiences of pharmacists with advanced-practice designations are reported. METHODS A questionnaire was sent to all certified Pharmacist Clinicians in New Mexico and all Clinical Pharmacist Practitioners in North Carolina (a total of 189 pharmacists at the time of the survey in late 2008) to elicit information on practice settings, billing and reimbursement methods, collaborative drug therapy management (CDTM) protocols, and other issues. RESULTS Of the 189 targeted pharmacists, 64 (34%) responded to the survey. On average, the reported interval from pharmacist licensure to certification as an advanced practitioner was 11 years. The majority of survey participants were practicing in community or institutional settings, most often hospital clinics or physician offices. About two thirds of the respondents indicated that their employer handled the billing of their services using standard evaluation and management codes, with estimated total monthly billings averaging $6500. At the time of the survey, about 80% of the respondents were engaged in a CDTM protocol. The survey results suggest that pharmacists with advanced-practice designations are perceived favorably by patients and physicians and their services are in high demand, but more than one third of respondents indicated a need to justify their advanced-practice positions to administrators. CONCLUSION Pharmacists with advanced-practice designations are providing clinical services in various settings under collaborative practice arrangements that include prescribing privileges. Despite growing patient and physician acceptance, reimbursement challenges continue to be a barrier to wider use of CDTM programs.

  11. Establishing radiation therapy advanced practice in New Zealand

    PubMed Central

    Coleman, Karen; Jasperse, Marieke; Herst, Patries; Yielder, Jill

    2014-01-01

    Introduction: Advanced practice (AP) is of increasing interest to many radiation therapists (RTs) both nationally and internationally. In New Zealand, initial research (2005–2008) showed strong support for the development of an AP role for medical radiation technologists (MRTs). Here, we report on a nationwide survey in which RTs validated and prioritised nine AP profiles for future development. Methods: All registered RTs in New Zealand (n = 260) were invited to take part in a survey in December 2011; 73 of whom returned a complete response. Results: RTs supported the implementation of AP roles in New Zealand and the requirement of a Master's degree qualification to underpin clinical knowledge. Most RTs endorsed the criteria attributed to each of the nine proposed AP profiles. The study identified that activities may qualify as either advanced practice or standard practice depending on the department. All participants agreed that an advanced practitioner should be a leader in the field, able to initiate and facilitate future developments within as well as outside this specific role. Acceptance of the AP roles by RTs and other health professionals as well as the availability of resources for successful implementation, were concerns expressed by some RTs. Conclusion: The authors recommend (1) the development of one scope of practice titled ‘advanced practitioner’ with generic and specialist criteria for each profile as the future career pathway, (2) promotion and support for the AP pathway by the New Zealand Institute of Medical Radiation Technology and the New Zealand Medical Radiation Technologists Board. PMID:26229634

  12. 27th Annual APRN legislative update: advancements continue for APRN practice.

    PubMed

    Phillips, Susanne J

    2015-01-16

    As the tides of healthcare in the United States continue to change, advanced practice registered nurses (APRNs) are at the forefront of legislative history. This overview provides a snapshot of legislative and regulatory activity in 2014 as reported by state Boards of Nursing and nursing organizations representing APRNs.

  13. Does a Social Work Degree Predict Practice Orientation? Measuring Strengths-Based Practice among Child Welfare Workers with the Strengths-Based Practices Inventory-Provider Version

    ERIC Educational Resources Information Center

    Douglas, Emily M.; McCarthy, Sean C.; Serino, Patricia A.

    2014-01-01

    Strengths-based practice (SBP) is one of the primary modalities of social work practice. The literature on SBP does not address a standardized tool for measuring SBP or whether receipt of a social work degree is related to practice orientation. We measure SBP with a provider-based Strengths-Based Practices Inventory (SBPI-P) and examine whether a…

  14. [Advance Directives: theoretical concept and practical significance in the USA].

    PubMed

    Vollmann, J; Pfaff, M

    2003-07-01

    The article examines on the basic of empirical data the discrepancy between the theoretical demand and the practical role of advance directives. Often advance directives have no influence on medical decision-making in clinical care of critically ill patients. The vague language of the widely used standard living wills and the lack of physician-patient communication in the process of delivering an advance directives are contributing factors. However, many physicians even disregard patients' preferences in concrete and meaningful living wills at the end of life. Besides the lack of information many even seriously ill patients do not deliver an advance because they misjudge their medical prognosis and life expectancy. Often the communication between patients and doctors are blocked because they expect from the each other the first step to talk about end of life decisions and advance directives. In this context physicians claim lack of time, training in communication skills and their discomfort in talking about death and dying with their patients.

  15. [Anticoagulant therapy clinic: moving towards Advanced Nursing Practice].

    PubMed

    Romero Ruiz, Adolfo; Parrado Borrego, Gema; Rodríguez González, José; Caparrós Miranda, Isabel S; Vargas Lirio, M Isabel; Ortiz Fernández, Primitiva

    2014-01-01

    There is currently around one million people receiving oral anticoagulants in Spain. The drug most used is acenocoumarol, which requires coagulation monitoring to ensure that the patient is within its normal therapeutic range. Patients usually start this treatment in a hospital clinic and, when they are stabilised, they are referred to primary care, where they are followed-up by their community nurses. The usual practice is that nurses are responsible for changes in the dose when the patients are outside the range. This practice is not performed by hospital nurses, despite having sufficient experience and knowledge to adequately manage these types of patients. An Advanced Nursing Practice model has been introduced into the Haematology management unit of the Hospital Universitario Virgen de la Victoria, Málaga. This involves various aspects of attention and care of patients on anticoagulant therapy, and includes adjusting the doses of their treatment following a catalogue of therapeutic and diagnostic ranges.

  16. The "nuts & bolts" of becoming an aesthetic provider: part 3-maximizing your aesthetic practice and client outcomes.

    PubMed

    Brennan, Connie

    2014-01-01

    The final installment of this 3-part series of articles on becoming an aesthetic provider centers on the steps necessary to maximize an aesthetic medical practice and tips for optimal client outcomes. We discuss the importance of education for the aesthetic provider, the staff, and the client, as well as how to create client loyalty. On the basis of years of experience, "pearls and pitfalls" are discussed, so the novice, intermediate, and advanced aesthetic providers can minimize mistakes and maximize their success in this exciting and growing profession.

  17. The advanced practice professionals' perspective: keys to a good working relationship between advanced practice professions and physicians.

    PubMed

    Polansky, Maura

    2013-01-01

    A strong working relationship between advanced practice professionals (APPs) and supervising oncologists is essential for reducing medical errors, retaining employees, and improving work environments. Although there is rather limited data on the unique relationship of the APP and physician, fundamental communication skills-including open communication, mutual respect, establishing expectations, and working with mutual purpose-should be the foundation of these relationships. This paper addresses various aspects of relationship building between APPs and physicians with suggestions for establishing successful working relationships.

  18. Educating advanced practice nurses in using social media in rural health care.

    PubMed

    Rutledge, Carolyn M; Renaud, Michelle; Shepherd, Laurel; Bordelon, Michele; Haney, Tina; Gregory, Donna; Ayers, Paula

    2011-01-01

    Health care in the United States is facing a crisis in providing access to quality care for those in underserved and rural regions. Advanced practice nurses are at the forefront of addressing such issues, through modalities such as health care technology. Many nursing education programs are seeking strategies for better educating students on technology utilization. Health care technology includes electronic health records, telemedicine, and clinical decision support systems. However, little focus has been placed on the role of social media in health care. This paper describes an educational workshop using standardized patients and hands-on experiences to introduce advanced practice nurses in a Doctor of Nursing Practice program to the role of social media in addressing issues inherent in the delivery of rural health care. The students explore innovative approaches for utilizing social media for patient and caregiver support as well as identify online resources that assist providers in a rural setting. PMID:22718665

  19. Penn Macy initiative to advance academic nursing practice.

    PubMed

    Lang, Norma M; Evans, Lois K; Swan, Beth Ann

    2002-01-01

    Academic nursing practice holds great promise for the future of the nursing discipline. The successful and intentional integration of the tripartite mission of research, education, and clinical practice can facilitate both the evolution of the science and implementation of evidence-based practice, while imbuing practitioners in the making with the world of the possible. Although many schools of nursing have been involved in some aspects of academic practice, the lack of common focus and direction has hampered concerted movement. The Penn Macy Initiative was conceived as a vehicle to help build and coalesce the critical mass needed to bridge this gap. The Penn Macy Initiative, its implementation and experience in the first 3 years, and how its alumni fellows, an annual conference, and Web-based consultation will continue to provide impetus, leadership, and resources for academic nursing practice in the years to come are described.

  20. Managing the gap: balancing advances in technology with advances in management practice.

    PubMed

    Ritchie, D

    1997-01-01

    Expenditure on information systems is widely anticipated to lead to improved management of health care resources. Despite large investments in hardware and software, these expectations are difficult to realise. Part of the difficulty lies in the manner in which information systems are applied to, rather than integrated within, organisations. This paper considers some of the the personal and organisational issues that need to be addressed to 'manage the gap' in balancing advances in information technology with advances in management practice. The issues identified are consistent with the concept of a learning organisation dealing with environmental change.

  1. Caring for Special Populations: Total Pain Theory in Advanced Heart Failure: Applications to Research and Practice

    PubMed Central

    Goebel, Joy R.; Doering, Lynn V.; Lorenz, Karl A.; Maliski, Sally L.; Nyamathi, Adeline M.; Evangelista, Lorraine S.

    2010-01-01

    PURPOSE Describe total pain theory and apply it to research and practice in advanced heart failure (HF). SOURCE OF INFORMATION Total pain theory provides a holistic perspective for improving care, especially at the end of life. In advanced HF, multiple domains of well-being known to influence pain perception are adversely affected by declining health and increasing frailty. A conceptual framework is suggested which addresses domains of well-being identified by total pain theory. CONCLUSION By applying total pain theory, providers may be more effective in mitigating the suffering of individuals with progressive, life-limiting diseases. PMID:19691653

  2. [Advanced nursing practice: a must for the quality of care and mental health services].

    PubMed

    Ricard, Nicole; Page, Claire; Laflamme, France

    2014-01-01

    New professional legislation and reorganization of mental health services have had a significant influence on mental health nursing practice. Many nurses have demonstrated clinical leadership and have been able to adapt their services to the needs of the population specially in the primary health care setting. However, many believe that the role of nurses is not sufficiently known and optimally utilized in mental health services. In this article we take a critical look at the mental health nursing practice in Quebec and at the essential requirements for its development. This review aims to: 1) describe current trends in the changing roles and the modernization of mental health nursing practice in Quebec, 2) provide an overview of the development of advanced nursing practice and its impact on the quality of mental health services; 3) clarify the concept of advanced nursing practice and position its development in Quebec and 4) propose various strategies for optimizing the role of nurses and their complementarity with other professionals providing mental health services. This review presents innovative practices developed by nurses in the context of the restructuring of mental health services. For example, new nursing roles have been developed to improve the collaboration with general practitioners groups in primary care settings and facilitate the evaluation and monitoring of patient presenting medical and psychological problems. Another interesting innovation was set up by nurses in developing a new service to allow timely access to integrated care for patients with substance abuse and mental health problems. The various testimonies reported in this article illustrate the potential contribution of these nursing innovations in improving the mental health services in Quebec. Also, in few countries, the reform of mental health services has been a good time to recognize this potential. Thus, some countries have repositioned the role of mental health nurses and

  3. [Advanced nursing practice: a must for the quality of care and mental health services].

    PubMed

    Ricard, Nicole; Page, Claire; Laflamme, France

    2014-01-01

    New professional legislation and reorganization of mental health services have had a significant influence on mental health nursing practice. Many nurses have demonstrated clinical leadership and have been able to adapt their services to the needs of the population specially in the primary health care setting. However, many believe that the role of nurses is not sufficiently known and optimally utilized in mental health services. In this article we take a critical look at the mental health nursing practice in Quebec and at the essential requirements for its development. This review aims to: 1) describe current trends in the changing roles and the modernization of mental health nursing practice in Quebec, 2) provide an overview of the development of advanced nursing practice and its impact on the quality of mental health services; 3) clarify the concept of advanced nursing practice and position its development in Quebec and 4) propose various strategies for optimizing the role of nurses and their complementarity with other professionals providing mental health services. This review presents innovative practices developed by nurses in the context of the restructuring of mental health services. For example, new nursing roles have been developed to improve the collaboration with general practitioners groups in primary care settings and facilitate the evaluation and monitoring of patient presenting medical and psychological problems. Another interesting innovation was set up by nurses in developing a new service to allow timely access to integrated care for patients with substance abuse and mental health problems. The various testimonies reported in this article illustrate the potential contribution of these nursing innovations in improving the mental health services in Quebec. Also, in few countries, the reform of mental health services has been a good time to recognize this potential. Thus, some countries have repositioned the role of mental health nurses and

  4. Oral health care and smoking cessation practices of interprofessional home care providers for their patients with HIV.

    PubMed

    VanDevanter, Nancy; Dorsen, Caroline G; Messeri, Peter; Shelley, Donna; Person, Andresa

    2012-07-01

    The need for oral health services among patients with HIV, especially those in advanced stages of disease and those who smoke, has been well documented. Patients receiving HIV-related home care services provide an opportunity for assessment of oral health and smoking cessation needs; however, the majority of home care providers lack formal training to provide these services, thus interprofessional collaborations may be of value. This study assessed the oral health and smoking cessation practices of a random sample of 81 HIV home care providers. Results showed very favorable attitudes toward providing these services with some differences across disciplines. More than 70% of nurses would like to receive additional training in comprehensive oral health assessment by dental professionals. The study provides evidence for the potential of expanding these services for patients with HIV through interprofessional collaboration, in particular with nurses and dentists. PMID:22506858

  5. Enhancing Practice Improvement by Facilitating Practitioner Interactivity: New Roles for Providers of Continuing Medical Education

    ERIC Educational Resources Information Center

    Parboosingh, I. John; Reed, Virginia A.; Palmer, James Caldwell; Bernstein, Henry H.

    2011-01-01

    Research into networking and interactivity among practitioners is providing new information that has the potential to enhance the effectiveness of practice improvement initiatives. This commentary reviews the evidence that practitioner interactivity can facilitate emergent learning and behavior change that lead to practice improvements. Insights…

  6. Comparison of Triadic and Provider-Led Intervention Practices in Early Intervention Home Visits

    ERIC Educational Resources Information Center

    Salisbury, Christine L.; Cushing, Lisa S.

    2013-01-01

    Despite calls for adoption and use of triadic early intervention practices, remarkably little research has prospectively compared this approach with traditional, provider-led service delivery. The aim of this study was to compare the actions of providers and caregivers within triadic and provider-led interactions with regard to the following: (1)…

  7. Beliefs and practices of obstetric care providers regarding umbilical cord clamping.

    PubMed

    Hill, Allyson L; Fontenot, Holly B

    2014-01-01

    The optimal timing for umbilical cord clamping after birth has yet to be established, and controversy exists. There is evidence of potentially significant health benefits of delayed cord clamping for both full-term and preterm newborns, but this practice has not been widely adopted. This column takes a second look at two recent studies in which researchers examined the beliefs and practices of obstetric care providers regarding umbilical cord clamping in North America. Nurses who are aware of the latest science and who understand both existing practice patterns as well as practice barriers to delayed clamping can be leaders in and advocates for change.

  8. The advanced practice professionals' perspective: keys to a good working relationship between advanced practice professions and physicians.

    PubMed

    Polansky, Maura

    2013-01-01

    A strong working relationship between advanced practice professionals (APPs) and supervising oncologists is essential for reducing medical errors, retaining employees, and improving work environments. Although there is rather limited data on the unique relationship of the APP and physician, fundamental communication skills-including open communication, mutual respect, establishing expectations, and working with mutual purpose-should be the foundation of these relationships. This paper addresses various aspects of relationship building between APPs and physicians with suggestions for establishing successful working relationships. PMID:23714552

  9. Mental Health Provider Attitudes Toward Adoption of Evidence-Based Practice: The Evidence-Based Practice Attitude Scale (EBPAS)

    PubMed Central

    Aarons, Gregory A.

    2006-01-01

    Mental health provider attitudes toward organizational change have not been well studied. Dissemination and implementation of evidence-based practices (EBPs) into real-world settings represent organizational change that may be limited or facilitated by provider attitudes toward adoption of new treatments, interventions, and practices. A brief measure of mental health provider attitudes toward adoption of EBPs was developed and attitudes were examined in relation to a set of provider individual difference and organizational characteristics. Methods Participants were 322 public sector clinical service workers from 51 programs providing mental health services to children and adolescents and their families. Results Four dimensions of attitudes toward adoption of EBPs were identified: (1) intuitive Appeal of EBP, (2) likelihood of adopting EBP given Requirements to do so, (3) Openness to new practices, and (4) perceived Divergence of usual practice with research-based/academically developed interventions. Provider attitudes varied by education level, level of experience, and organizational context. Conclusions Attitudes toward adoption of EBPs can be reliably measured and vary in relation to individual differences and service context. EBP implementation plans should include consideration of mental health service provider attitudes as a potential aid to improve the process and effectiveness of dissemination efforts. PMID:15224451

  10. Partner for Promotion: An Innovative Advanced Community Pharmacy Practice Experience

    PubMed Central

    Legg, Julie E.; Casper, Kristin A.

    2008-01-01

    Objectives To implement the Partner for Promotion (PFP) program which was designed to enhance the skills and confidence of students and community pharmacy preceptors to deliver and expand advanced patient care services in community pharmacies and also to assess the program's impact. Design A 10-month longitudinal community advanced pharmacy practice experience was implemented that included faculty mentoring of students and preceptors via formal orientation; face-to-face training sessions; online monthly meetings; feedback on service development materials; and a web site offering resources and a discussion board. Pre- and post-APPE surveys of students and preceptors were used to evaluate perceptions of knowledge and skills. Assessment The skills survey results for the first 2 years of the PFP program suggest positive changes occurring from pre- to post-APPE survey in most areas for both students and preceptors. Four of the 7 pharmacies in 2005-2006 and 8 of the 14 pharmacies in 2006-2007 were able to develop an advanced patient care service and begin seeing patients prior to the conclusion of the APPE. As a result of the PFP program from 2005-2007, 14 new experiential sites entered into affiliation agreements with The Ohio State University College of Pharmacy. Conclusion The PFP program offers an innovative method for community pharmacy faculty members to work with students and preceptors in community pharmacies in developing patient care services. PMID:19325954

  11. Reading Research: Advances in Theory and Practice. Volume 4.

    ERIC Educational Resources Information Center

    MacKinnon, G. E., Ed.; Waller, T. Gary, Ed.

    Intended to provide an outlet for systematic and substantive reviews, both empirical and theoretical, and for extended integrative reports of programatic research, this volume focuses on the nature of reading and reading disabilities, with implications for both theory and practice. The first chapter of the book reports on a long-term study of the…

  12. Enhancing practice improvement by facilitating practitioner interactivity: new roles for providers of continuing medical education.

    PubMed

    Parboosingh, I John; Reed, Virginia A; Caldwell Palmer, James; Bernstein, Henry H

    2011-01-01

    Research into networking and interactivity among practitioners is providing new information that has the potential to enhance the effectiveness of practice improvement initiatives. This commentary reviews the evidence that practitioner interactivity can facilitate emergent learning and behavior change that lead to practice improvements. Insights from learning theories provide a framework for understanding emergent learning as the product of interactions between individuals in trusted relationships, such as occurs in communities of practice. This framework helps explain why some groups respond more favorably to improvement initiatives than others. Failure to take advantage of practitioner interactivity may explain in part the disappointingly low mean rates of practice improvement reported in studies of the effectiveness of practice improvement projects. Examples of improvement models in primary care settings that explicitly use relationship building and facilitation techniques to enhance practitioner interactivity are provided. Ingredients of a curriculum to teach relationship building in communities of practice and facilitation skills to enhance learning in small group education sessions are explored. Sufficient evidence exists to support the roles of relationships and interactivity in practice improvement initiatives such that we recommend the development of training programs to teach these skills to CME providers.

  13. Enhancing practice improvement by facilitating practitioner interactivity: new roles for providers of continuing medical education.

    PubMed

    Parboosingh, I John; Reed, Virginia A; Caldwell Palmer, James; Bernstein, Henry H

    2011-01-01

    Research into networking and interactivity among practitioners is providing new information that has the potential to enhance the effectiveness of practice improvement initiatives. This commentary reviews the evidence that practitioner interactivity can facilitate emergent learning and behavior change that lead to practice improvements. Insights from learning theories provide a framework for understanding emergent learning as the product of interactions between individuals in trusted relationships, such as occurs in communities of practice. This framework helps explain why some groups respond more favorably to improvement initiatives than others. Failure to take advantage of practitioner interactivity may explain in part the disappointingly low mean rates of practice improvement reported in studies of the effectiveness of practice improvement projects. Examples of improvement models in primary care settings that explicitly use relationship building and facilitation techniques to enhance practitioner interactivity are provided. Ingredients of a curriculum to teach relationship building in communities of practice and facilitation skills to enhance learning in small group education sessions are explored. Sufficient evidence exists to support the roles of relationships and interactivity in practice improvement initiatives such that we recommend the development of training programs to teach these skills to CME providers. PMID:21671279

  14. To be involved or not: factors that influence nurses' involvement in providing treatment decisional support in advanced cancer.

    PubMed

    Barthow, Christine; Moss, Cheryle; McKinlay, Eileen; McCullough, Leslie; Wise, Debbie

    2009-02-01

    Decisional support is a multifaceted process of facilitating patients' decision making regarding treatment choices. Effective decisional support practices of nurses in relation to the use of anticancer therapies in patients with advanced disease are central to quality cancer care. A recent qualitative descriptive study (n=21) exploring the decision making practices of doctors and nurses in one tertiary cancer centre in New Zealand identified many complexities associated with nurses and their participation in decisional support. The study revealed that cancer nurses had varied opinions about the meaning and importance of their roles in treatment related decision making. This variation was significant and led the researchers to undertake a detailed secondary exploration of factors that impacted on the nurses' involvement in the provision of decisional support. Four key groups of factors were identified. These were factors relating to degree of knowledge, level of experience, beliefs and understandings about nursing roles and cancer therapies, and structural interfaces in the work setting. Understanding these factors is important because it allows modification of the conditions which impact on the ability to provide effective decisional care. It also provides some understanding of clinical drivers associated with nurses' decisional support work with patients who have advanced cancer.

  15. Attitudes and beliefs toward the use of a dental diagnostic terminology A survey of dental providers in a dental practice

    PubMed Central

    Ramoni, Rachel B.; Walji, Muhammad F.; Kim, Soyun; Tokede, Oluwabunmi; McClellan, Lyle; Simmons, Kristen; Skourtes, Eugene; Yansane, Alfa; White, Joel M.; Kalenderian, Elsbeth

    2015-01-01

    Background Attitudes and views are critical to the adoption of innovation. While there have been broadening calls for a standardized dental diagnostic terminology, little is known about the views of private practice dental team members towards the adoption of such a terminology. Methods A survey was developed using validated questions identified through literature review. Domain experts’ input allowed for further modifications. The final survey was administered electronically to 814 team members at a multi-office practice based in the Pacific Northwest. Results Response proportion was 92%. The survey had excellent reliability (Cronbach alpha coefficient = 0.87). Results suggested that participants showed, in general, positive attitudes and beliefs towards using a standardized diagnostic terminology in their practices. Additional written comments by participants highlighted the potential for improved communication with use of the terminology. Conclusions Dental providers and staff in one multi-office practice showed positive attitudes towards the use of a diagnostic terminology, specifically they believed it would improve communication between the dentist and patient as well as among providers, while expressing some concerns if using standardized dental diagnostic terms helps clinicians to deliver better dental care. Practical Implications As the dental profession is advancing towards the use of standardized diagnostic terminologies, successful implementation will require that dental team leaders prepare their dental teams by gauging their attitude toward the use of such a terminology. PMID:26025826

  16. Practical use of advanced mouse models for lung cancer.

    PubMed

    Safari, Roghaiyeh; Meuwissen, Ralph

    2015-01-01

    To date a variety of non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) mouse models have been developed that mimic human lung cancer. Chemically induced or spontaneous lung cancer in susceptible inbred strains has been widely used, but the more recent genetically engineered somatic mouse models recapitulate much better the genotype-phenotype correlations found in human lung cancer. Additionally, improved orthotopic transplantation of primary human cancer tissue fragments or cells into lungs of immune-compromised mice can be valuable tools for preclinical research such as antitumor drug tests. Here we give a short overview of most somatic mouse models for lung cancer that are currently in use. We accompany each different model with a description of its practical use and application for all major lung tumor types, as well as the intratracheal injection or direct injection of fresh or freeze-thawed tumor cells or tumor cell lines into lung parenchyma of recipient mice. All here presented somatic mouse models are based on the ability to (in) activate specific alleles at a time, and in a tissue-specific cell type, of choice. This spatial-temporal controlled induction of genetic lesions allows the selective introduction of main genetic lesions in an adult mouse lung as found in human lung cancer. The resulting conditional somatic mouse models can be used as versatile powerful tools in basic lung cancer research and preclinical translational studies alike. These distinctively advanced lung cancer models permit us to investigate initiation (cell of origin) and progression of lung cancer, along with response and resistance to drug therapy. Cre/lox or FLP/frt recombinase-mediated methods are now well-used techniques to develop tissue-restricted lung cancer in mice with tumor-suppressor gene and/or oncogene (in)activation. Intranasal or intratracheal administration of engineered adenovirus-Cre or lentivirus-Cre has been optimized for introducing Cre

  17. The impact of nonphysician providers on diagnostic and interventional radiology practices: regulatory, billing, and compliance perspectives.

    PubMed

    Hawkins, C Matthew; Bowen, Michael A; Gilliland, Charles A; Walls, D Gail; Duszak, Richard

    2015-08-01

    The numbers of nurse practitioners and physician assistants are increasing throughout the entire health care enterprise, and a similar expansion continues within radiology. Some practices have instead embraced radiologist assistants. The increased volume of services rendered by this growing nonphysician provider subset of the health care workforce within and outside of radiology departments warrants closer review. The authors evaluate the recent literature and offer recommendations to radiology practices regarding both regulatory and scope-of-practice issues related to these professionals. Additionally, billing and compliance issues for care provided by nurse practitioners, physician assistants, and radiologist assistants are detailed. An analysis of the integration of these professionals into interventional and diagnostic radiology practices, as well as potential implications for medical education, is provided in the second part of this series. PMID:26006744

  18. Organizational Culture and Climate and Mental Health Provider Attitudes Toward Evidence-Based Practice.

    PubMed

    Aarons, Gregory A; Sawitzky, Angelina C

    2006-02-01

    Mental health provider attitudes toward adopting evidence-based practice (EBP) are associated with organizational context and provider individual differences. Organizational culture and climate are contextual factors that can affect staff acceptance of innovation. This study examined the association of organizational culture and climate with attitudes toward adopting EBP. Participants were 301 public sector mental health service providers from 49 programs providing mental health services for youths and families. Correlation analyses and multilevel hierarchical regressions, controlling for effects of provider characteristics, showed that constructive culture was associated with more positive attitudes toward adoption of EBP and poor organizational climates with perceived divergence of usual practice and EBP. Behavioral health organizations may benefit from consideration of how culture and climate affect staff attitudes toward change in practice.

  19. Providers' attitudes towards treating depression and self-reported depression treatment practices in HIV outpatient care.

    PubMed

    Bess, Kiana D; Adams, Julie; Watt, Melissa H; O'Donnell, Julie K; Gaynes, Bradley N; Thielman, Nathan M; Heine, Amy; Zinski, Anne; Raper, James L; Pence, Brian W

    2013-03-01

    Depression is highly prevalent among HIV-infected patients, yet little is known about the quality of HIV providers' depression treatment practices. We assessed depression treatment practices of 72 HIV providers at three academic medical centers in 2010-2011 with semi-structured interviews. Responses were compared to national depression treatment guidelines. Most providers were confident that their role included treating depression. Providers were more confident prescribing a first antidepressant than switching treatments. Only 31% reported routinely assessing all patients for depression, 13% reported following up with patients within 2 weeks of starting an antidepressant, and 36% reported systematically assessing treatment response and tolerability in adjusting treatment. Over half of providers reported not being comfortable using the full FDA-approved dosing range for antidepressants. Systematic screening for depression and best-practices depression management were uncommon. Opportunities to increase HIV clinicians' comfort and confidence in treating depression, including receiving treatment support from clinic staff, are discussed.

  20. Collagenase Clostridium histolyticum : emerging practice patterns and treatment advances

    PubMed Central

    Warwick, David; Arandes-Renú, José M.; Pajardi, Giorgio; Witthaut, Jörg; Hurst, Lawrence C.

    2016-01-01

    Abstract Objective: This study aims to provide a comprehensive review of the role of Collagenase Clostridium histolyticum (CCH). Methods: This review is based on a literature review and practical experience. Results: This review provides practical management strategies for using collagenase by sharing clinical experiences over the past few years; logistical aspects of in-clinic treatment, lessons learned, and novel approaches to correct traditionally hard-to-treat contractures are discussed. In addition a brief, yet comprehensive overview is provided on the pathophysiology of the disease, the mechanism of collagenase action and results of clinical studies. Conclusion: CCH has an evolving role as one of the tools available for treating Dupuytren's disease. PMID:27050718

  1. Advancing the practice of systems engineering at JPL

    NASA Technical Reports Server (NTRS)

    Jansma, Patti A.; Jones, Ross M.

    2006-01-01

    In FY 2004, JPL launched an initiative to improve the way it practices systems engineering. The Lab's senior management formed the Systems Engineering Advancement (SEA) Project in order to "significantly advance the practice and organizational capabilities of systems engineering at JPL on flight projects and ground support tasks." The scope of the SEA Project includes the systems engineering work performed in all three dimensions of a program, project, or task: 1. the full life-cycle, i.e., concept through end of operations 2. the full depth, i.e., Program, Project, System, Subsystem, Element (SE Levels 1 to 5) 3. the full technical scope, e.g., the flight, ground and launch systems, avionics, power, propulsion, telecommunications, thermal, etc. The initial focus of their efforts defined the following basic systems engineering functions at JPL: systems architecture, requirements management, interface definition, technical resource management, system design and analysis, system verification and validation, risk management, technical peer reviews, design process management and systems engineering task management, They also developed a list of highly valued personal behaviors of systems engineers, and are working to inculcate those behaviors into members of their systems engineering community. The SEA Project is developing products, services, and training to support managers and practitioners throughout the entire system lifecycle. As these are developed, each one needs to be systematically deployed. Hence, the SEA Project developed a deployment process that includes four aspects: infrastructure and operations, communication and outreach, education and training, and consulting support. In addition, the SEA Project has taken a proactive approach to organizational change management and customer relationship management - both concepts and approaches not usually invoked in an engineering environment. This paper'3 describes JPL's approach to advancing the practice of

  2. Developing Structured-Learning Exercises for a Community Advanced Pharmacy Practice Experience

    PubMed Central

    Thomas, Renee Ahrens

    2006-01-01

    The recent growth in the number of pharmacy schools across the nation has resulted in the need for high-quality community advanced pharmacy practice experience (APPE) sites. A vital part of a student's education, these APPEs should be structured and formalized to provide an environment conducive to student learning. This paper discusses how to use a calendar, structured-learning activities, and scheduled evaluations to develop students' knowledge, skills, and abilities in a community pharmacy setting. PMID:17136164

  3. A Guide to Providing Social Support for Apprentices. Good Practice Guide

    ERIC Educational Resources Information Center

    National Centre for Vocational Education Research (NCVER), 2016

    2016-01-01

    The main purpose of this guide is to provide some ideas for employers of apprentices to provide an environment in which strong informal bases of support can succeed. Formal mentoring is an important aspect of apprenticeships; however, it is also informal mentoring--practices that are difficult to formally nurture--that plays a significant and…

  4. Developmental Surveillance and Screening Practices by Pediatric Primary Care Providers: Implications for Early Intervention Professionals

    ERIC Educational Resources Information Center

    Porter, Sallie; Qureshi, Rubab; Caldwell, Barbara Ann; Echevarria, Mercedes; Dubbs, William B.; Sullivan, Margaret W.

    2016-01-01

    This study used a survey approach to investigate current developmental surveillance and developmental screening practices by pediatric primary care providers in a diverse New Jersey county. A total of 217 providers were contacted with a final sample size of 57 pediatric primary care respondents from 13 different municipalities. Most providers…

  5. Biomarkers in inflammatory bowel disease: current practices and recent advances.

    PubMed

    Iskandar, Heba N; Ciorba, Matthew A

    2012-04-01

    Crohn's disease and ulcerative colitis represent the two main forms of the idiopathic chronic inflammatory bowel diseases (IBD). Currently available blood and stool based biomarkers provide reproducible, quantitative tools that can complement clinical assessment to aid clinicians in IBD diagnosis and management. C-reactive protein and fecal based leukocyte markers can help the clinician distinguish IBD from noninflammatory diarrhea and assess disease activity. The ability to differentiate between forms of IBD and predict risk for disease complications is specific to serologic tests including antibodies against Saccharomyces cerevisiae and perinuclear antineutrophil cytoplasmic proteins. Advances in genomic, proteomic, and metabolomic array based technologies are facilitating the development of new biomarkers for IBD. The discovery of novel biomarkers, which can correlate with mucosal healing or predict long-term disease course has the potential to significantly improve patient care. This article reviews the uses and limitations of currently available biomarkers and highlights recent advances in IBD biomarker discovery. PMID:22424434

  6. The impact of interprofessional collaboration on the effectiveness, significance, and future of advanced practice registered nurses.

    PubMed

    Brooten, Dorothy; Youngblut, JoAnne M; Hannan, Jean; Guido-Sanz, Frank

    2012-06-01

    Interprofessional collaboration was essential for the conduct of research that demonstrated the effectiveness and significance of advanced practice registered nurses (APRNs) in providing care, in reducing health care costs, and in developing innovative models of care for the nation's citizens. If the 2010 Affordable Care Act is to be implemented, APRNs, with their expertise and numbers, are essential to its implementation. Continued interdisciplinary collaboration is needed to expand the scope of APRN state practice regulations, to change reimbursement for APRN services, and to mute opposition to these changes by medical organizations. PMID:22579063

  7. The Caring Connections Project: Providing palliative care to Medicaid patients with advanced cancer.

    PubMed

    Pfeifer, Mark P; Ritchie, Christine; Scharfenberger, Jennifer; Keeney, Cynthia; Hermann, Carla; Berwick, Marilyn; Head, Barbara

    2006-01-01

    Palliative care, with its focus on symptom management, patient-centered goals, preparation for life's end, and preservation of quality of life in the face of advancing illness, is a rapidly advancing component of mainstream American medicine. Yet, access to palliative care is often lacking in the community setting and may be further hindered by the presence of healthcare disparities that impact the poor. This article presents a unique approach to assuring the availability of palliative care to Medicaid patients receiving case management services. This descriptive article describes the evolution of a palliative care management pilot program, the Caring Connections Program, beginning with the initial planning and progressing through implementation and provision of services to 56 persons. "Lessons learned" are shared to enable other providers to develop similar programs with success. Patient profiles and intervention strategies are offered to illustrate the work accomplished.

  8. Scope of practice review: providers for triage and assessment of spine-related disorders

    PubMed Central

    Boakye, Omenaa; Birney, Arden; Suter, Esther; Phillips, Leah Adeline; Suen, Victoria YM

    2016-01-01

    Purpose This study explored which health care providers could be involved in centralized intake for patients with nonspecific low back pain to enhance access, continuity, and appropriateness of care. Methods We reviewed the scope of practice regulations for a range of health care providers. We also conducted telephone interviews with 17 individuals representing ten provincial colleges and regulatory bodies to further understand providers’ legislated scopes of practice. Activities relevant to triaging and assessing patients with low back pain were mapped against professionals’ scope of practice. Results Family physicians and nurse practitioners have the most comprehensive scopes and can complete all restricted activities for spine assessment and triage, while the scope of registered nurses and licensed practical nurses are progressively narrower. Chiropractors, occupational therapists, physiotherapists, and athletic therapists are considered experts in musculoskeletal assessments and appear best suited for musculoskeletal specific assessment and triage. Other providers may play a complementary role depending on the individual patient needs. Conclusion These findings indicate that an interprofessional assessment and triage team that includes allied health professionals would be a feasible option to create a centralized intake model. Implementation of such teams would require removing barriers that currently prevent providers from delivering on their full scope of practice. PMID:27274267

  9. Emergency nurse practitioners' perceptions of their role and scope of practice: is it advanced practice?

    PubMed

    McConnell, Donna; Slevin, Oliver D; McIlfatrick, Sonja J

    2013-04-01

    There are multiple interpretations of the nurse practitioner role which appear to be shaped by discourses within and outside the profession and its regulatory body. This study aimed to explore and clarify the role and scope of practice of emergency nurse practitioners in a region in the United Kingdom and determine if they fulfil the proposed criteria for Advanced Nurse Practitioners. A survey approach using questionnaires (n=42) was adopted. The sample included all emergency nurse practitioners working in Accident and Emergency Departments and Minor Injury Units in the region. Statistical data was analysed using SPSS for Windows and qualitative data was content analysed for themes. Results revealed a variation in education. Investigation of role typology and scope of practice revealed a relatively homogenous group where the clinical aspect of the role dominated. The scope of practice was perceived to be influenced by internal factors such as competence; however protocol use, referral rights and prescribing authority could be considered ways that nursing management and medical staff indirectly control the role. Findings suggested that emergency nurse practitioners were working at a level significantly beyond registration, yet do not fulfil the Nursing and Midwifery Council proposed criteria for Advanced Nurse Practitioner. PMID:23615513

  10. Emergency Department Mental Health Triage and Consultancy Service: an advanced practice role for mental health nurses.

    PubMed

    McDonough, Stuart; Wynaden, Dianne; Finn, Michael; McGowan, Sunita; Chapman, Rose; Gray, Shirilee

    2003-04-01

    This paper describes a four-month preparatory training program for mental health nurses to provide an Emergency Mental Health Triage and Consultancy Service in the emergency department. The emergency department is an important gateway for patients presenting with psychiatric/psychosocial problems and mental health professionals need to provide prompt and effective care to this group of patients. Prior to the implementation of the service, it was acknowledged that occupational stress and burnout could affect the turnover of mental health nurses in the department. Therefore, a training program was employed to prepare a number of experienced mental health nurses to work at an advanced practitioner level. The four-month training program developed at Fremantle Hospital in Western Australia provided support, guidance and clinical supervision. In the first 12 months of the service, five mental health nurses completed the program, thus creating a pool of nurses who were able to provide the service. The results demonstrated that providing mental health nurses with a structured program was instrumental in facilitating their movement to an advanced practitioner level. The nurses were able to apply advanced knowledge and skills to assess and manage clients with complex mental health /psychosocial problems. Furthermore, on leaving the emergency department these nurses were able to utilise the advanced skills in other areas of mental health nursing practice.

  11. Advanced practice role characteristics of the community/public health nurse specialist.

    PubMed

    Robertson, Julie Fisher; Baldwin, Karen Brandt

    2007-01-01

    The purpose of this qualitative study was to describe the advanced practice role of nurses with master's degrees in community/public health nursing using their experiences and perspectives. The purposive sample consisted of 10 nurses who had master's degrees in community/public health nursing and were working in a variety of community health settings. Data were collected using audiotaped interviews and 1-day observations of study participants in their workplaces. An editing analysis technique was used to analyze the data. Findings indicated that role characteristics included advocacy and policy setting at the organizational, community, and state levels; a leadership style centered on empowerment; a broad sphere of influence; and high-level skills in large-scale program planning, project management, and building partnerships. Results provide important descriptive data about significant aspects of the advanced practice role of nurses with master's degrees in community/public health nursing.

  12. Anal Cancer Screening in an Urban HIV Clinic: Provider Perceptions and Practice.

    PubMed

    Sowah, Leonard Anang; Buchwald, Ulrike K; Riedel, David J; Gilliam, Bruce L; Khambaty, Mariam; Fantry, Lori; Spencer, Derek E; Weaver, Jeffery; Taylor, Gregory; Skoglund, Mary; Amoroso, Anthony; Redfield, Robert R

    2015-01-01

    In this article, we sought to understand the perceptions and practice of providers on anal cancer screening in HIV-infected patients. Providers in an academic outpatient HIV practice were surveyed. Data were analyzed to determine the acceptability and perceptions of providers on anal Papanicolaou tests. Survey response rate was 55.3% (60.7% among male and 47.4% among female providers). One-third of the providers had received screening requests from patients. Female providers had higher self-rated comfort with anal Papanicolaou tests, with a mean score of 7.1 (95% confidence interval [CI] 4.7-9.5) compared to 3.6 (95% CI 1.5-5.7) for male providers, P = .02. Sixty-seven percent of male providers and 37.5% of female providers would like to refer their patients for screening rather than perform the test themselves. Only 54.2% of our providers have ever performed anal cytology examination. Our survey revealed that not all providers were comfortable performing anal cancer screening for their patients.

  13. Advancing the practice of health impact assessment in Canada: Obstacles and opportunities

    SciTech Connect

    McCallum, Lindsay C.; Ollson, Christopher A.; Stefanovic, Ingrid L.

    2015-11-15

    Health Impact Assessment (HIA) is recognized as a useful tool that can identify potential health impacts resulting from projects or policy initiatives. Although HIA has become an established practice in some countries, it is not yet an established practice in Canada. In order to enable broader support for HIA, this study provides a comprehensive review and analysis of the peer-reviewed and gray literature on the state of HIA practice. The results of this review revealed that, although there is an abundance of publications relating to HIA, there remains a lack of transparent, consistent and reproducible approaches and methods throughout the process. Findings indicate a need for further research and development on a number of fronts, including: 1) the nature of HIA triggers; 2) consistent scoping and stakeholder engagement approaches; 3) use of evidence and transparency of decision-making; 4) reproducibility of assessment methods; 5) monitoring and evaluation protocols; and, 6) integration within existing regulatory frameworks. Addressing these issues will aid in advancing the more widespread use of HIA in Canada. - Highlights: • Reviewed current state of practice in the field of HIA • Identified key obstacles and opportunities for HIA advancement • Major issues include lack of consistent approach and methodology. • No national regulatory driver hinders opportunity for widespread use of HIA. • Identified research opportunities vital to developing HIA practice in Canada.

  14. Collaborative Practice in Early Childhood Intervention from the Perspectives of Service Providers

    ERIC Educational Resources Information Center

    Yang, Chih-Hung; Hossain, Syeda Zakia; Sitharthan, Gomathi

    2013-01-01

    Effective early childhood intervention (ECI) relies on collaboration among agencies, service providers, and families. Although previous literature has primarily focused on segments of collaboration within ECI service delivery, the actual process and how the adult stakeholders perceive and engage in collaborative practice have important…

  15. Implementing Secondary Transition Evidence-Based Practices: A Multi-State Survey of Transition Service Providers

    ERIC Educational Resources Information Center

    Mazzotti, Valerie L.; Plotner, Anthony J.

    2016-01-01

    Inadequate transition outcomes for youth with disabilities have produced a call for enhanced transition service delivery that includes implementation of evidence-based practices (EBPs). However, research indicates transition service providers still lack the knowledge and skills to effectively implement EBPs to ensure youth with disabilities…

  16. Feeding Students in School: Providing Guidelines and Information on Safe Feeding Practices for Special Students.

    ERIC Educational Resources Information Center

    Hall, Sandra; And Others

    This manual provides guidelines for safe feeding practices for students with disabilities in Oregon schools. Stressed is the importance of distinguishing between feeding for the maintenance of health and feeding for the acquisition of skills. Individual sections cover: definitions of feeding programs; the school district responsibility; risks;…

  17. USDA food and nutrient databases provide the infrastructure for food and nutrition research, policy and practice

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The USDA food and nutrient databases provide the basic infrastructure for food and nutrition research, nutrition monitoring, and dietary practice. They have had a long history that goes back to 1892, and are unique, as they are the only databases available in the public domain that perform these fu...

  18. Interaction of Socioeconomic Status and Provider Practices as Predictors of Immunization Coverage in Virginia Children.

    ERIC Educational Resources Information Center

    Williams, Ian T.; And Others

    1995-01-01

    Found that beginning the immunization schedule at the recommended age was crucial to appropriate vaccination later in life, and that health provider practices (such as failure to administer vaccinations simultaneously) were important predictors of underimmunization. Serious delays in vaccine administration were observed for poor children in all…

  19. The Relationship between Practices and Child Care Providers' Beliefs Related to Child Feeding and Obesity Prevention

    ERIC Educational Resources Information Center

    Lanigan, Jane D.

    2012-01-01

    Objective: To examine the association between child care practices and child care provider knowledge and beliefs about their role in supporting children's healthful eating. Design: Longitudinal design using survey and observation data from baseline and year 1 of the Encouraging Healthy Activity and Eating in Childcare Environments (ENHANCE) pilot…

  20. 28th Annual APRN Legislative Update: Advancements continue for APRN practice.

    PubMed

    Phillips, Susanne J

    2016-01-16

    The Annual Legislative Update discusses the legislative accomplishments in the areas of practice authority, reimbursement, and prescriptive authority that have the most impact on nurse practitioners and other advanced practice nurses across the country.

  1. Practical strategies for providing culturally sensitive, ethical care in developing nations.

    PubMed

    Crigger, Nancy J; Holcomb, Lygia

    2007-01-01

    Providing health care in developing nations results in cultural and ethical challenges for health care professionals. The authors' intent is to raise readers' awareness of how to maintain an ethical and culturally sensitive approach to practice in developing nations. Four practical approaches to ethical decision-making, developed from the literature and praxis, in conjunction with traditional moral theory and guidelines from professional and international organizations are discussed. Ethical multiculturalism, a view that combines universalism and multiculturalism undergirds culturally appropriate and ethically responsive decisions.

  2. Beliefs and practices of healthcare providers regarding obesity: a systematic review.

    PubMed

    Teixeira, Filipa Valente; Pais-Ribeiro, José Luis; Maia, Ângela Rosa Pinho da Costa

    2012-01-01

    Despite the implementation of various intervention measures, the number of obese individuals remain high; thus, it is important to consider what is contributing to this scenario. Authors have been striving to understand the role healthcare providers, especially in primary healthcare, seem to play in this context. The present review aims to synthesize the main investigation results regarding beliefs, attitudes, and practices of healthcare providers, as they seem to negatively influence the practitioner's actions. The words "obesity", "beliefs", "healthcare professionals", "general practitioners", "attitudes", "practices", "health physicians", and "family practitioners" were entered into databases, such as EBSCOHost, ScienceDirect, Psychlnfo, PubMed, and SciELO. Thirteen studies from 1991 to 2011 were reviewed. The data indicate a lack of appropriate understanding and adequate competence regarding obesity, which likely contributes to ambivalent belief development and negative attitudes toward obese individuals, who are described as unmotivated, lazy, and lacking self-control. These professionals consider it hard to deal with obesity, manifesting low expectations of success regarding weight loss, thus considering themselves unsuccessful. Their practices are inconsistent, mirroring a certain skepticism towards the efficacy of available interventions. Either during graduation or as active practitioners, it is imperative to make healthcare providers aware of the impact their beliefs regarding obesity can exert on their practices, as these may impair appropriate and effective treatment delivery to obese individuals.

  3. Paying for prevention in clinical practice: Aligning provider remuneration with system objectives

    PubMed Central

    2015-01-01

    Evidence on the efficacy of preventive procedures in oral health care has not been matched by uptake of prevention in clinical practice. Reducing oral disease in the population reduces the size of the future market for treatment. Hence a provider's intention to adopt prevention in clinical practice may be offset by the financial implications of such behaviour. Effective prevention may therefore depend upon prevention-friendly methods of remuneration if providers are to be rewarded appropriately for doing what the system expects them to do. This paper considers whether changing the way providers are paid for delivering care can be expected to change the utilisation of preventive care in the population in terms of the proportion of the population receiving preventive care, the distribution of preventive care in the population and the pattern of preventive care received. A conceptual framework is presented that identifies the determinants of rewards under different approaches to provider remuneration. The framework is applied to develop recommendations for paying for prevention in clinical practice. Literature on provider payment in dental care is reviewed to assess the evidence base for the effects of changing payment methods, identify gaps in the evidence-base and inform the design of future research on dental remuneration. PMID:26390928

  4. Paying for prevention in clinical practice: Aligning provider remuneration with system objectives.

    PubMed

    Birch, Stephen

    2015-01-01

    Evidence on the efficacy of preventive procedures in oral health care has not been matched by uptake of prevention in clinical practice. Reducing oral disease in the population reduces the size of the future market for treatment. Hence a provider's intention to adopt prevention in clinical practice may be offset by the financial implications of such behaviour. Effective prevention may therefore depend upon prevention-friendly methods of remuneration if providers are to be rewarded appropriately for doing what the system expects them to do. This paper considers whether changing the way providers are paid for delivering care can be expected to change the utilisation of preventive care in the population in terms of the proportion of the population receiving preventive care, the distribution of preventive care in the population and the pattern of preventive care received. A conceptual framework is presented that identifies the determinants of rewards under different approaches to provider remuneration. The framework is applied to develop recommendations for paying for prevention in clinical practice. Literature on provider payment in dental care is reviewed to assess the evidence base for the effects of changing payment methods, identify gaps in the evidence-base and inform the design of future research on dental remuneration.

  5. Advanced practice nursing for enduring health needs management: a global perspective.

    PubMed

    Koskinen, Liisa; Mikkonen, Irma; Graham, Iain; Norman, Linda D; Richardson, Jim; Savage, Eileen; Schorn, Mavis

    2012-07-01

    Advanced practice nursing expertise has been acknowledged worldwide as one response to the challenges arising from changes in society and health care. The roots of advanced practice nursing education are at the University of Colorado where the first known programme started in 1965. In many countries advanced practice nurses (APNs) have taken responsibility for routine patient care formerly carried out by physicians in order to reduce their workload. However, more and more, APNs have taken responsibility for new service areas and quality programmes not previously provided. Chronic disease management is one of these new service areas because long-term diseases are increasingly challenging service systems globally. This article is based on an international APN partnership. The aim of the article is to describe how the partnership will design a 15 ECTS credit course on Enduring Health Need Management as a cross-cultural collaborative endeavour. The adaptation of an inquiry based learning framework will be described drawing on four main principles of the theory: authentic learning communities; student encouragement in analysing gradually more complicated problems; networking in knowledge creation and; student engagement and activity. The cross-cultural online course aims to increase APNs' intercultural competence as well as their global and international work orientation. PMID:21839552

  6. The CNS with practitioner preparation: an emerging role in advanced practice nursing.

    PubMed

    Busen, N H; Engleman, S G

    1996-05-01

    As health care reform continues, CNSs are retooling for nurse practitioner (NP) roles. Although the debate regarding role integration is ongoing, advanced practice nurses (APNs) with blended preparation are appearing in the workplace. Much has been written about attributes the NP brings to the practice setting, but little has been said about the unique skills and knowledge base that the CNS brings. CNSs, with additional preparation as practitioners, will be marketable providers with population-specific knowledge, technological expertise, and comfort with higher acuity levels. This will allow APNs to combine a preventive model with high acuity levels, practice holistically, improve quality, and decrease costs of care. A case study of care given by a pediatric critical care CNS returning to school for practitioner preparation, which demonstrates several of the above concepts, is presented.

  7. Practical feasibility of advanced steam systems for combined-cycle power plants: Final report

    SciTech Connect

    Not Available

    1988-05-01

    Over the past decade, advances in gas turbine design have lead to significant advances in the performance of simple cycle units. Higher turbine outlet temperatures with modern gas turbines provide an opportunity for improvements in the steam bottoming cycle of combined cycle configurations as well. This report covers the study, conducted under EPRI Project RP2052-2, to evaluate the practical feasibility of various steam cycle improvement approaches. The concept of ''Fully Reserved Cost of Electricity'' (FRCOE), developed for assessing the practical merits of proposed cycle improvement schemes, is described. FRCOE assigns cost penalties for the loss of availability or increased uncertainty due to any complexity introduced by these schemes. Experience with existing units incorporating advanced features is described, together with the technology limits to some of the advanced features. Practical feasibility assessments of steam bottoming cycle configurations, such as multiple steam pressures and reheating, are presented. Assessment of adjustments in steam cycle parameters included steam throttle pressure, superheater approach, pinch point, economizer approach and condensing pressure. Using data for a representative advanced gas turbine and conservative component availability estimates, the assessments found that lowering the pinch point has the greatest beneficial effects on the FRCOE. Favorable FRCOE results from two-pressure and nonreheat cycles. Only minor benefits acrue from lower superheater and economizer approaches, and throttle pressures above 1500 psi. There is no universally optimum system. At low fuel costs and low capacity factors, cycle improvements leading to loss of availabililty are not found to be economically justifiable. Conversely, at high fuel costs and capacity factors, these complex high performance cycles result in economically advantageous plants. Each plant application needs to be specifically analyzed. 3 refs., 17 figs., 8 tabs.

  8. Impact of advanced manufacturing technology on prosthetic and orthotic practice.

    PubMed

    Jones, D

    1988-04-01

    Radical changes in the technology applied to prosthetics and orthotics are being proposed. This paper attempts to define the scope and character of advanced manufacturing technology and examines the rehabilitation problems which are or could be tackled. Lower-limb prosthetics has been the major area under investigation so far, but orthopaedic footwear, spinal orthotics and custom seating for the disabled have also been investigated using similar technological approaches. The whole process of patient measurement, device design, and component manufacture is conceived as an integrated system relying upon shape or tissue property sensing, computer based device design and computer-numerically-controlled or robot manufacturing processes. The aim is to retain flexibility for custom design which is necessary to provide for individual patients, and yet improve the rapidity and precision of overall device manufacture and service delivery.

  9. Attitudes and practices of hemophilia care providers involved in HIV risk-reduction counseling.

    PubMed

    Meredith, K L; Hannan, J A; Green, T A; Wiley, S D

    1994-10-01

    Hemophilia physicians, nurses, and social workers attending a national conference were asked to complete a questionnaire assessing their attitudes and practices regarding HIV risk-reduction counseling. All of the 150 respondents reported recommending the use of condoms to their clients, but only two-thirds felt comfortable demonstrating a condom, while fewer could explain condom choices or how to make safe sex more pleasurable. Less than half questioned their clients about history of STDs, sexual practices, or level of sexual satisfaction. Those who devoted 50 percent or more time to HIV risk-reduction efforts reported being more complete in their assessment and more comfortable in their counseling role. Providers claimed it would help if they had more time (84%) and better skills (64%, especially nurses) for this practice. Because HIV prevention services in hemophilia are delivered by a team, further studies are required to determine the aggregate impact of their intervention on the client.

  10. Integrating interprofessional collaboration skills into the advanced practice registered nurse socialization process.

    PubMed

    Farrell, Kathleen; Payne, Camille; Heye, Mary

    2015-01-01

    The emergence of interprofessional collaboration and practice as a means to provide patient-centered care and to decrease the current fragmentation of health care services in the 21st century provides a clear and unique opportunity for the advanced practice registered nurse (APRN) to assume a key role. For APRNs and other health care providers, to participate effectively as team members requires an interprofessional mindset. Development of interprofessional skills and knowledge for the APRN has been hindered by a silo approach to APRN role socialization. The Institute of Medicine Report (IOM; 2010) states that current health care systems should focus on team collaboration to deliver accessible, high-quality, patient-centered health care that addresses wellness and prevention of illness and adverse events, management of chronic illness, and increased capacity of all providers on the team. The purpose of this article is to demonstrate the need to incorporate interprofessional education (IPE) into the socialization models used in advanced practice nursing programs. IPE requires moving beyond profession-specific educational efforts to engage students of different health care professions in interactive learning. Being able to work effectively as member of a clinical team while a student is a fundamental part of that learning (Interprofessional Education Collaborative Expert Panel, 2011). The objective of IPE curriculum models in graduate nursing programs is to educate APRNs in the development of an interprofessional mindset. Interprofessional collaboration and coordination are needed to achieve seamless transitions for patients between providers, specialties, and health care settings (IOM, 2010). Achieving the vision requires the continuous development of interprofessional competencies by APRNs as part of the learning process, so that upon entering the workforce, APRNs are ready to practice effective teamwork and team-based care. Socialization of the professional APRN

  11. Advancing geriatrics research, education, and practice: policy challenges after the great recession.

    PubMed

    Zerzan, Judy T; Rich, Eugene C

    2014-06-01

    The series of articles in this JGIM issue provides a number of policy-relevant recommendations for advancing geriatrics research, education and practice. Despite the unprecedented pressure to reduce state and federal spending, policymakers must concurrently address the challenges of a growing population of older individuals with increasingly complex health care problems. Thus, there may be opportunities to advance this agenda in creative ways. For example, without new spending, federal research agencies can make changes to encourage needed new directions in aging research, and the ACA provides new funding opportunities such as the Patient Centered Outcomes Research Institute. States and the federal government have an increasing need for the health professions workforce to have collaborative care skills and geriatrics clinical competencies, and are finding ways to invest in relevant initiatives. On the clinical program side, state and federal governments are initiating programs to promote delivery system changes that improve the care of older adults. Nonetheless, in the face of the policy challenges that have persisted after the "great recession," academic geriatrics and general internal medicine will need to join forces with public and private interests to secure the resources needed to advance this ambitious agenda for geriatrics research, education and practice.

  12. Attitudes About and Practices of Health Promotion and Prevention Among Primary Care Providers.

    PubMed

    Luquis, Raffy R; Paz, Harold L

    2015-09-01

    The Patient Protection and Affordable Care Act's emphasis on health promotion and prevention activities required an examination of the current practices of primary care providers in these areas. A total of 196 primary care providers completed a survey to assess current health promotion and prevention attitudes, practices, and barriers. Results of this study showed that family physicians in Pennsylvania recognize the importance of and their role in providing health promotion and prevention and offer advice in key behavioral and disease prevention areas. Results from the study suggest that their ability to provide these services is hindered by a lack of time and the heavy workload. Although most family physicians provided advice to patients in several health promotion and prevention areas, few participants reported that they referred patients to other health professionals. Finally, when it comes to preventive services, participants ranked blood pressure screening, tobacco use screening, and tobacco use cessation interventions as the most important services. Effective implementation of the Patient Protection and Affordable Care Act will require necessary resources and support of primary care providers to help patients achieve healthier lives.

  13. Use of antenatal corticosteroids for preterm birth in Latin America: providers knowledge, attitudes and practices

    PubMed Central

    2013-01-01

    Background Antenatal corticosteroids administered to women at risk of preterm birth is an intervention which has been proved to reduce the risk of respiratory distress syndrome, intraventricular hemorrhage, and neonatal mortality. There is a significant gap in the literature regarding the prevalence of the use of antenatal corticosteroids in Latin American countries and the attitudes and opinions of providers regarding this practice. The aim of this study was to assess the knowledge, attitudes and practices of health care providers regarding the use of antenatal corticosteroids in women at risk of preterm birth in Latin America. Methods This was a multicenter, prospective, descriptive study conducted in maternity hospitals in Ecuador, El Salvador, Mexico and Uruguay. Physicians and midwives who provide prenatal care or intrapartum care for women delivering in the selected hospitals were approached using a self-administered questionnaire. Descriptive statistics was used. Results The percentage of use of ACT in threatened preterm labour (TPL) reported by providers varies from 70% in Mexico to 97% in Ecuador. However, 60% to 20% of the providers mentioned that they would not use this medication in women at risk and would limit its use when there was a threatened preterm labour. In only one country recommended regimens of antenatal corticosteroids are followed by around 90% of providers whereas in the other three countries recommended regimens are followed by only 21%, 61%, 69% of providers. Around 40% of providers mentioned that they would administer a new dose of corticosteroids again, regardless the patient already receiving an entire regimen. Between 11% and 35% of providers, according to the countries, mentioned that they do not have adequate information on the correct use of this medication. Conclusions This study shows that the use of this intervention could be improved by increasing the knowledge of Latin American providers on its indications, benefits, and

  14. An Advanced Pharmacy Practice Experience in a Student-Staffed Medication Therapy Management Call Center

    PubMed Central

    Hall, Anna M.; Roane, Teresa E.; Mistry, Reena

    2012-01-01

    Objective. To describe the implementation of an advanced pharmacy practice experience (APPE) in medication therapy management (MTM) designed to contribute to student pharmacists’ confidence and abilities in providing MTM. Design. Sixty-four student pharmacists provided MTM services during an APPE in a communication and care center. Assessment. Students conducted 1,495 comprehensive medication reviews (CMRs) identifying 6,056 medication-related problems. Ninety-eight percent of the students who completed a survey instrument (52 of 53) following the APPE expressed that they had the necessary knowledge and skills to provide MTM services. Most respondents felt that pharmacist participation in providing Medicare MTM could move the profession of pharmacy forward and that pharmacists will have some role in deciding the specific provisions of the Medicare MTM program (92% and 91%, respectively). Conclusion. Students completing the MTM APPE received patient-centered experiences that supplemented their confidence, knowledge, and skill in providing MTM services in the future. PMID:22919086

  15. Advancing community stakeholder engagement in biomedical HIV prevention trials: principles, practices and evidence.

    PubMed

    Newman, Peter A; Rubincam, Clara

    2014-12-01

    Community stakeholder engagement is foundational to fair and ethically conducted biomedical HIV prevention trials. Concerns regarding the ethical engagement of community stakeholders in HIV vaccine trials and early terminations of several international pre-exposure prophylaxis trials have fueled the development of international guidelines, such as UNAIDS' good participatory practice (GPP). GPP aims to ensure that stakeholders are effectively involved in all phases of biomedical HIV prevention trials. We provide an overview of the six guiding principles in the GPP and critically examine them in relation to existing social and behavioral science research. In particular, we highlight the challenges involved in operationalizing these principles on the ground in various global contexts, with a focus on low-income country settings. Increasing integration of social science in biomedical HIV prevention trials will provide evidence to advance a science of community stakeholder engagement to support ethical and effective practices informed by local realities and sociocultural differences.

  16. Artificial intelligence in medicine and cardiac imaging: harnessing big data and advanced computing to provide personalized medical diagnosis and treatment.

    PubMed

    Dilsizian, Steven E; Siegel, Eliot L

    2014-01-01

    Although advances in information technology in the past decade have come in quantum leaps in nearly every aspect of our lives, they seem to be coming at a slower pace in the field of medicine. However, the implementation of electronic health records (EHR) in hospitals is increasing rapidly, accelerated by the meaningful use initiatives associated with the Center for Medicare & Medicaid Services EHR Incentive Programs. The transition to electronic medical records and availability of patient data has been associated with increases in the volume and complexity of patient information, as well as an increase in medical alerts, with resulting "alert fatigue" and increased expectations for rapid and accurate diagnosis and treatment. Unfortunately, these increased demands on health care providers create greater risk for diagnostic and therapeutic errors. In the near future, artificial intelligence (AI)/machine learning will likely assist physicians with differential diagnosis of disease, treatment options suggestions, and recommendations, and, in the case of medical imaging, with cues in image interpretation. Mining and advanced analysis of "big data" in health care provide the potential not only to perform "in silico" research but also to provide "real time" diagnostic and (potentially) therapeutic recommendations based on empirical data. "On demand" access to high-performance computing and large health care databases will support and sustain our ability to achieve personalized medicine. The IBM Jeopardy! Challenge, which pitted the best all-time human players against the Watson computer, captured the imagination of millions of people across the world and demonstrated the potential to apply AI approaches to a wide variety of subject matter, including medicine. The combination of AI, big data, and massively parallel computing offers the potential to create a revolutionary way of practicing evidence-based, personalized medicine.

  17. Review: Coastal groundwater optimization—advances, challenges, and practical solutions

    NASA Astrophysics Data System (ADS)

    Ketabchi, Hamed; Ataie-Ashtiani, Behzad

    2015-09-01

    Decision models are essential tools for coastal groundwater management (CGM). A combined simulation-optimization framework is employed to develop these models. One of the main barriers in the widespread application of these models for real-world cases is their large computational burden. Recent advances in efficient computational approaches and robust optimization methods can crack this barrier. This study surveys the scientific basis of CGM to provide an overview on this subject and reviews the-state-of-the-art to clarify recent developments and to outline ideas for improving the computational performance. Key details are presented on the performance and choice of possible robust tools such as efficient evolutionary algorithms (EAs), surrogate models, and parallel processing techniques. Then, the potential challenges remaining in this context are scrutinized, demonstrating open fields for further research, which include issues related to advances in simulating and optimizing phases such as introducing new robust algorithms and considering multi-objective purposes, implementing novel and high-performance tools, considering global concerns (e.g. climate change impacts), enhancing the existing models to fit the real world, and taking into account the complexities of real-world applications (e.g. uncertainties in the modeling parameters, and data acquisition). Finally, the outcomes of the systematic review are applied to solve a real-world CGM problem in Iran, to quantitatively examine the performance of combined implementation of some of the suggested tools. It is revealed that the required computational time is considerably reduced by as much as three orders of magnitude when correct combinations of robust EAs, surrogate model, and parallelization technique are utilized.

  18. Advance market commitment for pneumococcal vaccines: putting theory into practice.

    PubMed

    Cernuschi, Tania; Furrer, Eliane; Schwalbe, Nina; Jones, Andrew; Berndt, Ernst R; McAdams, Susan

    2011-12-01

    Markets for life-saving vaccines do not often generate the most desired outcomes from a public health perspective in terms of product quantity, quality, affordability, programmatic suitability and/or sustainability for use in the lowest income countries. The perceived risks and uncertainties about sustainably funded demand from developing countries often leads to underinvestment in development and manufacturing of appropriate products. The pilot initiative Advance Market Commitment (AMC) for pneumococcal vaccines, launched in 2009, aims to remove some of these market risks by providing a legally binding forward commitment to purchase vaccines according to predetermined terms. To date, 14 countries have already introduced pneumococcal vaccines through the AMC with a further 39 countries expected to introduce before the end of 2013.This paper describes early lessons learnt on the selection of a target disease and the core design choices for the pilot AMC. It highlights the challenges faced with tailoring the AMC design to the specific supply situation of pneumococcal vaccines. It points to the difficulty - and the AMC's apparent early success - in establishing a long-term, credible commitment in a constantly changing unpredictable environment. It highlights one of the inherent challenges of the AMC: its dependence on continuous donor funding to ensure long-term purchases of products. The paper examines alternative design choices and aims to provide a starting point to inform discussions and encourage debate about the potential application of the AMC concept to other fields.

  19. Colorectal cancer screening practices of primary care providers: results of a national survey in Malaysia.

    PubMed

    Norwati, Daud; Harmy, Mohamed Yusoff; Norhayati, Mohd Noor; Amry, Abdul Rahim

    2014-01-01

    The incidence of colorectal cancer has been increasing in many Asian countries including Malaysia during the past few decades. A physician recommendation has been shown to be a major factor that motivates patients to undergo screening. The present study objectives were to describe the practice of colorectal cancer screening by primary care providers in Malaysia and to determine the barriers for not following recommendations. In this cross sectional study involving 132 primary care providers from 44 Primary Care clinics in West Malaysia, self-administered questionnaires which consisted of demographic data, qualification, background on the primary care clinic, practices on colorectal cancer screening and barriers to colorectal cancer screening were distributed. A total of 116 primary care providers responded making a response rate of 87.9%. About 21% recommended faecal occult blood test (FOBT) in more than 50% of their patients who were eligible. The most common barrier was "unavailability of the test". The two most common patient factors are "patient in a hurry" and "poor patient awareness". This study indicates that colorectal cancer preventive activities among primary care providers are still poor in Malaysia. This may be related to the low availability of the test in the primary care setting and poor awareness and understanding of the importance of colorectal cancer screening among patients. More awareness programmes are required for the public. In addition, primary care providers should be kept abreast with the latest recommendations and policy makers need to improve colorectal cancer screening services in health clinics.

  20. Knowledge and practice of clinical ethics among healthcare providers in a government hospital, Chennai.

    PubMed

    Subramanian, Thilakavathi; Mathai, A K; Kumar, Nandini

    2013-01-01

    The growing public concern about the ethical conduct of healthcare professionals highlights the need to incorporate clinical ethics in medical education. This study examined the knowledge and practice of clinical ethics among healthcare providers in a government hospital in Chennai. A sample of 51 treating physicians and 58 other non-physician service providers from the hospital answered a self-administered, semi-structured questionnaire on their knowledge of and adherence to ethical principles, and the problems they faced related to healthcare ethics. More than 30% did not give a definition of healthcare ethics, and 40% did not name a single ethical principle. 51% stated that they witnessed ethical problems in their settings and named patient dissatisfaction, gender bias by provider, and not maintaining confidentiality. The responses of healthcare providers to various ethical scenarios are reported.

  1. Providers' knowledge, attitudes, and practices related to colorectal cancer control in Brazil.

    PubMed

    Perin, Douglas M Puricelli; Saraiya, Mona; Thompson, Trevor D; de Moura, Lenildo; Simoes, Eduardo J; Parra, Diana C; Brownson, Ross C

    2015-12-01

    In Brazil, colorectal cancer (CRC) is the fourth most common cause of cancer-related death among men, and the third most common among women. We aimed to examine CRC screening-related knowledge, attitudes, and practices among physicians and nurses working in Brazil's network of health units, and to describe the capacity of these units for CRC screening. In 2011, 1600 health units were randomly selected from all 26 states and the Federal District. One coordinator and one health care provider were selected for the interview. Response rates were 78% for coordinators, 34% for physicians, and 65% for nurses. The Brazilian National Cancer Institute (INCA) recommendations for CRC screening were not often used in the health units, but screening outreach and use of CRC exams were more common in units that were using them. Physicians and nurses differed in most characteristics, and in their knowledge, attitudes, and practices of CRC screening. Forty-seven percent of physicians reported not conducting CRC screening compared to 65% of nurses. Fecal occult blood test was most often used by physicians and nurses, but fewer physicians than nurses perceived this exam as very effective in reducing CRC mortality. Physicians' gender, years since graduation, and geographical region of practice in Brazil were associated to CRC screening practice. The findings may reflect the low influence of INCA CRC screening recommendations, physicians receiving their medical education when CRC burden in Brazil was of low concern, and the lack of CRC screening capacity in some regions of Brazil.

  2. Requiring formal training in preventive health practices for child day care providers.

    PubMed Central

    Bassoff, B Z; Willis, W O

    1991-01-01

    The study was a test of the feasibility of mandating training in preventive health practices for child day care providers in California. Three approaches were taken to determining the feasibility of mandatory training. They were (a) to identify persons and groups with the capability to provide training, (b) to identify systems and networks for communication and collaboration on health issues related to day care at the local level, and (c) to determine the child day care providers' concerns, needs, and future interests regarding child health. Information was collected on relevant courses offered by universities, colleges, and adult education programs; on training offered by child health authorities; and on formal curriculums offered by local and national sources. Day care center and family day care home providers were surveyed to determine their knowledge of child health issues, their concerns, and their future needs. The providers surveyed cared for a total of 14,340 children. Information on local networks was obtained from the surveys, from interviews, and from a special task force that had been set up to advise the State legislature. Study results supported the conclusion that a coordinated system of State-wide training was feasible, given the existing networks of training and educational resources, the number of day care providers who had already been motivated to seek some training in child health practices, and the almost unanimous interest among day care providers in obtaining training. Mandating training in child health for day care providers will require a commitment in the form of new legislation outlining basic requirements and allocating funding. The implementation and costs of such a mandate at the State and local level are discussed. PMID:1910186

  3. Advances in endodontics: Potential applications in clinical practice

    PubMed Central

    Kishen, Anil; Peters, Ove A.; Zehnder, Matthias; Diogenes, Anibal R.; Nair, Madhu K.

    2016-01-01

    Contemporary endodontics has seen an unprecedented advance in technology and materials. This article aimed to review some of the challenges and advances in the following sections: (1) endodontic imaging, (2) root canal preparation, (3) root canal disinfection, (4) root canal filling, and (4) regenerative endodontic procedures (REPs). Jointly, these advances are aimed at improving the state of the art and science of root canal treatment. PMID:27217630

  4. Advances in endodontics: Potential applications in clinical practice.

    PubMed

    Kishen, Anil; Peters, Ove A; Zehnder, Matthias; Diogenes, Anibal R; Nair, Madhu K

    2016-01-01

    Contemporary endodontics has seen an unprecedented advance in technology and materials. This article aimed to review some of the challenges and advances in the following sections: (1) endodontic imaging, (2) root canal preparation, (3) root canal disinfection, (4) root canal filling, and (4) regenerative endodontic procedures (REPs). Jointly, these advances are aimed at improving the state of the art and science of root canal treatment. PMID:27217630

  5. Advanced Energy Retrofit Guide: Practical Ways to Improve Energy Performance; Grocery Stores (Revised) (Book)

    SciTech Connect

    Hendron, B.

    2013-07-01

    The U.S. Department of Energy developed the Advanced Energy Retrofit Guides (AERGs) to provide specific methodologies, information, and guidance to help energy managers and other stakeholders successfully plan and execute energy efficiency improvements. Detailed technical discussion is fairly limited in these guides. Instead, we emphasize actionable information, practical methodologies, diverse case studies, and unbiased evaluations of the most promising retrofit measures for each building type. A series of AERGs is under development, addressing key segments of the commercial building stock. Grocery stores were selected as one of the highest priority sectors, because they represent one of the most energy-intensive market segments.

  6. Advanced Energy Retrofit Guide: Practical Ways to Improve Energy Performance, K-12 Schools (Book)

    SciTech Connect

    Not Available

    2013-02-01

    The U.S. Department of Energy developed the K-12 Advanced Energy Retrofit Guide to provide specific methodologies, information, and guidance to help energy managers and other stakeholders plan and execute energy efficiency improvements. We emphasize actionable information, practical methodologies, diverse case studies, and unbiased evaluation of the most promising retrofit measure for each building type. K-12 schools were selected as one of the highest priority building sectors, because schools affect the lives of most Americans. They also represent approximately 8% of the energy use and 10% of the floor area in commercial buildings.

  7. Practices and policies of providers testing school-aged children for tuberculosis, Connecticut, 2008.

    PubMed

    Lazar, Christina M; Sosa, Lynn; Lobato, Mark N

    2010-10-01

    This study identified current practices and policies related to testing school children for latent tuberculosis infection (LTBI) in Connecticut. A cross-sectional survey was mailed to a random sample of community pediatricians and family practitioners in Connecticut who provide health care services to children aged 4-18 years. The main outcome measure was adherence to national guidelines for tuberculosis (TB) testing of school-aged children. The response rate was 66.3% (345 of 520), 258 of whom provided services to children. Responses showed that 60% (152 of 252) of replying providers read the American Academy of Pediatrics (AAP) published guidelines, and 85% routinely assess children for TB risk before skin testing although only a minority (22%) use a written questionnaire. Of 153 responding providers, 130 (85%) report that schools require formal TB risk assessments at mandated school physical examinations or at school entry. Results also showed providers who read AAP-published guidelines and who are trained in the United States are more likely to follow the national guidelines for TB testing of children. The majority of health care providers reported following AAP-published guidelines for screening school-aged children for LTBI and TB disease; however, an important number of providers still do not follow recommended guidelines. Public health officials should make efforts to increase provider awareness of, and adherence to, guidelines. School districts also should take steps to ensure the appropriate level of testing of children for TB disease and LTBI.

  8. Influenza Vaccination among Pregnant Women: Patient Beliefs and Medical Provider Practices

    PubMed Central

    Samelson, Renee; Siddiqui, Maryam M.; Paglia, Michael J.; Strassberg, Emmie R.; Kelly, Elizabeth; Murtough, Katie L.; Schulkin, Jay

    2016-01-01

    ACOG's research department recruited four medical centers to participate in a study on the attitudes and practices of medical providers and pregnant patients regarding influenza vaccination. Medical providers and patients were given voluntary surveys and medical record data was collected over two flu seasons, from 2013 to 2015. Discrepancies between self-reports of medical providers and patients and medical records were observed. Nearly 80% of patients self-reported accepting the influenza vaccine, but medical record data only reported 36% of patients accepting the vaccine. Similarly, all medical providers reported giving recommendations for the vaccine, but only 85% of patients reported receiving a recommendation. Age, education, a medical provider's recommendation, and educational materials were found to positively influence patient beliefs about the influenza vaccine. Accepting the vaccine was influenced by a patient's previous actions, beliefs, and a medical provider's recommendation. Patients who reported previously not accepting the vaccine and had negative feelings towards the vaccine but accepted it while pregnant reported concern for the health and safety of their baby. Future research should focus on groups that may be less likely to accept the vaccine and ways to dispel negative myths. Medical provider should continue to strongly recommend the vaccine and provide educational materials. PMID:27559272

  9. Influenza Vaccination among Pregnant Women: Patient Beliefs and Medical Provider Practices.

    PubMed

    Stark, Lauren M; Power, Michael L; Turrentine, Mark; Samelson, Renee; Siddiqui, Maryam M; Paglia, Michael J; Strassberg, Emmie R; Kelly, Elizabeth; Murtough, Katie L; Schulkin, Jay

    2016-01-01

    ACOG's research department recruited four medical centers to participate in a study on the attitudes and practices of medical providers and pregnant patients regarding influenza vaccination. Medical providers and patients were given voluntary surveys and medical record data was collected over two flu seasons, from 2013 to 2015. Discrepancies between self-reports of medical providers and patients and medical records were observed. Nearly 80% of patients self-reported accepting the influenza vaccine, but medical record data only reported 36% of patients accepting the vaccine. Similarly, all medical providers reported giving recommendations for the vaccine, but only 85% of patients reported receiving a recommendation. Age, education, a medical provider's recommendation, and educational materials were found to positively influence patient beliefs about the influenza vaccine. Accepting the vaccine was influenced by a patient's previous actions, beliefs, and a medical provider's recommendation. Patients who reported previously not accepting the vaccine and had negative feelings towards the vaccine but accepted it while pregnant reported concern for the health and safety of their baby. Future research should focus on groups that may be less likely to accept the vaccine and ways to dispel negative myths. Medical provider should continue to strongly recommend the vaccine and provide educational materials. PMID:27559272

  10. Primary Care Providers' Knowledge and Practices of Diabetes Management During Ramadan.

    PubMed

    Ali, Mujtaba; Adams, Alexandra; Hossain, Md Anwar; Sutin, David; Han, Benjamin Hyun

    2016-01-01

    There are an estimated 3.5 million Muslims in North America. During the holy month of Ramadan, healthy adult Muslims are to fast from predawn to after sunset. While there are exemptions for older and sick adults, many adults with diabetes fast during Ramadan. However, there are risks associated with fasting and specific management considerations for patients with diabetes. We evaluated provider practices and knowledge regarding the management of patients with diabetes who fast during Ramadan. A 15-question quality improvement survey based on a literature review and the American Diabetes Association guidelines was developed and offered to providers at the outpatient primary care and geriatric clinics at an inner-city hospital in New York City. Forty-five providers completed the survey. Most respondents did not ask their Muslim patients with diabetes if they were fasting during the previous Ramadan. Knowledge of fasting practices during Ramadan was variable, and most felt uncomfortable managing patients with diabetes during Ramadan. There is room for improvement in educating providers about specific cultural and medical issues regarding fasting for patients with diabetes during Ramadan.

  11. Health care providers' training, perceptions, and practices regarding stress and health outcomes.

    PubMed Central

    Avey, Holly; Matheny, Kenneth B.; Robbins, Anna; Jacobson, Terry A.

    2003-01-01

    In order to assess health care providers' training, perceptions, and practices regarding stress and health outcomes, a survey was administered to primary care providers in the outpatient medical clinics of a southeastern urban hospital serving a predominantly African-American indigent population. One-hundred-fifty-one of 210 providers (72%) responded. Forty-two percent of respondents reported receiving no instruction regarding stress and health outcomes during their medical/professional education. While 90% believed stress management was "very" or "somewhat" effective in improving health outcomes, 45% "rarely" or "never" discussed stress management with their patients. Respondents were twice as likely to believe that counseling patients about smoking, nutrition, or exercise was more important than counseling them about stress. Seventy-six percent lacked confidence in their ability to counsel patients about stress. The majority of respondents (57%) "rarely" or "never" practiced stress reduction techniques themselves. Belief in the importance of stress counseling, its effectiveness in improving health, and confidence in one's ability to teach relaxation techniques were all related to the probability that providers would counsel patients regarding stress. There is a need for curriculum reform that emphasizes new knowledge about stress and disease, new skills in stress reduction, and more positive beliefs about mind/body medicine and its integration into the existing health care structure. PMID:14527051

  12. Personal, practical, and professional issues in providing managed mental health care: a discussion for new psychotherapists.

    PubMed

    Alleman, J R

    2001-01-01

    Written by a former corporate manager pursuing counseling as a 2nd career, this article offers pointed views on managed mental health. Values of practitioners that are a mismatch for managed care are noted, and more specific disadvantages and advantages are examined. Loss of client confidentiality is addressed and procedures and technologies for its reclamation are noted. Negative effects on therapy are acknowledged and potential for better accountability and research are pointed out. Economic disadvantages of a small provider's practice as well as opportunities for creating new value and additional income are reviewed. The relatively sudden emergence of managed care is credited with a natural time lag preceding regulatory responses. Acknowledging that most new practitioners have little choice about the clients they serve, the article concludes that it would be shortsighted to rule managed care out of one's practice. PMID:11838505

  13. [Challenges and opportunities: contributions of the Advanced Practice Nurse in the chronicity. Learning from experiences].

    PubMed

    Appleby, Christine; Camacho-Bejarano, Rafaela

    2014-01-01

    Undoubtedly, our society is facing new economic, political, demographic, social and cultural challenges that require healthcare services able to meet the growing health needs of the population, especially in dealing with chronic conditions. In this new context, some countries such as the United Kingdom have made a firm commitment to develop new models for chronic patients care based on the introduction of new figures of Advanced Practice Nurses, which includes 4 cornerstones of professional practice: advanced clinical skills, clinical management, teaching and research. The implementation of this new figures implies a redefinition of professional competencies and has its own accreditation system and a specific catalogue of services adapted to the population requirements, in order to provide chronic care support from Primary Care settings. This trajectory allows us analysing the process of design and implementation of these new models and the organizational structure where it is integrated. In Spain, there are already experiences in some regions such as Andalucia and the Basque Country, focused on the creation of new advanced nursing roles. At present, it is necessary to consider suitable strategic proposals for the complete development of these models and to achieve the best results in terms of overall health and quality of life of patients with chronic conditions, improving the quality of services and cost-effectiveness through a greater cohesion and performance of healthcare teams towards the sustainability of healthcare services and patient satisfaction.

  14. Cultural Diversity Training: The Necessity of Cultural Competence for Health Care Providers and in Nursing Practice.

    PubMed

    Young, Susan; Guo, Kristina L

    2016-01-01

    The purpose of this article is to discuss the need to provide culturally sensitive care to the growing number of diverse health care consumers. A literature review of national standards and research on cultural competency was conducted and specifically focused on the field of nursing. This study supports the theory that cultural competence is learned over time and is a process of inner reflection and awareness. The domains of awareness, skill, and knowledge are essential competencies that must be gained by health care providers and especially for nurses. Although barriers to providing culturally sensitive care exist, gaining a better understanding of cultural competence is essential to developing realistic education and training techniques, which will lead to quality professional nursing practice for increasingly diverse populations. PMID:27111680

  15. Provider practice style and patient health outcomes: The case of heart attacks.

    PubMed

    Currie, Janet; MacLeod, W Bentley; Van Parys, Jessica

    2016-05-01

    When a patient arrives at the Emergency Room with acute myocardial infarction (AMI), the provider on duty must quickly decide how aggressively the patient should be treated. Using Florida data on all such patients from 1992 to 2014, we decompose practice style into two components: The provider's probability of conducting invasive procedures on the average patient (which we characterize as aggressiveness), and the responsiveness of the choice of procedure to the patient's characteristics. We show that within hospitals and years, patients with more aggressive providers have consistently higher costs and better outcomes. Since all patients benefit from higher utilization of invasive procedures, targeting procedure use to the most appropriate patients benefits these patients at the expense of the less appropriate patients. We also find that the most aggressive and responsive physicians are young, male, and trained in top 20 schools. PMID:26938940

  16. Bedside resource stewardship in disasters: a provider's dilemma practicing in an ethical gap.

    PubMed

    Daniel, Michelle

    2012-01-01

    During disasters, clinicians may be forced to play dual roles, as both a provider and an allocator of scarce resources. At present, a clear framework to govern resource stewardship at the bedside is lacking. Clinicians who find themselves practicing in this ethical gap between clinical and public health ethics can experience significant moral distress. One provider describes her experience allocating an oxygen tank in the intensive care unit at a hospital in Port-au-Prince, Haiti, immediately following the 2010 earthquake. Using a clinical vignette and reflective narrative she attempts to identify the factors that influenced her allocation decision, opening up the factors for commentary and debate by an ethicist. A better paradigm for the ethical care of patients during disasters is needed to better guide provider choices in the future.

  17. The Experiences of Advanced Practice Nurses Caring for Patients with Substance Use Disorder and Chronic Pain.

    PubMed

    St Marie, Barbara

    2016-10-01

    Management of chronic pain is a challenge shared by healthcare providers in various clinical settings. The epidemic of opioid misuse has escalated this challenge. A gap exists in understanding barriers and facilitators to practices of advanced practice registered nurses (APRNs) caring for patients with chronic pain and substance use disorder (SUD). The purpose of this study was to examine the APRNs' experiences while caring for patients with coexisting SUD and chronic pain to help envision better ways to manage pain and direct educational initiatives. Qualitative narrative method. Telephone interviews. Twenty APRNs caring for patients with coexisting SUD and chronic pain were recruited nationwide through the American Society for Pain Management Nursing list serve. Semistructured interviews with thematic analysis. Participants identified 1) a shift of patients from other healthcare providers into the APRNs' practices; 2) barriers to accessing nonmedical modalities for managing pain, including insurance coverage, geographic location, and the patient's desire for only medication management; 3) the role of the APRN in caring for this population contained subthemes of educating and guiding patients through a process of change, applying risk strategies to keep patients safe, and educating colleagues on implementing risk management strategies while prescribing opioids. The APRNs identified barriers to providing care for patients with coexisting SUD and chronic pain. They also described the role of APRNs in providing focused education regarding risk management strategies for assessment, prescribing opioids to manage pain, and minimizing risk. PMID:27567096

  18. Documenting Student Engagement Using an Intention/Reflection Exercise during an Advanced Pharmacy Practice Experience

    ERIC Educational Resources Information Center

    Fierke, Kerry K.; Lepp, Gardner A.

    2015-01-01

    The article shares the outcomes of a practice called Intention/Reflection (I/R) when applied to a group of ten students in a five-week course involving an international advanced pharmacy practice experience. Developed by the authors and founded on a combination of theoretical principles, this practice is unique because of the blend of formative…

  19. Assuring Quality and Access in Advanced Practice Nursing: A Challenge to Nurse Educators.

    ERIC Educational Resources Information Center

    Mundinger, Mary O.; Cook, Sarah Sheets; Lenz, Elizabeth R.; Piacentini, Karen; Auerhahn, Carolyn; Smith, Jennifer

    2000-01-01

    Advanced practice nurses are assuming increasingly accountable roles in primary health care. A doctor of nursing practice degree would signify the high level of competency they achieve. Columbia University's training model is an example of the preparation needed for this level of professional practice. (SK)

  20. Current Practices in Global/International Advanced Pharmacy Practice Experiences: Home/Host Country or Site/Institution Considerations

    PubMed Central

    Dakkuri, Adnan; Abrons, Jeanine P.; Williams, Dennis; Ombengi, David N.; Zheng, HaiAn; Al-Dahir, Sara; Tofade, Toyin; Gim, Suzanna; O’Connell, Mary Beth; Ratka, Anna; Dornblaser, Emily

    2016-01-01

    International outreach by schools and colleges of pharmacy is increasing. In this paper, we provide current practice guidelines to establish and maintain successful global/international advanced pharmacy practice experiences (G/I APPEs) with specific recommendations for home/host country and host site/institution. The paper is based on a literature review (2000-2014) in databases and Internet searches with specific keywords or terms. Educational documents such as syllabi and memoranda of understanding (MoUs) from pharmacy programs were also examined. In addition, a preliminary draft was developed and the findings and recommendations were reviewed in a 90-minute roundtable discussion at the 2014 American Association of Colleges of Pharmacy Annual Meeting. Recommendations for the host country include travel considerations (eg, passport, visa, air travel), safety, housing, transportation, travel alerts and warnings, health issues, and financial considerations. For the home country, considerations for establishment of G/I APPE site (eg, vetting process, MoU, site expectations) are described. The paper is a resource for development of new G/I APPEs and provides guidance for continuous quality improvement of partnerships focusing on G/I pharmacy education. PMID:27170809

  1. Current Practices in Global/International Advanced Pharmacy Practice Experiences: Home/Host Country or Site/Institution Considerations.

    PubMed

    Alsharif, Naser Z; Dakkuri, Adnan; Abrons, Jeanine P; Williams, Dennis; Ombengi, David N; Zheng, HaiAn; Al-Dahir, Sara; Tofade, Toyin; Gim, Suzanna; O'Connell, Mary Beth; Ratka, Anna; Dornblaser, Emily

    2016-04-25

    International outreach by schools and colleges of pharmacy is increasing. In this paper, we provide current practice guidelines to establish and maintain successful global/international advanced pharmacy practice experiences (G/I APPEs) with specific recommendations for home/host country and host site/institution. The paper is based on a literature review (2000-2014) in databases and Internet searches with specific keywords or terms. Educational documents such as syllabi and memoranda of understanding (MoUs) from pharmacy programs were also examined. In addition, a preliminary draft was developed and the findings and recommendations were reviewed in a 90-minute roundtable discussion at the 2014 American Association of Colleges of Pharmacy Annual Meeting. Recommendations for the host country include travel considerations (eg, passport, visa, air travel), safety, housing, transportation, travel alerts and warnings, health issues, and financial considerations. For the home country, considerations for establishment of G/I APPE site (eg, vetting process, MoU, site expectations) are described. The paper is a resource for development of new G/I APPEs and provides guidance for continuous quality improvement of partnerships focusing on G/I pharmacy education. PMID:27170809

  2. Current Practices in Global/International Advanced Pharmacy Practice Experiences: Home/Host Country or Site/Institution Considerations.

    PubMed

    Alsharif, Naser Z; Dakkuri, Adnan; Abrons, Jeanine P; Williams, Dennis; Ombengi, David N; Zheng, HaiAn; Al-Dahir, Sara; Tofade, Toyin; Gim, Suzanna; O'Connell, Mary Beth; Ratka, Anna; Dornblaser, Emily

    2016-04-25

    International outreach by schools and colleges of pharmacy is increasing. In this paper, we provide current practice guidelines to establish and maintain successful global/international advanced pharmacy practice experiences (G/I APPEs) with specific recommendations for home/host country and host site/institution. The paper is based on a literature review (2000-2014) in databases and Internet searches with specific keywords or terms. Educational documents such as syllabi and memoranda of understanding (MoUs) from pharmacy programs were also examined. In addition, a preliminary draft was developed and the findings and recommendations were reviewed in a 90-minute roundtable discussion at the 2014 American Association of Colleges of Pharmacy Annual Meeting. Recommendations for the host country include travel considerations (eg, passport, visa, air travel), safety, housing, transportation, travel alerts and warnings, health issues, and financial considerations. For the home country, considerations for establishment of G/I APPE site (eg, vetting process, MoU, site expectations) are described. The paper is a resource for development of new G/I APPEs and provides guidance for continuous quality improvement of partnerships focusing on G/I pharmacy education.

  3. Technological advances in the treatment of trauma: a review of promising practices.

    PubMed

    Paul, Lisa A; Hassija, Christina M; Clapp, Joshua D

    2012-11-01

    Given the availability of empirically supported practices for addressing posttraumatic stress disorder and other forms of trauma-related distress, the development and implementation of new technology to deliver these treatments is exciting. Technological innovations in this literature aim to expand availability of empirically based intervention, increase treatment adherence and acceptability, and overcome barriers commonly encountered with conventional trauma-focused treatment. Much of the current research on these technological developments consists of brief reviews and case studies of the separate therapy modalities. Although this work serves to document the appeal and utility of these innovations, it does not provide comprehensive information about the host of options available. To that end, the three general categories of technological advances in trauma therapy (i.e., videoconferencing, e-Health, virtual reality) are reviewed here, including information regarding their empirical support and suggestions for future research and clinical practice.

  4. Using an Informed Advocacy Framework to Advance the Practice of Family-Centered Care.

    PubMed

    Marcellus, Lenora; MacKinnon, Karen

    2016-01-01

    The philosophical framework of family-centered care (FCC) has been promoted consistently since the 1980s in perinatal and neonatal settings as a gold standard approach for developing programs and providing care that supports the meaningful involvement of parents in the care of their infants and children. Recent literature suggests that despite years of promotion, FCC remains an elusive practice. Sources frequently state that FCC is based on principles of communication and empowerment, but the literature overall does not suggest substantial underlying philosophical or theoretical underpinnings. There have been theoretical advances in nursing and other disciplines that hold potential for moving our practice of FCC forward. In this article, we describe the informed advocacy framework and apply the framework to FCC. PMID:27465458

  5. Integrating first-line treatment options into clinical practice: what's new in advanced melanoma?

    PubMed

    Dummer, Reinhard; Schadendorf, Dirk; Ascierto, Paolo A; Larkin, James; Lebbé, Celeste; Hauschild, Axel

    2015-12-01

    Melanoma remains a serious form of skin cancer in Europe and worldwide. Localized, early-stage melanomas can usually be treated with surgical excision. However, the prognosis is poorer for patients with advanced disease. Before 2011, treatment for advanced melanoma included palliative surgery and/or radiotherapy, and chemotherapy with or without immunotherapy, such as interleukin-2. As none of these treatments had shown survival benefits in patients with advanced melanoma, European guidelines had recommended that patients be entered into clinical trials. The lack of approved first-line options and varying access to clinical trials meant that European clinicians relied on experimental regimens and chemotherapy-based treatments when no other options were available. Since 2011, ipilimumab, an immuno-oncology therapy, and vemurafenib and dabrafenib, targeted agents that inhibit mutant BRAF, have been approved by the European Medicines Agency for the treatment of advanced melanoma. More recently, the MEK inhibitor, trametinib, received European marketing authorization for use in patients with BRAF mutation-positive advanced melanoma. In 2014, the anti-PD-1 antibody nivolumab was approved as a first-line therapy in Japan. Whereas nivolumab and another anti-PD-1 antibody, pembrolizumab, were approved as second-line therapies in the USA, their recent approval in Europe are for first-line use based on new clinical trial data in this setting. Together these agents are changing clinical practice and making therapeutic decisions more complex. Here, we discuss current and emerging therapeutic options for the first-line treatment of advanced melanoma, and how these therapies can be optimized to provide the best possible outcomes for patients. PMID:26426764

  6. Well-Child Care Clinical Practice Redesign at a Community Health Center: Provider and Staff Perspectives

    PubMed Central

    Mooney, Kelly; Moreno, Candice; Chung, Paul J.; Elijah, Jacinta; Coker, Tumaini R.

    2014-01-01

    Background Community health centers (CHCs) are a key element of the health care safety net for underserved children. They may be an ideal setting to create well-child care (WCC) clinical practice redesign to drastically improve WCC delivery. Objective To examine the perspectives of clinical and administrative staff at a large, multisite urban CHC on alternative ways to deliver WCC services for low-income children aged 0 to 3 years. Methods Eight semistructured interviews were conducted with 4 pediatric teams (each consisting of 1 pediatrician and 2 medical assistants) and 4 CHC executive/administrative staff (Medical Director, COO, CEO, and Nurse Supervisor). Discussions were recorded, transcribed, and analyzed using the constant comparative method of qualitative analysis. Salient themes included WCC delivery challenges and endorsed WCC clinical practice redesign solutions. Results The 3 main WCC delivery challenges included long wait times due to insurance verification and intake paperwork, lack of time for parent education and sick visits due to WCC visit volume, and absence of a system to encourage physicians to use non–face-to-face communication with parents. To address WCC delivery challenges, CHC providers and administrators endorsed several options for clinical practice redesign in their setting. These included use of a health educator in a team-based model of care, a previsit tool for screening and surveillance, Web site health education, a structured system for non–face-to-face (eg, phone) parent communication, and group visits. Conclusion CHC-specific strategies for WCC clinical practice redesign endorsed by a large, multisite safety net clinic may lead to more efficient, effective, and family-centered WCC for low-income populations. PMID:24327599

  7. Male circumcision for HIV prevention in India: emerging viewpoints and practices of health care providers.

    PubMed

    Sinha, Anju; Chandhiok, Nomita; Sahay, Seema; Deb, Sibnath; Bharat, Shalini; Gupta, Abhilasha; Bhatt, Sripad; Kanthe, Vidisha; Kumar, Bijesh; Joglekar, Neelam; Paranjape, Ramesh; Mehendale, Sanjay

    2015-01-01

    A compelling case for promoting male circumcision (MC) as an intervention for reducing the risk of heterosexually acquired HIV infection was made by dissemination of the results of three studies in Africa. The WHO/UNAIDS recommendation for MC for countries like India, where the epidemic in concentrated in high-risk groups, advocates MC for specific population groups such as men at higher risk for HIV acquisition. A multicentre qualitative study was conducted in four geographically distinct districts (Belgaum, Kolkata, Meerut and Mumbai) in India during June 2009 to June 2011. Two categories of health care providers: Registered Healthcare Providers (RHCPs) and traditional circumcisers were interviewed by trained research staff who had received master's level education using interview guides with probes and open-ended questions. Respondents were selected using purposive sampling. A comparative analysis of the perspectives of the RHCP vs. traditional circumcisers is presented. Representatives of both categories of providers expressed the need for Indian data on MC. Providers feared that promoting circumcision might jeopardize/undermine the progress already made in the field of condom promotion. Reservation was expressed regarding its adoption by Hindus. Behavioural disinhibition was perceived as an important limitation. A contrast in the practice of circumcision was apparent between the traditional and the trained providers. MC should be mentioned as a part of comprehensive HIV prevention services in India that includes HIV counselling and testing, condom distribution and diagnosis and treatment of sexually transmitted infections. It should become an issue of informed personal choice rather than ethnic identity.

  8. `Learning Experience' Provided by Science Teaching Practice in a Classroom and the Development of Students' Competences

    NASA Astrophysics Data System (ADS)

    Lopes, J. Bernardino; Branco, Julia; Jimenez-Aleixandre, Maria Pilar

    2011-11-01

    According to the literature, there is a very important corpus of knowledge that allows for the investigation of some dimensions of `learning experience' provided to students, in relation to epistemic, pedagogical and meta-cognitive practices. However, in the literature, there is little investigation into the invariance (or not) of the characteristics of students' learning experience while being taught a scientific subject by the same teacher. This paper suggests that the relationship between the learning experience provided and the competences developed is not properly highlighted. This paper analyses the learning experience provided to students in epistemic, pedagogical and meta-cognitive terms. The students were taught the proprieties and applications of light by one teacher, in three classes, over 7 weeks. We analysed the data in each referred learning experience, using a pre-defined category system. The students' competences were evaluated by a competence test. The epistemic demand of each item and the students' performances were also analysed. Our findings point to the non invariance of learning experiences provided to students and the influence of some dimensions of learning experiences provided in the development of certain competences. These findings and their implications are contextualized and discussed.

  9. From Practice to Research: Training Health Care Providers to Conduct Culturally Relevant Community Focus Groups

    PubMed Central

    Wallen, Gwenyth R.; Rivera-Goba, Migdalia V.

    2015-01-01

    Qualitative data from focus groups can provide an “insiders’ view” of the culture of those being studied. Such data can help health care providers and program planners understand how people perceive themselves, and therefore guide providers and planners in developing culturally appropriate outcome measures that can strengthen the planning, implementation, and evaluation of future programs. This article discusses the process used to train Latino and African American health care providers to moderate focus groups that will be conducted as one phase of a research study looking at health beliefs and health practices in an urban arthritis health center. After taking part in two lecture and discussion training sessions, members of the training class were asked to participate in a pilot focus group. The ½ to 2 hour focus group included nine individuals who fulfilled the roles of moderator, facilitator, or respondent. Community health center practitioners provided valuable insight into the design and feasibility of the focus groups during their training sessions. PMID:26225128

  10. Narrative in interprofessional education and practice: implications for professional identity, provider-patient communication and teamwork.

    PubMed

    Clark, Phillip G

    2014-01-01

    Health and social care professionals increasingly use narrative approaches to focus on the patient and to communicate with each other. Both effective interprofessional education (IPE) and practice (IPP) require recognizing the various values and voices of different professions, how they relate to the patient's life story, and how they interact with each other at the level of the healthcare team. This article analyzes and integrates the literature on narrative to explore: self-narrative as an expression of one's professional identity; the co-creation of the patient's narrative by the professional and the patient; and the interprofessional multi-vocal narrative discourse as co-constructed by members of the healthcare team. Using a narrative approach to thinking about professional identity, provider-patient communication, and interprofessional teamwork expands our thinking about both IPE and IPP by providing new insights into the nature of professional practice based on relationships to oneself, the patient, and others on the team. How professionals define themselves, gather and present information from the patient, and communicate as members of a clinical team all have important dimensions that can be revealed by a narrative approach. Implications and conclusions for the further development of the narrative approach in IPE and IPP are offered.

  11. Enhancing presentation skills for the advanced practice nurse: strategies for success.

    PubMed

    Vollman, Kathleen M

    2005-01-01

    Professional speaking is a component of the professional practice role of the advanced practice nurse (APN). The skills to communicate effectively to one person or an audience of 100 provide the APN with the essential tools for implementing change, collaborating effectively, presenting information at professional meetings, or communicating the impact of clinical outcomes in the boardroom. Public speaking skills, a professional image, and improved communication can facilitate advancement along any career ladder. The greater your fear, the more self-confidence you will gain by stepping up to a challenge and conquering it. This article describes strategies for organizing and presenting your message in a clear and concise format. Techniques to manage the anxiety produced when attempting to articulate your thoughts is essential for effective communication. Skills for enhancing the delivery of your message through effective body language, professional image, voice modulation, and use of audiovisual aids are addressed. Creative techniques for fielding questions are key in promoting a dynamic closure and provide consistent reinforcement of the key message content. PMID:15714019

  12. Enhancing presentation skills for the advanced practice nurse: strategies for success.

    PubMed

    Vollman, Kathleen M

    2005-01-01

    Professional speaking is a component of the professional practice role of the advanced practice nurse (APN). The skills to communicate effectively to one person or an audience of 100 provide the APN with the essential tools for implementing change, collaborating effectively, presenting information at professional meetings, or communicating the impact of clinical outcomes in the boardroom. Public speaking skills, a professional image, and improved communication can facilitate advancement along any career ladder. The greater your fear, the more self-confidence you will gain by stepping up to a challenge and conquering it. This article describes strategies for organizing and presenting your message in a clear and concise format. Techniques to manage the anxiety produced when attempting to articulate your thoughts is essential for effective communication. Skills for enhancing the delivery of your message through effective body language, professional image, voice modulation, and use of audiovisual aids are addressed. Creative techniques for fielding questions are key in promoting a dynamic closure and provide consistent reinforcement of the key message content.

  13. Identifying components of advanced-level clinical nutrition practice: a Delphi study.

    PubMed

    Brody, Rebecca A; Byham-Gray, Laura; Touger-Decker, Riva; Passannante, Marian R; O'Sullivan Maillet, Julie

    2012-06-01

    The dietetics profession lacks a comprehensive definition of advanced-level practice. Using a three-round Delphi study with mailed surveys, expert consensus on four dimensions of advanced-level practice that define advanced practice registered dietitians (RDs) in clinical nutrition was explored. Purposive sampling identified 117 RDs who met advanced-level practice criteria. In round 1, experts rated the essentiality of statements on a 7-point ordinal scale and generated open-ended practice activity statements regarding the following four dimensions of advanced-level practice: professional knowledge, abilities and skills, approaches to practice, roles and relationships, and practice behaviors. Median ratings of 1.0 to 3.0 were defined as essential, 4.0 was neutral, and 5.0 to 7.0 were nonessential. In rounds 2 and 3, experts re-rated statements not reaching consensus by evaluating their previous responses, group median rating, and comments. Consensus was reached when the interquartile range of responses to a statement was ≤2.0. Eighty-five experts enrolled (72.6%); 76 (89.4%) completed all rounds. In total, 233 statements were rated, with 100% achieving consensus; 211 (90.6%) were essential to advanced practice RD clinical practice. Having a master's degree; completing an advanced practice residency; research coursework; and advanced continuing education were essential, as were having 8 years of experience; clinical nutrition knowledge/expertise; specialization; participation in research activities; and skills in technology and communication. Highly essential approaches to practice were systematic yet adaptable and used critical thinking and intuition and highly essential values encompassed professional growth and service to patients. Roles emphasized patient care and leadership. Essential practice activities within the nutrition care process included provision of complex patient-centered nutrition care using application of advanced knowledge/expertise and

  14. EPOSAR: an innovative service to provide EPOS community with advanced DInSAR products

    NASA Astrophysics Data System (ADS)

    Manunta, Michele; De Luca, Claudio; Elefante, Stefano; Lanari, Riccardo; Pepe, Antonio; Zinno, Ivana; Casu, Francesco

    2015-04-01

    The quantitative evaluation of ground deformation is traditionally based on in-situ surveying techniques that, through the intensive use of GPS stations, automatic total stations and levelling benchmarks, can measure up to sub-centimetre displacements. In the last decades, the extensive use of satellite remote sensing data, such as Synthetic Aperture Radar (SAR) images, has represented an important breakthrough in the context of non-invasive ground deformation analyses over large areas, thanks to their large spatial coverage and relatively short revisit time, as well as to their medium-high ground resolution. In such a context, the well-known Differential SAR Interferometry (DInSAR) technique allows us to map and measure deformation phenomena due to both natural and man-made causes with centimetre to millimetre accuracy. The Earth Science community has a wide interest in the use of DInSAR displacement maps both for crisis management and risk mitigation activities, and for surveillance, monitoring and analysis of geophysical phenomena. In areas characterized by high level of hazards the availability of routinely generated advanced DInSAR products would allow a fast analysis of their current status, providing a near real time monitoring. Similarly, an on-demand service would allow the customization of the products by selecting the area of interest, the SAR data to be processed, and other processing parameters to be set by the users to edit/correct/improve the final products. In this work we discuss the Satellite Data Thematic Core Service of EPOS and we present the EPOSAR service. In particular, the EPOSAR service, based on the well-known DInSAR approach referred to as Small Baseline Subset (SBAS), accomplishes a shared and synergic Earth Observation (EO) service aimed at designing, implementing and harmonizing efficient satellite data processing chains capable of ingesting the significantly increased data stream expected from the ESA Sentinel-1 satellites. EPOSAR

  15. Current Practices in Global/International Advanced Pharmacy Practice Experiences: Preceptor and Student Considerations

    PubMed Central

    Ratka, Anna; Gleason, Shaun E.; Ombengi, David N.; Tofade, Toyin; Wigle, Patricia R.; Zapantis, Antonia; Ryan, Melody; Connor, Sharon; Jonkman, Lauren J.; Ochs, Leslie; Jungnickel, Paul W.; Abrons, Jeanine P.; Alsharif, Naser Z.

    2016-01-01

    The objective of this article is to describe the key areas of consideration for global/international advanced pharmacy practice experience (G/I APPE) preceptors, students and learning objectives. At the 2013 Annual Meeting of the American Association of Colleges of Pharmacy (AACP), the GPE SIG prepared and presented an initial report on the G/IAPPE initiatives. Round table discussions were conducted at the 2014 AACP Annual Meeting to document GPE SIG member input on key areas in the report. Literature search of PubMed, Google Scholar and EMBASE with keywords was conducted to expand this report. In this paper, considerations related to preceptors and students and learning outcomes are described. Preceptors for G/I APPEs may vary based on the learning outcomes of the experience. Student learning outcomes for G/I APPEs may vary based on the type of experiential site. Recommendations and future directions for development of G/IAPPEs are presented. Development of a successful G/I APPE requires significant planning and consideration of appropriate qualifications for preceptors and students. PMID:27170810

  16. A conceptual framework for advanced practice nursing in a pediatric tertiary care setting: the SickKids' experience.

    PubMed

    LeGrow, Karen; Hubley, Pam; McAllister, Mary

    2010-05-01

    Advanced practice nurses (APNs) at The Hospital for Sick Children (SickKids) are pediatric healthcare providers who integrate principles and theories of advanced nursing with specialty knowledge to provide autonomous, independent, accountable, ethical and developmentally appropriate care in complex, often ambiguous and rapidly changing healthcare environments. Caring for children and adolescents requires culturally sensitive and family-centred approaches to care that incorporate a unique body of knowledge. Family-centred care is an approach to planning, delivery and evaluation of healthcare that is governed by the establishment of mutually beneficial partnerships among APNs, health professionals and children/families. The cornerstone of APN practice at SickKids is the recognition of "family" as the recipients of care. By valuing and developing relationships with families, APNs promote excellence in healthcare across the care continuum to optimize the child's and family's physical, emotional, social, psychological and spiritual well-being. This paper outlines the evolution of advanced practice nursing at SickKids, beginning with the introduction of APN roles in the 1970s and culminating in the current critical mass of APNs who have been integrated throughout the hospital's infrastructure. We describe the process used to create a common vision and a framework to guide pediatric advanced nursing practice.

  17. Position Paper: General Practice Residency and Advanced Education in General Dentistry Programs: Evaluation.

    ERIC Educational Resources Information Center

    Cassidy, Robert E.

    1983-01-01

    The currently used internal and external program evaluation processes for general practice residency and advanced education in general dentistry programs are discussed, noting accrediting and evaluation groups, criteria, and designs. A generalized evaluation plan is proposed. (MSE)

  18. Infusing informatics into interprofessional education: the iTEAM (Interprofessional Technology Enhanced Advanced practice Model) project.

    PubMed

    Skiba, Diane J; Barton, Amy J; Knapfel, Sarah; Moore, Gina; Trinkley, Katy

    2014-01-01

    The iTEAM goal is to prepare advanced practice nurses, physicians and pharmacists with the interprofessional (IP) core competencies (informatics, patient centric, quality-focused, evidence based care) to provide technology enhanced collaborative care by: offering technology enhanced learning opportunities through a required informatics course, advanced practice courses (team based experiences with both standardized and virtual patients) and team based clinical experiences including e-health experiences. The innovative features of iTEAM project will be achieved through use of social media strategies, a web accessible Electronic Health Records (EHRs) system, a Virtual Clinic/Hospital in Second Life, various e-health applications including traditional telehealth tools and consumer oriented tools such as patient portals, social media consumer groups and mobile health (m-health) applications for health and wellness functions. It builds upon the schools' rich history of IP education and includes clinical partners, such as the VA and other clinical sites focused on care for underserved patient populations. PMID:24943525

  19. How Quality Improvement Practice Evidence Can Advance the Knowledge Base.

    PubMed

    OʼRourke, Hannah M; Fraser, Kimberly D

    2016-01-01

    Recommendations for the evaluation of quality improvement interventions have been made in order to improve the evidence base of whether, to what extent, and why quality improvement interventions affect chosen outcomes. The purpose of this article is to articulate why these recommendations are appropriate to improve the rigor of quality improvement intervention evaluation as a research endeavor, but inappropriate for the purposes of everyday quality improvement practice. To support our claim, we describe the differences between quality improvement interventions that occur for the purpose of practice as compared to research. We then carefully consider how feasibility, ethics, and the aims of evaluation each impact how quality improvement interventions that occur in practice, as opposed to research, can or should be evaluated. Recommendations that fit the evaluative goals of practice-based quality improvement interventions are needed to support fair appraisal of the distinct evidence they produce. We describe a current debate on the nature of evidence to assist in reenvisioning how quality improvement evidence generated from practice might complement that generated from research, and contribute in a value-added way to the knowledge base. PMID:27584696

  20. 41 CFR 301-75.203 - May we provide the interviewee with a travel advance?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... interviewee with a travel advance? 301-75.203 Section 301-75.203 Public Contracts and Property Management Federal Travel Regulation System TEMPORARY DUTY (TDY) TRAVEL ALLOWANCES AGENCY RESPONSIBILITIES 75-PRE-EMPLOYMENT INTERVIEW TRAVEL Obtaining Travel Services and Claiming Reimbursement § 301-75.203 May we...

  1. 41 CFR 301-75.203 - May we provide the interviewee with a travel advance?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... interviewee with a travel advance? 301-75.203 Section 301-75.203 Public Contracts and Property Management Federal Travel Regulation System TEMPORARY DUTY (TDY) TRAVEL ALLOWANCES AGENCY RESPONSIBILITIES 75-PRE-EMPLOYMENT INTERVIEW TRAVEL Obtaining Travel Services and Claiming Reimbursement § 301-75.203 May we...

  2. Effects of knowledge, attitudes, and practices of primary care providers on antibiotic selection, United States.

    PubMed

    Sanchez, Guillermo V; Roberts, Rebecca M; Albert, Alison P; Johnson, Darcia D; Hicks, Lauri A

    2014-12-01

    Appropriate selection of antibiotic drugs is critical to optimize treatment of infections and limit the spread of antibiotic resistance. To better inform public health efforts to improve prescribing of antibiotic drugs, we conducted in-depth interviews with 36 primary care providers in the United States (physicians, nurse practitioners, and physician assistants) to explore knowledge, attitudes, and self-reported practices regarding antibiotic drug resistance and antibiotic drug selection for common infections. Participants were generally familiar with guideline recommendations for antibiotic drug selection for common infections, but did not always comply with them. Reasons for nonadherence included the belief that nonrecommended agents are more likely to cure an infection, concern for patient or parent satisfaction, and fear of infectious complications. Providers inconsistently defined broad- and narrow-spectrum antibiotic agents. There was widespread concern for antibiotic resistance; however, it was not commonly considered when selecting therapy. Strategies to encourage use of first-line agents are needed in addition to limiting unnecessary prescribing of antibiotic drugs.

  3. USDA food and nutrient databases provide the infrastructure for food and nutrition research, policy, and practice.

    PubMed

    Ahuja, Jaspreet K C; Moshfegh, Alanna J; Holden, Joanne M; Harris, Ellen

    2013-02-01

    The USDA food and nutrient databases provide the basic infrastructure for food and nutrition research, nutrition monitoring, policy, and dietary practice. They have had a long history that goes back to 1892 and are unique, as they are the only databases available in the public domain that perform these functions. There are 4 major food and nutrient databases released by the Beltsville Human Nutrition Research Center (BHNRC), part of the USDA's Agricultural Research Service. These include the USDA National Nutrient Database for Standard Reference, the Dietary Supplement Ingredient Database, the Food and Nutrient Database for Dietary Studies, and the USDA Food Patterns Equivalents Database. The users of the databases are diverse and include federal agencies, the food industry, health professionals, restaurants, software application developers, academia and research organizations, international organizations, and foreign governments, among others. Many of these users have partnered with BHNRC to leverage funds and/or scientific expertise to work toward common goals. The use of the databases has increased tremendously in the past few years, especially the breadth of uses. These new uses of the data are bound to increase with the increased availability of technology and public health emphasis on diet-related measures such as sodium and energy reduction. Hence, continued improvement of the databases is important, so that they can better address these challenges and provide reliable and accurate data.

  4. Conducting Reflective, Hands-On Research with Advanced Characterization Instruments: A High-Level Undergraduate Practical Exploring Solid-State Polymorphism

    ERIC Educational Resources Information Center

    Coles, S. J.; Mapp, L. K.

    2016-01-01

    An undergraduate practical exercise has been designed to provide hands-on, instrument-based experience of advanced characterization techniques. A research experience approach is taken, centered around the concept of solid-state polymorphism, which requires a detailed knowledge of molecular and crystal structure to be gained by advanced analytical…

  5. Primary care providers' knowledge, practices, and perceived barriers to the treatment and prevention of childhood obesity.

    PubMed

    Spivack, Jordan G; Swietlik, Maggie; Alessandrini, Evaline; Faith, Myles S

    2010-07-01

    This study evaluated primary care providers' (PCPs, pediatricians, and nurse practitioners) knowledge, current practices, and perceived barriers to childhood obesity prevention and treatment, with an emphasis on first-year well-child care visits. A questionnaire was distributed to 192 PCPs in the primary care network at The Children's Hospital of Philadelphia (CHOP) addressing (i) knowledge of obesity and American Academy of Pediatrics (AAP) guidelines, (ii) anticipatory guidance practices at well visits regarding nutrition and exercise, and (iii) perceived barriers to childhood obesity treatment and prevention. Eighty pediatricians and seven nurse practitioners responded, and a minority correctly identified the definition (26%) and prevalence (9%) of childhood overweight and AAP guidelines for exercise (39%) and juice consumption (44%). Most PCPs (81%) spent 11-20 min per well visit during the first 2 years, and 79% discussed diet, nutrition, and exercise for > or =3 min. Although >95% of PCPs discussed juice, fruits and vegetables, sippy cups, and finger foods during the first year, over 35% never discussed fast food, TV, or candy, and 55% never discussed exercise. Few rated current resources as adequate to treat or prevent childhood obesity. Over 90% rated the following barriers for obesity prevention and treatment as important or very important: parent is not motivated, child is not motivated, parents are overweight, families often have fast food, watch too much TV, and do not get enough exercise. In conclusion, there is much room to improve PCPs' knowledge of obesity and AAP guidelines. Although PCPs rate fast-food consumption, TV viewing, and lack of exercise as important treatment barriers, many never discussed these topics during the first year.

  6. [Practical chemistry education provided by team-based learning (TBL) and peer evaluation].

    PubMed

    Yasuhara, Tomohisa; Konishi, Motomi; Nishida, Takahiro; Kushihata, Taro; Sone, Tomomichi; Kurio, Wasako; Yamamoto, Yumi; Nishikawa, Tomoe; Yanada, Kazuo; Nakamura, Mitsutaka

    2014-01-01

    Learning chemistry is cumulative: basic knowledge and chemical calculation skills are required to gain understanding of higher content. However, we often suffer from students' lack of learning skills to acquire these concepts. One of the reasons is the lack of adequate training in the knowledge and skills of chemistry, and one of the reasons for this lack is the lack of adequate evaluation of training procedures and content. Team-based learning (TBL) is a strong method for providing training in the knowledge and skills of chemistry and reaffirms the knowledge and skills of students of various levels. In our faculty, TBL exercises are provided for first-year students concurrently with lectures in physical chemistry and analytical chemistry. In this study, we researched the adoption of a peer evaluation process for this participatory learning model. Questionnaires taken after TBL exercises in the previous year showed a positive response to TBL. Further, a questionnaire taken after TBL exercises in the spring semester of the current year also yielded a positive response not only to TBL but also to peer evaluation. In addition, a significant correlation was observed between the improvement of students' grades in chemistry classes and the feeling the percentage (20%) of peer evaluation in overall evaluation low (logistic regression analysis, p=0.022). On the basis of the findings, we argue that TBL provides a generic, practical learning environment including an effective focus on learning strategy and evaluation of knowledge, skills, and attitudes, and studies on the educational effects of TBL and peer evaluation.

  7. Positioning advanced practice registered nurses for health care reform: consensus on APRN regulation.

    PubMed

    Stanley, Joan M; Werner, Kathryn E; Apple, Kathy

    2009-01-01

    Advanced practice registered nurses (APRNs) have positioned themselves to serve an integral role in national health care reform. This article addresses both the policy and the process to develop this policy that has placed them in a strategic position. A successful transformation of the nation's health system will require utilization of all clinicians, particularly primary care providers, to the full extent of their education and scope of practice. APRNs are highly qualified clinicians who provide cost-effective, accessible, patient-centered care and have the education to provide the range of services at the heart of the reform movement, including care coordination, chronic care management, and wellness and preventive care. The APRN community faces many challenges amidst the opportunities of health reform. However, the APRN community's triumph in reaching consensus on APRN regulation signifies a cohesive approach to overcoming the obstacles. The consensus model for APRN regulation, endorsed by 44 national nursing organizations, will serve as a beacon for nursing, as well as a guidepost for consumers and policymakers, on titling, education, certification, accreditation, and licensing for all four APRN roles.

  8. Inter-professional work based learning within an MSc in Advanced Practice: lessons from one UK higher education programme.

    PubMed

    Gaskell, Lynne; Beaton, Susan

    2010-09-01

    This paper will describe the implementation of inter-professional work based education (IPE) in one postgraduate Advanced Practitioner programme in the UK. The concept of Advanced Practice has developed as a response of a number of drivers including change in junior doctor training; government policy and increasing demands on the central government funded UK health service (the NHS). The programme was commissioned by the then greater Manchester Strategic Health Authority (now NHS North West) to meet service needs. The educational philosophy underpinning the MSc Advanced Practice (health and social care) provided by the University of Salford is IPE linked to work based learning. The process of work based learning (WBL) and inter-professional learning underpinning the programme will be discussed in relation to feedback from university staff, Advanced Practitioner (AP) students and employer feedback taken from programme and module evaluations. We argue that IPE at this level facilitates a greater understanding of the connectivity between professionals working in the health care system in the UK; a better understanding of the skills and knowledge base of colleagues; more inter-professional working and appropriate referrals in the work place. This has raised the profile of Advanced Practice (AP) in the region and ultimately resulted in better patient care with more effective and efficient use of resources (Acton Shapiro, 2006, 2008).

  9. Integrating Social Neuroscience and Social Work: Innovations for Advancing Practice-Based Research

    ERIC Educational Resources Information Center

    Matto, Holly C.; Strolin-Goltzman, Jessica

    2010-01-01

    Throughout the social work profession, there is ongoing interest in building a social science agenda that can address the complex practice-based questions faced by social work professionals today. Methodological innovations and unique funding opportunities have already significantly advanced research on social work practice. Still, there is…

  10. Cost-effectiveness of a WOC Advanced Practice Nurse in the Acute Care and Outpatient Setting

    PubMed Central

    2014-01-01

    Increasing numbers of advanced practice nurses who practice within the WOC specialty are challenged by the need to justify their role by demonstrating clinical and fiscal benefits to the employing agency. This View From Here column describes the steps I took while completing such an analysis for a position for a nurse practitioner with WOC certification in upstate New York. PMID:24918767

  11. Advanced hemodynamic monitoring: principles and practice in neurocritical care.

    PubMed

    Lazaridis, Christos

    2012-02-01

    Advanced hemodynamic monitoring is necessary for many patients with acute brain and/or spinal cord injury. Optimizing cerebral and systemic physiology requires multi-organ system function monitoring. Hemodynamic manipulations are cardinal among interventions to regulate cerebral perfusion pressure and cerebral blood flow. The pulmonary artery catheter is not any more the sole tool available; less invasive and potentially more accurate methodologies have been developed and employed in the operating room and among diverse critically ill populations. These include transpulmonary thermodilution, arterial pressure pulse contour, and waveform analysis and bedside critical care ultrasound. A thorough understanding of hemodynamics and of the available monitoring modalities is an essential skill for the neurointensivist.

  12. Unpacking University-Community Partnerships to Advance Scholarship of Practice.

    PubMed

    Suarez-Balcazar, Yolanda; Mirza, Mansha Parven; Hansen, Anne Marie Witchger

    2015-01-01

    Today, more than ever, occupational therapists are engaged in close partnerships with community organizations and community settings such as service agencies, refugee and immigrant enclaves, and faith-based organizations, to name a few, for the purpose of engaging in scholarship of practice. However, we know little about the views of community partners regarding the development and sustainability of university-community partnerships. The purpose of this article is twofold: First, we will describe a pilot study in which we gathered qualitative data from community partners engaged in scholarship of practice with faculty and students, regarding their views about benefits of partnerships, challenges, and characteristics of sustainable partnerships. Second, based on this pilot study and extensive experience of the authors, we propose a revised version of a partnerships model available in the literature. We illustrate the model through examples of the authors' collective experiences developing and sustaining successful university-community partnerships. PMID:26053328

  13. Unpacking University-Community Partnerships to Advance Scholarship of Practice.

    PubMed

    Suarez-Balcazar, Yolanda; Mirza, Mansha Parven; Hansen, Anne Marie Witchger

    2015-01-01

    Today, more than ever, occupational therapists are engaged in close partnerships with community organizations and community settings such as service agencies, refugee and immigrant enclaves, and faith-based organizations, to name a few, for the purpose of engaging in scholarship of practice. However, we know little about the views of community partners regarding the development and sustainability of university-community partnerships. The purpose of this article is twofold: First, we will describe a pilot study in which we gathered qualitative data from community partners engaged in scholarship of practice with faculty and students, regarding their views about benefits of partnerships, challenges, and characteristics of sustainable partnerships. Second, based on this pilot study and extensive experience of the authors, we propose a revised version of a partnerships model available in the literature. We illustrate the model through examples of the authors' collective experiences developing and sustaining successful university-community partnerships.

  14. Changing focus of practice for community health nurses: advancing the practice role.

    PubMed

    Munns, Ailsa; Downie, Jill; Wynaden, Diane; Hubble, Jane

    2004-01-01

    Many parents lack support in their parenting role that was once provided through extended families and community structures. Thus, some new parents experience high levels of stress and low self-esteem associated with the challenges of parenting. The lack of support also results in family discord and breakdown with the family environment having the potential to adversely impact children's mental and physical wellbeing and development. The Community Mothers Program (CMP) was initially developed in England and offers support to families during the first year of parenting. The program aims to provide parents with the support once experienced from within the extended family. It also aims to enrich community development by building the capacity of community members living in local communities to support parents. This paper describes the impact of the CMP when implemented into Western Australian as well as the changes to the professional practice role of community child health nurses involved in the program. The Community Mothers Program has proved to be very successful. The success is attributed to the partnership model established between community members, parents, and child health nurses.

  15. Preserving the Art and Science of Psychotherapy for Advance Practice Psychiatric Mental Health Nurses.

    PubMed

    Caughill, Ann

    2016-01-01

    Psychiatric Mental Health (PMH) Nurses are challenged to maintain the viability of their roles in today's healthcare climate as advances in research and complexity of mental healthcare needs of society continue to unfold. Today's mental health practice environment includes disciplines with marketable credentials. Roles for PMH nurses in recent decades are less clearly defined than for other disciplines, much of this related to changes in educational and practice settings. This article reviews literature on the topic of psychotherapy and a call for a renewed emphasis on this mode of treatment for psychiatric mental health advance practice nurses.

  16. A Qualitative Analysis of an Advanced Practice Nurse–Directed Transitional Care Model Intervention

    PubMed Central

    Bradway, Christine; Trotta, Rebecca; Bixby, M.Brian; McPartland, Ellen; Wollman, M. Catherine; Kapustka, Heidi; McCauley, Kathleen; Naylor, Mary D.

    2012-01-01

    Purpose: The purpose of this study was to describe barriers and facilitators to implementing a transitional care intervention for cognitively impaired older adults and their caregivers lead by advanced practice nurses (APNs). Design and Methods: APNs implemented an evidence-based protocol to optimize transitions from hospital to home. An exploratory, qualitative directed content analysis examined 15 narrative case summaries written by APNs and fieldnotes from biweekly case conferences. Results: Three central themes emerged: patients and caregivers having the necessary information and knowledge, care coordination, and the caregiver experience. An additional category was also identified, APNs going above and beyond. Implications: APNs implemented individualized approaches and provided care that exceeds the type of care typically staffed and reimbursed in the American health care system by applying a Transitional Care Model, advanced clinical judgment, and doing whatever was necessary to prevent negative outcomes. Reimbursement reform as well as more formalized support systems and resources are necessary for APNs to consistently provide such care to patients and their caregivers during this vulnerable time of transition. PMID:21908805

  17. Standards--the common element in providing the safety, quality and performance of the medical practice.

    PubMed

    Greabu, Maria

    2009-01-01

    Knowing and applying standards is an opportunity of the years 2007-2008 in any kind of field where a successful activity is intended and this assures a certain way towards competence and quality. The most recent German studies highlighted, to the surprise of the specialists, that standardization holds the second place, after the material means, in the row of the elements considered to be decisive for the success of a business. The existence of standards and the concern for their implementation in the activity provides a high technical and quality level of the products/services offered to the clients and the increase in the level of competence of the personnel, who will be able to cope with all the challenges. This need comes from the process of Romania's accession to the European Union. There are a lot of reasons why standards represent a fundamental part of our daily life. Practically, we are surrounded by standards. Everything is "working" well and it is efficient if the standards used as a base for manufacturing "things" have been correctly developed and applied. Standards open communication channels and commercial channels, promote the understanding of technical products, the compatibility of products and services, facilitate mass production and, most importantly, they are the necessary base for the achievement of the objectives in the fields of health and safety and a better quality of life. The transition towards the global market needs an instrument for the removal of the barriers to the application of the latest discoveries in the field of medical instruments, materials and manual labor. Each medical device, equipment and material used in the Dental and General Medicine is standardized, in fact that leads to their better knowing and provides controllable treatment for manual labor with predictable and repeatable results. This presentation intends to make a survey of some general aspects on standardization as well as a review of the standards in the medical

  18. Standards--the common element in providing the safety, quality and performance of the medical practice.

    PubMed

    Greabu, Maria

    2009-01-01

    Knowing and applying standards is an opportunity of the years 2007-2008 in any kind of field where a successful activity is intended and this assures a certain way towards competence and quality. The most recent German studies highlighted, to the surprise of the specialists, that standardization holds the second place, after the material means, in the row of the elements considered to be decisive for the success of a business. The existence of standards and the concern for their implementation in the activity provides a high technical and quality level of the products/services offered to the clients and the increase in the level of competence of the personnel, who will be able to cope with all the challenges. This need comes from the process of Romania's accession to the European Union. There are a lot of reasons why standards represent a fundamental part of our daily life. Practically, we are surrounded by standards. Everything is "working" well and it is efficient if the standards used as a base for manufacturing "things" have been correctly developed and applied. Standards open communication channels and commercial channels, promote the understanding of technical products, the compatibility of products and services, facilitate mass production and, most importantly, they are the necessary base for the achievement of the objectives in the fields of health and safety and a better quality of life. The transition towards the global market needs an instrument for the removal of the barriers to the application of the latest discoveries in the field of medical instruments, materials and manual labor. Each medical device, equipment and material used in the Dental and General Medicine is standardized, in fact that leads to their better knowing and provides controllable treatment for manual labor with predictable and repeatable results. This presentation intends to make a survey of some general aspects on standardization as well as a review of the standards in the medical

  19. Standards - the common element in providing the safety, quality and performance of the medical practice

    PubMed Central

    Greabu, Mihai

    2009-01-01

    Knowing and applying standards is an opportunity of the years 2007-2008 in any kind of field where a successful activity is intended and this assures a certain way towards competence and quality. The most recent German studies highlighted, to the surprise of the specialists, that standardization holds the second place, after the material means, in the row of the elements considered to be decisive for the success of a business. The existence of standards and the concern for their implementation in the activity provides a high technical and quality level of the products services offered to the clients and the increase in the level of competence of the personnel, who will be able to cope with all the challenges. This need comes from the process of Romania’s accession to the European Union. There are a lot of reasons why standards represent a fundamental part of our daily life. Practically, we are surrounded by standards. Everything is „working” well and it is efficient if the standards used as a base for manufacturing „things” have been correctly developed and applied. Standards open communication channels and commercial channels, promote the understanding of technical products, the compatibility of products and services, facilitate mass production and, most importantly, they are the necessary base for the achievement of the objectives in the fields of health and safety and a better quality of life. The transition towards the global market needs an instrument for the removal of the barriers to the application of the latest discoveries in the field of medical instruments, materials and manual labor. Each medical device, equipment and material used in the Dental and General Medicine is standardized, in fact that leads to their better knowing and provides controllable treatment for manual labor with predictable and repeatable results. This presentation intends to make a survey of some general aspects on standardization as well as a review of the standards in

  20. Second Helping: An Advanced Enrichment Course for Family Child Care Providers. Program Information Package. [Revised.

    ERIC Educational Resources Information Center

    Windflower Enterprises, Colorado Springs, CO.

    Second Helping is a 32-hour, 4-module course designed by and for family child care providers to address issues of concern to the provider, such as individual well-being, business skills, family relations, and child development. This booklet discusses the Second Helping family child care provider training course and outlines the qualifications…

  1. The 2015 NASN School Nurse Survey: Developing and Providing Leadership to Advance School Nursing Practice.

    PubMed

    Mangena, Anantha Sameera; Maughan, Erin

    2015-11-01

    This article summarizes the results of the 2015 NASN School Nurse Survey, identifies similarities and differences between this survey and the 2013 NASN School Nurse Survey, and evaluates the possible impacts of this data on the organization. PMID:26515570

  2. Impact of Instruction and Feedback on Reflective Responses during an Ambulatory Care Advanced Pharmacy Practice Experience

    PubMed Central

    Spangler, Mikayla; Klug, Laura; Tilleman, Jennifer; Coover, Kelli

    2016-01-01

    Objective. To investigate whether instruction and feedback on reflective responses are beneficial in developing pharmacy students to become more reflective practitioners. Methods. Students on an advanced pharmacy practice experience answered weekly reflection questions and were randomly assigned to either an intervention (received instruction and feedback on reflection) or control group. The final week’s responses were de-identified and two blinded faculty members independently categorized them as reflective or nonreflective. The primary outcome measure was comparing the number of “reflective” responses in each group. Results. The responses were classified as reflective in 83.3% of students in the intervention group (n=18) compared to 37.5% of the control group (n=16). The odds that the response was categorized as reflective were 8.3 times higher in the intervention group. Conclusion. Providing instruction and feedback to students improved the likelihood that their work was reflective. PMID:27402984

  3. New advanced technologies to provide decentralised and secure access to medical records: case studies in oncology.

    PubMed

    Quantin, Catherine; Coatrieux, Gouenou; Allaert, François André; Fassa, Maniane; Bourquard, Karima; Boire, Jean-Yves; de Vlieger, Paul; Maigne, Lydia; Breton, Vincent

    2009-08-07

    The main problem for health professionals and patients in accessing information is that this information is very often distributed over many medical records and locations. This problem is particularly acute in cancerology because patients may be treated for many years and undergo a variety of examinations. Recent advances in technology make it feasible to gain access to medical records anywhere and anytime, allowing the physician or the patient to gather information from an "ephemeral electronic patient record". However, this easy access to data is accompanied by the requirement for improved security (confidentiality, traceability, integrity, ...) and this issue needs to be addressed. In this paper we propose and discuss a decentralised approach based on recent advances in information sharing and protection: Grid technologies and watermarking methodologies. The potential impact of these technologies for oncology is illustrated by the examples of two experimental cases: a cancer surveillance network and a radiotherapy treatment plan. It is expected that the proposed approach will constitute the basis of a future secure "google-like" access to medical records.

  4. New Advanced Technologies to Provide Decentralised and Secure Access to Medical Records: Case Studies in Oncology

    PubMed Central

    Quantin, Catherine; Coatrieux, Gouenou; Allaert, François André; Fassa, Maniane; Bourquard, Karima; Boire, Jean-Yves; de Vlieger, Paul; Maigne, Lydia; Breton, Vincent

    2009-01-01

    The main problem for health professionals and patients in accessing information is that this information is very often distributed over many medical records and locations. This problem is particularly acute in cancerology because patients may be treated for many years and undergo a variety of examinations. Recent advances in technology make it feasible to gain access to medical records anywhere and anytime, allowing the physician or the patient to gather information from an “ephemeral electronic patient record”. However, this easy access to data is accompanied by the requirement for improved security (confidentiality, traceability, integrity, ...) and this issue needs to be addressed. In this paper we propose and discuss a decentralised approach based on recent advances in information sharing and protection: Grid technologies and watermarking methodologies. The potential impact of these technologies for oncology is illustrated by the examples of two experimental cases: a cancer surveillance network and a radiotherapy treatment plan. It is expected that the proposed approach will constitute the basis of a future secure “google-like” access to medical records. PMID:19718446

  5. Practical advance in obtaining an emergency airway via cricothyroidotomy.

    PubMed

    Huber, William G; Dahman, Marc H; Thomas, Deanna; Lipschutz, Joshua H

    2007-05-01

    By the time a cricothyroidotomy is deemed necessary, the patient is in critical need of an emergency airway before anoxic damage ensues. Two things are necessary for the delivery of the requisite oxygen. First, an airway must be rapidly established. Second, the airway must be large enough to facilitate ventilation. Present methods for emergency cricothyroidotomy include needle cricothyroidotomy, which suffers from difficulties in both establishment and ventilation. We describe here a practical and widely available method for establishing a timely effective airway that has been used successfully for five patients since 1992.

  6. Advancing the Practice of Health Coaching: Differentiation From Wellness Coaching.

    PubMed

    Huffman, Melinda H

    2016-09-01

    The increasing demand for health coaches and wellness coaches in worksite health promotion and the marketplace has resulted in a plethora of training programs with wide variations in coaching definitions, content, attributes, and eligibility of those who may train. It is in the interest of public awareness and safety that those in clinical practice take the lead in this discussion and offer a reasonable contrast and comparison focusing on the risks and responsibilities of health coaching in particular. With the endorsement of the American Association of Occupational Health Nurses (AAOHN), the National Society of Health Coaches, whose membership is primarily nurses, discusses the issue and states its position here. PMID:27174131

  7. Advancing the Practice of Health Coaching: Differentiation From Wellness Coaching.

    PubMed

    Huffman, Melinda H

    2016-09-01

    The increasing demand for health coaches and wellness coaches in worksite health promotion and the marketplace has resulted in a plethora of training programs with wide variations in coaching definitions, content, attributes, and eligibility of those who may train. It is in the interest of public awareness and safety that those in clinical practice take the lead in this discussion and offer a reasonable contrast and comparison focusing on the risks and responsibilities of health coaching in particular. With the endorsement of the American Association of Occupational Health Nurses (AAOHN), the National Society of Health Coaches, whose membership is primarily nurses, discusses the issue and states its position here.

  8. Meeting report: advancing practical applications of biodiversity ontologies

    PubMed Central

    2014-01-01

    We describe the outcomes of three recent workshops aimed at advancing development of the Biological Collections Ontology (BCO), the Population and Community Ontology (PCO), and tools to annotate data using those and other ontologies. The first workshop gathered use cases to help grow the PCO, agreed upon a format for modeling challenging concepts such as ecological niche, and developed ontology design patterns for defining collections of organisms and population-level phenotypes. The second focused on mapping datasets to ontology terms and converting them to Resource Description Framework (RDF), using the BCO. To follow-up, a BCO hackathon was held concurrently with the 16th Genomics Standards Consortium Meeting, during which we converted additional datasets to RDF, developed a Material Sample Core for the Global Biodiversity Information Framework, created a Web Ontology Language (OWL) file for importing Darwin Core classes and properties into BCO, and developed a workflow for converting biodiversity data among formats.

  9. On-the-Job Practices of Early Childhood Special Education Providers Trained in Family-Centered Practices

    ERIC Educational Resources Information Center

    Murray, Mary M.; Mandell, Colleen J.

    2006-01-01

    This qualitative study investigated the use of family-centered practices by graduates of two early childhood special education personnel preparation programs that embedded family-centered pedagogy and involvement in all coursework. Three cohorts, involving 19 graduates employed in 19 different programs located in six states, participated in…

  10. Advanced practice physiotherapy in patients with musculoskeletal disorders: a systematic review

    PubMed Central

    2012-01-01

    Background The convergence of rising health care costs and physician shortages have made health care transformation a priority in many countries resulting in the emergence of new models of care that often involve the extension of the scope of practice for allied health professionals. Physiotherapists in advanced practice/extended scope roles have emerged as key providers in such new models, especially in settings providing services to patients with musculoskeletal disorders. However, evidence of the systematic evaluation of advance physiotherapy practice (APP) models of care is scarce. A systematic review was done to update the evaluation of physiotherapists in APP roles in the management of patients with musculoskeletal disorders. Methods Structured literature search was conducted in 3 databases (Medline, Cinahl and Embase) for articles published between 1980 and 2011. Included studies needed to present original quantitative data that addressed the impact or the effect of APP care. A total of 16 studies met all inclusion criteria and were included. Pairs of raters used four structured quality appraisal methodological tools depending on design of studies to analyse included studies. Results Included studies varied in designs and objectives and could be categorized in four areas: diagnostic agreement or accuracy compared to medical providers, treatment effectiveness, economic efficiency or patient satisfaction. There was a wide range in the quality of studies (from 25% to 93%), with only 43% of papers reaching or exceeding a score of 70% on the methodological quality rating scales. Their findings are however consistent and suggest that APP care may be as (or more) beneficial than usual care by physicians for patients with musculoskeletal disorders, in terms of diagnostic accuracy, treatment effectiveness, use of healthcare resources, economic costs and patient satisfaction. Conclusions The emerging evidence suggests that physiotherapists in APP roles provide equal

  11. Advanced Energy Retrofit Guide: Practical Ways to Improve Energy Performance, K-12 Schools (Book)

    SciTech Connect

    Not Available

    2013-12-01

    The U.S. Department of Energy developed the Advanced Energy Retrofit Guides (AERGs) to provide specific methodologies, information, and guidance to help energy managers and other stakeholders plan and execute energy efficiency improvements. Detailed technical discussion is fairly limited. Instead, we emphasize actionable information, practical methodologies, diverse case studies, and unbiased evaluations of the most promising retrofit energy efficiency measures for each building type. A series of AERGs is under development, addressing key segments of the commercial building stock. K-12 schools were selected as one of the highest priority building sectors, because schools affect the lives of most Americans. They also represent approximately 8% of the energy use and 10% of the floor area in commercial buildings nationwide. U.S. K-12 school districts spend more than $8 billion each year on energy - more than they spend on computers and textbooks combined. Most occupy older buildings that often have poor operational performance - more than 30% of schools were built before 1960. The average age of a school is about 42 years - which is nearly the expected serviceable lifespan of the building. K-12 schools offer unique opportunities for deep, cost-effective energy efficiency improvements, and this guide provides convenient and practical guidance for exploiting these opportunities in the context of public, private, and parochial schools.

  12. Advances in osteoporosis therapy. 2003 update of practical guidelines.

    PubMed Central

    Khan, Aliya

    2003-01-01

    OBJECTIVE: To review evidence for current therapies for postmenopausal osteoporosis and to establish practical guidelines for management of osteoporosis by family physicians. QUALITY OF EVIDENCE: MEDLINE was searched from January 1990 to January 2003. Articles retrieved were graded by level of evidence (I to III). Recommendations for diagnosis and therapy were based on evidence from randomized controlled trials and meta-analyses. MAIN MESSAGE: Osteoporosis is treatable. Early diagnosis and intervention is recommended. After excluding secondary causes of osteoporosis, physicians should advise patients to take appropriate calcium and vitamin D supplementation. Those with osteopenia at risk of fractures and those with established osteoporosis need additional therapy. CONCLUSION: Approved pharmacologic therapies include alendronate, risedronate, raloxifene, calcitonin, cyclical etidronate, and hormone replacement therapy. Family physicians can help with early diagnosis and intervention and should discuss lifestyle modification with patients. PMID:12729240

  13. Healthcare providers balancing norms and practice: challenges and opportunities in providing contraceptive counselling to young people in Uganda – a qualitative study

    PubMed Central

    Paul, Mandira; Näsström, Sara B.; Klingberg-Allvin, Marie; Kiggundu, Charles; Larsson, Elin C.

    2016-01-01

    Background Pregnancies among young women force girls to compromise education, resulting in low educational attainment with subsequent poverty and vulnerability. A pronounced focus is needed on contraceptive use, pregnancy, and unsafe abortion among young women. Objective This study aims to explore healthcare providers’ (HCPs) perceptions and practices regarding contraceptive counselling to young people. Design We conducted 27 in-depth interviews with doctors and midwives working in seven health facilities in central Uganda. Interviews were open-ended and allowed the participant to speak freely on certain topics. We used a topic guide to cover areas topics of interest focusing on post-abortion care (PAC) but also covering contraceptive counselling. Transcripts were transcribed verbatim and data were analysed using thematic analysis. Results The main theme, HCPs' ambivalence to providing contraceptive counselling to sexually active young people is based on two sub-themes describing the challenges of contraceptive counselling: A) HCPs echo the societal norms regarding sexual practice among young people, while at the same time our findings B) highlights the opportunities resulting from providers pragmatic approach to contraceptive counselling to young women. Providers expressed a self-identified lack of skill, limited resources, and inadequate support from the health system to successfully provide appropriate services to young people. They felt frustrated with the consultations, especially when meeting young women seeking PAC. Conclusions Despite existing policies for young people's sexual and reproductive health in Uganda, HCPs are not sufficiently equipped to provide adequate contraceptive counselling to young people. Instead, HCPs are left in between the negative influence of social norms and their pragmatic approach to address the needs of young people, especially those seeking PAC. We argue that a clear policy supported by a clear strategy with practical

  14. Targeted Therapies in Breast Cancer: Implications for Advanced Oncology Practice

    PubMed Central

    Bourdeanu, Laura; Luu, Thehan

    2014-01-01

    The systemic therapeutic management of breast cancer has undergone significant transformation in the past decade. Without targeted therapies, conventional treatment with cytotoxic agents has reached the limit of its potential in terms of patient survival for most types of cancer. Enhanced understanding of the pathogenesis of tumor cell growth and metastasis has led to the identification of signaling growth pathways as targets for these directed therapies. Novel therapies targeted to HER2/neu, epidermal growth factor receptor (EGFR), vascular endothelial growth factor (VEGF), poly(ADP ribose) polymerase (PARP), mammalian target of rapamycin (mTOR), histone deacetylase (HDAC), the heat shock protein, and cyclin-dependent kinase (CDK) inhibitors have been developed and have demonstrated some efficacy in breast cancer. Recognition and management of the toxicities associated with targeted therapies is imperative. This review will describe the clinical development and utilization of targeted therapies currently in use or in clinical trials, with a focus on considerations for the oncology advanced practitioner. PMID:26110069

  15. Privacy and confidentiality issues in primary care: views of advanced practice nurses and their patients--an APRNet study [corrected].

    PubMed

    Deshefy-Longhi, Terry; Dixon, Jane Karpe; Olsen, Douglas; Grey, Margaret

    2004-01-01

    Various aspects of the concepts of privacy and confidentiality are discussed in relation to health care information in primary health care settings. In addition, findings are presented from patient and nurse practitioner focus groups held to elicit concerns that these two groups have in relation to privacy and confidentiality in their respective primary care settings. The focus groups were held prior to the implementation of the Health Insurance Portability and Accessibility Act in the USA. Implications for advanced practice registered nurses in primary care practices are provided.

  16. Putting PrEP into Practice: Lessons Learned from Early-Adopting U.S. Providers' Firsthand Experiences Providing HIV Pre-Exposure Prophylaxis and Associated Care.

    PubMed

    Calabrese, Sarah K; Magnus, Manya; Mayer, Kenneth H; Krakower, Douglas S; Eldahan, Adam I; Gaston Hawkins, Lauren A; Hansen, Nathan B; Kershaw, Trace S; Underhill, Kristen; Betancourt, Joseph R; Dovidio, John F

    2016-01-01

    Optimizing access to HIV pre-exposure prophylaxis (PrEP), an evidence-based HIV prevention resource, requires expanding healthcare providers' adoption of PrEP into clinical practice. This qualitative study explored PrEP providers' firsthand experiences relative to six commonly-cited barriers to prescription-financial coverage, implementation logistics, eligibility determination, adherence concerns, side effects, and anticipated behavior change (risk compensation)-as well as their recommendations for training PrEP-inexperienced providers. U.S.-based PrEP providers were recruited via direct outreach and referral from colleagues and other participants (2014-2015). One-on-one interviews were conducted in person or by phone, transcribed, and analyzed. The sample (n = 18) primarily practiced in the Northeastern (67%) or Southern (22%) U.S. Nearly all (94%) were medical doctors (MDs), most of whom self-identified as infectious disease specialists. Prior experience prescribing PrEP ranged from 2 to 325 patients. Overall, providers reported favorable experiences with PrEP implementation and indicated that commonly anticipated problems were minimal or manageable. PrEP was covered via insurance or other programs for most patients; however, pre-authorization requirements, laboratory/service provision costs, and high deductibles sometimes presented challenges. Various models of PrEP care and coordination with other providers were utilized, with several providers highlighting the value of clinical staff support. Eligibility was determined through joint decision-making with patients; CDC guidelines were commonly referenced but not considered absolute. Patient adherence was variable, with particularly strong adherence noted among patients who had actively sought PrEP (self-referred). Providers observed minimal adverse effects or increases in risk behavior. However, they identified several barriers with respect to accessing and engaging PrEP candidates. Providers offered a wide

  17. Putting PrEP into Practice: Lessons Learned from Early-Adopting U.S. Providers' Firsthand Experiences Providing HIV Pre-Exposure Prophylaxis and Associated Care.

    PubMed

    Calabrese, Sarah K; Magnus, Manya; Mayer, Kenneth H; Krakower, Douglas S; Eldahan, Adam I; Gaston Hawkins, Lauren A; Hansen, Nathan B; Kershaw, Trace S; Underhill, Kristen; Betancourt, Joseph R; Dovidio, John F

    2016-01-01

    Optimizing access to HIV pre-exposure prophylaxis (PrEP), an evidence-based HIV prevention resource, requires expanding healthcare providers' adoption of PrEP into clinical practice. This qualitative study explored PrEP providers' firsthand experiences relative to six commonly-cited barriers to prescription-financial coverage, implementation logistics, eligibility determination, adherence concerns, side effects, and anticipated behavior change (risk compensation)-as well as their recommendations for training PrEP-inexperienced providers. U.S.-based PrEP providers were recruited via direct outreach and referral from colleagues and other participants (2014-2015). One-on-one interviews were conducted in person or by phone, transcribed, and analyzed. The sample (n = 18) primarily practiced in the Northeastern (67%) or Southern (22%) U.S. Nearly all (94%) were medical doctors (MDs), most of whom self-identified as infectious disease specialists. Prior experience prescribing PrEP ranged from 2 to 325 patients. Overall, providers reported favorable experiences with PrEP implementation and indicated that commonly anticipated problems were minimal or manageable. PrEP was covered via insurance or other programs for most patients; however, pre-authorization requirements, laboratory/service provision costs, and high deductibles sometimes presented challenges. Various models of PrEP care and coordination with other providers were utilized, with several providers highlighting the value of clinical staff support. Eligibility was determined through joint decision-making with patients; CDC guidelines were commonly referenced but not considered absolute. Patient adherence was variable, with particularly strong adherence noted among patients who had actively sought PrEP (self-referred). Providers observed minimal adverse effects or increases in risk behavior. However, they identified several barriers with respect to accessing and engaging PrEP candidates. Providers offered a wide

  18. [Providing studies quality for pesticides risk evaluation in their use according to proper laboratory practice rules].

    PubMed

    Rakitskiy, V N; Bereznyak, I V

    2016-01-01

    The article covers experience of proper laboratory practice in hygienic studies examining air and workers' skin for assessment of exposure levels of pesticides in natural conditions of agricultural production. PMID:27265940

  19. Advances and Best Practices in Airborne Gravimetry from the U.S. GRAV-D Project

    NASA Astrophysics Data System (ADS)

    Diehl, Theresa; Childers, Vicki; Preaux, Sandra; Holmes, Simon; Weil, Carly

    2013-04-01

    The Gravity for the Redefinition of the American Vertical Datum (GRAV-D) project, an official policy of the U.S. National Geodetic Survey as of 2007, is working to survey the entire U.S. and its holdings with high-altitude airborne gravimetry. The goal of the project is to provide a consistent, high-quality gravity dataset that will become the cornerstone of a new gravimetric geoid and national vertical datum in 2022. Over the last five years, the GRAV-D project has surveyed more than 25% of the country, accomplishing almost 500 flights on six different aircraft platforms and producing more than 3.7 Million square km of data thus far. This wealth of experience has led to advances in the collection, processing, and evaluation of high-altitude (20,000 - 35,000 ft) airborne gravity data. This presentation will highlight the most important practical and theoretical advances of the GRAV-D project, giving an introduction to each. Examples of innovation include: 1. Use of navigation grade inertial measurement unit data and precise lever arm measurements for positioning; 2. New quality control tests and software for near real-time analysis of data in the field; 3. Increased accuracy of gravity post-processing by reexamining assumptions and simplifications that were inconsistent with a goal of 1 mGal precision; and 4. Better final data evaluation through crossovers, additional statistics, and inclusion of airborne data into harmonic models that use EGM08 as a base model. The increases in data quality that resulted from implementation of the above advances (and others) will be shown with a case study of the GRAV-D 2008 southern Alaska survey near Anchorage, over Cook Inlet. The case study's statistics and comparisons to global models illustrate the impact that these advances have had on the final airborne gravity data quality. Finally, the presentation will summarize the best practices identified by the project from its last five years of experience.

  20. Reading Research: Advances in Theory and Practice. Volume 1.

    ERIC Educational Resources Information Center

    Waller, T. Gary, Ed.; MacKinnon, G. E., Ed.

    The first of a series providing reviews, syntheses (empirical and rhetorical), and reports of reading research, the chapters in this volume treat the question, "What does a child have to know (or be able to do) in order to learn to read?" The book begins with an in-depth logical analysis in historical perspective of the concept of reading…

  1. Electronic Mentoring: Issues To Advance Research and Practice.

    ERIC Educational Resources Information Center

    Single, Peg Boyle; Muller, Carol B.

    E-mentoring is the merger of mentoring with electronic communications and has been termed telementoring, cybermentoring, or virtual mentoring. By leveraging the growth in information technology, electronic mentoring provides opportunities for mentoring prohibited by face-to-face mentoring programs. Yet, the ease with which e-mentoring programs can…

  2. Advanced Energy Retrofit Guide (AERG): Practical Ways to Improve Energy Performance; Healthcare Facilities (Book)

    SciTech Connect

    Hendron, R.; Leach, M.; Bonnema, E.; Shekhar, D.; Pless, S.

    2013-09-01

    The Advanced Energy Retrofit Guide for Healthcare Facilities is part of a series of retrofit guides commissioned by the U.S. Department of Energy. By presenting general project planning guidance as well as detailed descriptions and financial payback metrics for the most important and relevant energy efficiency measures (EEMs), the guides provide a practical roadmap for effectively planning and implementing performance improvements in existing buildings. The Advanced Energy Retrofit Guides (AERGs) are intended to address key segments of the U.S. commercial building stock: retail stores, office buildings, K-12 schools, grocery stores, and healthcare facilities. The guides' general project planning considerations are applicable nationwide; the energy and cost savings estimates for recommended EEMs were developed based on energy simulations and cost estimates for an example hospital tailored to five distinct climate regions. These results can be extrapolated to other U.S. climate zones. Analysis is presented for individual EEMs, and for packages of recommended EEMs for two project types: existing building commissioning projects that apply low-cost and no-cost measures, and whole-building retrofits involving more capital-intensive measures.

  3. Advanced Glycation End Products in Foods and a Practical Guide to Their Reduction in the Diet

    PubMed Central

    URIBARRI, JAIME; WOODRUFF, SANDRA; GOODMAN, SUSAN; CAI, WEIJING; CHEN, XUE; PYZIK, RENATA; YONG, ANGIE; STRIKER, GARY E.; VLASSARA, HELEN

    2013-01-01

    Modern diets are largely heat-processed and as a result contain high levels of advanced glycation end products (AGEs). Dietary advanced glycation end products (dAGEs) are known to contribute to increased oxidant stress and inflammation, which are linked to the recent epidemics of diabetes and cardiovascular disease. This report significantly expands the available dAGE database, validates the dAGE testing methodology, compares cooking procedures and inhibitory agents on new dAGE formation, and introduces practical approaches for reducing dAGE consumption in daily life. Based on the findings, dry heat promotes new dAGE formation by >10- to 100-fold above the uncooked state across food categories. Animal-derived foods that are high in fat and protein are generally AGE-rich and prone to new AGE formation during cooking. In contrast, carbohydrate-rich foods such as vegetables, fruits, whole grains, and milk contain relatively few AGEs, even after cooking. The formation of new dAGEs during cooking was prevented by the AGE inhibitory compound aminoguanidine and significantly reduced by cooking with moist heat, using shorter cooking times, cooking at lower temperatures, and by use of acidic ingredients such as lemon juice or vinegar. The new dAGE database provides a valuable instrument for estimating dAGE intake and for guiding food choices to reduce dAGE intake. PMID:20497781

  4. Improving End-of-Life Care Prognostic Discussions: Role of Advanced Practice Nurses.

    PubMed

    Kalowes, Peggy

    2015-01-01

    Research has validated the desire of patients and families for ongoing prognostic information; however, few conversations occur before patients reach the advanced stages of their disease trajectory. Physician hesitance and delay in discussing unfavorable prognoses deny patients and families optimal time to prepare for critical decision making. Advanced practice registered nurses can play a crucial, complementary role with the critical care interdisciplinary team to implement strategies to improve communication about prognosis and end of life with patients and families. Clinicians should discuss deterioration in disease-specific characteristics and changes (decline) in functional status. Functional status can serve as an accurate guide for forecasting prognosis, particularly in patients with heart failure, stroke, chronic lung disease, and end-stage renal disease. This article provides an overview of effective intensive care unit prognostic systems and discusses barriers and opportunities for nurses to use evidence-based knowledge related to disease trajectory and prognosis to improve communication and the quality of palliative and end-of-life care for patients.

  5. Design and Implementation of a Laboratory-Based Drug Design and Synthesis Advanced Pharmacy Practice Experience

    PubMed Central

    Philip, Ashok; Stephens, Mark; Mitchell, Sheila L.

    2015-01-01

    Objective. To provide students with an opportunity to participate in medicinal chemistry research within the doctor of pharmacy (PharmD) curriculum. Design. We designed and implemented a 3-course sequence in drug design or drug synthesis for pharmacy students consisting of a 1-month advanced elective followed by two 1-month research advanced pharmacy practice experiences (APPEs). To maximize student involvement, this 3-course sequence was offered to third-year and fourth-year students twice per calendar year. Assessment. Students were evaluated based on their commitment to the project’s success, productivity, and professionalism. Students also evaluated the course sequence using a 14-item course evaluation rubric. Student feedback was overwhelmingly positive. Students found the experience to be a valuable component of their pharmacy curriculum. Conclusion. We successfully designed and implemented a 3-course research sequence that allows PharmD students in the traditional 4-year program to participate in drug design and synthesis research. Students report the sequence enhanced their critical-thinking and problem-solving skills and helped them develop as independent learners. Based on the success achieved with this sequence, efforts are underway to develop research APPEs in other areas of the pharmaceutical sciences. PMID:25995518

  6. Identifying landmark articles for advancing the practice of geriatrics.

    PubMed

    Vaughan, Camille P; Fowler, Rachel; Goodman, Richard A; Graves, Taylor R; Flacker, Jonathan M; Johnson, Theodore M

    2014-11-01

    Landmark articles from the peer-reviewed literature can be used to teach the fundamental principles of geriatric medicine. Three approaches were used in sequential combination to identify landmark articles as a resource for geriatricians and other healthcare practitioners. Candidate articles were identified first through a literature review and expert opinion survey of geriatric medicine faculty. Candidate articles in a winnowed list (n = 30) were then included in a bibliometric analysis that incorporated the journal impact factor and average monthly citation index. Finally, a consensus panel reviewed articles to assess each manuscript's clinical relevance. For each article, a final score was determined by averaging, with equal weight, the opinion survey, bibliometric analysis, and consensus panel review. This process ultimately resulted in the identification of 27 landmark articles. Overall, there was weak correlation between articles that the expert opinion survey and bibliometric analysis both rated highly. This process demonstrates a feasible method combining subjective and objective measures that can be used to identify landmark papers in geriatric medicine for the enhancement of geriatrics education and practice.

  7. Psychological Well-Being Revisited: Advances in Science and Practice

    PubMed Central

    Ryff, Carol D.

    2014-01-01

    This article reviews the research and interventions that have grown up around a model of psychological well-being (Ryff, 1989) generated more than two decades ago to address neglected aspects of positive functioning, such as purposeful engagement in life, realization of personal talents and capacities, and enlightened self-knowledge. The conceptual origins of this formulation are revisited and scientific products emerging from six thematic areas are examined: (1) how well-being changes across adult development and later life, (2) what are the personality correlates of well-being, (3) how well-being is linked with experiences in family life, (4) how well-being relates to work and other community activities, (5) what are the connections between well-being and health, including biological risk factors, (6) and via clinical and intervention studies, how psychological well-being can be promoted for ever greater segments of society. Together, these topics illustrate flourishing interest across diverse scientific disciplines in understanding adults as striving, meaning-making, proactive organisms who are actively negotiating the challenges of life. A take-home message is that increasing evidence supports the health protective features of psychological well-being in reducing risk for disease and promoting length of life. A recurrent and increasingly important theme is resilience – the capacity to maintain or regain well-being in the face of adversity. Implications for future research and practice are considered. PMID:24281296

  8. Health: support provided and received in advanced old age. A five-year follow-up.

    PubMed

    Armi, F; Guilley, E; Lalive d'Epinay, C J

    2008-02-01

    While research focuses mainly on support provided to the elderly, this paper deals with the very old as a support provider to his family as much as a care recipient from both his family and a formal network. We hypothesize that elders with declining health will try to maintain the provision of services, even when they require and receive help.A total of 340 octogenarians from the Swiss Interdisciplinary Longitudinal Study on the Oldest Old (SWILSOO) were interviewed up to five times over five years (N=1225 interviews). A multilevel model was applied to assess the effects of health, controlled for socio-demographic and family network variables, on the frequency of services that the old persons provided to their family and received from their family and formal networks. Health is operationalized in three statuses: ADL-dependent, ADL-independent frail, and robust.While the recourse to the informal network increased progressively with the process of frailty, the recourse to the formal network drastically increased for ADL-dependent individuals. Being ADL-dependent seriously altered the capacity to provide services, but ADL-independent frail persons were providers with the same frequency as the robust oldest old, showing their ability to preserve a principle of reciprocity in their exchanges with their family network. This continuity of roles may help frail persons to maintain their self-esteem and well-being.

  9. Identifying factors that impact patient length of stay metrics for healthcare providers with advanced analytics.

    PubMed

    Kudyba, Stephan; Gregorio, Thomas

    2010-12-01

    Managing patients' length of stay is a critical task for healthcare organizations. In order to better manage the processes impacting this performance metric, providers can leverage data resources describing the network of activities that impact a patient's stay with analytic methods. Interdependencies between departmental activities exist within the patient treatment process, where inefficiency in one element of the patient care network of activities can adversely affect process outcomes.This work utilizes the method of neural networks to analyze data describing inpatient cases that incorporate radiology process variables to determine their effect on patient length of stay excesses for a major NJ based healthcare provider. The results indicate that inefficiencies at the radiology level can adversely extend a patient's length of stay beyond initial estimations. Proactive analysis of networks of activities in the patient treatment process can enhance organizational efficiencies of healthcare providers by enabling decision makers to better optimize resource allocations to increase throughput of activities.

  10. Providing the Basis for Innovative Improvements in Advanced LWR Reactor Passive Safety Systems Design: An Educational R&D Project

    SciTech Connect

    Brian G. Williams; Jim C. P. Liou; Hiral Kadakia; Bill Phoenix; Richard R. Schultz

    2007-02-27

    This project characterizes typical two-phase stratified flow conditions in advanced water reactor horizontal pipe sections, following activation of passive cooling systems. It provides (1) a means to educate nuclear engineering students regarding the importance of two-phase stratified flow in passive cooling systems to the safety of advanced reactor systems and (2) describes the experimental apparatus and process to measure key parameters essential to consider when designing passive emergency core cooling flow paths that may encounter this flow regime. Based on data collected, the state of analysis capabilities can be determined regarding stratified flow in advanced reactor systems and the best paths forward can be identified to ensure that the nuclear industry can properly characterize two-phase stratified flow in passive emergency core cooling systems.

  11. Geographic Medical History: Advances in Geospatial Technology Present New Potentials in Medical Practice

    NASA Astrophysics Data System (ADS)

    Faruque, F. S.; Finley, R. W.

    2016-06-01

    Genes, behaviour, and the environment are known to be the major risk factors for common diseases. When the patient visits a physician, typical questions include family history (genes) and lifestyle of the patient (behaviour), but questions concerning environmental risk factors often remain unasked. It is ironic that 25 centuries ago Hippocrates, known as the father of medicine, noted the importance of environmental exposure in medical investigation as documented in his classic work, "Airs, Waters, Places", yet the practice of routinely incorporating environmental risk factors is still not in place. Modern epigenetic studies have found that unhealthy lifestyle and environmental factors can cause changes to our genes that can increase disease risk factors. Therefore, attempting to solve the puzzle of diseases using heredity and lifestyle alone will be incomplete without accounting for the environmental exposures. The primary reason why environmental exposure has not yet been a routine part of the patient's medical history is mostly due to our inability to provide clinicians useful measures of environmental exposures suitable for their clinical practices. This presentation will discuss advances in geospatial technology that show the potential to catalyse a paradigm shift in medical practice and health research by allowing environmental risk factors to be documented as the patient's "Geographic Medical History". In order to accomplish this we need information on: a) relevant spatiotemporal environmental variables, and b) location of the individual in that person's dynamic environment. Common environmental agents that are known to interact with genetic make-up include air pollutants, mold spores, pesticides, etc. Until recently, the other component, location of an individual was limited to a static representation such as residential or workplace location. Now, with the development of mobile technology, changes in an individual's location can be tracked in real time if

  12. Diagnosis and treatment of patients with bipolar disorder: A review for advanced practice nurses

    PubMed Central

    Murray, Bethany; McNew, Brittany

    2015-01-01

    Abstract Purpose This review article provides an overview of the frequency, burden of illness, diagnosis, and treatment of bipolar disorder (BD) from the perspective of the advanced practice nurses (APNs). Data sources PubMed searches were conducted using the following keywords: “bipolar disorder and primary care,” restricted to dates 2000 to present; “bipolar disorder and nurse practitioner”; and “bipolar disorder and clinical nurse specialist.” Selected articles were relevant to adult outpatient care in the United States, with a prioritization of articles written by APNs or published in nursing journals. Conclusions BD has a substantial lifetime prevalence in the population at 4%. Because the manic or depressive symptoms of BD tend to be severe and recurrent over a patient's lifetime, the condition is associated with significant burden to the individual, caregivers, and society. Clinician awareness that BD may be present increases the likelihood of successful recognition and appropriate treatment. A number of pharmacological and nonpharmacological treatments are available for acute and maintenance treatments, with the prospect of achieving reduced symptom burden and increased functioning for many patients. Implications for practice Awareness of the disease burden, diagnostic issues, and management choices in BD has the potential to enhance outcome in substantial proportions of patients. PMID:26172568

  13. Recent advances toward the practical application of embryo transfer in pigs.

    PubMed

    Martinez, Emilio A; Cuello, Cristina; Parrilla, Inmaculada; Martinez, Cristina A; Nohalez, Alicia; Vazquez, Jose L; Vazquez, Juan M; Roca, Jordi; Gil, Maria A

    2016-01-01

    Porcine embryo transfer (ET) technology has been in demand for decades because of its potential to provide considerable improvements in pig production with important sanitary, economic, and animal welfare benefits. Despite these advantages, the commercial use of ET is practically nonexistent. However, the two main obstacles hindering the commercial use of ET in pigs in the past several decades (i.e., surgical transfer and embryo preservation) have recently been overcome. A technique for nonsurgical deep-uterine (NsDU) ET of nonsedated gilts and sows, which was seemingly an impossible challenge just a few years ago, is a reality today. The improvements in embryo preservation that have been achieved in recent years and the excellent reproductive performance of the recipients after the NsDU-ET technique coupled with short-term and long-term-stored embryos represent essential progress for the international trade of porcine embryos and the practical use of ET by the pig industry. This review focuses, with an emphasis on our own findings, on the recent advances in embryo preservation and NsDU-ET technologies, which are starting to show potential for application under field conditions. PMID:26164803

  14. Multispectral Filter Arrays: Recent Advances and Practical Implementation

    PubMed Central

    Lapray, Pierre-Jean; Wang, Xingbo; Thomas, Jean-Baptiste; Gouton, Pierre

    2014-01-01

    Thanks to some technical progress in interferencefilter design based on different technologies, we can finally successfully implement the concept of multispectral filter array-based sensors. This article provides the relevant state-of-the-art for multispectral imaging systems and presents the characteristics of the elements of our multispectral sensor as a case study. The spectral characteristics are based on two different spatial arrangements that distribute eight different bandpass filters in the visible and near-infrared area of the spectrum. We demonstrate that the system is viable and evaluate its performance through sensor spectral simulation. PMID:25407904

  15. Development and Implementation of the Advanced Practice Nurse Worldwide With an Interest in Geriatric Care.

    PubMed

    Fougère, Bertrand; Morley, John E; Decavel, Frédérique; Nourhashémi, Fati; Abele, Patricia; Resnick, Barbara; Rantz, Marilyn; Lai, Claudia Kam Yuk; Moyle, Wendy; Pédra, Maryse; Chicoulaa, Bruno; Escourrou, Emile; Oustric, Stéphane; Vellas, Bruno

    2016-09-01

    Many countries are seeking to improve health care delivery by reviewing the roles of health professionals, including nurses. Developing new and more advanced roles for nurses could improve access to care in the face of a limited or diminishing supply of doctors and growing health care demand. The development of new nursing roles varies greatly from country to country. The United States and Canada established "nurse practitioners" (NPs) in the mid-1960s. The United Kingdom and Finland also have a long experience in using different forms of collaboration between doctors and nurses. In other countries, such as Australia, NPs were endorsed more recently in 2000. In France, Belgium, or Singapore, the formal recognition of advanced practice nurses is still in its infancy, whereas in other countries, such as Japan or China, advanced practice nurses are not licensed titles. The aims of this article were to define precisely what is meant by the term "advanced practice nurse (APN)," describe the state of development of APN roles, and review the main factors motivating the implementation of APN in different countries. Then, we examine the main factors that have hindered the development of APN roles. Finally, we explain the need for advanced practice roles in geriatrics. PMID:27321868

  16. Development and Implementation of the Advanced Practice Nurse Worldwide With an Interest in Geriatric Care.

    PubMed

    Fougère, Bertrand; Morley, John E; Decavel, Frédérique; Nourhashémi, Fati; Abele, Patricia; Resnick, Barbara; Rantz, Marilyn; Lai, Claudia Kam Yuk; Moyle, Wendy; Pédra, Maryse; Chicoulaa, Bruno; Escourrou, Emile; Oustric, Stéphane; Vellas, Bruno

    2016-09-01

    Many countries are seeking to improve health care delivery by reviewing the roles of health professionals, including nurses. Developing new and more advanced roles for nurses could improve access to care in the face of a limited or diminishing supply of doctors and growing health care demand. The development of new nursing roles varies greatly from country to country. The United States and Canada established "nurse practitioners" (NPs) in the mid-1960s. The United Kingdom and Finland also have a long experience in using different forms of collaboration between doctors and nurses. In other countries, such as Australia, NPs were endorsed more recently in 2000. In France, Belgium, or Singapore, the formal recognition of advanced practice nurses is still in its infancy, whereas in other countries, such as Japan or China, advanced practice nurses are not licensed titles. The aims of this article were to define precisely what is meant by the term "advanced practice nurse (APN)," describe the state of development of APN roles, and review the main factors motivating the implementation of APN in different countries. Then, we examine the main factors that have hindered the development of APN roles. Finally, we explain the need for advanced practice roles in geriatrics.

  17. Differences in Parent-Provider Concordance Regarding Prognosis and Goals of Care Among Children With Advanced Cancer

    PubMed Central

    Rosenberg, Abby R.; Orellana, Liliana; Kang, Tammy I.; Geyer, J. Russell; Feudtner, Chris; Dussel, Veronica; Wolfe, Joanne

    2014-01-01

    Purpose Concordance between parents of children with advanced cancer and health care providers has not been described. We aimed to describe parent-provider concordance regarding prognosis and goals of care, including differences by cancer type. Patients and Methods A total of 104 pediatric patients with recurrent or refractory cancer were enrolled at three large children's hospitals. On enrollment, their parents and providers were invited to complete a survey assessing perceived prognosis and goals of care. Patients' survival status was retrospectively abstracted from medical records. Concordance was assessed via discrepancies in perceived prognosis, κ statistics, and McNemar's test. Distribution of categorical variables and survival rates across cancer type were compared with Fisher's exact and log-rank tests, respectively. Results Data were available from 77 dyads (74% of enrolled). Parent-provider agreement regarding prognosis and goals of care was poor (κ, 0.12 to 0.30). Parents were more likely to report cure was likely (P < .001). The frequency of perceived likelihood of cure and the goal of cure varied by cancer type for both parents and providers (P < .001 to .004). Relatively optimistic responses were more common among parents and providers of patients with hematologic malignancies, although there were no differences in survival. Conclusion Parent-provider concordance regarding prognosis and goals in advanced pediatric cancer is generally poor. Perceptions of prognosis and goals of care vary by cancer type. Understanding these differences may inform parent-provider communication and decision making. PMID:25024073

  18. Meaningful Use of Data in Care Coordination by the Advanced Practice Registered Nurse: The TeleFamilies Project

    PubMed Central

    Looman, Wendy S.; Erickson, Mary M.; Garwick, Ann W.; Cady, Rhonda G.; Kelly, Anne; Pettey, Carrie; Finkelstein, Stanley M.

    2012-01-01

    Meaningful use of electronic health records to coordinate care requires skillful synthesis and integration of subjective and objective data by practitioners to provide context for information. This is particularly relevant in the coordination of care for children with complex special health care needs. The purpose of this paper is to present a conceptual framework and example of meaningful use within an innovative telenursing intervention to coordinate care for children with complex special health care needs. The TeleFamilies intervention engages an advanced practice nurse in a full-time care coordinator role within an existing hospital-based medical home for children with complex special health care needs. Care coordination is facilitated by the synthesis and integration of internal and external data using an enhanced electronic health record and telehealth encounters via telephone and videoconferencing between the advanced practice nurse and the family at home. The advanced practice nurse’s ability to maintain an updated plan of care that is shared across providers and systems and build a relationship over time with the patient and family supports meaningful use of these data. PMID:22948406

  19. Gender Differences in Rural and Urban Practice Location among Mid-Level Health Care Providers

    ERIC Educational Resources Information Center

    Lindsay, Sally

    2007-01-01

    Context: Mid-level providers comprise an increasing proportion of the health care workforce and play a key role in providing health services in rural and underserved areas. Although women comprise the majority of mid-level providers, they are less likely to work in a rural area than men. Maldistribution of health providers between urban and rural…

  20. Knowledge and Use of Intervention Practices by Community-Based Early Intervention Service Providers

    ERIC Educational Resources Information Center

    Paynter, Jessica M.; Keen, Deb

    2015-01-01

    This study investigated staff attitudes, knowledge and use of evidence-based practices (EBP) and links to organisational culture in a community-based autism early intervention service. An EBP questionnaire was completed by 99 metropolitan and regionally-based professional and paraprofessional staff. Participants reported greater knowledge and use…

  1. Providing Assistance to the Victims of Adolescent Dating Violence: A National Assessment of School Nurses' Practices

    ERIC Educational Resources Information Center

    Khubchandani, Jagdish; Telljohann, Susan K.; Price, James H.; Dake, Joseph A.; Hendershot, Candace

    2013-01-01

    Background: This study assessed the perceptions and practices of school nurses regarding adolescent dating violence (ADV). Methods: The membership list of the National Association of School Nurses was used to identify a national random cross-sectional sample of high school nurses in the United States (N?=?750). A valid and reliable survey…

  2. Knowledge of Child Abuse and Reporting Practices among Early Care and Education Providers

    ERIC Educational Resources Information Center

    Dinehart, Laura; Kenny, Maureen C.

    2015-01-01

    This study sought to assess child abuse knowledge and reporting practices of a diverse sample of early care and education (ECE) practitioners. One hundred and thirty-seven practitioners in the state of Florida completed the "Early Childhood Educators Child Abuse Questionnaire." Results revealed that only a minority of participants have…

  3. Advance directives for mental health care: innovation in law, policy, and practice.

    PubMed

    Zelle, Heather; Kemp, Kathleen; Bonnie, Richard J

    2015-01-01

    Virginia appears to be the first state to commit itself to statewide implementation of psychiatric advance directives, and its experience may be highly instructive for other states. The project began with consensus building among stakeholders (2007-2009), followed by revisions to Virginia's Health Care Decisions Act (2009-2010) and designation of five of the state's 40 Community Services Boards as demonstration sites for facilitation efforts. Early implementation efforts quickly showed that psychiatric advance directives are not self-executing innovations. This column describes the early policy and practice innovations, lessons learned from initial implementation efforts, and three approaches to facilitating completion of advance directives by consumers.

  4. Informal Allopathic Provider Knowledge and Practice Regarding Hypertension in Urban and Rural Bangladesh

    PubMed Central

    Parr, John; Lindeboom, Wietze; Khanam, Masuma; Sanders, James; Koehlmoos, Tracey Pérez

    2012-01-01

    Objectives Describe informal allopathic practitioner (IAP) knowledge and practice about management of hypertension and identify gaps in IAP knowledge and practice amenable to interventions. Methods A cross sectional descriptive survey of 642 IAPs in Kamalapur (urban) and Mirsarai (rural) Bangladesh was conducted from March to April, 2011. Using a structured, pre-tested questionnaire sociodemographic, training, knowledge and practice data about management of hypertension was collected. Comparative statistics were preformed to show differences between urban and rural practitioners using SAS 8.0. Findings 99.4% of IAPs were male, mean age was 37.5 (12.5 SD) years. Greater than 65% correctly identified the upper limit of normal blood pressure. 50.2% underestimated lower limit of systolic hypertension. 79.8% allowed age to affect their treatment approach. As blood pressure increased, willingness to treat with medication decreased and tendency to refer increased. Sedative/sleeping pills, antidepressants, and beta blockers were the most commonly prescribed medications for prehypertension (58.7%, 50.3% and 53.7% respectively), stage I hypertension (55.0%, 38.6%, 49.8% respectively) and stage II hypertension (42.4%, 23.7%, and 28.8% respectively). Rural IAPs were more likely than urban IAPs to treat (84.7% vs 77.7%), order tests (27.1% vs 6.0%) and write prescriptions (60.4% vs 18.7%). Conclusion While IAPs are crucial to Bangladesh’s pluralistic healthcare system, gaps in knowledge and practice could cause unnecessary harm. To include IAPs in the public sector’s fight against the chronic disease epidemic, interventions aimed at standardizing IAPs knowledge and practice will be essential. Successfully utilizing IAPs will have beneficial implications not only for Bangladesh, but for all developing countries. PMID:23133546

  5. Technology advances in hospital practices: robotics in treatment of patients.

    PubMed

    Rosiek, Anna; Leksowski, Krzysztof

    2015-06-01

    Laparoscopic cholecystectomy is widely considered as the treatment of choice for acute cholecystitis. The safety of the procedure and its minimal invasiveness made it a valid treatment option for a patient not responding to antibiotic therapy. Our research shows that patients positively assess this treatment method, but the world's tendency is to turn to a more sophisticated method utilizing robot-assisted surgery as a gold standard. Providing patient with minimally invasive surgical procedures that utilize the state-of-the-art equipment like the da Vinci Robotic Surgical System underscores the commitment to high-quality patient care while enhancing patient safety. The advantages include minimal invasive scarring, less pain and bleeding, faster recovery time, and shorter hospital stay. The move toward less invasive and less morbid procedures and a need to re-create the true open surgical experience have paved the way for the development and application of robotic and computer-assisted systems in surgery in Poland as well as the rest of the world.

  6. Technology advances in hospital practices: robotics in treatment of patients.

    PubMed

    Rosiek, Anna; Leksowski, Krzysztof

    2015-06-01

    Laparoscopic cholecystectomy is widely considered as the treatment of choice for acute cholecystitis. The safety of the procedure and its minimal invasiveness made it a valid treatment option for a patient not responding to antibiotic therapy. Our research shows that patients positively assess this treatment method, but the world's tendency is to turn to a more sophisticated method utilizing robot-assisted surgery as a gold standard. Providing patient with minimally invasive surgical procedures that utilize the state-of-the-art equipment like the da Vinci Robotic Surgical System underscores the commitment to high-quality patient care while enhancing patient safety. The advantages include minimal invasive scarring, less pain and bleeding, faster recovery time, and shorter hospital stay. The move toward less invasive and less morbid procedures and a need to re-create the true open surgical experience have paved the way for the development and application of robotic and computer-assisted systems in surgery in Poland as well as the rest of the world. PMID:25782187

  7. Toward Advancing Nano-Object Count Metrology: A Best Practice Framework

    PubMed Central

    Boyko, Volodymyr; Meyers, Greg; Voetz, Matthias; Wohlleben, Wendel

    2013-01-01

    Background: A movement among international agencies and policy makers to classify industrial materials by their number content of sub–100-nm particles could have broad implications for the development of sustainable nanotechnologies. Objectives: Here we highlight current particle size metrology challenges faced by the chemical industry due to these emerging number percent content thresholds, provide a suggested best-practice framework for nano-object identification, and identify research needs as a path forward. Discussion: Harmonized methods for identifying nanomaterials by size and count for many real-world samples do not currently exist. Although particle size remains the sole discriminating factor for classifying a material as “nano,” inconsistencies in size metrology will continue to confound policy and decision making. Moreover, there are concerns that the casting of a wide net with still-unproven metrology methods may stifle the development and judicious implementation of sustainable nanotechnologies. Based on the current state of the art, we propose a tiered approach for evaluating materials. To enable future risk-based refinements of these emerging definitions, we recommend that this framework also be considered in environmental and human health research involving the implications of nanomaterials. Conclusion: Substantial scientific scrutiny is needed in the area of nanomaterial metrology to establish best practices and to develop suitable methods before implementing definitions based solely on number percent nano-object content for regulatory purposes. Strong cooperation between industry, academia, and research institutions will be required to fully develop and implement detailed frameworks for nanomaterial identification with respect to emerging count-based metrics. Citation: Brown SC, Boyko V, Meyers G, Voetz M, Wohlleben W. 2013. Toward advancing nano-object count metrology: a best practice framework. Environ Health Perspect 121:1282–1291;

  8. An examination of advanced cancer caregivers’ support provided by staff interventions at hospices in Argentina

    PubMed Central

    Luxardo, Natalia; Brage, Eugenia; Alvarado, Cynthia

    2012-01-01

    The aim of the study was to describe the type of intervention provided by hospice staff in order to address the pragmatic, psycho-social, and spiritual needs of home-caregivers for patients in the last stage of cancer. The qualitative inquiry was carried out in real life contexts. The explicit demands that caregivers (n = 40) identified in the first interviews were: (1) helping to organize the care of the patient at home; (2) unspecific demands, with unclear or unrealistic purposes (e.g., curative treatment or a miracle expected to occur); (3) specific resources (such as formal caregivers to replace them), and (4) a place to leave the patient either for a temporary period (a respite for the family) or in a permanent way. The main issues discussed were the delays in the patients’ referral to the hospice and the lack of time for long-term interventions; explicit focus is placed on the care by addressing the spiritual and emotional needs of caregivers, unlike in hospital settings where professionals avoid discussions of spiritual needs due to a lack of time, inadequate training and poor understanding of spirituality; hospices’ interventions are based upon an ethos similar to the movement’s original Christian spirit with emphasis placed on qualities of care such as love, charity, and compassion besides expertise and end-of-life competence, all while tolerating a sense of abandonment by health and social security systems following the patient’s referral. PMID:23226163

  9. Evidence-Based Practice Knowledge, Use, and Factors that Influence Decisions: Results from an Evidence-Based Practice Survey of Providers in American Indian/Alaska Native Communities

    ERIC Educational Resources Information Center

    Sheehan, Angela; Walrath-Greene, Christine; Fisher, Sylvia; Crossbear, Shannon; Walker, Joseph

    2007-01-01

    Data from the Evidence-based Treatment Survey were used to compare providers serving families in American Indian and Alaska Native communities to their counterparts in non-American Indian/Alaska Native communities on provider characteristics and factors that influence their decision to use evidence-based practices (N = 467). The findings suggest…

  10. Recent advances in bone biology provide insight into the pathogenesis of bone diseases.

    PubMed

    Boyce, B F; Hughes, D E; Wright, K R; Xing, L; Dai, A

    1999-02-01

    Bone is modeled during embryonic development by endochondral and membranous ossification and is continuously remodeled thereafter under the influence of local and systemic factors to provide structural support and assist in calcium homeostasis. Recent studies of knockout and transgenic mice have increased understanding of the regulation of bone modeling during development and of remodeling of mature bone and have shed new light on the pathogenesis of a number of bone disorders. For example, fibroblast growth factor receptor-3, parathyroid hormone-related protein, and tartrate-resistant acid phosphatase affect the function of chondrocytes during endochondral ossification (the latter two by regulating their life spans and thus growth plate thickness and bone length). Some ubiquitously expressed genes seem unexpectedly to have unique functions that are largely confined to bone cells: M-CSF, C-Fos, PU.1, and NF-kappaB are required for osteoclast formation, whereas c-Src and Mitf (microphthalmia transcription factor) are required for osteoclast activity after the cells have formed. Knockout of these genes results in osteopetrosis, a disorder characterized by persistence in marrow cavities of unresorbed osteocartilaginous matrix and, as in some affected humans, by increased mortality. Some proteins seem to act as negative regulators of bone cell function, for example osteoprotegerin (a soluble TNF receptor) in osteoclasts; osteocalcin, bone sialoprotein, and 5-lipoxygenase in osteoblasts. Regulation of osteoclast life span may be an important mechanism by which estrogen and bisphosphonates prevent bone loss in conditions characterized by increased bone resorption, such as postmenopausal osteoporosis. The unique requirement of bone cells for certain gene products raises the possibility that these cells may have specific responses to inhibitory or stimulatory agents, and that signaling molecules in these response pathways could be specific targets for novel therapies to

  11. Literacy Agents Online: E-Discussion Forums for Advancing Adults' Literacy Practices

    ERIC Educational Resources Information Center

    Guzzetti, Barbara J.; Foley, Leslie M.

    2014-01-01

    This study explored how adults used a self-selected online forum to advance their own and others' literacy practices. The study was a discourse-centered online ethnography using triangulated methods, including analysis of list archives, semi-structured and informal interviews, and document collection. These data were analyzed by discourse…

  12. Forging Strategic Partnerships to Advance Mental Health Science and Practice for Vulnerable Children

    ERIC Educational Resources Information Center

    Fantuzzo, John; McWayne, Christy; Bulotsky, Rebecca

    2003-01-01

    The purpose of this article is to present a conceptual framework for advancing mental health science and practice for vulnerable children that is in accord with the Surgeon General's priorities for change. Three elements distinguish the framework presented. It is: (a) population-focused, (b) child-centered, and (c) partnership-based. Empirical…

  13. Addressing Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome in Advanced Practice Nursing Education.

    ERIC Educational Resources Information Center

    Nokes, Kathleen M.; Stein, Gary L.

    1997-01-01

    A survey of 23 advanced practice nursing programs showed only 3 had HIV-specific graduate-level nursing courses. Recommendations were made for HIV-specific courses, integration of HIV content into other courses, use of Centers for Disease Control and Occupational Safety and Health Administration guidelines, and subspecialties in HIV nursing. (SK)

  14. A Qualitative Analysis of an Advanced Practice Nurse-Directed Transitional Care Model Intervention

    ERIC Educational Resources Information Center

    Bradway, Christine; Trotta, Rebecca; Bixby, M. Brian; McPartland, Ellen; Wollman, M. Catherine; Kapustka, Heidi; McCauley, Kathleen; Naylor, Mary D.

    2012-01-01

    Purpose: The purpose of this study was to describe barriers and facilitators to implementing a transitional care intervention for cognitively impaired older adults and their caregivers lead by advanced practice nurses (APNs). Design and Methods: APNs implemented an evidence-based protocol to optimize transitions from hospital to home. An…

  15. Advances in circulating tumor cells (ACTC): from basic research to clinical practice

    PubMed Central

    2013-01-01

    The first 'Advances in Circulating Tumor Cells (ACTC): from Basic Research to Clinical Practice' meeting was held in Athens, Greece, September 26–29, 2012 (abstracts, presentations and a more detailed meeting report are freely available online: http://www.actc2012.org). We summarize in this report most major findings presented and the main conclusions derived during the expert panel sessions. PMID:24314311

  16. Delta's Key to the TOEFL iBT[R]: Advanced Skill Practice. Revised Edition

    ERIC Educational Resources Information Center

    Gallagher, Nancy

    2012-01-01

    Delta's Key to the TOEFL iBT: Advanced Skill Practice is a revised and updated edition of Delta's Key to the Next Generation TOEFL Test. Since the introduction of the TOEFL iBT in 2005, there have been significant changes to some of the test questions, particularly the integrated writing and integrated speaking tasks. The new 2011 edition of…

  17. Sandia National Laboratories Advanced Simulation and Computing (ASC) software quality plan : ASC software quality engineering practices Version 3.0.

    SciTech Connect

    Turgeon, Jennifer L.; Minana, Molly A.; Hackney, Patricia; Pilch, Martin M.

    2009-01-01

    The purpose of the Sandia National Laboratories (SNL) Advanced Simulation and Computing (ASC) Software Quality Plan is to clearly identify the practices that are the basis for continually improving the quality of ASC software products. Quality is defined in the US Department of Energy/National Nuclear Security Agency (DOE/NNSA) Quality Criteria, Revision 10 (QC-1) as 'conformance to customer requirements and expectations'. This quality plan defines the SNL ASC Program software quality engineering (SQE) practices and provides a mapping of these practices to the SNL Corporate Process Requirement (CPR) 001.3.6; 'Corporate Software Engineering Excellence'. This plan also identifies ASC management's and the software project teams responsibilities in implementing the software quality practices and in assessing progress towards achieving their software quality goals. This SNL ASC Software Quality Plan establishes the signatories commitments to improving software products by applying cost-effective SQE practices. This plan enumerates the SQE practices that comprise the development of SNL ASC's software products and explains the project teams opportunities for tailoring and implementing the practices.

  18. Providing oral health care to underserved population of pregnant women: retrospective review of 320 patients treated in private practice setting.

    PubMed

    Kerpen, Steven J; Burakoff, Ronald

    2013-01-01

    This article aims to quantify the impact of a novel partnership between a fee-for-service private practice and a teaching hospital dental service intended to provide oral care to an underserved population of pregnant women. Further, it seeks to ascertain the oral needs of this high-risk and diverse population. Data is presented that suggests the dire need for oral care among this pregnant population and the efficacy of treating these women in a private practice setting.

  19. Activity-based funding model provides foundation for province-wide best practices in renal care.

    PubMed

    Levin, Adeera; Lo, Clifford; Noel, Kevin; Djurdjev, Ogjnenka; Amano, Erlyn C

    2013-01-01

    British Columbia has a unique funding model for renal care in Canada. Patient care is delivered through six health authorities, while funding is administered by the Provincial Renal Agency using an activity-based funding model. The model allocates funding based on a schedule of costs for every element of renal care, excluding physician fees. Accountability, transparency of allocation and tracking of outcomes are key features that ensure successful implementation. The model supports province-wide best practices and equitable care and fosters innovation. Since its introduction, the outpatient renal services budget has grown less than the population, while maintaining or improving clinical outcomes. PMID:24485244

  20. Health-care providers' perceptions, attitudes towards and recommendation practice of cervical cancer screening.

    PubMed

    Hweissa, N Ab; Lim, J N W; Su, T T

    2016-09-01

    In Libya, cervical cancer is ranked third as the most frequent cancer among women with early diagnosis being shown to reduce morbidity and mortality. Health-care providers can influence women's screening behaviours, and their lack of recommendations for screening can be one of the barriers that affect women's participation in screening programmes. This study aims to assess the health-care provider's perception around cervical cancer screening. In-depth, face-to-face interviews were conducted with 16 health-care providers, from both public and private sectors in Az-Zawiya city, Libya, between February and July of 2014. The interviews were recorded and transcribed, then analysed using thematic analysis. Our findings suggest that health-care providers did not provide sufficient information regarding cervical cancer screening for women who attend health-care facilities. The results highlight the role played by health-care professionals in motivating women to attend cervical cancer screening programs, and the need for health education of health-care providers to offer a precious advice regarding the screening. On the other hand, health-care providers highlighted that implementation of reminding system of cervical cancer screening will support them to improve screening attendance. In addition, health-care providers stressed the necessity for educational and awareness campaigns of cervical cancer screening among Libyan women. PMID:27350095

  1. Health-care providers' perceptions, attitudes towards and recommendation practice of cervical cancer screening.

    PubMed

    Hweissa, N Ab; Lim, J N W; Su, T T

    2016-09-01

    In Libya, cervical cancer is ranked third as the most frequent cancer among women with early diagnosis being shown to reduce morbidity and mortality. Health-care providers can influence women's screening behaviours, and their lack of recommendations for screening can be one of the barriers that affect women's participation in screening programmes. This study aims to assess the health-care provider's perception around cervical cancer screening. In-depth, face-to-face interviews were conducted with 16 health-care providers, from both public and private sectors in Az-Zawiya city, Libya, between February and July of 2014. The interviews were recorded and transcribed, then analysed using thematic analysis. Our findings suggest that health-care providers did not provide sufficient information regarding cervical cancer screening for women who attend health-care facilities. The results highlight the role played by health-care professionals in motivating women to attend cervical cancer screening programs, and the need for health education of health-care providers to offer a precious advice regarding the screening. On the other hand, health-care providers highlighted that implementation of reminding system of cervical cancer screening will support them to improve screening attendance. In addition, health-care providers stressed the necessity for educational and awareness campaigns of cervical cancer screening among Libyan women.

  2. Sustainable land management practices as providers of several ecosystem services under rainfed Mediterranean agroecosystems

    NASA Astrophysics Data System (ADS)

    Almagro, María; de Vente, Joris; Boix-Fayós, Carolina; García-Franco, Noelia; Melgares de Aguilar, Javier; González, David; Solé-Benet, Albert; Martínez-Mena, María

    2015-04-01

    Little is known about the multiple impacts of sustainable land management practices on soil and water conservation, carbon sequestration, mitigation of global warming, and crop yield productivity in semiarid Mediterranean agroecosystems. We hypothesized that a shift from intensive tillage to more conservative tillage management practices (reduced tillage optionally combined with green manure) leads to an improvement in soil structure and quality and will reduce soil erosion and enhance carbon sequestration in semiarid Mediterranean rainfed agroecosystems. To test the hypothesis, we assessed the effects of different tillage treatments (conventional (CT), reduced (RT), reduced tillage combined with green manure (RTG), and no tillage (NT)) on soil structure and soil water content, runoff and erosion control, soil CO2 emissions, crop yield and carbon sequestration in two semiarid agroecosystems with organic rainfed almond in the Murcia Region southeast Spain). It was found that reduction and suppression of tillage under almonds led to an increase in soil water content in both agroecosystems. Crop yields ranged from 775 to 1766 kg ha-1 between tillage 18 treatments, but we did not find a clear relation between soil water content and crop yield. RT and RTG treatments showed lower soil erosion rates and higher crop yields of almonds than under CT treatment. Overall, higher soil organic carbon contents and aggregate stability were observed under RTG treatment than under RT or CT treatment. It is concluded that conversion from CT to RTG is suitable to increase carbon inputs without enhancing soil CO2 emissions in semiarid Mediterranean agroecosystems.

  3. Standardized Clinical Assessment And Management Plans (SCAMPs) Provide A Better Alternative To Clinical Practice Guidelines

    PubMed Central

    Farias, Michael; Jenkins, Kathy; Lock, James; Rathod, Rahul; Newburger, Jane; Bates, David W.; Safran, Dana G.; Friedman, Kevin; Greenberg, Josh

    2014-01-01

    Variability in medical practice in the United States leads to higher costs without achieving better patient outcomes. Clinical practice guidelines, which are intended to reduce variation and improve care, have several drawbacks that limit the extent of buy-in by clinicians. In contrast, standardized clinical assessment and management plans (SCAMPs) offer a clinician-designed approach to promoting care standardization that accommodates patients’ individual differences, respects providers’ clinical acumen, and keeps pace with the rapid growth of medical knowledge. Since early 2009 more than 12,000 patients have been enrolled in forty-nine SCAMPs in nine states and Washington, D.C. In one example, a SCAMP was credited with increasing clinicians’ rate of compliance with a recommended specialist referral for children from 19.6 percent to 75 percent. In another example, SCAMPs were associated with an 11–51 percent decrease in total medical expenses for six conditions when compared with a historical cohort. Innovative tools such as SCAMPs should be carefully examined by policy makers searching for methods to promote the delivery of high-quality, cost-effective care. PMID:23650325

  4. Integrating social neuroscience and social work: innovations for advancing practice-based research.

    PubMed

    Matto, Holly C; Strolin-Goltzman, Jessica

    2010-04-01

    Throughout the social work profession, there is ongoing interest in building a social science agenda that can address the complex practice-based questions faced by social work professionals today. Methodological innovations and unique funding opportunities have already significantly advanced research on social work practice. Still, there is enthusiastic discussion of how to ensure that such capacity development helps the profession move forward in ways that make use of the biological sciences and that facilitate social work-specific contributions to the larger interdisciplinary scientific community. This article describes how the social work profession can make use of biomedical knowledge and technological advances from social neuroscience to inform psychosocial treatment development, and it illustrates an application to social work practice by giving an example of a substance abuse treatment development process built on social neuroscientific research.

  5. Legal issues in neonatal nursing: considerations for staff nurses and advanced practice nurses.

    PubMed

    Enzman Hagedorn, M I; Gardner, S L

    1999-01-01

    A neonatal nurse is a professional with special training, skill, and knowledge in the care of newborns and their families. The neonatal nurse is accountable to the patient, profession, and employer. Failure of the neonatal nurse to meet these obligations can result in liability in the profession, liability in the employment, a civil suit, or a criminal conviction. Regardless of the health care setting, professional nurses, whether at the bedside or in advanced practice, are morally, ethically, and legally accountable for their nursing judgments and actions. Although most nurses assume they will never be named in a lawsuit, and it is true that few are, their professional actions can be the focus of a suit. An overview of the legal implications found within neonatal nursing practice is presented. Two recent legal cases are presented and discussed to illustrate neonatal nursing and advanced practice liability.

  6. The continuing challenge of providing drug information services to diminish the knowledge--practice gap in medical practice.

    PubMed

    Alván, Gunnar; Andersson, Marine L; Asplund, Annika B; Böttiger, Ylva; Elwin, Carl-Eric; Gustafsson, Lars L; Öhman, Birgitta; Törnqvist, Elisabeth

    2013-05-01

    Information must be collected, evaluated and utilized to support every qualified activity. Medicine, with a written scientific tradition stretching back more than 2,000 years, is no exception. Here, we discuss a number of important items associated with the establishment of a drug information centre run by clinical pharmacologists and information pharmacists, serving a broad demand, mainly among clinical specialists. The working methods include a professional literature search, critical evaluation of the material, writing a structured answer, quality control, feedback to the inquirer and storage in a database which is publicly available. One can foresee even more complex systems wherein a number of active and specialized databases communicate to provide relevant advice and support at the point of care, supplying information on drug recommendations, reimbursement, environmental aspects, antimicrobial resistance, pharmacogenetics and adverse effects, and linked to a list of prescribed drugs for the individual patient. This will be possible in both rich and poor countries through the application of modern and developing information technology. However, research on the best and safest methods of such decision support systems will be needed to ensure that they really do improve the quality of drug prescribing and use.

  7. Strategic Planning: A Practical Primer for the Healthcare Provider: Part I.

    PubMed

    Baum, Neil; Brockmann, Erich N; Lacho, Kenneth J

    2016-01-01

    Entrepreneurs are known for opportunity recognition--that is, "How can I start a business to make money from this opportunity?" However, once a commercial entity is formed to take advantage of an opportunity, the leadership priority shifts from entrepreneurial to strategic. A strategic perspective leverages limited resources to position a business for future success relative to rivals in a competitive environment. Often, the talents needed for one priority are not the same as those needed for the other. This article, the first part of a two-part article, intends to simplify the transition from an entrepreneurial to a strategic focus. It walks an entrepreneur through the strategic management planning process using a fictional business. The various tasks in the process (i.e., mission, vision, internal analysis, external analysis) are illustrated with examples from a typical primary physician's private practice. The examples show how the strategic management tasks are interrelated and ultimately lead to a philosophical approach to managing a business.

  8. Social Media and the Practicing Hematologist: Twitter 101 for the Busy Healthcare Provider.

    PubMed

    Thompson, Michael A; Majhail, Navneet S; Wood, William A; Perales, Miguel-Angel; Chaboissier, Mélanie

    2015-12-01

    Social media is a relatively new form of media that includes social networks for communication dissemination and interaction. Patients, physicians, and other users are active on social media including the microblogging platform Twitter. Many online resources are available to facilitate joining and adding to online conversations. Social media can be used for professional uses, therefore, we include anecdotes of physicians starting on and implementing social media successfully despite the limits of time in busy practices. Various applications demonstrating the utility of social media are explored. These include case discussions, patient groups, research collaborations, medical education, and crowdsourcing/crowdfunding. Social media is integrating into the professional workflow for some individuals and hematology/oncology societies. The potential for improving hematology care and research is just starting to be explored.

  9. Ethical and Practical Considerations in Providing Critical Care to Patients With Ebola Virus Disease

    PubMed Central

    Davey, Richard T.; Suffredini, Anthony F.; Chertow, Daniel S.

    2015-01-01

    Infectious disease epidemics in the past have given rise to psychologic and emotional responses among health-care workers (HCWs), stemming from fear of infection during patient care. Early experiences in the AIDS epidemic provide an example where fear of contagion resulted in differential treatment of patients infected with HIV. However, with a deeper understanding of AIDS pathogenesis and treatment, fear and discrimination diminished. Parallels exist between early experiences with AIDS and the present outbreak of Ebola virus disease in West Africa, particularly regarding discussions of medical futility in seriously ill patients. We provide a historical perspective on HCWs’ risk of infection during the provision of CPR, discuss physicians’ duty to treat in the face of perceived or actual HCW risk, and, finally, present the protocols implemented at the National Institutes of Health to reduce HCW risk while providing lifesaving and life-sustaining care. PMID:25764372

  10. Australian rural remote registered nurses' experiences of learning to provide antenatal services in general practice: a pilot study.

    PubMed

    Mills, Jane; Birks, Melanie; Francis, Karen; Miles, Maureen; Jones, Jan

    2010-08-01

    This article reports on a pilot vocational study programme for provision of antenatal services in the general practice environment. The concurrent evaluation study assessed practice nurses' experiences of undertaking the pilot programme, the level and applicability of the content, and the mode of delivery. General practitioners' understanding of the role of the nurse in providing antenatal services, and the actual and potential impact of this new role on models of service delivery and care were also investigated. Women receiving care from practice nurses within this new model of service delivery and care were also of interest in this study. Findings showed that the current role of the general practice nurse in caring for pregnant women is restricted to assisting the general practitioner to complete their assessment of clients. Organizing clinical placement with a midwife was a major barrier to completing the pilot programme.

  11. Continuous quality improvement programs provide new opportunities to drive value innovation initiatives in hospital-based radiology practices.

    PubMed

    Steele, Joseph R; Schomer, Don F

    2009-07-01

    Imaging services constitute a huge portion of the of the total dollar investment within the health care enterprise. Accordingly, this generates competition among medical specialties organized along service lines for their pieces of the pie and increased scrutiny from third-party payers and government regulators. These market and political forces create challenge and opportunity for a hospital-based radiology practice. Clearly, change that creates or builds greater value for patients also creates sustainable competitive advantage for a radiology practice. The somewhat amorphous concept of quality constitutes a significant value driver for innovation in this scenario. Quality initiatives and programs seek to define and manage this amorphous concept and provide tools for a radiology practice to create or build more value. Leadership and the early adoption of these inevitable programs by a radiology practice strengthens relationships with hospital partners and slows the attrition of imaging service lines to competitors.

  12. Health care provider education as a tool to enhance antibiotic stewardship practices.

    PubMed

    Ohl, Christopher A; Luther, Vera P

    2014-06-01

    Antibiotic stewardship education for health care providers provides a foundation of knowledge and an environment that facilitates and supports optimal antibiotic prescribing. There is a need to extend this education to medical students and health care trainees. Education using passive techniques is modestly effective for increasing prescriber knowledge, whereas education using active techniques is more effective for changing prescribing behavior. Such education has been shown to enhance other antibiotic stewardship interventions. In this review, the need and suggested audience for antibiotic stewardship education are highlighted, and effective education techniques are recommended for increasing knowledge of antibiotics and improving their use.

  13. An Exploratory Case Study of Providers' Collaborative Consultation Practices with Latina Mothers during Home Visits

    ERIC Educational Resources Information Center

    Cambray-Engstrom, Elizabeth; Salisbury, Christine

    2010-01-01

    In this exploratory case study, 4 early intervention providers' use of collaborative intervention strategies and everyday activities was examined in relation to the participation of a small group of Latina mothers (n = 10) during home visits over a 6-month period in an urban community. Videotapes (n = 40) of home visits were clustered into more…

  14. Reggio Emilia, Vygotsky, and Family Childcare: Four American Providers Describe Their Pedagogical Practice

    ERIC Educational Resources Information Center

    Freeman, Ramona

    2011-01-01

    This case study considers pedagogical techniques used in family childcare to promote children's learning experiences. Data extracted from an earlier study were used to inform this examination of four family childcare providers' pedagogy. In the current study, I use socio-cultural theory and the Reggio Emilia approach to address the following…

  15. Literacy Training for Early Childhood Providers: Changes in Knowledge, Beliefs, and Instructional Practices

    ERIC Educational Resources Information Center

    Armstrong, Kathleen; Cusumano, Dale Lynn; Todd, Melissa; Cohen, Rachel

    2008-01-01

    While it is clear that reading is critical to children's success throughout schooling and reading instruction research has dramatically increased over the past 2 decades, few early childhood providers have the necessary knowledge, skills and/or confidence to effectively implement evidence-based, emergent literacy strategies in their settings. This…

  16. Maintaining Long-Distance Friendships: Communication Practices for Seeking and Providing Social Support across Geographic Divides

    ERIC Educational Resources Information Center

    Lobburi, Patipan

    2012-01-01

    People seek and provide support through their personal social network, especially when they must cope with stress, deal with an emergency, or need help. Coping with a new culture or new environment is a stressful situation that sojourner students must face. Support through friendship plays an important role in facing such new situations. Focusing…

  17. Best Practices of Small IT Services Providers in the Federal Arena

    ERIC Educational Resources Information Center

    Trammell, Stacy Dacole

    2009-01-01

    Today, more than 139,294 (43%) small businesses registered in the CCR and DSBS databases offer IT services to the federal government. Providing IT services to the federal government is an affordable and feasible low risk approach for emerging and seasoned small IT businesses in the federal arena. This dissertation captures how successful small…

  18. Considerations of Administrative Licensure, Provider Type, and Leadership Quality: Recommendations for Research, Policy, and Practice

    ERIC Educational Resources Information Center

    Hackmann, Donald G.

    2016-01-01

    This article reviews U.S. administrative licensure regulations, focusing on type of school leader licensure, provider types, and leadership quality. Licensure obtained through university-based and alternative routes is examined. Due to limited research on alternative school administrative licensure, regulations in medicine, psychology,…

  19. Authentic Learning Experience: Subtle but Useful Ways to Provide It in Practice

    ERIC Educational Resources Information Center

    Watagodakumbura, Chandana

    2013-01-01

    Authentic learning is conceptualised as an individualised experience learners undergo fulfilling their unique psychological as well as neurological needs. It provides a deep, more lasting experience and ideally assessed through generic attributes that are related to individual learners' intrinsic characteristics, spanning throughout the life.…

  20. Establishing best practices to improve usability of web interfaces providing atmospheric data

    NASA Astrophysics Data System (ADS)

    Oakley, N.; Daudert, B.

    2014-12-01

    Accessing scientific data through an online portal can be a frustrating task. The concept of making web interfaces easy to use known as "usability" has been thoroughly researched in the field of e-commerce but has not been explicitly addressed in the atmospheric sciences. As more observation stations are installed, satellite missions flown, models run, and field campaigns performed, large amounts of data are produced. Portals on the Internet have become the favored mechanisms to share this information and are ever increasing in number. Portals are often created without being tested for usability with the target audience though the expenses of testing are low and the returns high. To remain competitive and relevant in the provision of atmospheric data, it is imperative that developers understand design elements of a successful portal to make their product stand out among others. This presentation informs the audience of the benefits and basic principles of usability for web pages presenting atmospheric data. We will also share some of the best practices and recommendations we have formulated from the results of usability testing performed on two data provision web sites hosted by the Western Regional Climate Center.

  1. Strategic Planning: A Practical Primer for the Healthcare Provider: Part I.

    PubMed

    Baum, Neil; Brockmann, Erich N; Lacho, Kenneth J

    2016-01-01

    Entrepreneurs are known for opportunity recognition--that is, "How can I start a business to make money from this opportunity?" However, once a commercial entity is formed to take advantage of an opportunity, the leadership priority shifts from entrepreneurial to strategic. A strategic perspective leverages limited resources to position a business for future success relative to rivals in a competitive environment. Often, the talents needed for one priority are not the same as those needed for the other. This article, the first part of a two-part article, intends to simplify the transition from an entrepreneurial to a strategic focus. It walks an entrepreneur through the strategic management planning process using a fictional business. The various tasks in the process (i.e., mission, vision, internal analysis, external analysis) are illustrated with examples from a typical primary physician's private practice. The examples show how the strategic management tasks are interrelated and ultimately lead to a philosophical approach to managing a business. PMID:27443061

  2. The influence of providing a clinical practice guideline on dental students' decision making.

    PubMed

    van der Sanden, Wil J M; Mettes, Dirk G; Plasschaert, Alphons J M; Mulder, Jan; Verdonschot, Emiel H

    2004-02-01

    The aim of this study was to assess the effect of the provision of a clinical practice guideline (CPG) on dental students' decisions to remove asymptomatic, impacted lower third molars. All dental students, who in 2001 were in the 3rd, 4th or 5th (final) year of their study at the Nijmegen College of Dental Sciences, were invited to participate. A pre-test-post-test control group design was used. Given 36 patient cases, all dental students were asked to assess the need for removal of asymptomatic, impacted lower third molars. All pre-test respondents were randomly allocated to the control or intervention group. After the provision of a CPG to the intervention group, both groups were asked to assess the same cases again. Frequencies of decisions to remove the third molars were calculated. Chi-square tests and anova were used to test the influence of study year and gender on the drop-out rate and on the effect of the provision of a CPG on students' treatment decisions. The decrease in indications to remove third molars by the intervention group was statistically significant (P < 0.05). In the control group, no significant decrease was observed. It was concluded that the provision of a CPG significantly influences dental students' decision making about treatment in a third-molar decision task. Students who used the CPG showed more guideline-conformed decision making. PMID:14717683

  3. A Medical Mission to Guatemala as an Advanced Pharmacy Practice Experience

    PubMed Central

    Skoy, Elizabeth T.

    2012-01-01

    Objective. To describe the development and outcomes of an advanced pharmacy practice experience (APPE) for a medical mission trip to Guatemala. Design. Pre-mission preparation and post-mission reflection activities were combined with in-country activities to create a 5-week APPE. During the 10-day medical mission trip, pharmacy students dispensed medications, counseled patients, conducted quality improvement assessments, and presented their findings and experiences as part of an interdisciplinary health care team. Assessment. The students who completed the mission trip met the objectives of the APPE and reported substantial learning in the areas of interdisciplinary teamwork and cultural competency. All students’ scores on the Inventory for Assessing the Process of Cultural Competence—Student Version (IAPCC-SV) increased. The majority (81%) of student-generated quality improvement recommendations were implemented by the mission team. Conclusions. The medical mission APPE provided a rich learning environment for pharmacy students and resulted in modifications to the medical mission operation. This type of APPE could be implemented in other colleges of pharmacy via formation of partnerships with established medical mission teams as this one was. PMID:23129855

  4. Identifying contamination with advanced visualization and analysis practices: metagenomic approaches for eukaryotic genome assemblies

    PubMed Central

    Delmont, Tom O.

    2016-01-01

    High-throughput sequencing provides a fast and cost-effective mean to recover genomes of organisms from all domains of life. However, adequate curation of the assembly results against potential contamination of non-target organisms requires advanced bioinformatics approaches and practices. Here, we re-analyzed the sequencing data generated for the tardigrade Hypsibius dujardini, and created a holistic display of the eukaryotic genome assembly using DNA data originating from two groups and eleven sequencing libraries. By using bacterial single-copy genes, k-mer frequencies, and coverage values of scaffolds we could identify and characterize multiple near-complete bacterial genomes from the raw assembly, and curate a 182 Mbp draft genome for H. dujardini supported by RNA-Seq data. Our results indicate that most contaminant scaffolds were assembled from Moleculo long-read libraries, and most of these contaminants have differed between library preparations. Our re-analysis shows that visualization and curation of eukaryotic genome assemblies can benefit from tools designed to address the needs of today’s microbiologists, who are constantly challenged by the difficulties associated with the identification of distinct microbial genomes in complex environmental metagenomes. PMID:27069789

  5. A survey of oncology advanced practice nurses in Ontario: profile and predictors of job satisfaction.

    PubMed

    Bryant-Lukosius, Denise; Green, Esther; Fitch, Margaret; Macartney, Gail; Robb-Blenderman, Linda; McFarlane, Sandra; Bosompra, Kwadwo; DiCenso, Alba; Matthews, Susan; Milne, Harry

    2007-01-01

    The purpose of this study was to examine role structures and processes and their impact on job satisfaction for oncology advanced practice nurses (APNs) in Ontario. APNs caring for adult, paediatric or palliative patients in integrated regional cancer programs, tertiary care hospitals or community hospitals and agencies were invited to complete a mailed self-report questionnaire. A total of 73 of 77 APNs participated in the study. Most APNs (55%) were acute care nurse practitioners employed by regional cancer programs or tertiary care hospitals. Adult patients with breast or haematological cancers and those receiving initial treatment or palliative care were the primary focus of APN roles. APN education needs related to specialization in oncology, leadership and research were identified. Overall, APNs were minimally satisfied with their roles. Role confidence (beta = .404, p = .001) and the number of overtime hours (beta = -.313, p = .008) were respective positive and negative predictors of APN job satisfaction. Progress in role development is described, and recommendations for improving role development and expanding the delivery of oncology APN services are provided. PMID:17619596

  6. Engaging academia to advance the science and practice of environmental public health tracking

    PubMed Central

    Strosnider, Heather; Zhou, Ying; Balluz, Lina; Qualters, Judith

    2015-01-01

    Public health agencies at the federal, state, and local level are responsible for implementing actions and policies that address health problems related to environmental hazards. These actions and policies can be informed by integrating or linking data on health, exposure, hazards, and population. The mission of the Centers for Disease Control and Prevention's National Environmental Public Health Tracking Program (Tracking Program) is to provide information from a nationwide network of integrated health, environmental hazard, and exposure data that drives actions to improve the health of communities. The Tracking Program and federal, state, and local partners collect, integrate, analyze, and disseminate data and information to inform environmental public health actions. However, many challenges exist regarding the availability and quality of data, the application of appropriate methods and tools to link data, and the state of the science needed to link and analyze health and environmental data. The Tracking Program has collaborated with academia to address key challenges in these areas. The collaboration has improved our understanding of the uses and limitations of available data and methods, expanded the use of existing data and methods, and increased our knowledge about the connections between health and environment. Valuable working relationships have been forged in this process, and together we have identified opportunities and improvements for future collaborations to further advance the science and practice of environmental public health tracking. PMID:25038624

  7. Engaging academia to advance the science and practice of environmental public health tracking.

    PubMed

    Strosnider, Heather; Zhou, Ying; Balluz, Lina; Qualters, Judith

    2014-10-01

    Public health agencies at the federal, state, and local level are responsible for implementing actions and policies that address health problems related to environmental hazards. These actions and policies can be informed by integrating or linking data on health, exposure, hazards, and population. The mission of the Centers for Disease Control and Prevention׳s National Environmental Public Health Tracking Program (Tracking Program) is to provide information from a nationwide network of integrated health, environmental hazard, and exposure data that drives actions to improve the health of communities. The Tracking Program and federal, state, and local partners collect, integrate, analyze, and disseminate data and information to inform environmental public health actions. However, many challenges exist regarding the availability and quality of data, the application of appropriate methods and tools to link data, and the state of the science needed to link and analyze health and environmental data. The Tracking Program has collaborated with academia to address key challenges in these areas. The collaboration has improved our understanding of the uses and limitations of available data and methods, expanded the use of existing data and methods, and increased our knowledge about the connections between health and environment. Valuable working relationships have been forged in this process, and together we have identified opportunities and improvements for future collaborations to further advance the science and practice of environmental public health tracking.

  8. Sandia National Laboratories Advanced Simulation and Computing (ASC) software quality plan. Part 1: ASC software quality engineering practices, Version 2.0.

    SciTech Connect

    Sturtevant, Judith E.; Heaphy, Robert; Hodges, Ann Louise; Boucheron, Edward A.; Drake, Richard Roy; Minana, Molly A.; Hackney, Patricia; Forsythe, Christi A.; Schofield, Joseph Richard, Jr.; Pavlakos, Constantine James; Williamson, Charles Michael; Edwards, Harold Carter

    2006-09-01

    The purpose of the Sandia National Laboratories Advanced Simulation and Computing (ASC) Software Quality Plan is to clearly identify the practices that are the basis for continually improving the quality of ASC software products. The plan defines the ASC program software quality practices and provides mappings of these practices to Sandia Corporate Requirements CPR 1.3.2 and 1.3.6 and to a Department of Energy document, ASCI Software Quality Engineering: Goals, Principles, and Guidelines. This document also identifies ASC management and software project teams responsibilities in implementing the software quality practices and in assessing progress towards achieving their software quality goals.

  9. Sandia National Laboratories Advanced Simulation and Computing (ASC) Software Quality Plan. Part 2, Mappings for the ASC software quality engineering practices. Version 1.0.

    SciTech Connect

    Ellis, Molly A.; Heaphy, Robert; Sturtevant, Judith E.; Hodges, Ann Louise; Boucheron, Edward A.; Drake, Richard Roy; Forsythe, Christi A.; Schofield, Joseph Richard, Jr.; Pavlakos, Constantine James; Williamson, Charles Michael; Edwards, Harold Carter

    2005-01-01

    The purpose of the Sandia National Laboratories Advanced Simulation and Computing (ASC) Software Quality Plan is to clearly identify the practices that are the basis for continually improving the quality of ASC software products. The plan defines the ASC program software quality practices and provides mappings of these practices to Sandia Corporate Requirements CPR 1.3.2 and 1.3.6 and to a Department of Energy document, 'ASCI Software Quality Engineering: Goals, Principles, and Guidelines'. This document also identifies ASC management and software project teams responsibilities in implementing the software quality practices and in assessing progress towards achieving their software quality goals.

  10. Sandia National Laboratories Advanced Simulation and Computing (ASC) software quality plan part 2 mappings for the ASC software quality engineering practices, version 2.0.

    SciTech Connect

    Heaphy, Robert; Sturtevant, Judith E.; Hodges, Ann Louise; Boucheron, Edward A.; Drake, Richard Roy; Minana, Molly A.; Hackney, Patricia; Forsythe, Christi A.; Schofield, Joseph Richard, Jr.; Pavlakos, Constantine James; Williamson, Charles Michael; Edwards, Harold Carter

    2006-09-01

    The purpose of the Sandia National Laboratories Advanced Simulation and Computing (ASC) Software Quality Plan is to clearly identify the practices that are the basis for continually improving the quality of ASC software products. The plan defines the ASC program software quality practices and provides mappings of these practices to Sandia Corporate Requirements CPR001.3.2 and CPR001.3.6 and to a Department of Energy document, ''ASCI Software Quality Engineering: Goals, Principles, and Guidelines''. This document also identifies ASC management and software project teams' responsibilities in implementing the software quality practices and in assessing progress towards achieving their software quality goals.

  11. Social support in the practices of informal providers: The case of patent and proprietary medicine vendors in Nigeria.

    PubMed

    Sieverding, Maia; Liu, Jenny; Beyeler, Naomi

    2015-10-01

    The social and institutional environments in which informal healthcare providers operate shape their health and business practices, particularly in contexts where regulatory enforcement is weak. In this study, we adopt a social capital perspective to understanding the social networks on which proprietary and patent medicine vendors (PPMVs) in Nigeria rely for support in the operation of their shops. Data are drawn from 70 in-depth interviews with PPMVs in three states, including interviews with local leaders of the PPMV professional association. We find that PPMVs primarily relied on more senior colleagues and formal healthcare professionals for informational support, including information about new medicines and advice on how to treat specific cases of illness. For instrumental support, including finance, start-up assistance, and intervention with regulatory agencies, PPMVs relied on extended family, the PPMVs with whom they apprenticed, and the leaders of their professional association. PPMVs' networks also provided continual reinforcement of what constitutes good PPMV practice through admonishments to follow scope of practice limitations. These informal reminders, as well as monitoring activities conducted by the professional association, served to reinforce PPMVs' concern with avoiding negative customer health outcomes, which were perceived to be detrimental to their business reputations. That PPMVs' networks both encouraged practices to reduce the likelihood of poor health outcomes, and provided advice regarding customers' health conditions, highlights the potential impact of informal providers' access to different forms of social capital on their delivery of health services, as well as their success as microenterprises. PMID:26331864

  12. Social support in the practices of informal providers: The case of patent and proprietary medicine vendors in Nigeria.

    PubMed

    Sieverding, Maia; Liu, Jenny; Beyeler, Naomi

    2015-10-01

    The social and institutional environments in which informal healthcare providers operate shape their health and business practices, particularly in contexts where regulatory enforcement is weak. In this study, we adopt a social capital perspective to understanding the social networks on which proprietary and patent medicine vendors (PPMVs) in Nigeria rely for support in the operation of their shops. Data are drawn from 70 in-depth interviews with PPMVs in three states, including interviews with local leaders of the PPMV professional association. We find that PPMVs primarily relied on more senior colleagues and formal healthcare professionals for informational support, including information about new medicines and advice on how to treat specific cases of illness. For instrumental support, including finance, start-up assistance, and intervention with regulatory agencies, PPMVs relied on extended family, the PPMVs with whom they apprenticed, and the leaders of their professional association. PPMVs' networks also provided continual reinforcement of what constitutes good PPMV practice through admonishments to follow scope of practice limitations. These informal reminders, as well as monitoring activities conducted by the professional association, served to reinforce PPMVs' concern with avoiding negative customer health outcomes, which were perceived to be detrimental to their business reputations. That PPMVs' networks both encouraged practices to reduce the likelihood of poor health outcomes, and provided advice regarding customers' health conditions, highlights the potential impact of informal providers' access to different forms of social capital on their delivery of health services, as well as their success as microenterprises.

  13. Perceptions about Representative English-Language Accents from Prospective and Practicing Providers of Business-Related Language Services in Argentina

    ERIC Educational Resources Information Center

    Scott, James Calvert; Green, Diana J.; Rosewarne, David D.

    2004-01-01

    The purposes of the study were (a) to identify perceptions about representative English-language accents from prospective and practicing providers of business-related language services residing in Argentina and (b) to examine the differences in their perceptions of these English-language accents. The respondents ranked the accents in this order:…

  14. Optimizing Music Learning: Exploring How Blocked and Interleaved Practice Schedules Affect Advanced Performance.

    PubMed

    Carter, Christine E; Grahn, Jessica A

    2016-01-01

    Repetition is the most commonly used practice strategy by musicians. Although blocks of repetition continue to be suggested in the pedagogical literature, work in the field of cognitive psychology suggests that repeated events receive less processing, thereby reducing the potential for long-term learning. Motor skill learning and sport psychology research offer an alternative. Instead of using a blocked practice schedule, with practice completed on one task before moving on to the next task, an interleaved schedule can be used, in which practice is frequently alternated between tasks. This frequent alternation involves more effortful processing, resulting in increased long-term learning. The finding that practicing in an interleaved schedule leads to better retention than practicing in a blocked schedule has been labeled the "contextual interference effect." While the effect has been observed across a wide variety of fields, few studies have researched this phenomenon in a music-learning context, despite the broad potential for application to music practice. This study compared the effects of blocked and interleaved practice schedules on advanced clarinet performance in an ecologically valid context. Ten clarinetists were given one concerto exposition and one technical excerpt to practice in a blocked schedule (12 min per piece) and a second concerto exposition and technical excerpt to practice in an interleaved schedule (3 min per piece, alternating until a total of 12 min of practice were completed on each piece). Participants sight-read the four pieces prior to practice and performed them at the end of practice and again one day later. The sight-reading and two performance run-throughs of each piece were recorded and given to three professional clarinetists to rate using a percentage scale. Overall, whenever there was a ratings difference between the conditions, pieces practiced in the interleaved schedule were rated better than those in the blocked schedule

  15. Optimizing Music Learning: Exploring How Blocked and Interleaved Practice Schedules Affect Advanced Performance

    PubMed Central

    Carter, Christine E.; Grahn, Jessica A.

    2016-01-01

    Repetition is the most commonly used practice strategy by musicians. Although blocks of repetition continue to be suggested in the pedagogical literature, work in the field of cognitive psychology suggests that repeated events receive less processing, thereby reducing the potential for long-term learning. Motor skill learning and sport psychology research offer an alternative. Instead of using a blocked practice schedule, with practice completed on one task before moving on to the next task, an interleaved schedule can be used, in which practice is frequently alternated between tasks. This frequent alternation involves more effortful processing, resulting in increased long-term learning. The finding that practicing in an interleaved schedule leads to better retention than practicing in a blocked schedule has been labeled the “contextual interference effect.” While the effect has been observed across a wide variety of fields, few studies have researched this phenomenon in a music-learning context, despite the broad potential for application to music practice. This study compared the effects of blocked and interleaved practice schedules on advanced clarinet performance in an ecologically valid context. Ten clarinetists were given one concerto exposition and one technical excerpt to practice in a blocked schedule (12 min per piece) and a second concerto exposition and technical excerpt to practice in an interleaved schedule (3 min per piece, alternating until a total of 12 min of practice were completed on each piece). Participants sight-read the four pieces prior to practice and performed them at the end of practice and again one day later. The sight-reading and two performance run-throughs of each piece were recorded and given to three professional clarinetists to rate using a percentage scale. Overall, whenever there was a ratings difference between the conditions, pieces practiced in the interleaved schedule were rated better than those in the blocked schedule

  16. Optimizing Music Learning: Exploring How Blocked and Interleaved Practice Schedules Affect Advanced Performance.

    PubMed

    Carter, Christine E; Grahn, Jessica A

    2016-01-01

    Repetition is the most commonly used practice strategy by musicians. Although blocks of repetition continue to be suggested in the pedagogical literature, work in the field of cognitive psychology suggests that repeated events receive less processing, thereby reducing the potential for long-term learning. Motor skill learning and sport psychology research offer an alternative. Instead of using a blocked practice schedule, with practice completed on one task before moving on to the next task, an interleaved schedule can be used, in which practice is frequently alternated between tasks. This frequent alternation involves more effortful processing, resulting in increased long-term learning. The finding that practicing in an interleaved schedule leads to better retention than practicing in a blocked schedule has been labeled the "contextual interference effect." While the effect has been observed across a wide variety of fields, few studies have researched this phenomenon in a music-learning context, despite the broad potential for application to music practice. This study compared the effects of blocked and interleaved practice schedules on advanced clarinet performance in an ecologically valid context. Ten clarinetists were given one concerto exposition and one technical excerpt to practice in a blocked schedule (12 min per piece) and a second concerto exposition and technical excerpt to practice in an interleaved schedule (3 min per piece, alternating until a total of 12 min of practice were completed on each piece). Participants sight-read the four pieces prior to practice and performed them at the end of practice and again one day later. The sight-reading and two performance run-throughs of each piece were recorded and given to three professional clarinetists to rate using a percentage scale. Overall, whenever there was a ratings difference between the conditions, pieces practiced in the interleaved schedule were rated better than those in the blocked schedule

  17. Waste lubricating oil disposal practices in Providence, Rhode Island: potential significance to coastal water quality

    SciTech Connect

    Hoffman, E.J.; Falke, A.M.; Quinn, J.G.

    1980-01-01

    A 1979-80 survey of Providence, R.I., residents indicated that about 35% change their own automotive lubricating oil, disposing of this oil by a variety of methods. The most popular disposal method was putting the oil in garbage cans, followed by backyard dumping, sewer disposal, dumping it on roads, or taking it to the town dump. Road and sewer disposal can account for 44 metric tons of hydrocarbons discharged into the city's combined storm and sanitary sewage treatment system. Residents indicated a high degree of willingness to participate in a state-wide recycling program.

  18. Developing a professional poster: four "ps" for advanced practice nurses to consider.

    PubMed

    Bindon, Susan L; Davenport, Joan M

    2013-01-01

    Professional posters play an important role in the dissemination of knowledge and the professional development of advanced practice nurses, graduate students, and clinical faculty. Posters should be considered an integral component in communication of professional work in practice, research, and education. The invitation to submit a poster abstract is an important opportunity for clinicians and faculty alike to consider. Though sometimes misperceived as less prestigious than a podium presentation, posters add a unique element to professional and academic events. The argument is made for posters as an equal among scholarly presentation formats. The poster serves as a tremendous opportunity for collaboration between partners and a way to communicate important findings and advertise the presenters' work. For the advanced practice nurse who is a novice in presenting best practice or evidence from research trials, the poster format may be less intimidating while allowing the invaluable sharing of results. Four critical elements of professional poster development are deciding on a clear Purpose, targeting the right People, outlining key steps in the Process, and delivering a memorable Presentation. Using the "4 Ps" as cornerstones for the work of developing, preparing, and delivering the poster to an audience, the authors aim to help organize the entire process into these essential considerations. The poster, as a means of scholarly work, is a viable and essential activity, as interdisciplinary collaboration and sharing of best practice becomes the expectation for all professional development. PMID:23615014

  19. Ke Alahaka Program of the Advanced Technology Solar Telescope (ATST) Mitigation Initiative Provides STEM Workshops for Native Hawaiian Students

    NASA Astrophysics Data System (ADS)

    Coopersmith, A.; Cie, D. K.; Naho`olewa, D.; Chirico, J.

    2012-12-01

    The Advanced Technology Solar Telescope (ATST) Mitigation Initiative and the Kahikina O Ka Lā Program are NSF-funded projects at the University of Hawai`i Maui College. These projects will provide instruction and activities intended to increase diversity in STEM or STEM-related careers. Ke Alahaka, the 2012 summer bridge program, was offered to Native Hawaiian high-school students who indicated an interest in STEM areas. Three STEM-content workshops were offered including Marine Science, Sustainable Energy Technology, and Computer Science and Engineering. Students attended hands-on classes three days a week for a month concentrating on only one of the three topics. On the other days, students participated in a Hawaiian Studies course designed to provide a cultural context for the STEM instruction. Focus groups and other program assessments indicate that 50% of the 60 students attending the workshops intend to pursue a STEM major during their undergraduate studies.

  20. Healthcare Hackathons Provide Educational and Innovation Opportunities: A Case Study and Best Practice Recommendations.

    PubMed

    Silver, Julie K; Binder, David S; Zubcevik, Nevena; Zafonte, Ross D

    2016-07-01

    Physicians and other healthcare professionals are often the end users of medical innovation; however, they are rarely involved in the beginning design stages. This often results in ineffective healthcare solutions with poor adoption rates. At the early design stage, innovation would benefit from input from healthcare professionals. This report describes the first-ever rehabilitation hackathon-an interdisciplinary and competitive team event aimed at accelerating and improving healthcare solutions and providing an educational experience for participants. Hackathons are gaining traction as a way to accelerate innovation by bringing together a diverse group of interdisciplinary professionals from different industries who work collaboratively in teams and learn from each other, focus on a specific problem ("pain point"), develop a solution using design thinking techniques, pitch the solution to participants, gather fast feedback and quickly alter the prototype design ("pivoting"). 102 hackers including 19 (18.6 %) physicians and other professionals participated, and over the course of 2 days worked in teams, pitched ideas and developed design prototypes. Three awards were given for prototypes that may improve function in persons with disabilities. 43 hackers were women (42.2 %) and 59 men (57.8 %); they ranged in age from 16 to 79 years old; and, of the 75 hackers who reported their age, 63 (84 %) were less than 40 years old and 12 (16 %) were 40 years or older. This report contributes to the emerging literature on healthcare hackathons as a means of providing interdisciplinary education and training and supporting innovation.

  1. Healthcare Hackathons Provide Educational and Innovation Opportunities: A Case Study and Best Practice Recommendations.

    PubMed

    Silver, Julie K; Binder, David S; Zubcevik, Nevena; Zafonte, Ross D

    2016-07-01

    Physicians and other healthcare professionals are often the end users of medical innovation; however, they are rarely involved in the beginning design stages. This often results in ineffective healthcare solutions with poor adoption rates. At the early design stage, innovation would benefit from input from healthcare professionals. This report describes the first-ever rehabilitation hackathon-an interdisciplinary and competitive team event aimed at accelerating and improving healthcare solutions and providing an educational experience for participants. Hackathons are gaining traction as a way to accelerate innovation by bringing together a diverse group of interdisciplinary professionals from different industries who work collaboratively in teams and learn from each other, focus on a specific problem ("pain point"), develop a solution using design thinking techniques, pitch the solution to participants, gather fast feedback and quickly alter the prototype design ("pivoting"). 102 hackers including 19 (18.6 %) physicians and other professionals participated, and over the course of 2 days worked in teams, pitched ideas and developed design prototypes. Three awards were given for prototypes that may improve function in persons with disabilities. 43 hackers were women (42.2 %) and 59 men (57.8 %); they ranged in age from 16 to 79 years old; and, of the 75 hackers who reported their age, 63 (84 %) were less than 40 years old and 12 (16 %) were 40 years or older. This report contributes to the emerging literature on healthcare hackathons as a means of providing interdisciplinary education and training and supporting innovation. PMID:27277278

  2. The role of the nurse executive in fostering and empowering the advanced practice registered nurse.

    PubMed

    Talbert, Tukea L

    2012-06-01

    The nurse executive plays a critical role in the design, oversight, and outcomes of the delivery of care and a key role in the success of the integration of advanced practice registered nurses (APRNs) into an organization. The critical areas that nurse executives must consider to foster and empower APRNs are: (1) knowledge and self preparation, especially of political initiatives that affect the role, (2) visionary leadership and development of clear role expectations and appropriate credentialing, (3) strategies to reduce disconnection between the APRN and their practice setting, and (4) appropriate education and marketing of the role to stakeholders.

  3. Primary healthcare provider knowledge, beliefs and clinic-based practices regarding alternative tobacco products and marijuana: a qualitative study.

    PubMed

    Bascombe, Ta Misha S; Scott, Kimberly N; Ballard, Denise; Smith, Samantha A; Thompson, Winifred; Berg, Carla J

    2016-06-01

    Use prevalence of alternative tobacco products and marijuana has increased dramatically. Unfortunately, clinical guidelines have focused on traditional cigarettes with limited attention regarding these emerging public health issues. Thus, it is critical to understand how healthcare professionals view this issue and are responding to it. This qualitative study explored knowledge, beliefs and clinic-based practices regarding traditional and alternative tobacco products (cigar-like products, smokeless tobacco, hookah, e-cigarettes) and marijuana among rural and urban Georgia primary healthcare providers. The sample comprised 20 healthcare providers in primary care settings located in the Atlanta Metropolitan area and rural southern Georgia who participated in semi-structured interviews. Results indicated a lack of knowledge about these products, with some believing that some products were less harmful than traditional cigarettes or that they may be effective in promoting cessation or harm reduction. Few reported explicitly assessing use of these various products in clinic. In addition, healthcare providers reported a need for empirical evidence to inform their clinical practice. Healthcare providers must systematically assess use of the range of tobacco products and marijuana. Evidence-based recommendations or information sources are needed to inform clinical practice and help providers navigate conversations with patients using or inquiring about these products.

  4. Provider management of child stress behavior in family day care facilities: scaffolding for learning and development by developmentally appropriate practice.

    PubMed

    Chang, Chih-Ying; Austin, Ann M Berghout; Piercy, Kathleen W

    2006-06-01

    Six children (5 boys, 1 girl; aged 36-60 months) participated in this qualitative study. Each child was enrolled in a different family child care facility. The authors rated the child care providers in 3 of the facilities as using developmentally appropriate practices (DAP) most of the time and rated the providers in the 3 other facilities as rarely or never using DAP. They also examined provider management of children's stress behaviors. The authors observed less active and passive stress behaviors in the high-DAP facilities than in the low-DAP facilities. The authors discuss the results with regard to the distinctively different day care culture found in high-DAP facilities versus low-DAP facilities and the implications for practice.

  5. Women's Access and Provider Practices for the Case Management of Malaria during Pregnancy: A Systematic Review and Meta-Analysis

    PubMed Central

    Hill, Jenny; D'Mello-Guyett, Lauren; Hoyt, Jenna; van Eijk, Anna M.; ter Kuile, Feiko O.; Webster, Jayne

    2014-01-01

    Background WHO recommends prompt diagnosis and quinine plus clindamycin for treatment of uncomplicated malaria in the first trimester and artemisinin-based combination therapies in subsequent trimesters. We undertook a systematic review of women's access to and healthcare provider adherence to WHO case management policy for malaria in pregnant women. Methods and Findings We searched the Malaria in Pregnancy Library, the Global Health Database, and the International Network for the Rational Use of Drugs Bibliography from 1 January 2006 to 3 April 2014, without language restriction. Data were appraised for quality and content. Frequencies of women's and healthcare providers' practices were explored using narrative synthesis and random effect meta-analysis. Barriers to women's access and providers' adherence to policy were explored by content analysis using NVivo. Determinants of women's access and providers' case management practices were extracted and compared across studies. We did not perform a meta-ethnography. Thirty-seven studies were included, conducted in Africa (30), Asia (4), Yemen (1), and Brazil (2). One- to three-quarters of women reported malaria episodes during pregnancy, of whom treatment was sought by >85%. Barriers to access among women included poor knowledge of drug safety, prohibitive costs, and self-treatment practices, used by 5%–40% of women. Determinants of women's treatment-seeking behaviour were education and previous experience of miscarriage and antenatal care. Healthcare provider reliance on clinical diagnosis and poor adherence to treatment policy, especially in first versus other trimesters (28%, 95% CI 14%–47%, versus 72%, 95% CI 39%–91%, p = 0.02), was consistently reported. Prescribing practices were driven by concerns over side effects and drug safety, patient preference, drug availability, and cost. Determinants of provider practices were access to training and facility type (public versus private). Findings were limited

  6. Evidence-based practice implementation: The impact of public versus private sector organization type on organizational support, provider attitudes, and adoption of evidence-based practice

    PubMed Central

    2009-01-01

    Background The goal of this study is to extend research on evidence-based practice (EBP) implementation by examining the impact of organizational type (public versus private) and organizational support for EBP on provider attitudes toward EBP and EBP use. Both organization theory and theory of innovation uptake and individual adoption of EBP guide the approach and analyses in this study. We anticipated that private sector organizations would provide greater levels of organizational support for EBPs leading to more positive provider attitudes towards EBPs and EBP use. We also expected attitudes toward EBPs to mediate the association of organizational support and EBP use. Methods Participants were mental health service providers from 17 communities in 16 states in the United States (n = 170). Path analyses were conducted to compare three theoretical models of the impact of organization type on organizational support for EBP and of organizational support on provider attitudes toward EBP and EBP use. Results Consistent with our predictions, private agencies provided greater support for EBP implementation, and staff working for private agencies reported more positive attitudes toward adopting EBPs. Organizational support for EBP partially mediated the association of organization type on provider attitudes toward EBP. Organizational support was significantly positively associated with attitudes toward EBP and EBP use in practice. Conclusion This study offers further support for the importance of organizational context as an influence on organizational support for EBP and provider attitudes toward adopting EBP. The study demonstrates the role organizational support in provider use of EBP in practice. This study also suggests that organizational support for innovation is a malleable factor in supporting use of EBP. Greater attention should be paid to organizational influences that can facilitate the dissemination and implementation of EBPs in community settings. PMID

  7. Reflections on ethnocentrism and racism: a challenge for advanced practice nurses.

    PubMed

    Harris, S H; Cummings, S H

    1996-01-01

    As nurses and patient populations increasingly reflect the changing demographics of the United States, it will be necessary for nurses to address the critical issues surrounding a multicultural society. Nurses have been relatively quiet on the topic of ethnocentric and racist behavior. If advanced practice nurses are to be successful in assisting nurses and organizations to embrace cultural diversity, understanding ethnocentric and racist behaviors is key to developing strategies to facilitate the provision of culturally competent care.

  8. Advancing maternal age and trisomy screening: the practice challenges of facilitating choice and gaining consent.

    PubMed

    Birt, Maria

    2015-12-01

    Antenatal screening for chromosomal anomalies such as Trisomy 13, 18 and 21 (Patau's, Edward's and Down's syndrome respectively) is offered to all pregnant women in the first two trimesters.This article explores the varying considerations of consent for this type of screening, particularly in relation to women of advancing age who are at increased risk of carrying a pregnancy affected by a trisomy. The practical challenges or barriers of gaining valid, meaningful informed consent are discussed. PMID:26753259

  9. Using the Rx for Change tobacco curriculum in advanced practice nursing education.

    PubMed

    Kelley, Frances J; Heath, Janie; Crowell, Nancy

    2006-03-01

    In today's health care system driven by quality outcome indicators and performance care measures, it is essential for nurses to know how to intervene with tobacco-dependent patients. This article discusses pilot results from the "Rx for Change: Clinician Assisted Tobacco Cessation Curriculum" intervention conducted at Georgetown University School of Nursing and Health Studies using advanced practice students. The results reveal that 6 hours of tobacco-cessation training can increase knowledge and self-efficiency scores. PMID:16546016

  10. A descriptive study of point-of-care reference resource use by advanced practice RNs in Texas.

    PubMed

    Bischoff, Whitney Rogers; Hinojosa, Rogelio H

    2013-11-01

    This descriptive study replicates and extends previous research on advanced practice RNs and the (1) reference resources available to them at the point of care, (2) resources they use to inform their clinical practice, and (3) resources they are accessing from handheld electronic devices such as PDAs, smartphones, and tablet computers during practice. These elements formed the purpose of the current study. A sample of advanced practice RNs from Texas Public Health Region 11 was surveyed. Available resources were current journals appropriate to setting and current clinical guidelines. These advanced practice RNs "always or frequently" based their professional practice on personal experience of caring for patients/clients over time, information learned in college/university, and information learned about each patient/client as an individual. Responses for Hispanic respondents as well as electronic device users were similar. Content and features accessed daily by handheld computer devices were reference materials, e-mail, address/phonebook, Internet access other than e-mail, calendar/date book, alarm/reminder, calculator, and memo pad. Software installed on handheld devices and used daily included drug references, medical text/reference book, medical math/formula calculator, practice guidelines, and language translator/dictionary. Respondents who did not report using handheld devices at work were older, had more years in advanced practice nursing, and were more likely to work in a hospital, birthing center, or institution such as a prison, school, or military facility. There was no difference in resource or electronic device use by Hispanic advanced practice RNs. Electronic resources for practice are growing and being used by advanced practice RNs. Consideration should be given to incorporating evaluation and implementation of electronic clinical resources into advanced practice RN educational programs. Future research should include greater detail about the origin of

  11. A descriptive study of point-of-care reference resource use by advanced practice RNs in Texas.

    PubMed

    Bischoff, Whitney Rogers; Hinojosa, Rogelio H

    2013-11-01

    This descriptive study replicates and extends previous research on advanced practice RNs and the (1) reference resources available to them at the point of care, (2) resources they use to inform their clinical practice, and (3) resources they are accessing from handheld electronic devices such as PDAs, smartphones, and tablet computers during practice. These elements formed the purpose of the current study. A sample of advanced practice RNs from Texas Public Health Region 11 was surveyed. Available resources were current journals appropriate to setting and current clinical guidelines. These advanced practice RNs "always or frequently" based their professional practice on personal experience of caring for patients/clients over time, information learned in college/university, and information learned about each patient/client as an individual. Responses for Hispanic respondents as well as electronic device users were similar. Content and features accessed daily by handheld computer devices were reference materials, e-mail, address/phonebook, Internet access other than e-mail, calendar/date book, alarm/reminder, calculator, and memo pad. Software installed on handheld devices and used daily included drug references, medical text/reference book, medical math/formula calculator, practice guidelines, and language translator/dictionary. Respondents who did not report using handheld devices at work were older, had more years in advanced practice nursing, and were more likely to work in a hospital, birthing center, or institution such as a prison, school, or military facility. There was no difference in resource or electronic device use by Hispanic advanced practice RNs. Electronic resources for practice are growing and being used by advanced practice RNs. Consideration should be given to incorporating evaluation and implementation of electronic clinical resources into advanced practice RN educational programs. Future research should include greater detail about the origin of

  12. Interprofessional collaborative practice incorporating training for alcohol and drug use screening for healthcare providers in rural areas.

    PubMed

    Puskar, Kathy; Mitchell, Ann M; Albrecht, Susan A; Frank, Linda R; Kane, Irene; Hagle, Holly; Lindsay, Dawn; Lee, Heeyoung; Fioravanti, Marie; Talcott, Kimberly S

    2016-07-01

    Interprofessional collaborative practice expands resources in rural and underserved communities. This article explores the impact of an online education programme on the perceptions of healthcare providers about interprofessional care within alcohol and drug use screening for rural residents. Nurses, behavioural health counsellors, and public health professionals participated in an evidence-based practice (screening, brief intervention, and referral to treatment-SBIRT) model that targets individuals who use alcohol and other drugs in a risky manner. SBIRT is recommended by the United States Preventive Services Task Force as a universal, evidence-based screening tool. Online modules, case simulation practice, and interprofessional dialogues are used to deliver practice-based learning experiences. A quasi-experimental method with pre-tests and post-tests was utilised. Results indicate increased perceptions of professional competence, need for cooperation, actual cooperation, and role values pre-to-post training. Implications suggest that online interprofessional education is useful but the added component of professional dialogues regarding patient cases offers promise in promoting collaborative practice. PMID:27295396

  13. Knowledge and practices of healthcare providers about essential newborn care and resuscitation in a district of Haryana.

    PubMed

    Louis, Deepak; Kumar, Praveen; Gupta, Ashish

    2013-02-01

    In India, institutionalisation of deliveries is happening at a fast pace. Evaluating the knowledge and practices of healthcare providers in these institutions is a priority in this current scenario. The objective of this study was to assess the knowledge and practices regarding essential newborn care and resuscitation among healthcare providers in Panchkula district of Haryana. A cross-sectional questionnaire based survey of healthcare personnel working in one district hospital, 2 community health centres, 5 primary health centres and 2 subcentres, each with at least 100 deliveries per year, was done. Fifty-eight medical personnel comprising of 27 staff nurses, 11 auxiliary nurse midwives, 15 doctors and 5 multipurpose health workers were interviewed. Of them, 33 (57%) had received training in newborn care, but only 9 (16%) knew all the initial steps of resuscitation. Twenty-eight (48%) had knowledge of positive pressure ventilation while 8 (13%) could provide chest compression or drugs during resuscitation. Thirty-three (57%) practiced holding the baby upside down after delivery. Early and exclusive breastfeeding including colostrum was advised by all. All practiced hand washing prior to delivery and kept the cord clean anddry. At least one danger sign was told to the mother at the time of discharge by 48 (83%). However, kangaroo mother care was rarely advised to mothers of preterm babies. It was found that majority of healthcare personnel had good awareness about breastfeeding and clean practices while conducting delivery. In contrast, knowledge about neonatal resuscitation and some aspects of essential newborn care was poor. PMID:24003568

  14. Power and promise of narrative for advancing physical therapist education and practice.

    PubMed

    Greenfield, Bruce H; Jensen, Gail M; Delany, Clare M; Mostrom, Elizabeth; Knab, Mary; Jampel, Ann

    2015-06-01

    This perspective article provides a justification for and an overview of the use of narrative as a pedagogical tool for educators to help physical therapist students, residents, and clinicians develop skills of reflection and reflexivity in clinical practice. The use of narratives is a pedagogical approach that provides a reflective and interpretive framework for analyzing and making sense of texts, stories, and other experiences within learning environments. This article describes reflection as a well-established method to support critical analysis of clinical experiences; to assist in uncovering different perspectives of patients, families, and health care professionals involved in patient care; and to broaden the epistemological basis (ie, sources of knowledge) for clinical practice. The article begins by examining how phronetic (ie, practical and contextual) knowledge and ethical knowledge are used in physical therapy to contribute to evidence-based practice. Narrative is explored as a source of phronetic and ethical knowledge that is complementary but irreducible to traditional objective and empirical knowledge-the type of clinical knowledge that forms the basis of scientific training. The central premise is that writing narratives is a cognitive skill that should be learned and practiced to develop critical reflection for expert practice. The article weaves theory with practical application and strategies to foster narrative in education and practice. The final section of the article describes the authors' experiences with examples of integrating the tools of narrative into an educational program, into physical therapist residency programs, and into a clinical practice.

  15. Providers' Note-Writing Practices for Post-traumatic Stress Disorder at Five United States Veterans Affairs Facilities.

    PubMed

    Tuepker, Anaïs; Zickmund, Susan L; Nicolajski, Cara E; Hahm, Bridget; Butler, Jorie; Weir, Charlene; Post, Lori; Hickam, David H

    2016-07-01

    The capacity of electronic health records (EHRs) to capture desired information depends on the practices of health care providers. These practices have not been well studied in relation to post-traumatic stress disorder (PTSD). This qualitative study investigated how providers write EHR notes on PTSD through 38 interviews with providers working at five Veterans Affairs (VA) hospitals across the United States of America. Two overarching themes were prominent in the results. Providers used progress notes primarily to remember and access details for direct patient care, but only rarely for care coordination. Providers infrequently recorded information not judged to directly contribute to improved care, sometimes deliberately omitting information perceived to jeopardize patients' access to, or quality of, care. Omitted information frequently included sexual or non-military trauma. Understanding providers' thought processes can help clinicians be aware of the limitations of EHR notes as a tool for learning the histories of new patients. Similarly, researchers relying on EHR data for PTSD research should be aware of likely areas of missing data.

  16. 49 CFR 39.37 - May PVOs require a passenger with a disability to provide advance notice in order to obtain...

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... provide advance notice in order to obtain particular auxiliary aids and services or to arrange group... aids and services or to arrange group travel? (a) Except as provided in this section, as a PVO you must... particular auxiliary aids and services, you may request reasonable advance notice to guarantee...

  17. 49 CFR 39.37 - May PVOs require a passenger with a disability to provide advance notice in order to obtain...

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... provide advance notice in order to obtain particular auxiliary aids and services or to arrange group... aids and services or to arrange group travel? (a) Except as provided in this section, as a PVO you must... particular auxiliary aids and services, you may request reasonable advance notice to guarantee...

  18. 49 CFR 39.37 - May PVOs require a passenger with a disability to provide advance notice in order to obtain...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... provide advance notice in order to obtain particular auxiliary aids and services or to arrange group... aids and services or to arrange group travel? (a) Except as provided in this section, as a PVO you must... particular auxiliary aids and services, you may request reasonable advance notice to guarantee...

  19. 49 CFR 39.37 - May PVOs require a passenger with a disability to provide advance notice in order to obtain...

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... provide advance notice in order to obtain particular auxiliary aids and services or to arrange group... aids and services or to arrange group travel? (a) Except as provided in this section, as a PVO you must... particular auxiliary aids and services, you may request reasonable advance notice to guarantee...

  20. 49 CFR 39.37 - May PVOs require a passenger with a disability to provide advance notice in order to obtain...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... provide advance notice in order to obtain particular auxiliary aids and services or to arrange group... aids and services or to arrange group travel? (a) Except as provided in this section, as a PVO you must... particular auxiliary aids and services, you may request reasonable advance notice to guarantee...

  1. Choosing a framework for ethical analysis in advanced practice settings: the case for casuistry.

    PubMed

    Artnak, K E; Dimmitt, J H

    1996-02-01

    The need for advanced practice nurses to incorporate ethical analysis into case management is becoming more apparent -- particularly for the increasingly independent practice settings of psychiatric and mental health nursing. The nursing literature contains many articles dealing with the more abstract treatment of clinical ethics, but for the practitioner there is unfortunately little information available that uses ethical principles in a practical framework, which addresses the concrete reality of daily, difficult clinical decision making. This article applies a model of reasoned analysis to an actual case study using the concepts of casuistry or case-based reasoning. This method offers an alternative to the more popular paradigm of principilism. Complicated by the existence of violence and abuse, the case examines several ethical issues including patient privacy and legitimate breaches of patient confidentiality.

  2. Clinical registered dietitians, employers, and educators are interested in advanced practice education and professional doctorate degrees in clinical nutrition.

    PubMed

    Skipper, Annalynn; Lewis, Nancy M

    2006-12-01

    A subset of registered dietitians (RDs) is known to practice at an advanced level, but a clear educational pathway supporting advanced medical nutrition therapy practice has not been identified. Thus, an electronic survey was designed to investigate interest of clinical RDs, employers, and educators in advanced practice competencies and professional doctorate degree programs in clinical nutrition. Usable responses were obtained from 440 of 978 (45%) RDs, 61 of 107 (57%) employers, and 76 of 114 (67%) educators. Mean interest (5 = very interested, 1 = very uninterested) in obtaining advanced practice education was highest among RDs (3.93+/-1.01) and was significantly different (P < 0.01) from employers (3.74 +/-1.28) and educators (2.76+/-1.33). Interest in completing a professional doctorate in clinical nutrition was significantly (P < 0.01) different among RDs (3.05+/-1.28), employers (3.18+/-1.30), and educators (2.3+/-1.34). Employers' mean interest score for hiring RDs with a professional doctorate in clinical nutrition was 4.02+/-0.93. A subset of clinical RDs appears to be interested in obtaining advanced practice competency and enrolling in professional doctorate degrees in clinical nutrition. Clinical nutrition managers in academic medical centers may be interested in hiring advanced practice clinical RDs with professional doctorate degrees. Opportunities exist for educators to develop advanced practice educational experiences and professional doctorate degree programs.

  3. Providing for energy efficiency in homes and small buildings. Part III. Determining which practices are most effective and installing materials

    SciTech Connect

    1980-06-01

    The training program is designed to educate students and individuals in the importance of conserving energy and to provide for developing skills needed in the application of energy-saving techniques that result in energy-efficient buildings. A teacher guide and student workbook are available to supplement the basic manual. Subjects covered in Part III are: determining which practices are most efficient and economical; installing energy-saving materials; and improving efficiency of equipment.

  4. Validation of an advanced practice physiotherapy model of care in an orthopaedic outpatient clinic

    PubMed Central

    2013-01-01

    Background In Canada, new models of orthopaedic care involving advanced practice physiotherapists (APP) are being implemented. In these new models, aimed at improving the efficiency of care for patients with musculoskeletal disorders, APPs diagnose, triage and conservatively treat patients. Formal validation of the efficiency and appropriateness of these emerging models is scarce. The purpose of this study is to assess the diagnostic agreement of an APP compared to orthopaedic surgeons as well as to assess treatment concordance, healthcare resource use, and patient satisfaction in this new model. Methods 120 patients presenting for an initial consult for hip or knee complaints in an outpatient orthopaedic hospital clinic in Montreal, Canada, were independently assessed by an APP and by one of three participating orthopaedic surgeons. Each health care provider independently diagnosed the patients and provided triage recommendations (conservative or surgical management). Proportion of raw agreement and Cohen’s kappa were used to assess inter-rater agreement for diagnosis, triage, treatment recommendations and imaging tests ordered. Chi-Square tests were done in order to compare the type of conservative treatment recommendations made by the APP and the surgeons and Student t-tests to compare patient satisfaction between the two types of care. Results The majority of patients assessed were female (54%), mean age was 54.1 years and 91% consulted for a knee complaint. The raw agreement proportion for diagnosis was 88% and diagnostic inter-rater agreement was very high (κ=0.86; 95% CI: 0.80-0.93). The triage recommendations (conservative or surgical management) raw agreement proportion was found to be 88% and inter-rater agreement for triage recommendation was high (κ=0.77; 95% CI: 0.65-0.88). No differences were found between providers with respect to imaging tests ordered (p≥0.05). In terms of conservative treatment recommendations made, the APP gave significantly

  5. Quality of chronic disease care in general practice: the development and validation of a provider interview tool

    PubMed Central

    Proudfoot, Judith; Jayasinghe, Upali W; Infante, Fernando; Beilby, Justin; Amoroso, Cheryl; Davies, Gawaine Powell; Grimm, Jane; Holton, Christine; Bubner, Tanya; Harris, Mark

    2007-01-01

    Background This article describes the development and psychometric evaluation of an interview instrument to assess provider-reported quality of general practice care for patients with diabetes, cardiovascular disease and asthma – the Australian General Practice Clinical Care Interview (GPCCI). Methods We administered the GPCCI to 28 general practitioners (family physicians) in 10 general practices. We conducted an item analysis and assessed the internal consistency of the instrument. We next assessed the quality of care recorded in the medical records of 462 of the general practitioners' patients with Type 2 diabetes, ischaemic heart disease/hypertension and/or moderate to severe asthma. This was then compared with results of the GPCCI for each general practice. Results Good internal consistency was found for the overall GPCCI (Cronbach's alpha = 0.75). As far as the separate sub-scales were concerned, diabetes had good internal consistency (0.76) but the internal consistency of the heart disease and asthma subscales was not strong (0.49 and 0.16 respectively). There was high inter-rater reliability of the adjusted scores of data extracted from patients' medical notes for each of the three conditions. Correlations of the overall GPCCI and patients' medical notes audit, combined across the three conditions and aggregated to practice level, showed that a strong relationship (r = 0.84, p = 0.003) existed between the two indices of clinical care. Conclusion This study suggests that the GPCCI has good internal consistency and concurrent validity with patients' medical records in Australian general practice and warrants further evaluation of its properties, validity and utility. PMID:17442118

  6. Health Care Providers' Knowledge and Practice Gap towards Joint Zoonotic Disease Surveillance System: Challenges and Opportunities, Gomma District, Southwest Ethiopia

    PubMed Central

    Sime, Abiot Girma; Hajito, Kifle Woldemichael; Gelalacha, Benti Deresa

    2016-01-01

    Background. Health care providers play a crucial role for realization of joint zoonotic diseases surveillance by human and animal health sectors, yet there is limited evidence. Hence, this study aimed to determine knowledge and practice gap of health care providers towards the approach for Rabies and Anthrax in Southwest Ethiopia. Methods. A cross-sectional survey was conducted from December 16, 2014, to January 14, 2015. Eligible health care providers were considered for the study. Data were entered in to Epi-data version 3.1 and analyzed using SPSS version 20. Results. A total of 323 (92.02%) health care providers participated in the study. Three hundred sixteen (97.8%) of participants reported that both human and animal health sectors can work together for zoonotic diseases while 96.9% of them replied that both sectors can jointly conduct surveillance. One hundred seventeen (36.2%) of them reported that their respective sectors had conducted joint surveillance for zoonotic diseases. Their involvement was, however, limited to joint outbreak response. Conclusion. There is good opportunity in health care providers' knowledge even though the practice was unacceptably low and did not address all surveillance components. Therefore, formal joint surveillance structure should be in place for optimal implementation of surveillance. PMID:27579311

  7. Health Care Providers' Knowledge and Practice Gap towards Joint Zoonotic Disease Surveillance System: Challenges and Opportunities, Gomma District, Southwest Ethiopia.

    PubMed

    Gemeda, Desta Hiko; Sime, Abiot Girma; Hajito, Kifle Woldemichael; Gelalacha, Benti Deresa; Tafese, Wubit; Gebrehiwot, Tsegaye Tewelde

    2016-01-01

    Background. Health care providers play a crucial role for realization of joint zoonotic diseases surveillance by human and animal health sectors, yet there is limited evidence. Hence, this study aimed to determine knowledge and practice gap of health care providers towards the approach for Rabies and Anthrax in Southwest Ethiopia. Methods. A cross-sectional survey was conducted from December 16, 2014, to January 14, 2015. Eligible health care providers were considered for the study. Data were entered in to Epi-data version 3.1 and analyzed using SPSS version 20. Results. A total of 323 (92.02%) health care providers participated in the study. Three hundred sixteen (97.8%) of participants reported that both human and animal health sectors can work together for zoonotic diseases while 96.9% of them replied that both sectors can jointly conduct surveillance. One hundred seventeen (36.2%) of them reported that their respective sectors had conducted joint surveillance for zoonotic diseases. Their involvement was, however, limited to joint outbreak response. Conclusion. There is good opportunity in health care providers' knowledge even though the practice was unacceptably low and did not address all surveillance components. Therefore, formal joint surveillance structure should be in place for optimal implementation of surveillance. PMID:27579311

  8. Advancing the State-of-the-Practice for Liquid Rocket Engine Injector Design

    NASA Technical Reports Server (NTRS)

    Tucker, P. K.; Kenny, R. J.; Richardson, B. R.; Anderso, W. E.; Austin, B. J.; Schumaker, S. A.; Muss, J. A.

    2015-01-01

    Current shortcomings in both the overall injector design process and its underlying combustion stability assessment methodology are rooted in the use of empirically based or low fidelity representations of complex physical phenomena and geometry details that have first order effects on performance, thermal environments and combustion stability. The result is a design and analysis capability that is often inadequate to reliably arrive at a suitable injector design in an efficient manner. Specifically, combustion instability has been particularly difficult to predict and mitigate. Large hydrocarbon-fueled booster engines have been especially problematic in this regard. Where combustion instability has been a problem, costly and time-consuming redesign efforts have often been an unfortunate consequence. This paper presents an overview of a recently completed effort at NASA Marshall Space Flight Center to advance the state-of-the-practice for liquid rocket engine injector design. Multiple perturbations of a gas-centered swirl coaxial (GCSC) element that burned gaseous oxygen and RP-1 were designed, assessed for combustion stability, and tested. Three designs, one stable, one marginally unstable and one unstable, were used to demonstrate both an enhanced overall injector design process and an improved combustion stability assessment process. High-fidelity results from state-of-the-art computational fluid dynamics CFD simulations were used to substantially augment and improve the injector design methodology. The CFD results were used to inform and guide the overall injector design process. They were also used to upgrade selected empirical or low-dimensional quantities in the ROCket Combustor Interactive Design (ROCCID) stability assessment tool. Hot fire single element injector testing was used to verify both the overall injector designs and the stability assessments. Testing was conducted at the Air Force Research Laboratory and at Purdue University. Companion papers

  9. Implementing a prescribing practicum within a Master's degree in advanced nursing practice.

    PubMed

    Spence, Deb; Anderson, Maxine

    2007-11-01

    The recent introduction of Nurse Practitioner registration in New Zealand has resulted in the development of a number of Master's degree programmes in which students focus clinically and can complete a Nursing Council of New Zealand approved programme for prescribing. This article reports the implementation of a collaborative project undertaken to monitor and improve the effectiveness of the prescribing practicum papers delivered within two Master's degree programmes in advanced nursing practice. A developmental action research approach was used. Data were collected through interviews with practicum students, their medical supervisors and academic staff. Formative findings were progressively used to refine delivery of the practicum papers and a thematic analysis of summative findings identified areas for further improvement. The findings suggest that the processes being implemented are developing well. Further education is required to clearly differentiate medical and advanced nursing roles. Greater attention needs to be paid to the preparation of medical supervisors and, most significantly, revision of funding is required to more equitably support the ongoing development of nurses for advanced practice roles.

  10. Clean delivery practices in rural northern Ghana: a qualitative study of community and provider knowledge, attitudes, and beliefs

    PubMed Central

    2012-01-01

    Background Knowledge, attitudes and practices of community members and healthcare providers in rural northern Ghana regarding clean delivery are not well understood. This study explores hand washing/use of gloves during delivery, delivering on a clean surface, sterile cord cutting, appropriate cord tying, proper cord care following delivery, and infant bathing and cleanliness. Methods In-depth interviews and focus group discussions were audiotaped, transcribed, and analyzed using NVivo 9.0. Results 253 respondents participated, including women with newborn infants, grandmothers, household and compound heads, community leaders, traditional birth attendants, and formally trained health care providers. There is widespread understanding of the need for clean delivery to reduce the risk of infection to both mothers and their babies during and shortly after delivery. Despite this understanding, the use of gloves during delivery and hand washing during and after delivery were mentioned infrequently. The need for a clean delivery surface was raised repeatedly, including explicit discussion of avoiding delivering in the dirt. Many activities to do with cord care involved non-sterile materials and practices: 1) Cord cutting was done with a variety of tools, and the most commonly used were razor blades or scissors; 2) Cord tying utilized a variety of materials, including string, rope, thread, twigs, and clamps; and 3) Cord care often involved applying traditional salves to the cord - including shea butter, ground shea nuts, local herbs, local oil, or “red earth sand.” Keeping babies and their surroundings clean was mentioned repeatedly as an important way to keep babies from falling ill. Conclusions This study suggests a widespread understanding in rural northern Ghana of the need for clean delivery. Nonetheless, many recommended clean delivery practices are ignored. Overarching themes emerging from this study included the increasing use of facility-based delivery, the

  11. Behavioral Disorders: Practice Concerns and Students with EBD. Advances in Special Education. Volume 23

    ERIC Educational Resources Information Center

    Bakken, Jeffrey P., Ed.; Obiakor, Festus E., Ed.; Rotatori, Anthony F., Ed.

    2012-01-01

    Volumes 22 and 23 of the "Advances in Special Education" address the current top perspectives and issues in the field of emotional and behavioral disorders (EBD) by providing chapters written by active researchers and scholarly university professors who specialize in this area. Volume 22 first delineates legal issues, themes, and dimensions…

  12. [Triple therapy in cirrhotic patients and those with advanced fibrosis: relevant aspects in clinical practice].

    PubMed

    Albillos, Agustín; Luis Calleja, José; Molina, Esther; Planas, Ramon; Romero-Gómez, Manuel; Turnes, Juan; Hernández-Guerra, Manuel

    2014-07-01

    The first-line option in the treatment of patients with advanced fibrosis and cirrhosis due to genotype 1 hepatitis C virus is currently triple therapy with boceprevir/telaprevir and pegylated interferon-ribavirin. However, certain limitations could constitute a barrier to starting treatment or achieving sustained viral response in these patients. These limitations include the patient's or physician's perception of treatment effectiveness in routine clinical practice-which can weight against the decision to start treatment-, the advanced stage of the disease with portal hypertension and comorbidity, treatment interruption due to poor adherence, and adverse effects, mainly anemia. In addition, it is now possible to identify patients who could benefit from a shorter therapeutic regimen with a similar cure rate. This review discusses these issues and their possible effect on the use of triple therapy. PMID:25907434

  13. Pharmacy Student Learning During Advanced Pharmacy Practice Experiences in Relation to the CAPE 2013 Outcomes

    PubMed Central

    May, Dianne W.; Kanmaz, Tina J.; Reidt, Shannon L.; Serres, Michelle L.; Edwards, Heather D.

    2016-01-01

    Outcomes from The Center for Advancement of Pharmacy Education (CAPE) are intended to represent the terminal knowledge, skills, and attitudes pharmacy students should possess and have guided delivery of pharmacy education for more than two decades. Advanced pharmacy practice experiences (APPEs) are the endpoint of pharmacy curricula where demonstration and assessment of terminal learning occurs. This review examines published literature in relation to the most recent CAPE outcomes to determine the extent to which they have been addressed during APPEs since 1996. Details related to the APPE focus, intervention(s)/learning setting(s), and assessments are summarized according to the 15 CAPE outcomes. Further, the assessments are categorized according to the level of learning achieved using an available method. Common CAPE outcomes are highlighted, as well as those for which published reports are lacking for APPEs. The range and quality of assessments are discussed and emphasize the need for continuous improvement of scholarly design and assessment. PMID:27756935

  14. Advanced Practice Nursing: Meeting the Caregiving Challenges for Families of Persons with Frontotemporal Dementia

    PubMed Central

    Merrilees, Jennifer; Ketelle, Robin

    2010-01-01

    Frontotemporal dementia (FTD), once thought to be a rare cause for dementia, is now acknowledged to be the most common presenile (before age 65) cause of dementia (1). FTD is associated with profound changes in behavior, personality, emotions, and cognition. The purpose of this paper is to describe two cases of patients with FTD in order to illustrate salient aspects of the caregiving experience. Issues faced by caregivers are organized into 6 categories: diagnosis, behavioral symptoms, function, communication, long term management and care, and maintenance of the caregiver’s emotional and physical health. Examples of interventions directed by advanced practice nurses are described. We suggest that management of FTD requires expertise as scientific advances and discoveries about FTD continually change the landscape of care. PMID:20716977

  15. The patient perspective: arthritis care provided by Advanced Clinician Practitioner in Arthritis Care program-trained clinicians

    PubMed Central

    Warmington, Kelly; Kennedy, Carol A; Lundon, Katie; Soever, Leslie J; Brooks, Sydney C; Passalent, Laura A; Shupak, Rachel; Schneider, Rayfel

    2015-01-01

    Objective To assess patient satisfaction with the arthritis care services provided by graduates of the Advanced Clinician Practitioner in Arthritis Care (ACPAC) program. Materials and methods This was a cross-sectional evaluation using a self-report questionnaire for data collection. Participants completed the Patient–Doctor Interaction Scale, modified to capture patient–practitioner interactions. Participants completed selected items from the Group Health Association of America’s Consumer Satisfaction Survey, and items capturing quality of care, appropriateness of wait times, and a comparison of extended-role practitioner (ERP) services with previously received arthritis care. Results A total of 325 patients seen by 27 ERPs from 15 institutions completed the questionnaire. Respondents were primarily adults (85%), female (72%), and living in urban areas (79%). The mean age of participants was 54 years (range 3–92 years), and 51% were not working. Patients with inflammatory (51%) and noninflammatory conditions (31%) were represented. Mean (standard deviation) Patient–Practitioner Interaction Scale subscale scores ranged from 4.50 (0.60) to 4.63 (0.48) (1 to 5 [greater satisfaction]). Overall satisfaction with the quality of care was high (4.39 [0.77]), as was satisfaction with wait times (referral to appointment, 4.27 [0.86]; in clinic, 4.24 [0.91]). Ninety-eight percent of respondents felt the arthritis care they received was comparable to or better than that previously received from other health care professionals. Conclusion Patients were very satisfied with and amenable to arthritis care provided by graduates of the ACPAC program. Our findings provide early support for the deployment and integration of ACPAC ERPs into the Ontario health care system and should inform future evaluation at the patient level. PMID:27790044

  16. Practice Patterns and Attitudes of Primary Care Providers and Barriers to Surveillance of Hepatocellular Carcinoma in Patients with Cirrhosis

    PubMed Central

    Dalton-Fitzgerald, Eimile; Tiro, Jasmin; Kandunoori, Pragathi; Halm, Ethan A.; Yopp, Adam; Singal, Amit G.

    2014-01-01

    Background & Aims Fewer than 20% of patients with cirrhosis undergo surveillance for hepatocellular carcinoma (HCC), so these tumors are often detected at late stages. Although primary care providers (PCPs) follow 60% of patients with cirrhosis in the US, little is known about their practice patterns for HCC surveillance. We investigated factors associated with adherence to guidelines for HCC surveillance by PCPs. Methods We conducted a web-based survey of all 131 PCPs at a large urban hospital. The survey was derived from validated surveys and pretested among providers; it included questions about provider and practice characteristics, self-reported rates of surveillance, surveillance test and frequency preference, and attitudes and barriers to HCC surveillance. Results We obtained a clinic-level response rate of 100% and provider-level response rate of 60%. Only 65% of respondents reported annual and 15% reported biannual surveillance of patients for HCC. Barriers to HCC surveillance included not being up-to-date with HCC guidelines (68% of PCPs), difficulties in communicating effectively with patients about HCC surveillance (56%), and more important issues to manage in clinic (52%). About half of PCPs (52%) reported using ultrasound or measurements of α-fetoprotein in surveillance; 96% said that this combination was effective in reducing HCC-related mortality. However, many providers incorrectly believed that clinical examination (45%), or levels of liver enzymes (59%) or α-fetoprotein alone (89%), were effective surveillance tools. Conclusions PCPs have misconceptions about tests to detect HCC that contribute to ineffective surveillance. Reported barriers to surveillance include suboptimal knowledge about guidelines, indicating a need for interventions, including provider education, to increase HCC surveillance effectiveness. PMID:25019694

  17. Real-world treatment practice in patients with advanced melanoma in the era before ipilimumab: results from the IMAGE study.

    PubMed

    Middleton, Mark R; Dalle, Stéphane; Claveau, Joel; Mut, Pilar; Hallmeyer, Sigrun; Plantin, Patrice; Highley, Martin; Kotapati, Srividya; Le, Trong Kim; Brokaw, Jane; Abernethy, Amy P

    2016-07-01

    The therapeutic landscape for advanced melanoma has recently been transformed by several novel agents (immune checkpoint inhibitors and molecular-targeted agents). The prospective, multi-site, observational study IMAGE (ipilimumab: management of advanced melanoma in real practice) included a retrospective cohort to describe real-world treatment prior to approval of the immune checkpoint inhibitor ipilimumab. This retrospective cohort of patients, who started second-line/subsequent treatment (index therapy) for advanced melanoma within 3 years before ipilimumab approval, was selected randomly by chart review. Collected data included treatment history, patient outcomes, and healthcare resource utilization. All patients had ≥1 year of follow-up data. This analysis included 177 patients from Europe (69%) and North America (31%). The most common index therapies (used alone or in combination) were fotemustine (23%), dacarbazine (21%), temozolomide (14%), and platinum-based chemotherapy (14%). Most patients (89%) discontinued index treatment during the study period; the most common reason was disease progression (59%). Among patients with tumor assessment (153/177; 86%), 2% had complete response, 5% had partial response, and 12% had stable disease on last tumor assessment. At 1-year study follow-up, median progression-free survival was 2.6 months (95% confidence interval [CI], 2.1-2.9) and median overall survival was 8.8 months (95% CI, 6.5-9.7). During follow-up, 95% of the patients had healthcare visits for advanced melanoma, 74% of whom were hospitalized or admitted to a hospice facility. These results provide insights into patient care with advanced melanoma in the era before ipilimumab and may serve as a benchmark for new agents in future real-world studies.

  18. Real-world treatment practice in patients with advanced melanoma in the era before ipilimumab: results from the IMAGE study.

    PubMed

    Middleton, Mark R; Dalle, Stéphane; Claveau, Joel; Mut, Pilar; Hallmeyer, Sigrun; Plantin, Patrice; Highley, Martin; Kotapati, Srividya; Le, Trong Kim; Brokaw, Jane; Abernethy, Amy P

    2016-07-01

    The therapeutic landscape for advanced melanoma has recently been transformed by several novel agents (immune checkpoint inhibitors and molecular-targeted agents). The prospective, multi-site, observational study IMAGE (ipilimumab: management of advanced melanoma in real practice) included a retrospective cohort to describe real-world treatment prior to approval of the immune checkpoint inhibitor ipilimumab. This retrospective cohort of patients, who started second-line/subsequent treatment (index therapy) for advanced melanoma within 3 years before ipilimumab approval, was selected randomly by chart review. Collected data included treatment history, patient outcomes, and healthcare resource utilization. All patients had ≥1 year of follow-up data. This analysis included 177 patients from Europe (69%) and North America (31%). The most common index therapies (used alone or in combination) were fotemustine (23%), dacarbazine (21%), temozolomide (14%), and platinum-based chemotherapy (14%). Most patients (89%) discontinued index treatment during the study period; the most common reason was disease progression (59%). Among patients with tumor assessment (153/177; 86%), 2% had complete response, 5% had partial response, and 12% had stable disease on last tumor assessment. At 1-year study follow-up, median progression-free survival was 2.6 months (95% confidence interval [CI], 2.1-2.9) and median overall survival was 8.8 months (95% CI, 6.5-9.7). During follow-up, 95% of the patients had healthcare visits for advanced melanoma, 74% of whom were hospitalized or admitted to a hospice facility. These results provide insights into patient care with advanced melanoma in the era before ipilimumab and may serve as a benchmark for new agents in future real-world studies. PMID:27118102

  19. Influences of attribution and stigma on working relationships with providers practicing Western psychiatry in the Taiwanese context.

    PubMed

    Chen, Fang-Pei; Wu, Hui-Ching; Huang, Chun-Jen

    2014-12-01

    This study examined influences of causal attributions of schizophrenia and perceived and internalized mental illness stigma on perceived working alliance with, and informational support received from doctors practicing Western psychiatry in the Taiwanese social-cultural context. This cross-sectional quantitative study used a non-probability, purposive sampling technique to recruit 212 Taiwanese diagnosed with schizophrenia from Taiwanese Alliance of the Mentally Ill, 4 community mental health rehabilitation centres and 2 psychiatric hospitals between July 2012 and March 2013. Linear regression models were used for analysis. The results showed that environmental attributions were positively associated with both perceived working alliance and perceived informational support, while supernatural attributions were negatively associated with perceived working alliance and perceived informational support. Perceived stigma had a negative association with perceived working alliance. The discrimination domain of internalized stigma specifically had a positive association with perceived working alliance, while the withdraw domain had a negative association with perceived informational support. Findings inform the importance of culturally sensitive practices in developing an effective working relationship. Western psychiatric care providers need to explore consumers' casual attributions of mental illness and understand the impact of stigma so that providers may successfully engage consumers in care and provide tailored illness education and information.

  20. Influences of attribution and stigma on working relationships with providers practicing Western psychiatry in the Taiwanese context.

    PubMed

    Chen, Fang-Pei; Wu, Hui-Ching; Huang, Chun-Jen

    2014-12-01

    This study examined influences of causal attributions of schizophrenia and perceived and internalized mental illness stigma on perceived working alliance with, and informational support received from doctors practicing Western psychiatry in the Taiwanese social-cultural context. This cross-sectional quantitative study used a non-probability, purposive sampling technique to recruit 212 Taiwanese diagnosed with schizophrenia from Taiwanese Alliance of the Mentally Ill, 4 community mental health rehabilitation centres and 2 psychiatric hospitals between July 2012 and March 2013. Linear regression models were used for analysis. The results showed that environmental attributions were positively associated with both perceived working alliance and perceived informational support, while supernatural attributions were negatively associated with perceived working alliance and perceived informational support. Perceived stigma had a negative association with perceived working alliance. The discrimination domain of internalized stigma specifically had a positive association with perceived working alliance, while the withdraw domain had a negative association with perceived informational support. Findings inform the importance of culturally sensitive practices in developing an effective working relationship. Western psychiatric care providers need to explore consumers' casual attributions of mental illness and understand the impact of stigma so that providers may successfully engage consumers in care and provide tailored illness education and information. PMID:24938185

  1. Advancing research and practice: the revised APA Division 30 definition of hypnosis.

    PubMed

    Elkins, Gary R; Barabasz, Arreed F; Council, James R; Spiegel, David

    2015-01-01

    This article describes the history, rationale, and guidelines for developing a new definition of hypnosis by the Society of Psychological Hypnosis, Division 30 of the American Psychological Association. The definition was developed with the aim of being concise, heuristic, and allowing for alternative theories of the mechanisms (to be determined in empirical scientific study). The definition of hypnosis is presented as well as definitions of the following related terms: hypnotic induction, hypnotizability, and hypnotherapy. The implications for advancing research and practice are discussed. The definitions are presented within the article.

  2. Advancing Research and Practice: The Revised APA Division 30 Definition of Hypnosis.

    PubMed

    Elkins, Gary R; Barabasz, Arreed F; Council, James R; Spiegel, David

    2015-04-01

    This article describes the history, rationale, and guidelines for developing a new definition of hypnosis by the Society of Psychological Hypnosis, Division 30 of the American Psychological Association. The definition was developed with the aim of being concise, being heuristic, and allowing for alternative theories of the mechanisms (to be determined in empirical scientific study). The definition of hypnosis is presented as well as definitions of the following related terms: hypnotic induction, hypnotizability, and hypnotherapy. The implications for advancing research and practice are discussed. The definitions are presented within the article.

  3. Can the Institute of Medicine trump the dominant logic of nursing? Leading change in advanced practice education.

    PubMed

    Dreher, Melanie C; Clinton, Patricia; Sperhac, Arlene

    2014-01-01

    The Institute of Medicine (IOM; 2010) has called for a transformation of the nursing profession to lead the redesign of health care in the United States. It acknowledges the need for profound change in nursing education, particularly advanced practice education, to produce the next generation of leaders in sufficient quantity to expand access, improve quality, and reduce cost. Although the IOM provides welcome validation of nursing's significant role, most of the recommendations are not new and have been advocated by nurse educators for decades. What has prevented us from creating the nimble and responsive educational programs that would ensure a sufficient corpus of advanced practice nurses with the relevant knowledge and skill to transform our ailing health system? Conceptualizing nursing as a complex, adaptive system (J.W. Begun and K. White, 1997), this article explores three examples of the dominant logic, grounded in a historical legacy that has kept the nursing profession from realizing its promise as a potent force: (a) the continuing preference for experience over education, (b) the belief that only nurses can teach nurses, and (c) the hegemony of the research doctorate.

  4. Gerontology found me: gaining understanding of advanced practice nurses in geriatrics.

    PubMed

    Campbell-Detrixhe, Dia D; Grassley, Jane S; Zeigler, Vicki L

    2013-10-01

    Examining the meanings of the experiences of advanced practice nurses (APNs) who chose to work with older adults and why they continue to work with this population was the focus of this hermeneutic qualitative research study. Twelve geriatric APNs currently practicing in two South Central states were interviewed using an open-ended interview guide. Using Gadamerian hermeneutics, the researchers identified Gerontology Found Me as the significant expression that reflected the fundamental meaning of the experience as a whole. Four themes emerged that further described the meanings of the participants' personal, educational, and professional experiences: Becoming a Gerontology Nurse, Being a Gerontology Nurse, Belonging to Gerontology, and Bringing Others to Gerontology. This study concluded that APNs' personal and professional experiences were more influential than educational experiences to become geriatric nurses, and having these personal and professional experiences of being in relationship with older individuals further contributed to their choice of gerontology.

  5. Variables Affecting Pharmacy Students’ Patient Care Interventions during Advanced Pharmacy Practice Experiences

    PubMed Central

    Patterson, Brandon J.; Sen, Sanchita; Bingham, Angela L.; Bowen, Jane F.; Ereshefsky, Benjamin; Siemianowski, Laura A.

    2016-01-01

    Objective. To identify the temporal effect and factors associated with student pharmacist self-initiation of interventions during acute patient care advanced pharmacy practice experiences (APPE). Methods. During the APPE, student pharmacists at an academic medical center recorded their therapeutic interventions and who initiated the intervention throughout clinical rotations. At the end of the APPE student pharmacists completed a demographic survey. Results. Sixty-two student pharmacists were included. Factors associated with lower rates of self-initiated interventions were infectious diseases and pediatrics APPEs and an intention to pursue a postgraduate residency. Timing of the APPE, previous specialty elective course completion, and previous hospital experience did not result in any significant difference in self-initiated recommendations. Conclusion. Preceptors should not base practice experience expectations for self-initiated interventions on previous student experience or future intentions. Additionally, factors leading to lower rates of self-initiated interventions on infectious diseases or pediatrics APPEs should be explored. PMID:27756924

  6. Description of an advanced practice nursing consultative model to reduce restrictive siderail use in nursing homes.

    PubMed

    Wagner, Laura M; Capezuti, Elizabeth; Brush, Barbara; Boltz, Marie; Renz, Susan; Talerico, Karen A

    2007-04-01

    Researchers have demonstrated that the use of physical restraints in nursing homes can be reduced, particularly where advanced practice nurses (APNs) are utilized. We examined the link between APN practice, siderail reduction, and the costs of siderail alternatives in 273 residents in four Philadelphia nursing homes. The majority of participants were cognitively and physically impaired with multiple co-morbidities. APNs recommended a total of 1,275 siderail-alternative interventions aimed at reducing fall risk. The median cost of siderail alternatives to prevent falls per resident was $135. Residents with a fall history experienced a significantly higher cost of recommendation compared to non-fallers. Findings suggest that an APN consultation model can effectively be implemented through comprehensive, individualized assessment without incurring substantial costs to the nursing home.

  7. Using focus groups to identify characteristics of an ideal work environment for Advanced Practice Clinicians.

    PubMed

    Motley, Robert J; Mazzaccaro, Richard J; Burmeister, David B; Land, Samuel D; Boulay, Richard M; Chung, Heiwon; Deitrick, Lynn; Sumner, Andrew D

    2016-09-01

    Advanced Practice Clinicians (APCs) in collaborative practice represent a diverse and valuable group of health care professionals, including nurse practitioners, physician assistants, nurse anesthetists, and nurse midwives. Because these healthcare professionals have been identified as part of the solution to physician shortages, it is critical for health networks to examine and address issues affecting collaborative relationships. We invited our network APCs to participate in focus group sessions to determine both attributes and barriers to an ideal work environment. Four major themes emerged: (1) compensation, (2) network representation, (3) employment structure, and (4) workplace culture. While issues relating to compensation and representation were prevalent, discussions also revealed the importance of relationships and communication. To ensure successful collaboration and, thereby, reduce clinician turnover, leaders must address gaps between the existing and ideal states in structural factors affecting job satisfaction (Themes 1-3) as well as the behavioral factors represented in workplace culture (Theme 4). PMID:27637819

  8. Using focus groups to identify characteristics of an ideal work environment for Advanced Practice Clinicians.

    PubMed

    Motley, Robert J; Mazzaccaro, Richard J; Burmeister, David B; Land, Samuel D; Boulay, Richard M; Chung, Heiwon; Deitrick, Lynn; Sumner, Andrew D

    2016-09-01

    Advanced Practice Clinicians (APCs) in collaborative practice represent a diverse and valuable group of health care professionals, including nurse practitioners, physician assistants, nurse anesthetists, and nurse midwives. Because these healthcare professionals have been identified as part of the solution to physician shortages, it is critical for health networks to examine and address issues affecting collaborative relationships. We invited our network APCs to participate in focus group sessions to determine both attributes and barriers to an ideal work environment. Four major themes emerged: (1) compensation, (2) network representation, (3) employment structure, and (4) workplace culture. While issues relating to compensation and representation were prevalent, discussions also revealed the importance of relationships and communication. To ensure successful collaboration and, thereby, reduce clinician turnover, leaders must address gaps between the existing and ideal states in structural factors affecting job satisfaction (Themes 1-3) as well as the behavioral factors represented in workplace culture (Theme 4).

  9. Examining clinicians' experiences providing sexual health services for LGBTQ youth: considering social and structural determinants of health in clinical practice.

    PubMed

    Knight, R E; Shoveller, J A; Carson, A M; Contreras-Whitney, J G

    2014-08-01

    Although barriers related to lesbian, gay, bisexual, transgender and queer (LGBTQ) youth's experiences accessing sexual health services have been examined in detail, research into the experiences and perceptions of clinicians providing these services has been conspicuously absent. The aim of this article is to explore the perceptions and experiences of clinicians providing sexual health services for LGBTQ youth. Drawing on in-depth, semi-structured interviews, this study examines 24 clinicians' experiences providing sexual health services to LGBTQ youth in five communities in British Columbia, Canada. Our findings reveal how many clinicians provide services to LGBTQ youth with a lack of cultural competency-either implicitly (e.g., by describing heteronormative practices) or explicitly (e.g., by expressing frustration that they had not been sufficiently provided with appropriate training related to LGBTQ youth sexual health). Institutional norms and values were identified as the dominant barriers in the effective provision of LGBTQ-tailored services. Many clinicians find themselves unprepared to provide culturally competent sexual health services that have both the capacity to address individual-level issues (e.g. promoting condom use) while considering (and adapting services to) the broader socio-cultural and structural conditions that can render LGBTQ youth socially vulnerable.

  10. Examining clinicians’ experiences providing sexual health services for LGBTQ youth: considering social and structural determinants of health in clinical practice

    PubMed Central

    Knight, R. E.; Shoveller, J. A.; Carson, A. M.; Contreras-Whitney, J. G.

    2014-01-01

    Although barriers related to lesbian, gay, bisexual, transgender and queer (LGBTQ) youth’s experiences accessing sexual health services have been examined in detail, research into the experiences and perceptions of clinicians providing these services has been conspicuously absent. The aim of this article is to explore the perceptions and experiences of clinicians providing sexual health services for LGBTQ youth. Drawing on in-depth, semi-structured interviews, this study examines 24 clinicians’ experiences providing sexual health services to LGBTQ youth in five communities in British Columbia, Canada. Our findings reveal how many clinicians provide services to LGBTQ youth with a lack of cultural competency—either implicitly (e.g. by describing heteronormative practices) or explicitly (e.g. by expressing frustration that they had not been sufficiently provided with appropriate training related to LGBTQ youth sexual health). Institutional norms and values were identified as the dominant barriers in the effective provision of LGBTQ-tailored services. Many clinicians find themselves unprepared to provide culturally competent sexual health services that have both the capacity to address individual-level issues (e.g. promoting condom use) while considering (and adapting services to) the broader socio-cultural and structural conditions that can render LGBTQ youth socially vulnerable. PMID:24412811

  11. Advanced practice in neurocritical care: an innovative orientation and competency model.

    PubMed

    Vicari-Christensen, Michele

    2014-02-01

    The advanced registered nurse practitioner (ARNP) began in the 1960s as an alternative provider to meet the demands of an escalating healthcare resource deficit. As the role evolved and ARNPs demonstrated safe and effective care, these providers began to appear in critical care settings. It is believed that in the specialty of Neurocritical Care, about half the providers are ARNPs. Hiring and training practitioners for this complex environment is daunting. At the University of Florida & Shands Jacksonville, an innovative orientation and competency model for ARNPs hired for the newly opened Neurocritical Care unit was developed and implemented. The program contains a roadmap for knowledge base and skill acquisition as well as competency training and maintenance. Experience with appropriate hiring and screening standards, internally developed training tools, and identification of necessary advanced classes are discussed. This model may be used as a guideline for Neurocritical Care ARNP training as well as adapted for all other critical care settings. PMID:24399169

  12. Effectiveness of Practices To Increase Timeliness of Providing Targeted Therapy for Inpatients with Bloodstream Infections: a Laboratory Medicine Best Practices Systematic Review and Meta-analysis

    PubMed Central

    Buehler, Stephanie S.; Madison, Bereneice; Snyder, Susan R.; Derzon, James H.; Saubolle, Michael A.; Weissfeld, Alice S.; Weinstein, Melvin P.; Liebow, Edward B.; Wolk, Donna M.

    2015-01-01

    SUMMARY Background. Bloodstream infection (BSI) is a major cause of morbidity and mortality throughout the world. Rapid identification of bloodstream pathogens is a laboratory practice that supports strategies for rapid transition to direct targeted therapy by providing for timely and effective patient care. In fact, the more rapidly that appropriate antimicrobials are prescribed, the lower the mortality for patients with sepsis. Rapid identification methods may have multiple positive impacts on patient outcomes, including reductions in mortality, morbidity, hospital lengths of stay, and antibiotic use. In addition, the strategy can reduce the cost of care for patients with BSIs. Objectives. The purpose of this review is to evaluate the evidence for the effectiveness of three rapid diagnostic practices in decreasing the time to targeted therapy for hospitalized patients with BSIs. The review was performed by applying the Centers for Disease Control and Prevention's (CDC's) Laboratory Medicine Best Practices Initiative (LMBP) systematic review methods for quality improvement (QI) practices and translating the results into evidence-based guidance (R. H. Christenson et al., Clin Chem 57:816–825, 2011, http://dx.doi.org/10.1373/clinchem.2010.157131). Search strategy. A comprehensive literature search was conducted to identify studies with measurable outcomes. A search of three electronic bibliographic databases (PubMed, Embase, and CINAHL), databases containing “gray” literature (unpublished academic, government, or industry evidence not governed by commercial publishing) (CIHI, NIHR, SIGN, and other databases), and the Cochrane database for English-language articles published between 1990 and 2011 was conducted in July 2011. Dates of search. The dates of our search were from 1990 to July 2011. Selection criteria. Animal studies and non-English publications were excluded. The search contained the following medical subject headings: bacteremia; bloodstream

  13. Effectiveness of Practices To Increase Timeliness of Providing Targeted Therapy for Inpatients with Bloodstream Infections: a Laboratory Medicine Best Practices Systematic Review and Meta-analysis

    PubMed Central

    Buehler, Stephanie S.; Madison, Bereneice; Snyder, Susan R.; Derzon, James H.; Saubolle, Michael A.; Weissfeld, Alice S.; Weinstein, Melvin P.; Liebow, Edward B.; Wolk, Donna M.

    2015-01-01

    SUMMARY Background. Bloodstream infection (BSI) is a major cause of morbidity and mortality throughout the world. Rapid identification of bloodstream pathogens is a laboratory practice that supports strategies for rapid transition to direct targeted therapy by providing for timely and effective patient care. In fact, the more rapidly that appropriate antimicrobials are prescribed, the lower the mortality for patients with sepsis. Rapid identification methods may have multiple positive impacts on patient outcomes, including reductions in mortality, morbidity, hospital lengths of stay, and antibiotic use. In addition, the strategy can reduce the cost of care for patients with BSIs. Objectives. The purpose of this review is to evaluate the evidence for the effectiveness of three rapid diagnostic practices in decreasing the time to targeted therapy for hospitalized patients with BSIs. The review was performed by applying the Centers for Disease Control and Prevention's (CDC's) Laboratory Medicine Best Practices Initiative (LMBP) systematic review methods for quality improvement (QI) practices and translating the results into evidence-based guidance (R. H. Christenson et al., Clin Chem 57:816–825, 2011, http://dx.doi.org/10.1373/clinchem.2010.157131). Search strategy. A comprehensive literature search was conducted to identify studies with measurable outcomes. A search of three electronic bibliographic databases (PubMed, Embase, and CINAHL), databases containing “gray” literature (unpublished academic, government, or industry evidence not governed by commercial publishing) (CIHI, NIHR, SIGN, and other databases), and the Cochrane database for English-language articles published between 1990 and 2011 was conducted in July 2011. Dates of search. The dates of our search were from 1990 to July 2011. Selection criteria. Animal studies and non-English publications were excluded. The search contained the following medical subject headings: bacteremia; bloodstream

  14. Advanced Practice Registered Nurses: Gateway to Screening for Bipolar Disorder in Primary Care

    PubMed Central

    Kriebel-Gasparro, Ann Marie

    2016-01-01

    Objective: The goal of this mixed methods descriptive study was to explore Advanced Practice Registered Nurses’ (APRNs’) knowledge of bipolar disorder (BPD) and their perceptions of facilitators and barriers to screening patients with known depression for BPD. Methods: A mixed method study design using surveys on BPD knowledge and screening practices as well as focus group data collection method for facilitators and barriers to screening. Results: 89 APRNs completed the survey and 12 APRNs participated in the focus groups. APRNs in any practice setting had low knowledge scores of BPD. No significant differences in screening for BPD for primary and non primary care APRNs. Qualitative findings revealed screening relates to tool availability; time, unsure of when to screen, fear of sigma, symptoms knowledge of BPD, accessible referral system, personal experiences with BPD, and therapeutic relationships with patients. Conclusion: Misdiagnosis of BPD as unipolar depression is common in primary care settings, leading to a long lag time to optimal diagnosis and treatment. The wait time to diagnosis and treatment could be reduced if APRNs in primary care settings screen patients with a diagnosis of depression by using validated screening tools. These results can inform APRN practice and further research on the effectiveness of screening for reducing the morbidity and mortality of BPDs in primary care settings; underscores the need for integration of mental health care into primary care as well as the need for more APRN education on the diagnosis and management of bipolar disorders. PMID:27347256

  15. Research for the advancement of green chemistry practice: Studies in atmospheric and educational chemistry

    NASA Astrophysics Data System (ADS)

    Cullipher, Steven Gene

    Green chemistry is a philosophy of chemistry that emphasizes a decreasing dependence on limited non-renewable resources and an increasing focus on preventing pollution byproducts of the chemical industry. In short, it is the discipline of chemistry practiced through the lens of environmental stewardship. In an effort to advance the practice of green chemistry, three studies will be described that have ramifications for the practice. The first study examines the atmospheric oxidation of a hydrofluorinated ether, a third-generation CFC replacement compound with primarily unknown atmospheric degradation products. Determination of these products has the potential to impact decisions on refrigerant usage in the future. The second study examines chemistry students' development of understanding benefits-costs-risks analysis when presented with two real-world scenarios: refrigerant choice and fuel choice. By studying how benefits-costs-risks thinking develops, curricular materials and instructional approaches can be designed to better foster the development of an ability that is both necessary for green chemists and important in daily decision-making for non-chemists. The final study uses eye tracking technology to examine students' abilities to interpret molecular properties from structural information in the context of global warming. Such abilities are fundamental if chemists are to appropriately assess risks and hazards of chemistry practice.

  16. Practice Variation in Percutaneous Endoscopic Gastrostomy Tube Placement: Trends and Predictors among Providers in the United States

    PubMed Central

    Day, Lukejohn W.; Nazareth, Michelle; Sewell, Justin L.; Williams, J. Lucas; Lieberman, David A.

    2014-01-01

    Background Enteral access placement is performed among a variety of providers and specialties, yet there is a dearth of literature on trends and factors related to enteral access placement in the United States. Objective To examine trends in the incidence of enteral access procedures performed by gastroenterologists in the United States. Design Retrospective review of upper endoscopic procedures that involved percutaneous endoscopic gastrostomy (PEG) tube placement between 2000 and 2010 was performed. Setting Endoscopy sites participating in the Clinical Outcomes Research Initiative (CORI). Patients Patients undergoing an upper endoscopy. Intervention PEG tube placement. Main Outcome Measurements Number of PEG tubes placed. Results Overall PEG tube placement by a provider from 2000-2010 was 1.7% (number of PEG tubes performed/number of upper endoscopies performed) with the majority of them being performed by gastroenterologists. Very young and very old, non-white racial background (Hispanic OR 1.21; 95% CI, 1.13-1.28; blacks OR 2.24; 95% CI, 2.12-2.36) and males (OR 1.44; 95% CI, 1.39-1.50) were patient characteristics associated with greater PEG tube placement. In terms of practice setting, PEG tube placement occurred more frequently in a community/HMO environment and the East Coast. With respect to provider characteristics, male providers were less likely than females to perform a PEG tube (OR, 0.67; 95% CI, 0.64-0.71) and there was a trend that as providers were further out of medical school they were less likely to perform a PEG tube procedure. Interestingly, surgeons (OR 6.69; 95% CI, 6.18-7.24) and other providers (non-pediatric/non-general practitioner) (OR 3.22; 95% CI, 2.63-3.94) were more likely to perform PEG tubes than gastroenterologists. Limitations Participation in CORI is voluntary and may not capture data on non-GI providers. Conclusions Significant practice variation was noted in PEG tube placement in the United States with respect to patient and

  17. Primary care provider practices and beliefs related to cervical cancer screening with the HPV test in Federally Qualified Health Centers

    PubMed Central

    Roland, K.B.; Benard, V.B.; Greek, A.; Hawkins, N.A.; Manninen, D.; Saraiya, M.

    2015-01-01

    Objective Cervical cancer screening using the human papillomavirus (HPV) test and Pap test together (co-testing) is an option for average-risk women ≥30 years of age. With normal co-test results, screening intervals can be extended. The study objective is to assess primary care provider practices, beliefs, facilitators and barriers to using the co-test and extending screening intervals among low-income women. Method Data were collected from 98 providers in 15 Federally Qualified Health Center (FQHC) clinics in Illinois between August 2009 and March 2010 using a cross-sectional survey. Results 39% of providers reported using the co-test, and 25% would recommend a three-year screening interval for women with normal co-test results. Providers perceived greater encouragement for co-testing than for extending screening intervals with a normal co-test result. Barriers to extending screening intervals included concerns about patients not returning annually for other screening tests (77%), patient concerns about missing cancer (62%), and liability (52%). Conclusion Among FQHC providers in Illinois, few administered the co-test for screening and recommended appropriate intervals, possibly due to concerns over loss to follow-up and liability. Education regarding harms of too-frequent screening and false positives may be necessary to balance barriers to extending screening intervals. PMID:23628517

  18. Blood and Body Fluid Exposure Related Knowledge, Attitude and Practices of Hospital Based Health Care Providers in United Arab Emirates

    PubMed Central

    Griffiths, Robin; Beshyah, Salem A; Myers, Julie; Zaidi, Mukarram A

    2012-01-01

    Objectives Knowledge, attitudes, and practices of healthcare providers related to occupational exposure to bloodborne pathogens were assessed in a tertiary-care hospital in Middle East. Methods A cross-sectional study was undertaken using a self-administered questionnaire based on 3 paired (infectivity known vs. not known-suspected) case studies. Only 17 out of 230 respondents had an exposure in the 12 months prior to the survey and of these, only 2 had complied fully with the hospital's exposure reporting policy. Results In the paired case studies, the theoretical responses of participating health professionals showed a greater preference for initiating self-directed treatment with antivirals or immunisation rather than complying with the hospital protocol, when the patient was known to be infected. The differences in practice when exposed to a patient with suspected blood pathogens compared to patient known to be infected was statistically significant (p < 0.001) in all 3 paired cases. Failure to test an infected patient's blood meant that an adequate risk assessment and appropriate secondary prevention could not be performed, and reflected the unwillingness to report the occupational exposure. Conclusion Therefore, the study demonstrated that healthcare providers opted to treat themselves when exposed to patient with infectious disease, rather than comply with the hospital reporting and assessment protocol. PMID:23019533

  19. The current practices of speech-language pathologists in providing information to clients with traumatic brain injury.

    PubMed

    Short, Jessica; McCormack, Jane; Copley, Anna

    2014-06-01

    The provision of information about cognitive-communication disorders (CCDs) following traumatic brain injury (TBI) is important given the impact these communication impairments can have on the rehabilitation of people with TBI. This study describes the results of an online survey which investigated the current practices of 74 Australian speech-language pathologists (SLPs) working with adults with TBI. Thirty-seven SLPs outlined their practices in information provision. SLPs reported they provide information to adults with TBI about CCDs, the impact of CCDs on participation in life activities, and rehabilitation from CCDs. In addition, SLPs identified barriers and facilitators to information provision. Barriers identified included time, impairments resulting from TBI, and personal characteristics of the client. Facilitators included family functioning and support and the multidisciplinary team. Findings of this research indicate a need for some changes in the format and content of information that SLPs provide to adults with TBI, to ensure they can achieve fundamental levels of health literacy and better health outcomes. PMID:24588453

  20. Contrasting views of animal healthcare providers on worm control practices for sheep and goats in an arid environment

    PubMed Central

    Saddiqi, H.A.; Jabbar, A.; Babar, W.; Sarwar, M.; Iqbal, Z.; Cabaret, J.

    2012-01-01

    A questionnaire survey was conducted to determine the worm control practices and anthelmintic usage of 150 key respondents involved in sheep and goat production in the arid Thal area of Pakistan. The information was collected by visiting farms, and interviewing the key respondents which included veterinary officers (n = 15), veterinary assistants (n = 51), traditional practitioners (n = 24), and small and large scale sheep/goat farm herders and owners (n = 60). Among all interviewed animal healthcare providers, the veterinary officers had the highest level of awareness of parasitic infection and advocated the use of modern available anthelmintics according to the predefined schedule. The farmers on the other hand, had the lowest level of knowledge about parasitic infections. They used modern anthelmintics at low frequencies (every six months) following an unusual practice of diluting the medicine. Veterinary assistants had a medium level of awareness about the parasitic infections using anthelmintic treatments when they deemed necessary rather than following a predefined treatment schedule. Traditional practitioners were also aware of parasitic infections and used traditional anthelmintics or a combination of the traditional and modern anthelmintics. The animal health providers had a different awareness and knowledge of parasitic infections which resulted in contrasting proposals for its control. The farmers used worm control measures in accordance with their own views and those of animal healthcare advisors, combining modern and traditional treatments. This study provides the first insight into the differing views of those animal healthcare providers who form the basis for effective parasitic control within the sheep and goat industry of an arid region. PMID:22314240

  1. How Do General Practitioners Conceptualise Advance Care Planning in Their Practice? A Qualitative Study

    PubMed Central

    De Vleminck, Aline; Pardon, Koen; Beernaert, Kim; Houttekier, Dirk; Vander Stichele, Robert; Deliens, Luc

    2016-01-01

    Objectives To explore how GPs conceptualise advance care planning (ACP), based on their experiences with ACP in their practice. Methods Five focus groups were held with 36 GPs. Discussions were analysed using a constant comparative method. Results Four overarching themes in the conceptualisations of ACP were discerned: (1) the organisation of professional care required to meet patients’ needs, (2) the process of preparing for death and discussing palliative care options, (3) the discussion of care goals and treatment decisions, (4) the completion of advance directives. Within these themes, ACP was both conceptualised in terms of content of ACP and/or in terms of tasks for the GP. A specific task that was mentioned throughout the discussion of the four different themes was (5) the task of actively initiating ACP by the GP versus passively waiting for patients’ initiation. Conclusions This study illustrates that GPs have varying conceptualisations of ACP, of which some are more limited to specific aspects of ACP. A shared conceptualisation and agreement on the purpose and goals of ACP is needed to ensure successful implementation, as well as a systematic integration of ACP in routine practice that could lead to a better uptake of all the important elements of ACP. PMID:27096846

  2. Mini Review of Integrated Care and Implications for Advanced Practice Nurse Role

    PubMed Central

    McIntosh, Diana; Startsman, Laura F.; Perraud, Suzanne

    2016-01-01

    Literature related to primary care and behavioral health integration initiatives is becoming abundant. The United States’ 2010 Patient Protection and Affordable Care Act included provisions encouraging increased collaboration of care for individuals with behavioral and physical health service needs in the public sector. There is relatively little known of Advanced Practice Registered Nurses’ (APRNs) roles with integrating primary and behavioral healthcare. The goal of this review article is to: (a) define integration of physical and behavioral healthcare and potential models; (b) answer the question as to what are effective evidence based models/strategies for integrating behavioral health and primary care; (c) explore the future role and innovations of APRNs in the integration of physical and behavioral healthcare. Results: The evidence- based literature is limited to three systematic reviews and six randomized controlled trials. It was difficult to generalize the data and the effective integration strategies varied from such interventions as care management to use of sertraline to depression management and to access. There were, though, implications for the integrated care advanced practice nurse to have roles inclusive of competencies, leadership, engagement, collaboration and advocacy. PMID:27347258

  3. Attributes of advanced practice registered nurse care coordination for children with medical complexity.

    PubMed

    Cady, Rhonda G; Kelly, Anne M; Finkelstein, Stanley M; Looman, Wendy S; Garwick, Ann W

    2014-01-01

    Care coordination is an essential component of the pediatric health care home. This study investigated the attributes of relationship-based advanced practice registered nurse care coordination for children with medical complexity enrolled in a tertiary hospital-based health care home. Retrospective review of 2,628 care coordination episodes conducted by telehealth over a consecutive 3-year time period for 27 children indicated that parents initiated the majority of episodes and the most frequent reason was acute and chronic condition management. During this period, care coordination episodes tripled, with a significant increase (p < .001) between years 1 and 2. The increased episodes could explain previously reported reductions in hospitalizations for this group of children. Descriptive analysis of a program-specific survey showed that parents valued having a single place to call and assistance in managing their child's complex needs. The advanced practice registered nurse care coordination model has potential for changing the health management processes for children with medical complexity.

  4. ICON 2013: practical consensus recommendations for hormone receptor-positive Her2-negative advanced or metastatic breastcancer.

    PubMed

    Parikh, P M; Gupta, S; Dawood, S; Rugo, H; Bhattacharyya, G S; Agarwal, A; Chacko, R; Sahoo, T P; Babu, G; Agarwal, S; Munshi, A; Goswami, C; Smruti, B K; Bondarde, S; Desai, C; Rajappa, S; Somani, N; Singh, M; Nimmagadda, R; Pavitran, K; Mehta, A; Parmar, V; Desai, S; Nair, R; Doval, D

    2014-01-01

    The management of hormone receptor-positive Her2-negative breast cancer patients with advanced or metastatic disease is a common problem in India and other countries in this region. This expert group used data from published literature, practical experience, and opinion of a large group of academic oncologists, to arrive at practical consensus recommendations for use by the community oncologists.

  5. Evaluating and Advancing the Effective Teaching of Special Educators with a Dynamic Instructional Practices Portfolio

    ERIC Educational Resources Information Center

    Elliott, Stephen N.; Roach, Andrew T.; Kurz, Alexander

    2014-01-01

    We describe the concept of a dynamic instructional practices portfolio to evaluate special education teachers. This portfolio features the My Instructional Learning Opportunities Guidance System (MyiLOGS) as the core component. MyiLOGS is an online, daily self-report measure of opportunity to learn (OTL) that provides detailed information on…

  6. An Advanced Pharmacy Practice Experience in Application of Evidence-Based Policy

    PubMed Central

    Johnson, Jill T.

    2012-01-01

    Objective. To determine the impact of an advanced pharmacy practice experience (APPE) to develop skills needed to apply an evidence-based approach to population-level practice decisions. Design. A 4-week evidence-based medicine APPE was implemented that included active-learning techniques and online learning modules, participation in state drug-policy committee meetings, and completion of an evidence-based medicine review for a specific drug agent or class. Assessment. Students’ mean score on application of principles related to biostatistics and information mastery on posttests increased 15.8% from pretest to posttest. Students’ mean score on a 22-question information mastery quiz was 90.8%. Mean scores for course evaluation components ranged from 4.8 to 5.0 on a 5-point Likert scale. All respondents indicated they would recommend the APPE to other students. Conclusions. An APPE that incorporated content from active drug-policy committees increased students’ evidence-based medicine skills and enhanced their understanding of, appreciation for, and confidence in evidence-based practice. PMID:23049105

  7. Swedish Students' and Preceptors' Perceptions of What Students Learn in a Six-Month Advanced Pharmacy Practice Experience

    PubMed Central

    Sporrong, Sofia Kälvemark; Gustavsson, Maria; Lindblad, Åsa Kettis; Johansson, Markus; Ring, Lena

    2011-01-01

    Objective. To identify what pharmacy students learn during the 6-month advanced pharmacy practice experience (APPE) in Sweden. Methods. Semi-structured interviews were conducted with 18 pharmacy APPE students and 17 pharmacist preceptors and analyzed in a qualitative directed content analysis using a defined workplace learning typology for categories. Results. The Swedish APPE provides students with task performance skills for work at pharmacies and social and professional knowledge, such as teamwork, how to learn while in a work setting, self-evaluation, understanding of the pharmacist role, and decision making and problem solving skills. Many of these skills and knowledge are not accounted for in the curricula in Sweden. Using a workplace learning typology to identify learning outcomes, as in this study, could be useful for curricula development. Conclusions. Exploring the learning that takes place during the APPE in a pharmacy revealed a broad range of skills and knowledge that students acquire. PMID:22345716

  8. Nurse/parent role perceptions in care of neonatal intensive care unit infants: implications for the advanced practice nurse.

    PubMed

    Paredes, S D; Frank, D I

    2000-09-01

    This study compared parent and nurse perceptions of the nurse's roles regarding responsibilities toward infants in the neonatal intensive care unit (NICU). It also examined the attitudes of nurses and parents regarding the extent to which parents should participate in the care of their infants in the NICU, as well as the role of the advanced practice nurse (APN). The convenience sample of 25 parents of infants in the NICU and 35 nurses who cared for the infants was surveyed regarding perceptions of nurses and parents about nurse responsibilities and parent roles in the NICU. Results suggest parents and nurses have different perceptions about role expectations and that nurses perceive themselves to lack comfort and knowledge in providing support to parents. The findings support a role of the APN as fostering a nursing NICU philosophy to facilitate role transition for parents of infants in the NICU.

  9. The diagnosis of autism in community pediatric settings: does advanced training facilitate practice change?

    PubMed

    Swanson, Amy R; Warren, Zachary E; Stone, Wendy L; Vehorn, Alison C; Dohrmann, Elizabeth; Humberd, Quentin

    2014-07-01

    The increased prevalence of autism spectrum disorder and documented benefits of early intensive intervention have created a need for flexible systems for determining eligibility for autism-specific services. This study evaluated the effectiveness of a training program designed to enhance autism spectrum disorder identification and assessment within community pediatric settings across the state. Twenty-seven pediatric providers participated in regional trainings across a 3.5-year period. Trainings provided clinicians with strategies for conducting relatively brief within-practice interactive assessments following positive autism spectrum disorder screenings. Program evaluation was measured approximately 1.5 years following training through (a) clinician self-reports of practice change and (b) blind diagnostic verification of a subset of children assessed. Pediatric providers participating in the training reported significant changes in screening and consultation practices following training, with a reported 85% increase in diagnostic identification of children with autism spectrum disorder within their own practice setting. In addition, substantial agreement (86%-93%) was found between pediatrician diagnostic judgments and independent, comprehensive blinded diagnostic evaluations. Collaborative training methods that allow autism spectrum disorder identification within broader community pediatric settings may help translate enhanced screening initiatives into more effective and efficient diagnosis and treatment.

  10. Combining QOF data with the care bundle approach may provide a more meaningful measure of quality in general practice

    PubMed Central

    2012-01-01

    Background A significant minority of patients do not receive all the evidence-based care recommended for their conditions. Health care quality may be improved by reducing this observed variation. Composite measures offer a different patient-centred perspective on quality and are utilized in acute hospitals via the ‘care bundle’ concept as indicators of the reliability of specific (evidence-based) care delivery tasks and improved outcomes. A care bundle consists of a number of time-specific interventions that should be delivered to every patient every time. We aimed to apply the care bundle concept to selected QOF data to measure the quality of evidence-based care provision. Methods Care bundles and components were selected from QOF indicators according to defined criteria. Five clinical conditions were suitable for care bundles: Secondary Prevention of Coronary Heart Disease (CHD), Stroke & Transient Ischaemic Attack (TIA), Chronic Kidney Disease (CKD), Chronic Obstructive Pulmonary Disease (COPD) and Diabetes Mellitus (DM). Each bundle has 3-8 components. A retrospective audit was undertaken in a convenience sample of nine general medical practices in the West of Scotland. Collected data included delivery (or not) of individual bundle components to all patients included on specific disease registers. Practice level and overall compliance with bundles and components were calculated in SPSS and expressed as a percentage. Results Nine practices (64.3%) with a combined patient population of 56,948 were able to provide data in the format requested. Overall compliance with developed QOF-based care bundles (composite measures) was as follows: CHD 64.0%, range 35.0-71.9%; Stroke/TIA 74.1%, range 51.6-82.8%; CKD 69.0%, range 64.0-81.4%; and COPD 82.0%, range 47.9-95.8%; and DM 58.4%, range 50.3-65.2%. Conclusions In this small study compliance with individual QOF-based care bundle components was high, but overall (‘all or nothing’) compliance was substantially

  11. Advance care planning for residents in aged care facilities: what is best practice and how can evidence-based guidelines be implemented?

    PubMed

    Lyon, Cheryl

    2007-12-01

    Background  Advance care planning in a residential care setting aims to assist residents to make decisions about future healthcare and to improve end-of-life care through medical and care staff knowing and respecting the wishes of the resident. The process enables individuals and others who are important to them, to reflect on what is important to the resident including their beliefs/values and preferences about care when they are dying. This paper describes a project conducted as part of the Joanna Briggs Institute Clinical Aged Care Fellowship Program implemented at the Manningham Centre in metropolitan Melbourne in a unit providing services for 46 low and high care residents. Objectives  The objectives of the study were to document implementation of best practice in advance care planning in a residential aged care facility using a cycle of audit, feedback and re-audit cycle audit with a clinical audit software program, the Practical Application of Clinical Evidence System. The evidence-based guidelines found in 'Guidelines for a Palliative Approach in Residential Aged Care' were used to inform the process of clinical practice review and to develop a program to implement advance care planning. Results  The pre-implementation audit results showed that advance care planning practice was not based on high level evidence as initial compliance with five audit criteria was 0%. The barriers to implementation that became apparent during the feedback stage included the challenge of creating a culture where advance care planning policy, protocols and guidelines could be implemented, and advance care planning discussions held, by adequately prepared health professionals and carers. Opportunities were made to equip the resident to discuss their wishes with family, friends and healthcare staff. Some residents made the decision to take steps to formally document those wishes and/or appoint a Medical Enduring Power of Attorney to act on behalf of the resident when they

  12. Genitourinary tumours in the targeted therapies era: new advances in clinical practice and future perspectives.

    PubMed

    Messina, Carlo; Buzzatti, Giulia; Dellepiane, Chiara; Cavo, Alessia; Tolomeo, Francesco; Cattrini, Carlo; Boccardo, Francesco

    2016-11-01

    Genitourinary cancers represent a heterogeneous group of malignancies arising from genitourinary tract, and are responsible for almost 359 000 newly diagnosed cases and 58 420 related deaths in USA. Continuous advances in cancer genetics and genomics have contributed towards changing the management paradigms of these neoplasms. Neoangiogenesis, through the activation of the tyrosine-kinase receptors signalling pathways, represents the key mediator event in promoting tumour proliferation, differentiation, invasiveness and motility. In the last decade, several treatments have been developed with the specific aim of targeting different cell pathways that have been recognized to drive tumour progression. The following review attempts to provide a comprehensive overview of the literature, focusing on new advances in targeted therapies for genitourinary tumours. Furthermore, the promising results of the latest clinical trials and future perspectives will be discussed.

  13. Advanced Practice Nursing Committee on Process Improvement in Trauma: An Innovative Application of the Strong Model.

    PubMed

    West, Sarah Katherine

    2016-01-01

    This article aims to summarize the successes and future implications for a nurse practitioner-driven committee on process improvement in trauma. The trauma nurse practitioner is uniquely positioned to recognize the need for clinical process improvement and enact change within the clinical setting. Application of the Strong Model of Advanced Practice proves to actively engage the trauma nurse practitioner in process improvement initiatives. Through enhancing nurse practitioner professional engagement, the committee aims to improve health care delivery to the traumatically injured patient. A retrospective review of the committee's first year reveals trauma nurse practitioner success in the domains of direct comprehensive care, support of systems, education, and leadership. The need for increased trauma nurse practitioner involvement has been identified for the domains of research and publication.

  14. Journal Clubs During Advanced Pharmacy Practice Experiences to Teach Literature-Evaluation Skills

    PubMed Central

    Gim, Suzanna; Nogid, Anna; Shah, Bupendra

    2012-01-01

    Objective. To determine pharmacy students’ attitudes and academic performance related to journal club during 2 advanced pharmacy practice experiences (APPEs). Design. Fourth-year pharmacy students were required to complete 3 journal club assignments during drug information and internal medicine APPEs. Assessment. A majority (91.3%) of the 105 students who responded to a 21-item survey instrument indicated that journal club assignments during the drug-information APPE were valuable to their understanding of research design and statistics. Students who completed the drug-information APPE before the internal medicine APPE scored higher on their understanding of the strengths and weaknesses and the clinical relevance of studies and had a higher learning slope (p = 0.01) than did students who completed the internal medicine APPE first. Conclusion. Incorporating journal clubs into APPEs is an effective means of teaching literature-evaluation skills to pharmacy students. PMID:22761529

  15. Advanced Practice Nursing Committee on Process Improvement in Trauma: An Innovative Application of the Strong Model.

    PubMed

    West, Sarah Katherine

    2016-01-01

    This article aims to summarize the successes and future implications for a nurse practitioner-driven committee on process improvement in trauma. The trauma nurse practitioner is uniquely positioned to recognize the need for clinical process improvement and enact change within the clinical setting. Application of the Strong Model of Advanced Practice proves to actively engage the trauma nurse practitioner in process improvement initiatives. Through enhancing nurse practitioner professional engagement, the committee aims to improve health care delivery to the traumatically injured patient. A retrospective review of the committee's first year reveals trauma nurse practitioner success in the domains of direct comprehensive care, support of systems, education, and leadership. The need for increased trauma nurse practitioner involvement has been identified for the domains of research and publication. PMID:27414145

  16. Advancing universal coverage of healthcare in China: translating political will into policy and practice.

    PubMed

    Tang, Shenglan; Brixi, Hana; Bekedam, Henk

    2014-01-01

    China launched its new health system reform plan in 2009 to advance its universal coverage of healthcare, after more than 4 years' consultations and discussions with various stakeholders including the public. This paper aims to introduce and discuss the context and process of China's current health system reform and analyse how political will in China has been translated into policy practice over the past decade. The paper also shares the insights of World Health Organization's contribution to China's health system reform, as the authors advised the Chinese government on the reform options and process. Furthermore, the paper describes and discusses key challenges in the implementation of the reform plan over the past 3 years and draws lessons for other countries.

  17. The practice of commissioning healthcare from a private provider: learning from an in-depth case study

    PubMed Central

    2013-01-01

    Background The direction of health service policy in England is for more diversification in the design, commissioning and provision of health care services. The case study which is the subject of this paper was selected specifically because of the partnering with a private sector organisation to manage whole system redesign of primary care and to support the commissioning of services for people with long term conditions at risk of unplanned hospital admissions and associated service provision activities. The case study forms part of a larger Department of Health funded project on the practice of commissioning which aims to find the best means of achieving a balance between monitoring and control on the one hand, and flexibility and innovation on the other, and to find out what modes of commissioning are most effective in different circumstances and for different services. Methods A single case study method was adopted to explore multiple perspectives of the complexities and uniqueness of a public-private partnership referred to as the “Livewell project”. 10 single depth interviews were carried out with key informants across the GP practices, the PCT and the private provider involved in the initiative. Results The main themes arising from single depth interviews with the case study participants include a particular understanding about the concept of commissioning in the context of primary care, ambitions for primary care redesign, the importance of key roles and strong relationships, issues around the adoption and spread of innovation, and the impact of the current changes to commissioning arrangements. The findings identified a close and high trust relationship between GPs (the commissioners) and the private commissioning support and provider firm. The antecedents to the contract for the project being signed indicated the importance of leveraging external contacts and influence (resource dependency theory). Conclusions The study has surfaced issues around

  18. Spiritual care competence for contemporary nursing practice: A quantitative exploration of the guidance provided by fundamental nursing textbooks.

    PubMed

    Timmins, Fiona; Neill, Freda; Murphy, Maryanne; Begley, Thelma; Sheaf, Greg

    2015-11-01

    Spirituality is receiving unprecedented attention in the nursing literature. Both the volume and scope of literature on the topic is expanding, and it is clear that this topic is of interest to nurses. There is consensus that the spiritual required by clients receiving health ought to be an integrated effort across the health care team. Although undergraduate nurses receive some education on the topic, this is ad hoc and inconsistent across universities. Textbooks are clearly a key resource in this area however the extent to which they form a comprehensive guide for nursing students and nurses is unclear. This study provides a hitherto unperformed analysis of core nursing textbooks to ascertain spirituality related content. 543 books were examined and this provides a range of useful information about inclusions and omissions in this field. Findings revealed that spirituality is not strongly portrayed as a component of holistic care and specific direction for the provision of spiritual care is lacking. Fundamental textbooks used by nurses and nursing students ought to inform and guide integrated spiritual care and reflect a more holistic approach to nursing care. The religious and/or spiritual needs of an increasingly diverse community need to be taken seriously within scholarly texts so that this commitment to individual clients' needs can be mirrored in practice.

  19. Survey of HIV care providers on management of HIV serodiscordant couples - assessment of attitudes, knowledge, and practices.

    PubMed

    Scherer, Matthew L; Douglas, Nataki C; Churnet, Bethlehem H; Grossman, Lisa C; Kline, Melissa; Yin, Michael T; Sauer, Mark V; Olender, Susan A

    2014-01-01

    Human immunodeficiency virus (HIV) serodiscordant couples are at risk of sexual transmission of HIV between the infected and uninfected partner. We assessed New York area care providers for people living with HIV regarding attitudes, knowledge, and practice patterns toward fertility and conception in serodiscordant couples. Data were collected via a survey distributed in October 2013. Seventeen percent of respondents reported prescribing antiretroviral preexposure prophylaxis (PrEP) for a woman in a serodiscordant couple, and 38% percent of respondents reported having counseled serodiscordant couples on timed, unprotected intercourse without PrEP. Respondents who reported being "very" familiar with the data on HIV transmission in serodiscordant couples were more likely to report counseling their patients in timed, unprotected intercourse compared with those who reported less familiarity with the data (41% vs. 8%, p = 0.001). Although only 20% reported being "very" or "somewhat" familiar with the data on the safety of sperm washing with intrauterine insemination, those who did were more likely to have reported referring a patient for assisted reproductive technology (61% vs. 32%, p = 0.006). Effective patient counseling and referral for appropriate reproductive options were associated with knowledge of the literature pertaining to these options. This emphasizes the need for further provider education on reproductive options and appropriate counseling for serodiscordant couples.

  20. Delivering biodefense continuing education to military medical providers by allowing a biodefense educational curriculum to unfold in practice.

    PubMed

    D'Alessandro, Donna M; D'Alessandro, Michael P

    2007-12-01

    A challenge today is how to deliver initial and continuing education on biodefense to military medical providers in a manner that can be integrated into their workflow and lifestyle. A summative evaluation of a prototypical biodefense digital library (BDL) and learning collaboratory was performed. The BDL posted daily links to biodefense news stories from January 2004 to December 2005. Four evaluations were completed, that is, content evaluation, curriculum comparison with a biodefense graduate program, usage evaluation, and impact factor analysis. News stories (N = 678) came from a broad range of authoritative national and international news sources (N = 178). News stories covered all of the categories in the required and elective formal biodefense graduate program courses. The BDL was consistently displayed on the first page of the top three Internet search engines, meaning that it was among the top 10 authoritative Internet sites on biodefense. Presenting biodefense news stories to busy military medical providers in an organized chronological fashion produces an unstructured biodefense educational curriculum that unfolds in practice and becomes an educational resource that is ultimately well regarded and may be efficient to use.

  1. Emergency contraception in Nairobi, Kenya: knowledge, attitudes and practices among policymakers, family planning providers and clients, and university students.

    PubMed

    Muia, E; Ellertson, C; Lukhando, M; Flul, B; Clark, S; Olenja, J

    1999-10-01

    To gauge knowledge, attitudes, and practices about emergency contraception in Nairobi, Kenya, we conducted a five-part study. We searched government and professional association policy documents, and clinic guidelines and service records for references to emergency contraception. We conducted in-depth interviews with five key policymakers, and with 93 family planning providers randomly selected to represent both the public and private sectors. We also surveyed 282 family planning clients attending 10 clinics, again representing both sectors. Finally, we conducted four focus groups with university students. Although one specially packaged emergency contraceptive (Postinor levonorgestrel tablets) is registered in Kenya, the method is scarcely known or used. No extant policy or service guidelines address the method specifically, although revisions to several documents were planned. Yet policymakers felt that expanding access to emergency contraception would require few overt policy changes, as much of the guidance for oral contraception is already broad enough to cover this alternative use of those same commodities. Participants in all parts of the study generally supported expanded access to emergency contraception in Kenya. They did, however, want additional, detailed information, particularly about health effects. They also differed over exactly who should have access to emergency contraception and how it should be provided. PMID:10640169

  2. Advancing the educational agenda.

    PubMed

    Baker, Cynthia

    2010-12-01

    This timely paper provides a thought-provoking analysis of current advanced practice nursing education in Canada. It comes at a critical juncture in the evolution of Canadian healthcare services and the redefinition of nursing roles. Increasingly, multiple sectors of society are calling for more nurses with advanced practice preparation and for a wider range of advanced practice nursing specialties. Advanced practice nurses (APNs) are being proposed as a solution to a financially overburdened national healthcare system, the increasing complexity of healthcare services, and a crisis in access to primary healthcare. Thus, governments seeking greater fiscal efficiency, medical specialists needing sophisticated collaborative support, and healthcare consumers see APNs as the way forward.

  3. Advanced practice nursing in Canada: overview of a decision support synthesis.

    PubMed

    DiCenso, Alba; Martin-Misener, Ruth; Bryant-Lukosius, Denise; Bourgeault, Ivy; Kilpatrick, Kelley; Donald, Faith; Kaasalainen, Sharon; Harbman, Patricia; Carter, Nancy; Kioke, Sandra; Abelson, Julia; McKinlay, R James; Pasic, Dianna; Wasyluk, Brandi; Vohra, Julie; Charbonneau-Smith, Renee

    2010-12-01

    The objective of this decision support synthesis was to identify and review published and grey literature and to conduct stakeholder interviews to (1) describe the distinguishing characteristics of clinical nurse specialist (CNS) and nurse practitioner (NP) role definitions and competencies relevant to Canadian contexts, (2) identify the key barriers and facilitators for the effective development and utilization of CNS and NP roles and (3) inform the development of evidence-based recommendations for the individual, organizational and system supports required to better integrate CNS and NP roles into the Canadian healthcare system and advance the delivery of nursing and patient care services in Canada. Four types of advanced practice nurses (APNs) were the focus: CNSs, primary healthcare nurse practitioners (PHCNPs), acute care nurse practitioners (ACNPs) and a blended CNS/NP role. We worked with a multidisciplinary, multijurisdictional advisory board that helped identify documents and key informant interviewees, develop interview questions and formulate implications from our findings. We included 468 published and unpublished English- and French-language papers in a scoping review of the literature. We conducted interviews in English and French with 62 Canadian and international key informants (APNs, healthcare administrators, policy makers, nursing regulators, educators, physicians and other team members). We conducted four focus groups with a total of 19 APNs, educators, administrators and policy makers. A multidisciplinary roundtable convened by the Canadian Health Services Research Foundation formulated evidence-informed policy and practice recommendations based on the synthesis findings. This paper forms the foundation for this special issue, which contains 10 papers summarizing different dimensions of our synthesis. Here, we summarize the synthesis methods and the recommendations formulated at the roundtable.

  4. Factors associated with the use of advanced practice nurses/physician assistants in a fee-for-service nursing home practice: a comparison with primary care physicians.

    PubMed

    Bakerjian, Debra; Harrington, Charlene

    2012-07-01

    The purpose of this research was to examine factors associated with the use of advanced practice nurse and physician assistant (APN/PA) visits to nursing home (NH) patients compared with those by primary care physicians (PCPs). This was a secondary analysis using Medicare claims data. General estimation equations were used to determine the odds of NH residents receiving APN/PA visits. Ordinary least squares analyses were used to examine factors associated with these visits. A total of 5,436 APN/PAs provided care to 27% of 129,812 residents and were responsible for 16% of the 1.1 million Medicare NH fee-for-service visits in 2004. APN/PAs made an average of 33 visits annually compared with PCPs (21 visits). Neuropsychiatric and acute diagnoses and patients with a long-stay status were associated with more APN/PA visits. APN/PAs provide a substantial amount of care, but regional variations occur, and Medicare regulations constrain the ability of APN/PAs to substitute for physician visits.

  5. A conversation about practice development and knowledge translation as mechanisms to align the academic and clinical contexts for the advancement of nursing practice.

    PubMed

    Walsh, Kenneth; Kitson, Alison; Cross, Wendy; Thoms, Debra; Thornton, Anna; Moss, Cheryle; Campbell, Steve; Graham, Iain

    2012-01-01

    Practice development (PD) and knowledge translation (KT) have emerged recently as methodologies which assist advancement in gathering and using evidence in practice. For nursing to benefit from these methodologies there is a need to advance the dialogue between academia and the service sector concerning the use and further development of these methodologies as well as how we create the most effective partnerships between academia and practice. To advance this dialogue and to gain insights into the similarities and differences between KT and PD and between the academic and the service sectors, four conversations from different leaders in these sectors have been gathered and are presented here. These four discrete narratives are presented to showcase the diversity of sector contexts in relation to PD and KT methodologies. Narrative One focuses on some of the theoretical and policy issues related to creating partnerships between traditional "knowledge creation systems" (universities) and "knowledge utilization systems" Narrative Two discusses how a large school of nursing responded to the challenge of creating partnerships for practice development in an attempt to bridge the academic/service divide and produce benefits to both organisations. Narratives Three and Four describe the view of practice development from the service side. The final section of the paper presents an agenda for discussion and action based on the emerging set of principles.

  6. Consumers' understanding of and interest in provider- versus practice-level quality characteristics: findings from a focus group study.

    PubMed

    Smith, Brad; Lynch, Wendy D; Markow, Cathie; Lifsey, Sarah; Slover, Michael

    2015-01-01

    Quality measures are currently reported almost exclusively at the facility level. Forthcoming physician quality data are expected to be reported primarily at the level of the group practice. Little is known about consumers' understanding of and interest in practice-level measures. The research team conducted 4 focus groups, half with individuals who had a chronic illness and half with individuals who did not. Most consumers correctly understand the concept of a physician practice. However, consumers exhibit little interest in practice-level characteristics, preferring information about their personal doctor. Understanding of and interest in practice-level quality does not differ by chronic disease status. Additional work must be done to design, develop, and test promotional and educational materials to accompany the planned reports to highlight the relevance of practice-level characteristics for consumer decision making. PMID:24755480

  7. Enhancing pediatric workforce diversity and providing culturally effective pediatric care: implications for practice, education, and policy making.

    PubMed

    2013-10-01

    This policy statement serves to combine and update 2 previously independent but overlapping statements from the American Academy of Pediatrics (AAP) on culturally effective health care (CEHC) and workforce diversity. The AAP has long recognized that with the ever-increasing diversity of the pediatric population in the United States, the health of all children depends on the ability of all pediatricians to practice culturally effective care. CEHC can be defined as the delivery of care within the context of appropriate physician knowledge, understanding, and appreciation of all cultural distinctions, leading to optimal health outcomes. The AAP believes that CEHC is a critical social value and that the knowledge and skills necessary for providing CEHC can be taught and acquired through focused curricula across the spectrum of lifelong learning. This statement also addresses workforce diversity, health disparities, and affirmative action. The discussion of diversity is broadened to include not only race, ethnicity, and language but also cultural attributes such as gender, religious beliefs, sexual orientation, and disability, which may affect the quality of health care. The AAP believes that efforts must be supported through health policy and advocacy initiatives to promote the delivery of CEHC and to overcome educational, organizational, and other barriers to improving workforce diversity. PMID:24081998

  8. Conditions for building a community of practice in an advanced physics laboratory

    NASA Astrophysics Data System (ADS)

    Irving, Paul W.; Sayre, Eleanor C.

    2014-06-01

    We use the theory of communities of practice and the concept of accountable disciplinary knowledge to describe how a learning community develops in the context of an upper-division physics laboratory course. The change in accountable disciplinary knowledge motivates students' enculturation into a community of practice. The enculturation process is facilitated by four specific structural features of the course and supported by a primary instructional choice. The four structural features are "paucity of instructor time," "all in a room together," "long and difficult experiments," and "same experiments at different times." The instructional choice is the encouragement of the sharing and development of knowledge and understanding by the instructor. The combination of the instructional choice and structural features promotes the development of the learning community in which students engage in authentic practices of a physicist. This results in a classroom community that can provide students with the opportunity to have an accelerated trajectory towards being a more central participant of the community of a practice of physicists. We support our claims with video-based observations of laboratory classroom interactions and individual, semistructured interviews with students about their laboratory experiences and physics identity.

  9. Sandia National Laboratories Advanced Simulation and Computing (ASC) software quality plan. Part 1 : ASC software quality engineering practices version 1.0.

    SciTech Connect

    Minana, Molly A.; Sturtevant, Judith E.; Heaphy, Robert; Hodges, Ann Louise; Boucheron, Edward A.; Drake, Richard Roy; Forsythe, Christi A.; Schofield, Joseph Richard, Jr.; Pavlakos, Constantine James; Williamson, Charles Michael; Edwards, Harold Carter

    2005-01-01

    The purpose of the Sandia National Laboratories (SNL) Advanced Simulation and Computing (ASC) Software Quality Plan is to clearly identify the practices that are the basis for continually improving the quality of ASC software products. Quality is defined in DOE/AL Quality Criteria (QC-1) as conformance to customer requirements and expectations. This quality plan defines the ASC program software quality practices and provides mappings of these practices to the SNL Corporate Process Requirements (CPR 1.3.2 and CPR 1.3.6) and the Department of Energy (DOE) document, ASCI Software Quality Engineering: Goals, Principles, and Guidelines (GP&G). This quality plan identifies ASC management and software project teams' responsibilities for cost-effective software engineering quality practices. The SNL ASC Software Quality Plan establishes the signatories commitment to improving software products by applying cost-effective software engineering quality practices. This document explains the project teams opportunities for tailoring and implementing the practices; enumerates the practices that compose the development of SNL ASC's software products; and includes a sample assessment checklist that was developed based upon the practices in this document.

  10. Role for Occupational Therapy in Community Mental Health: Using Policy to Advance Scholarship of Practice.

    PubMed

    Mahaffey, Lisa; Burson, Kathrine A; Januszewski, Celeste; Pitts, Deborah B; Preissner, Katharine

    2015-01-01

    Occupational therapists must be aware of professional and policy trends. More importantly, occupational therapists must be involved in efforts to influence policy both for the profession and for the people they serve (Bonder, 1987). Using the state of Illinois as an example, this article reviews the policies and initiatives that impact service decisions for persons with psychiatric disabilities as well as the rationale for including occupational therapy in community mental health service provision. Despite challenges in building a workforce of occupational therapists in the mental health system, this article makes the argument that the current climate of emerging policy and litigation combined with the supporting evidence provides the impetus to strengthen mental health as a primary area of practice. Implications for scholarship of practice related to occupational therapy services in community mental health programs for individuals with psychiatric disability are discussed. PMID:26115330

  11. Role for Occupational Therapy in Community Mental Health: Using Policy to Advance Scholarship of Practice.

    PubMed

    Mahaffey, Lisa; Burson, Kathrine A; Januszewski, Celeste; Pitts, Deborah B; Preissner, Katharine

    2015-01-01

    Occupational therapists must be aware of professional and policy trends. More importantly, occupational therapists must be involved in efforts to influence policy both for the profession and for the people they serve (Bonder, 1987). Using the state of Illinois as an example, this article reviews the policies and initiatives that impact service decisions for persons with psychiatric disabilities as well as the rationale for including occupational therapy in community mental health service provision. Despite challenges in building a workforce of occupational therapists in the mental health system, this article makes the argument that the current climate of emerging policy and litigation combined with the supporting evidence provides the impetus to strengthen mental health as a primary area of practice. Implications for scholarship of practice related to occupational therapy services in community mental health programs for individuals with psychiatric disability are discussed.

  12. Predictors of head start and child-care providers' healthful and controlling feeding practices with children aged 2 to 5 years.

    PubMed

    Dev, Dipti A; McBride, Brent A; Speirs, Katherine E; Donovan, Sharon M; Cho, Hyun Keun

    2014-09-01

    Few child-care providers meet the national recommendations for healthful feeding practices. Effective strategies are needed to address this disparity, but research examining influences on child-care providers' feeding practices is limited. The purpose of this study was to identify determinants of child-care providers' healthful and controlling feeding practices for children aged 2 to 5 years. In this cross-sectional study, child-care providers (n=118) from 24 center-based programs (six Head Start [HS], 11 Child and Adult Care Food Program [CACFP] funded, and seven non-CACFP) completed self-administered surveys during 2011-2012. Multilevel multivariate linear regression models were used to predict seven feeding practices. Working in an HS center predicted teaching children about nutrition and modeling healthy eating; that may be attributed to the HS performance standards that require HS providers to practice healthful feeding. Providers who reported being concerned about children's weight, being responsible for feeding children, and had an authoritarian feeding style were more likely to pressure children to eat, restrict intake, and control food intake to decrease or maintain children's weight. Providers with nonwhite race, who were trying to lose weight, who perceived nutrition as important in their own diet, and who had a greater number of nutrition training opportunities were more likely to use restrictive feeding practices. These findings suggest that individual- and child-care-level factors, particularly provider race, education, training, feeding attitudes and styles, and the child-care context may influence providers' feeding practices with young children. Considering these factors when developing interventions for providers to meet feeding practice recommendations may add to the efficacy of childhood obesity prevention programs. PMID:24618036

  13. 49 CFR 39.35 - May PVOs require a passenger with a disability to provide advance notice that he or she is...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 1 2010-10-01 2010-10-01 false May PVOs require a passenger with a disability to... TRANSPORTATION FOR INDIVIDUALS WITH DISABILITIES: PASSENGER VESSELS Nondiscrimination and Access to Services § 39.35 May PVOs require a passenger with a disability to provide advance notice that he or she...

  14. 14 CFR 382.25 - May a carrier require a passenger with a disability to provide advance notice that he or she is...

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 4 2010-01-01 2010-01-01 false May a carrier require a passenger with a disability to provide advance notice that he or she is traveling on a flight? 382.25 Section 382.25 Aeronautics and Space OFFICE OF THE SECRETARY, DEPARTMENT OF TRANSPORTATION (AVIATION PROCEEDINGS)...

  15. 14 CFR 382.27 - May a carrier require a passenger with a disability to provide advance notice in order to obtain...

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... service animal in the cabin; (9) Transportation of a service animal on a flight segment scheduled to take... disability to provide advance notice in order to obtain certain specific services in connection with a flight... Nondiscrimination and Access to Services and Information § 382.27 May a carrier require a passenger with...

  16. 14 CFR 382.27 - May a carrier require a passenger with a disability to provide advance notice in order to obtain...

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... service animal in the cabin; (9) Transportation of a service animal on a flight segment scheduled to take... disability to provide advance notice in order to obtain certain specific services in connection with a flight... Nondiscrimination and Access to Services and Information § 382.27 May a carrier require a passenger with...

  17. 14 CFR 382.27 - May a carrier require a passenger with a disability to provide advance notice in order to obtain...

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... service animal in the cabin; (9) Transportation of a service animal on a flight segment scheduled to take... disability to provide advance notice in order to obtain certain specific services in connection with a flight... Nondiscrimination and Access to Services and Information § 382.27 May a carrier require a passenger with...

  18. 14 CFR 382.27 - May a carrier require a passenger with a disability to provide advance notice in order to obtain...

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... service animal in the cabin; (9) Transportation of a service animal on a flight segment scheduled to take... disability to provide advance notice in order to obtain certain specific services in connection with a flight... Nondiscrimination and Access to Services and Information § 382.27 May a carrier require a passenger with...

  19. 14 CFR 382.25 - May a carrier require a passenger with a disability to provide advance notice that he or she is...

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 4 2014-01-01 2014-01-01 false May a carrier require a passenger with a disability to provide advance notice that he or she is traveling on a flight? 382.25 Section 382.25 Aeronautics and Space OFFICE OF THE SECRETARY, DEPARTMENT OF TRANSPORTATION (AVIATION PROCEEDINGS)...

  20. 14 CFR 382.25 - May a carrier require a passenger with a disability to provide advance notice that he or she is...

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 14 Aeronautics and Space 4 2012-01-01 2012-01-01 false May a carrier require a passenger with a disability to provide advance notice that he or she is traveling on a flight? 382.25 Section 382.25 Aeronautics and Space OFFICE OF THE SECRETARY, DEPARTMENT OF TRANSPORTATION (AVIATION PROCEEDINGS)...

  1. 14 CFR 382.25 - May a carrier require a passenger with a disability to provide advance notice that he or she is...

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 14 Aeronautics and Space 4 2013-01-01 2013-01-01 false May a carrier require a passenger with a disability to provide advance notice that he or she is traveling on a flight? 382.25 Section 382.25 Aeronautics and Space OFFICE OF THE SECRETARY, DEPARTMENT OF TRANSPORTATION (AVIATION PROCEEDINGS)...

  2. 14 CFR 382.25 - May a carrier require a passenger with a disability to provide advance notice that he or she is...

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 4 2011-01-01 2011-01-01 false May a carrier require a passenger with a disability to provide advance notice that he or she is traveling on a flight? 382.25 Section 382.25 Aeronautics and Space OFFICE OF THE SECRETARY, DEPARTMENT OF TRANSPORTATION (AVIATION PROCEEDINGS)...

  3. The impact of additional dental providers in the dental labor market on the income of private practice dentists.

    PubMed

    Brown, Timothy T; Hong, Juliette S

    2012-03-01

    This study estimates the impact that the entrance of hypothetical allied dental professionals into the dental labor market may have on the earnings of currently practicing private practice dentists. A simulation model that uses the most reliable available data was constructed and finds that the introduction of hypothetical allied dental professionals into the competitive California dental labor market is likely to have relatively small effects on the earnings of the average dentist in California.

  4. Some Misconceptions in Meiosis Shown by Students Responding to an Advanced Level Practical Examination Question in Biology.

    ERIC Educational Resources Information Center

    Brown, C. R.

    1990-01-01

    Discussed are problems revealed in student responses to a practical task which formed part of an advanced level examination. The frequencies with which some misconceptions about cell reproduction and genetics occurred are presented. The nature of these misconceptions is analyzed and their implications discussed. (CW)

  5. Feeding Tube Placement in Patients with Advanced Dementia: The Beliefs and Practice Patterns of Speech-Language Pathologists

    ERIC Educational Resources Information Center

    Sharp, Helen M.; Shega, Joseph W.

    2009-01-01

    Purpose: To describe the beliefs and practices of speech-language pathologists (SLPs) about the use of percutaneous endoscopic gastrostomy (PEG) among patients with advanced dementia and dysphagia. Method: A survey was mailed to a geographically stratified random sample of 1,050 medical SLPs. Results: The response rate was 57%, and 326 surveys met…

  6. Advanced practice nursing, health care teams, and perceptions of team effectiveness.

    PubMed

    Kilpatrick, Kelley; Lavoie-Tremblay, Mélanie; Ritchie, Judith A; Lamothe, Lise

    2011-01-01

    This article summarizes the results of an extensive review of the organizational and health care literature of advanced practice nursing (APN) roles, health care teams, and perceptions of team effectiveness. Teams have a long history in health care. Managers play an important role in mobilizing resources, guiding expectations of APN roles in teams and within organizations, and facilitating team process. Researchers have identified a number of advantages to the addition of APN roles in health care teams. The process within health care teams are dynamic and responsive to their surrounding environment. It appears that teams and perceptions of team effectiveness need to be understood in the broader context in which the teams are situated. Key team process are identified for team members to perceive their team as effective. The concepts of teamwork, perceptions of team effectiveness, and the introduction of APN roles in teams have been studied disparately. An exploration of the links between these concepts may further our understanding the health care team's perceptions of team effectiveness when APN roles are introduced. Such knowledge could contribute to the effective deployment of APN roles in health care teams and improve the delivery of health care services to patients and families.

  7. Advanced practice nursing, health care teams, and perceptions of team effectiveness.

    PubMed

    Kilpatrick, Kelley; Lavoie-Tremblay, Mélanie; Ritchie, Judith A; Lamothe, Lise

    2014-01-01

    This article summarizes the results of an extensive review of the organizational and health care literature of advanced practice nursing (APN) roles, health care teams, and perceptions of team effectiveness. Teams have a long history in health care. Managers play an important role in mobilizing resources, guiding expectations of APN roles in teams and within organizations, and facilitating team process. Researchers have identified a number of advantages to the addition of APN roles in health care teams. The process within health care teams are dynamic and responsive to their surrounding environment. It appears that teams and perceptions of team effectiveness need to be understood in the broader context in which the teams are situated. Key team process are identified for team members to perceive their team as effective. The concepts of teamwork, perceptions of team effectiveness, and the introduction of APN roles in teams have been studied disparately. An exploration of the links between these concepts may further our understanding the health care team's perceptions of team effectiveness when APN roles are introduced. Such knowledge could contribute to the effective deployment of APN roles in health care teams and improve the delivery of health care services to patients and families.

  8. Advanced practice nursing, health care teams, and perceptions of team effectiveness.

    PubMed

    Kilpatrick, Kelley; Lavoie-Tremblay, Mélanie; Ritchie, Judith A; Lamothe, Lise

    2014-01-01

    This article summarizes the results of an extensive review of the organizational and health care literature of advanced practice nursing (APN) roles, health care teams, and perceptions of team effectiveness. Teams have a long history in health care. Managers play an important role in mobilizing resources, guiding expectations of APN roles in teams and within organizations, and facilitating team process. Researchers have identified a number of advantages to the addition of APN roles in health care teams. The process within health care teams are dynamic and responsive to their surrounding environment. It appears that teams and perceptions of team effectiveness need to be understood in the broader context in which the teams are situated. Key team process are identified for team members to perceive their team as effective. The concepts of teamwork, perceptions of team effectiveness, and the introduction of APN roles in teams have been studied disparately. An exploration of the links between these concepts may further our understanding the health care team's perceptions of team effectiveness when APN roles are introduced. Such knowledge could contribute to the effective deployment of APN roles in health care teams and improve the delivery of health care services to patients and families. PMID:25397338

  9. Infusing Swanson's Theory of caring into an advanced practice nursing model for an infectious diseases anal dysplasia clinic.

    PubMed

    Ahern, Richard L; Corless, Inge B; Davis, Sheila M; Kwong, Jeffrey J

    2011-01-01

    The incidence of anal cancer is increasing among HIV-infected men and women. The process of screening for anal dysplasia and the management of abnormal findings are currently and most often based on a medical model. The needs of these patients, however, go well beyond medical care. A more comprehensive and holistic approach to health care is, therefore, required. Given the scope of practice of advanced practice nurses who are involved in the diagnosis and treatment of patients with anal dysplasia, it is appropriate for them to assume leadership roles in addressing the needs of these patients. This article describes the application of a theory of caring to create an advanced practice nursing model of care for HIV-infected men and women in infectious diseases anal dysplasia clinics. PMID:22035527

  10. Planning and scheduling the Hubble Space Telescope: Practical application of advanced techniques

    NASA Technical Reports Server (NTRS)

    Miller, Glenn E.

    1994-01-01

    NASA's Hubble Space Telescope (HST) is a major astronomical facility that was launched in April, 1990. In late 1993, the first of several planned servicing missions refurbished the telescope, including corrections for a manufacturing flaw in the primary mirror. Orbiting above the distorting effects of the Earth's atmosphere, the HST provides an unrivaled combination of sensitivity, spectral coverage and angular resolution. The HST is arguably the most complex scientific observatory ever constructed and effective use of this valuable resource required novel approaches to astronomical observation and the development of advanced software systems including techniques to represent scheduling preferences and constraints, a constraint satisfaction problem (CSP) based scheduler and a rule based planning system. This paper presents a discussion of these systems and the lessons learned from operational experience.

  11. Mind-body therapies: evidence and implications in advanced oncology practice.

    PubMed

    Mayden, Kelley D

    2012-11-01

    The idea that thoughts and emotions influence health outcomes is an ancient concept that was initially abandoned by Western medicine researchers. Today, researchers are showing a renewed interest in the interactions of the mind and body and the role these interactions play in disease formation and recovery. Complementary and alternative interventions, such as mind-body therapies, are increasingly being used by cancer survivors for disease prevention, immune system enhancement, and symptom control. Traditional training has not been structured to provide advanced practitioners with an in-depth knowledge of the clinical applications of mind-body therapies. The aim of this article is to acquaint the reader with common mind-body modalities (meditation/mindfulness-based stress reduction, relaxation therapy, cognitive-behavioral therapy, hypnosis, biofeedback, music therapy, art therapy, support groups, and aromatherapy) and to examine important evidence in support of or against their clinical application.

  12. Improving medical graduates’ training in palliative care: advancing education and practice

    PubMed Central

    Head, Barbara A; Schapmire, Tara J; Earnshaw, Lori; Chenault, John; Pfeifer, Mark; Sawning, Susan; Shaw, Monica A

    2016-01-01

    The needs of an aging population and advancements in the treatment of both chronic and life-threatening diseases have resulted in increased demand for quality palliative care. The doctors of the future will need to be well prepared to provide expert symptom management and address the holistic needs (physical, psychosocial, and spiritual) of patients dealing with serious illness and the end of life. Such preparation begins with general medical education. It has been recommended that teaching and clinical experiences in palliative care be integrated throughout the medical school curriculum, yet such education has not become the norm in medical schools across the world. This article explores the current status of undergraduate medical education in palliative care as published in the English literature and makes recommendations for educational improvements which will prepare doctors to address the needs of seriously ill and dying patients. PMID:26955298

  13. Improving medical graduates' training in palliative care: advancing education and practice.

    PubMed

    Head, Barbara A; Schapmire, Tara J; Earnshaw, Lori; Chenault, John; Pfeifer, Mark; Sawning, Susan; Shaw, Monica A

    2016-01-01

    The needs of an aging population and advancements in the treatment of both chronic and life-threatening diseases have resulted in increased demand for quality palliative care. The doctors of the future will need to be well prepared to provide expert symptom management and address the holistic needs (physical, psychosocial, and spiritual) of patients dealing with serious illness and the end of life. Such preparation begins with general medical education. It has been recommended that teaching and clinical experiences in palliative care be integrated throughout the medical school curriculum, yet such education has not become the norm in medical schools across the world. This article explores the current status of undergraduate medical education in palliative care as published in the English literature and makes recommendations for educational improvements which will prepare doctors to address the needs of seriously ill and dying patients.

  14. Advanced image reconstruction strategies for 4D prostate DCE-MRI: steps toward clinical practicality

    NASA Astrophysics Data System (ADS)

    Stinson, Eric G.; Borisch, Eric A.; Froemming, Adam T.; Kawashima, Akira; Young, Phillip M.; Warndahl, Brent A.; Grimm, Roger C.; Manduca, Armando; Riederer, Stephen J.; Trzasko, Joshua D.

    2015-09-01

    Dynamic contrast-enhanced (DCE) MRI is an important tool for the detection and characterization of primary and recurring prostate cancer. Advanced reconstruction strategies (e.g., sparse or low-rank regression) provide improved depiction of contrast dynamics and pharmacokinetic parameters; however, the high computation cost of reconstructing 4D (3D+time, 50+ frames) datasets typically inhibits their routine clinical use. Here, a novel alternating direction method-of-multipliers (ADMM) optimization strategy is described that enables these methods to be executed in ∠5 minutes, and thus within the standard clinical workflow. After overviewing the mechanics of this approach, high-performance implementation strategies will be discussed and demonstrated through clinical cases.

  15. Mind-Body Therapies: Evidence and Implications in Advanced Oncology Practice

    PubMed Central

    Mayden,, Kelley D.

    2012-01-01

    The idea that thoughts and emotions influence health outcomes is an ancient concept that was initially abandoned by Western medicine researchers. Today, researchers are showing a renewed interest in the interactions of the mind and body and the role these interactions play in disease formation and recovery. Complementary and alternative interventions, such as mind-body therapies, are increasingly being used by cancer survivors for disease prevention, immune system enhancement, and symptom control. Traditional training has not been structured to provide advanced practitioners with an in-depth knowledge of the clinical applications of mind-body therapies. The aim of this article is to acquaint the reader with common mind-body modalities (meditation/mindfulness-based stress reduction, relaxation therapy, cognitive-behavioral therapy, hypnosis, biofeedback, music therapy, art therapy, support groups, and aromatherapy) and to examine important evidence in support of or against their clinical application. PMID:25031967

  16. Advancing the application of systems thinking in health: exploring dual practice and its management in Kampala, Uganda

    PubMed Central

    2014-01-01

    Background Many full-time Ugandan government health providers take on additional jobs – a phenomenon called dual practice. We describe the complex patterns that characterize the evolution of dual practice in Uganda, and the local management practices that emerged in response, in five government facilities. An in-depth understanding of dual practice can contribute to policy discussions on improving public sector performance. Methods A multiple case study design with embedded units of analysis was supplemented by interviews with policy stakeholders and a review of historical and policy documents. Five facility case studies captured the perspective of doctors, nurses, and health managers through semi-structured in-depth interviews. A causal loop diagram illustrated interactions and feedback between old and new actors, as well as emerging roles and relationships. Results The causal loop diagram illustrated how feedback related to dual practice policy developed in Uganda. As opportunities for dual practice grew and the public health system declined over time, government providers increasingly coped through dual practice. Over time, government restrictions to dual practice triggered policy resistance and protest from government providers. Resulting feedback contributed to compromising the supply of government providers and, potentially, of service delivery outcomes. Informal government policies and restrictions replaced the formal restrictions identified in the early phases. In some instances, government health managers, particularly those in hospitals, developed their own practices to cope with dual practice and to maintain public sector performance. Management practices varied according to the health manager’s attitude towards dual practice and personal experience with dual practice. These practices were distinct in hospitals. Hospitals faced challenges managing internal dual practice opportunities, such as those created by externally-funded research projects based

  17. Evaluating Student Services Provided by School-based Health Centers: Applying the Shuler Nurse Practitioner Practice Model.

    ERIC Educational Resources Information Center

    Shuler, Pamela A.

    2000-01-01

    Presents guidelines for evaluating school-based health clinic services coordinated and/or staffed by nurse practitioners from a holistic approach. The Shuler Nurse Practitioner Practice Model is used as a theoretical framework for the guidelines because it presents a holistic approach to patient assessment, problem identification/diagnosis…

  18. Parents' Reports of School Practices to Provide Information to Families: 1996 and 2003. Statistics in Brief. NCES 2006-041

    ERIC Educational Resources Information Center

    Vaden-Kiernan, Nancy

    2005-01-01

    The purpose of the current report is to replicate analyses from the previous NCES report (Vaden-Kiernan 1996) with data from the 2003 survey. As with the previous report, parent-reported school information practices are discussed first and then examined in relation to the frequency of parent involvement at the school. Next, parent-reported school…

  19. Practical Considerations of Waste Heat Reuse for a Mars Mission Advanced Life Support System

    NASA Technical Reports Server (NTRS)

    Levri, Julie; Finn, Cory; Luna, Bernadette (Technical Monitor)

    2000-01-01

    Energy conservation is a key issue in design optimization of Advanced Life Support Systems (ALSS) for long-term space missions. By considering designs for conservation at the system level, energy saving opportunities arise that would otherwise go unnoticed. This paper builds on a steady-state investigation of system-level waste heat reuse in an ALSS with a low degree of crop growth for a Mars mission. In past studies, such a system has been defined in terms of technology types, hot and cold stream identification and stream energy content. The maximum steady-state potential for power and cooling savings within the system was computed via the Pinch Method. In this paper, several practical issues are considered for achieving a pragmatic estimate of total system savings in terms of equivalent system mass (ESM), rather than savings solely in terms of power and cooling. In this paper, more realistic ESM savings are computed by considering heat transfer inefficiencies during material transfer. An estimate of the steady-state mass, volume and crewtime requirements associated with heat exchange equipment is made by considering heat exchange equipment material type and configuration, stream flow characteristics and associated energy losses during the heat exchange process. Also, previously estimated power and cooling savings are adjusted to reflect the impact of such energy losses. This paper goes one step further than the traditional Pinch Method of considering waste heat reuse in heat exchangers to include ESM savings that occur with direct reuse of a stream. For example, rather than exchanging heat between crop growth lamp cooling air and air going to a clothes dryer, air used to cool crop lamps might be reused directly for clothes drying purposes. When thermodynamically feasible, such an approach may increase ESM savings by minimizing the mass, volume and crewtime requirements associated with stream routing equipment.

  20. Computer vision-based technologies and commercial best practices for the advancement of the motion imagery tradecraft

    NASA Astrophysics Data System (ADS)

    Phipps, Marja; Capel, David; Srinivasan, James

    2014-06-01

    Motion imagery capabilities within the Department of Defense/Intelligence Community (DoD/IC) have advanced significantly over the last decade, attempting to meet continuously growing data collection, video processing and analytical demands in operationally challenging environments. The motion imagery tradecraft has evolved accordingly, enabling teams of analysts to effectively exploit data and generate intelligence reports across multiple phases in structured Full Motion Video (FMV) Processing Exploitation and Dissemination (PED) cells. Yet now the operational requirements are drastically changing. The exponential growth in motion imagery data continues, but to this the community adds multi-INT data, interoperability with existing and emerging systems, expanded data access, nontraditional users, collaboration, automation, and support for ad hoc configurations beyond the current FMV PED cells. To break from the legacy system lifecycle, we look towards a technology application and commercial adoption model course which will meet these future Intelligence, Surveillance and Reconnaissance (ISR) challenges. In this paper, we explore the application of cutting edge computer vision technology to meet existing FMV PED shortfalls and address future capability gaps. For example, real-time georegistration services developed from computer-vision-based feature tracking, multiple-view geometry, and statistical methods allow the fusion of motion imagery with other georeferenced information sources - providing unparalleled situational awareness. We then describe how these motion imagery capabilities may be readily deployed in a dynamically integrated analytical environment; employing an extensible framework, leveraging scalable enterprise-wide infrastructure and following commercial best practices.

  1. Novel MEMS-based gas-cell/heating specimen holder provides advanced imaging capabilities for in situ reaction studies.

    PubMed

    Allard, Lawrence F; Overbury, Steven H; Bigelow, Wilbur C; Katz, Michael B; Nackashi, David P; Damiano, John

    2012-08-01

    In prior research, specimen holders that employ a novel MEMS-based heating technology (Aduro™) provided by Protochips Inc. (Raleigh, NC, USA) have been shown to permit sub-Ångström imaging at elevated temperatures up to 1,000°C during in situ heating experiments in modern aberration-corrected electron microscopes. The Aduro heating devices permit precise control of temperature and have the unique feature of providing both heating and cooling rates of 10⁶°C/s. In the present work, we describe the recent development of a new specimen holder that incorporates the Aduro heating device into a "closed-cell" configuration, designed to function within the narrow (2 mm) objective lens pole piece gap of an aberration-corrected JEOL 2200FS STEM/TEM, and capable of exposing specimens to gases at pressures up to 1 atm. We show the early results of tests of this specimen holder demonstrating imaging at elevated temperatures and at pressures up to a full atmosphere, while retaining the atomic resolution performance of the microscope in high-angle annular dark-field and bright-field imaging modes.

  2. [Palliative care for patients with advanced dementia: Evidence-based practice replaced by values-based practice].

    PubMed

    Kunz, R

    2003-10-01

    For the treatment of patients with advanced dementia, we could not find any evidence based guidelines to help in decision making. Individual values and expected quality of life must be the leading goals of any intervention. Symptom control and relieving suffering are core values of palliative care, but the recognition of discomfort needs qualified assessment skills. Pain assessment with common tools like the VAS fails in patients with cognitive impairment and inability to communicate; instruments like Doloplus and ECPA can be helpful to assess behavioral changes as expression of pain. The treatment of acute and chronic pain in advanced dementia is still not sufficient and needs improvement. Oral feeding in advanced dementia becomes more and more difficult. No randomized controlled study has found evidence that tube feeding will reduce the risk of aspiration or prolong life expectancy. Eating may be the only meaningful activity that remains for the patient; artificial feeding cannot serve the same function. All final complications, like pneumonia, call for a decision making process. Those who care for and care about these patients must make decisions. The feelings of the family have to be considered, but the probable will of the patient, his dignity and quality of life must not be overridden.

  3. Handbook of Institutional Advancement. A Practical Guide to College and University Relations, Fund Raising, Alumni Relations, Government Relations, Publications, and Executive Management for Continued Advancement.

    ERIC Educational Resources Information Center

    Rowland, A. Westley, Ed.

    The guide's purpose is to provide administrators with essential information that will maintain public confidence in higher education and ensure continued financial support. Six major aspects of institutional advancement are considered: (1) institutional relation (programs to improve communication and understanding among students, administrators,…

  4. Advances in X-ray Reflectivity (XRR) and X-ray Fluorescence (XRF) Measurements Provide Unique Advantages for Semiconductor Applications

    NASA Astrophysics Data System (ADS)

    Spear, Jennifer; Murakami, Hiroyuki; Terada, Shinichi

    2003-09-01

    We have developed a thin-film metrology tool that fulfills the metrology requirements for the production of 65nm node technology and beyond. This tool combines X-ray Reflectivity (XRR) and X-ray Fluorescence (XRF) measurements to provide accurate, high throughput, measurements. Improvements in both the XRR and XRF configurations were made to allow high throughput measurements on films as thin as 0.5 nm. The source intensity for the XRR measurements was increased using focusing X-ray optics. Wafer alignment, which is critical for XRR measurements to be accurate, is done using both X-rays and lasers to reduce the time required. A monochromatic X-ray source is used for XRF measurements since peak-to-background ratio is extremely important when detecting the XRF signal from ultra-thin films.

  5. A proof-of-concept implementation of a unit-based advanced practice registered nurse (APRN) role: structural empowerment, role clarity and team effectiveness.

    PubMed

    Feistritzer, Nancye R; Jones, Pam O

    2014-03-01

    The quest for decreased cost of care and improved outcomes has created the need for highly effective clinical roles and teams. This article describes the role of a unit-based advanced practice registered nurse (APRN) within a proof-of-concept implementation of a new care delivery model, the Vanderbilt Anticipatory Care Team. Role clarity is central to both structural empowerment of the APRN and team effectiveness. A modified PeaceHealth Team Development Measure tool measured baseline role clarity as a component of overall team effectiveness. A role description for the unit-based APRN based on a comprehensive assessment of the proof-of-concept unit is provided.

  6. Advancing the Interdisciplinary Collaborative Health Team Model: Applying Democratic Professionalism, Implementation Science, and Therapeutic Alliance to Enact Social Justice Practice.

    PubMed

    Murphy, Nancy

    2015-01-01

    This essay reframes the interdisciplinary collaborative health team model by proposing the application of 3 foundational pillars-democratic professionalism, implementation science, and therapeutic alliance to advance this practice. The aim was to address challenges to the model, enhance their functional capacity, and explicate and enact social justice practices to affect individual health outcomes while simultaneously addressing health inequities. The pillars are described and examples from the author's dissertation research illustrate how the pillars were used to bring about action. Related theories, models, and frameworks that have negotiation, capacity building, collaboration, and knowledge/task/power sharing as central concepts are presented under each of the pillars.

  7. Knowledge, Beliefs and Practices Regarding Antiretroviral Medications for HIV Prevention: Results from a Survey of Healthcare Providers in New England

    PubMed Central

    Krakower, Douglas S.; Oldenburg, Catherine E.; Mitty, Jennifer A.; Wilson, Ira B.; Kurth, Ann E.; Maloney, Kevin M.; Gallagher, Donna; Mayer, Kenneth H.

    2015-01-01

    Background Antiretroviral treatment for HIV-infection before immunologic decline (early ART) and pre-exposure chemoprophylaxis (PrEP) can prevent HIV transmission, but routine adoption of these practices by clinicians has been limited. Methods Between September and December 2013, healthcare practitioners affiliated with a regional AIDS Education and Training Center in New England were invited to complete online surveys assessing knowledge, beliefs and practices regarding early ART and PrEP. Multivariable models were utilized to determine characteristics associated with prescribing intentions and practices. Results Surveys were completed by 184 practitioners. Respondent median age was 44 years, 58% were female, and 82% were white. Among ART-prescribing clinicians (61% of the entire sample), 64% were aware that HIV treatment guidelines from the Department of Health and Human Services recommended early ART, and 69% indicated they would prescribe ART to all HIV-infected patients irrespective of immunologic status. However, 77% of ART-prescribing clinicians would defer ART for patients not ready to initiate treatment. Three-fourths of all respondents were aware of guidance from the U.S. Centers for Disease Control and Prevention recommending PrEP provision, 19% had prescribed PrEP, and 58% of clinicians who had not prescribed PrEP anticipated future prescribing. Practitioners expressed theoretical concerns and perceived practical barriers to prescribing early ART and PrEP. Clinicians with higher percentages of HIV-infected patients (aOR 1.16 per 10% increase in proportion of patients with HIV-infection, 95% CI 1.01–1.34) and infectious diseases specialists (versus primary care physicians; aOR 3.32, 95% CI 0.98–11.2) were more likely to report intentions to prescribe early ART. Higher percentage of HIV-infected patients was also associated with having prescribed PrEP (aOR 1.19, 95% CI 1.06–1.34), whereas female gender (aOR 0.26, 95% CI 0.10–0.71) was associated

  8. The Attending Nurse Caring Model: integrating theory, evidence and advanced caring-healing therapeutics for transforming professional practice.

    PubMed

    Watson, Jean; Foster, Roxie

    2003-05-01

    This paper presents a proposed model: The Attending Nursing Caring Model (ANCM) as an exemplar for advancing and transforming nursing practice within a reflective, theoretical and evidence-based context. Watson's theory of human caring is used as a guide for integrating theory, evidence and advanced therapeutics in the area of children's pain. The ANCM is offered as a programme for renewing the profession and its professional practices of caring-healing arts and science, during an era of decline, shortages, and crises in care, safety, and hospital and health reform. The ANCM elevates contemporary nursing's caring values, relationships, therapeutics and responsibilities to a higher/deeper order of caring science and professionalism, intersecting with other professions, while sustaining the finest of its heritage and traditions of healing.

  9. Positive Behavior Supports in Classrooms and Schools: Effective and Practical Strategies for Teachers and Other Service Providers

    ERIC Educational Resources Information Center

    Storey, Keith; Post, Michal

    2012-01-01

    This unique book will provide teachers and other service providers the knowledge and skills for positive behavior supports in school settings, thereby improving the academic and social skills of their students. The text is generic across age levels K-12, and focuses on the positive behavior supports in school settings. Each chapter begins with Key…

  10. Advanced Technologies and Data Management Practices in Environmental Science: Lessons from Academia

    ERIC Educational Resources Information Center

    Hernandez, Rebecca R.; Mayernik, Matthew S.; Murphy-Mariscal, Michelle L.; Allen, Michael F.

    2012-01-01

    Environmental scientists are increasing their capitalization on advancements in technology, computation, and data management. However, the extent of that capitalization is unknown. We analyzed the survey responses of 434 graduate students to evaluate the understanding and use of such advances in the environmental sciences. Two-thirds of the…

  11. Relative Preservation of Advanced Activities in Daily Living among Patients with Mild-to-Moderate Dementia in the Community and Overview of Support Provided by Family Caregivers

    PubMed Central

    Takechi, Hajime; Kokuryu, Atsuko; Kubota, Tomoko; Yamada, Hiroko

    2012-01-01

    Little is known about the extent to which advanced activities of daily living among patients with dementia are preserved and how family caregivers of these patients support them in the community. In this cross-sectional assessment of pairs of patients with dementia and their family caregivers, we evaluated basic, instrumental, and advanced activities of daily living by comparing past and present status observed by caregivers with subjective estimations by patients with dementia. We also asked about ways in which support was provided by family caregivers. Thirty-nine pairs of patients with dementia and caregivers who presented to our memory clinic were interviewed. The mean age of patients with dementia was 75.3 ± 7.0 years, and Mini-Mental State Examination scores were 22.3 ± 3.4. We found relative preservation of advanced activities of daily living compared with instrumental activities of daily living. Caregivers provided instrumental, informational, and reminding support to patients with dementia. These findings may reinforce the concept of person-centered support of patients with dementia in the community. PMID:22811947

  12. Best Practices in Weathering Climate Risks: Advancing Corporate and Community Resilience

    NASA Astrophysics Data System (ADS)

    Klima, K.; Winkelman, S.

    2012-12-01

    As the annual costs of severe weather events in the US grow into the billions of dollars, companies and communities are examining how best to plan ahead to protect their assets and bolster their bottom line. The Center for Clean Air Policy's Weathering Climate Risks program aims to help cities and companies enhance resilience to the economic impacts of severe weather and a changing climate. This presentation will highlight three communication techniques aimed at different types of audiences such as businesses, policymakers, the media, and society. First, we find that although planning for natural hazards now saves money later, stakeholders must fi¬nd their own self-interest if they are going to engage in a solution. Thus we research best practices and hold informational, off-the-record interviews to better understand the different stakeholders' perspectives, key concerns, and issues surrounding adaptation, resilience, and/or hazard mitigation. Diverse stakeholders find it attractive when a solution has multiple co-benefits such as climate resilience, greenhouse gas reduction, reduced costs, and social benefits. Second, we use off-the-record dialogues emphasizing candid public-private discussion to promote collaborative problem solving. Our high-level workshops typically consist of 30-40 scientists, companies, communities, and policymakers. We begin with presenting background material, such as geographic information systems (GIS) maps. Then we move to informal conservation. Topics include ideas such as "Ask the Climate Question": How will infrastructure, land development, and investment decisions affect GHG emissions and resilience to climate change impacts? We find these dialogues help stakeholders share their perspectives and advance public-private collaboration on climate resilience to protect critical urban infrastructure, ensure business continuity, and increase extreme weather resilience. Third, we find that communication to the general public must capture

  13. Providing health information to the general public: a survey of current practices in academic health sciences libraries.

    PubMed

    Hollander, S M

    2000-01-01

    A questionnaire was mailed to 148 publicly and privately supported academic health sciences libraries affiliated with Association of American Medical Colleges (AAMC-accredited medical schools in the United States and Canada to determine level of access and services provided to the general public. For purposes of this study, "general public" was defined as nonaffiliated students or health care professionals, attorneys and other nonhealth-related professionals, patients from affiliated or other hospitals or clinics, and general consumers. One hundred five (71%) libraries responded. Results showed 98% of publicly supported libraries and 88% of privately supported libraries provided access to some or all of the general public. Publicly supported libraries saw greater numbers of public patrons, often provided more services, and were more likely to circulate materials from their collections than were privately supported libraries. A significant number of academic health sciences libraries housed a collection of consumer-oriented materials and many provided some level of document delivery service, usually for a fee. Most allowed the public to use some or all library computers. Results of this study indicated that academic health sciences libraries played a significant role in serving the information-seeking public and suggested a need to develop written policies or guidelines covering the services that will be provided to minimize the impact of this service on primary clientele.

  14. Provider advice about smoking cessation and pharmacotherapy among cancer survivors who smoke: practice guidelines are not translating.

    PubMed

    Emmons, Karen M; Sprunck-Harrild, Kim; Puleo, Elaine; de Moor, Janet

    2013-06-01

    Smoking among childhood and young adult cancer survivors may increase risk for late effects of treatment, and survivors need assistance in quitting. This paper reports on the prevalence of discussions between childhood cancer survivors and their health care providers about smoking cessation and pharmacotherapy and explores factors that are associated with these discussions. This is a longitudinal study that included 329 smokers who were childhood or young adult cancer survivors, recruited from five cancer centers in the USA and Canada. Fifty-five percent of smokers reported receiving advice to quit smoking from their regular provider during the study period, and only 36 % of smokers reported discussing pharmacotherapy with their provider. Receipt of advice was associated with being female and having a heavier smoking rate. Pharmacotherapy discussions were associated with readiness to quit, heavier smoking rate, and previous provider advice to quit. Health care providers are missing key opportunities to advise cancer survivors about cessation and evidence-based interventions. Systematic efforts are needed to ensure that survivors who smoke get the treatment that they need.

  15. Understanding infant feeding beliefs, practices and preferred nutrition education and health provider approaches: an exploratory study with Somali mothers in the USA.

    PubMed

    Steinman, Lesley; Doescher, Mark; Keppel, Gina A; Pak-Gorstein, Suzinne; Graham, Elinor; Haq, Aliya; Johnson, Donna B; Spicer, Paul

    2010-01-01

    The objective of this study was to explore Somali mothers' beliefs and practices around infant feeding and education, towards developing a culturally informed infant nutrition curriculum for health providers. Four focus groups were conducted to explore: (1) beliefs about infant feeding, hunger and ideal weight; (2) feeding practices; (3) nutrition education approaches; and (4) provider/mother interactions. Thirty-seven Somali mother participants identified the following themes within these topics: (1) strategies for assessing hunger, satiety and when to feed; shared beliefs that plump babies are healthy, leading to worry about infant weight; (2) context of breast milk adequacy, difficulties breastfeeding and environmental and cultural barriers to breastfeeding, leading to nearly universal early supplementation with formula; (3) preferred education approaches include provider visits with interpreters, Somali language educational materials and advice from older, experienced family members; and (4) desired health provider skills include: listening, explaining, empathy, addressing specific concerns, repeating important information, offering preventive advice and sufficient visit time. This study presents knowledge about Somali beliefs and practices that can directly guide discussions with these families. Given that these infants appear on a trajectory towards obesity, influencing infant feeding practices in the Somali community is a good upstream approach to preventing obesity. These findings will underpin a new infant nutrition curriculum for health providers. PMID:20055931

  16. Understanding infant feeding beliefs, practices and preferred nutrition education and health provider approaches: an exploratory study with Somali mothers in the USA

    PubMed Central

    Steinman, Lesley; Doescher, Mark; Keppel, Gina A.; Pak-Gorstein, Suzinne; Graham, Elinor; Haq, Aliya; Johnson, Donna B.; Spicer, Paul

    2011-01-01

    The objective of this study was to explore Somali mothers’ beliefs and practices around infant feeding and education, towards developing a culturally informed infant nutrition curriculum for health providers. Four focus groups were conducted to explore: (1) beliefs about infant feeding, hunger and ideal weight; (2) feeding practices; (3) nutrition education approaches; and (4) provider/mother interactions. Thirty-seven Somali mother participants identified the following themes within these topics: (1) strategies for assessing hunger, satiety and when to feed; shared beliefs that plump babies are healthy, leading to worry about infant weight; (2) context of breast milk adequacy, difficulties breastfeeding and environmental and cultural barriers to breastfeeding, leading to nearly universal early supplementation with formula; (3) preferred education approaches include provider visits with interpreters, Somali language educational materials and advice from older, experienced family members; and (4) desired health provider skills include: listening, explaining, empathy, addressing specific concerns, repeating important information, offering preventive advice and sufficient visit time. This study presents knowledge about Somali beliefs and practices that can directly guide discussions with these families. Given that these infants appear on a trajectory towards obesity, influencing infant feeding practices in the Somali community is a good upstream approach to preventing obesity. These findings will underpin a new infant nutrition curriculum for health providers. PMID:20055931

  17. Practice and New Development for Promotion of Engineering Design Ability in Advanced Course

    NASA Astrophysics Data System (ADS)

    Watanabe, Seiji; Narisawa, Tetsuya; Iwabuchi, Yoshitaka; Ikeda, Yuichi

    Several years passed after advanced course had been set up National College of Technology. Kushiro National College of Technology advanced course entered fifth year in 2008. As for education of advanced course, the introduction of a progressive curriculum that acquires adaptability corresponding to the reformation in the age is needed to basic curriculum. This paper shows effectiveness of the proposed new design project based on finding problems to be solved through a reproducing the manuscript of Leonard de Vinci using 3D-CAD application, brainstorming and brainwriting method.

  18. The Education of Homeless Children: Rules, Rights and Practical Solutions. A Training Manual for Shelter Providers, Staff, Advocates and Parents.

    ERIC Educational Resources Information Center

    Heybach, Laurene M.; Nix-Hodes, Patricia; Price, Sarah

    These training materials provide advocates with the tools needed to help families obtain a stable and effective education for their children despite the condition of homelessness and the trauma that accompanies it. Nine sections include: (1) "Introduction"; (2) "How Mobility Hurts Homeless Children and Schools"; (3) "Laws and Rules Governing the…

  19. Providing Recreation Services for all Individuals: The Connection of Inclusive Practices to Commercial, Community, and Outdoor Recreation Students

    ERIC Educational Resources Information Center

    Piatt, Jennifer A.; Jorgensen, Lisa J.

    2012-01-01

    Individuals with disabilities currently represent the largest minority group in the United States, yet recreation undergraduate students often perceive this as a population they may or may not provide services to in their future careers. The activities presented in this paper, Inclusion Knowledge Audits (IKA), are developed to make the connection…

  20. Providing Students with Written Feedback on Their Assessment: A Collaborative Self-Study Exploring the Nexus of Research and Practice

    ERIC Educational Resources Information Center

    Pittaway, Sharon; Dowden, Tony

    2014-01-01

    This article is an account of a collaborative self-study of the process of providing written feedback on assessment to our teacher education students. Our five-year study grew out of concerns that written feedback might not always meet the learning needs of our students. The study was informed by on-going analysis of our reading of the relevant…

  1. Providers caring for adolescents with perinatally-acquired HIV: Current practices and barriers to communication about sexual and reproductive health.

    PubMed

    Albright, Jamie N; Fair, Cynthia D

    2014-11-01

    The population of adolescents and young adults (AYA) with perinatally-acquired HIV (PHIV) present challenges to HIV healthcare providers (HHCPs). Originally not expected to survive childhood, they are now living well into young adulthood. Little is known about the type of sexual and reproductive (SRH) information/services offered to AYA with PHIV by HHCPs. HHCPs (n=67) were recruited using snowball sampling, and completed an online survey. Providers' most frequently endorsed SRH topics discussed with both male and female patients included condom use (77.3%), STD prevention (73.1%), and screening (62.1%). Providers' reports indicated that females received significantly more education about SRH topics overall. The most frequently noted barriers to SRH communication included more pressing health concerns (53.0%), parent/guardian not receptive (43.9%), and lack of time during appointment (43.9%). Provider-reported SRH conversations with HHCPs were highly focused on horizontal transmission and pregnancy prevention. Salient social aspects of SRH promotion for AYAs with PHIV (e.g., managing disclosure and romantic relationships) were less commonly discussed, though such conversations may serve to reduce secondary transmission and enhance the overall well-being of AYA with PHIV. Findings indicated that further work must be done to identify strategies to address unmet SRH needs of the aging population of AYA with PHIV. PMID:25290765

  2. Evaluation of the Effect of Decision Support on the Efficiency of Primary Care Providers in the Outpatient Practice

    PubMed Central

    Hankey, Ronald A.; Decker, Lindsay K.; Cha, Stephen S.; Greenes, Robert A.; Liu, Hongfang; Chaudhry, Rajeev

    2015-01-01

    Background: Clinical decision support (CDS) for primary care has been shown to improve delivery of preventive services. However, there is little evidence for efficiency of physicians due to CDS assistance. In this article, we report a pilot study for measuring the impact of CDS on the time spent by physicians for deciding on preventive services and chronic disease management. Methods: We randomly selected 30 patients from a primary care practice, and assigned them to 10 physicians. The physicians were requested to perform chart review to decide on preventive services and chronic disease management for the assigned patients. The patients assignment was done in a randomized crossover design, such that each patient received 2 sets of recommendations—one from a physician with CDS assistance and the other from a different physician without CDS assistance. We compared the physician recommendations made using CDS assistance, with the recommendations made without CDS assistance. Results: The physicians required an average of 1 minute 44 seconds, when they were they had access to the decision support system and 5 minutes when they were unassisted. Hence the CDS assistance resulted in an estimated saving of 3 minutes 16 seconds (65%) of the physicians’ time, which was statistically significant (P < .0001). There was no statistically significant difference in the number of recommendations. Conclusion: Our findings suggest that CDS assistance significantly reduced the time spent by physicians for deciding on preventive services and chronic disease management. The result needs to be confirmed by performing similar studies at other institutions. PMID:25155103

  3. Patient Attitudes and Beliefs and Provider Practices Regarding Antibiotic Use for Acute Respiratory Tract Infections in Minya, Egypt

    PubMed Central

    Kandeel, Amr; El-Shoubary, Waleed; Hicks, Lauri A.; Abdel Fattah, Mohamed; Dooling, Kathleen L.; Lohiniva, Anna Leena; Ragab, Omnia; Galal, Ramy; Talaat, Maha

    2014-01-01

    The inappropriate use of antibiotics in the community is one of the major causes of antimicrobial resistance. This study aimed to explore the physician prescribing pattern of antibiotics for acute respiratory infections (ARIs) and to explore the knowledge, attitudes, and practices of patients regarding antibiotic use for ARIs. The study was conducted in Upper Egypt and used quantitative and qualitative research techniques. Eligible patients exiting outpatient clinics with ARIs were invited to participate in the study. A qualitative study was conducted through 20 focus group discussions. Out of 350 encounters for patients with various ARIs, 292 (83%) had been prescribed at least one antibiotic. Factors significantly associated with antibiotic prescribing for adults included patient preference that an antibiotic be prescribed. For children younger than 18, presentation with fever, cough, loss of appetite, and sore throat, along with the caregiver’s antibiotic preference, were associated with an antibiotic prescription. Several misconceptions regarding antibiotic use among community members were stated, such as the strong belief of the curing and prophylactic power of antibiotics for the common cold. Interventions to promote proper antibiotic use for ARIs need to be piloted, targeting both physicians and the public. Educational programs for physicians and campaigns to raise public awareness regarding proper antibiotic use for ARIs need to be developed. PMID:27025759

  4. Physician Assistant and Advance Practice Nurse Care in Hospital Outpatient Departments: United States, 2008-2009

    MedlinePlus

    ... Vital Statistics Rapid Release Quarterly Provisional Estimates Dashboard Technical Notes Other Publications Advance Data From Vital and ... Vital Statistics of the United States: 1890-1938 Technical Appendices Miscellaneous Publications National Conference on Health Statistics ...

  5. Advances in the management of multiple sclerosis spasticity: experiences from recent studies and everyday clinical practice.

    PubMed

    Pozzilli, Carlo

    2013-12-01

    Although spasticity of varying severity affects up to 80% of patients with multiple sclerosis (MS) during the course of their disease, the symptom is often overlooked and undertreated. Despite the availability of oral antispasticity treatments (baclofen, tizanidine and others), approximately one-third of MS patients in Europe and the USA experience moderate or severe nonfocalized spasticity. At present, a thorough clinical evaluation of MS-related spasticity that takes into account the patient's own perception of spasms, spasticity-related pain and other associated symptoms is not common in daily neurological practice. Some of the usual spasticity scales, such as the Ashworth and modified Ashworth scales, reflect the observer's measurement of spasticity at a particular point in time. Herbal (smoked) cannabis has long been recognized as a possible option for relief of spasticity and neuropathic pain, but pertinent concerns about psychoactive effects and addiction risk have prevented its common use. An innovative method of benefiting from the mode of action of cannabinoids while limiting their drawbacks is to reduce peak plasma levels of 9-delta-tetrahydrocannabinol and counteract psychoactivity with higher than naturally occurring proportions of a second cannabinoid, cannabidiol. Sativex® oromucosal spray (1:1 ratio of 9-delta-tetrahydrocannabinol/cannabidiol) has recently been approved in a number of EU countries and elsewhere for use in patients with MS-related spasticity who are resistant to treatment with other antispasticity medications. In clinical trials, Sativex provided initial relief of spasticity symptoms within the first 4 weeks of treatment (trial period) in up to about half of patients resistant to other available oral antispasticity medications and demonstrated clinically significant improvement in spasticity (30% or higher reduction from baseline) in three-quarters of the initial responders. Adverse events were limited mainly to mild or moderate

  6. Theory and Practice in Early Childhood Teaching. Advances in Early Education and Day Care.

    ERIC Educational Resources Information Center

    Chafel, Judith A., Ed.; Riefel, Stuart, Ed.

    Reflecting the complexity of the early childhood education enterprise--classroom practice, teacher preparation, research, and conceptualization--this volume reflects an examination of the literature for illumination as to the value of early education theory and its usefulness to practice. The book has 10 chapters divided into three parts that…

  7. Conditions for Building a Community of Practice in an Advanced Physics Laboratory

    ERIC Educational Resources Information Center

    Irving, Paul W.; Sayre, Eleanor C.

    2014-01-01

    We use the theory of communities of practice and the concept of accountable disciplinary knowledge to describe how a learning community develops in the context of an upper-division physics laboratory course. The change in accountable disciplinary knowledge motivates students' enculturation into a community of practice. The enculturation…

  8. Re-Storying Practice: Using Stories about Students to Advance Mathematics Education Reform

    ERIC Educational Resources Information Center

    Sengupta-Irving, Tesha; Redman, Elizabeth; Enyedy, Noel

    2013-01-01

    We apply a literary definition of story (struggle, protagonist, and resolution) to an American primary school teacher's reflections on experimenting with new teaching practices. This definition makes issues of equity explicit and revealed what the teacher saw as possible for changing her practice. By re-storying her stories--offering evidence from…

  9. Practical Intelligence and Tacit Knowledge: Advancements in the Measurement of Developing Expertise

    ERIC Educational Resources Information Center

    Cianciolo, Anna T.; Grigorenko, Elena L.; Jarvin, Linda; Gil, Guillermo; Drebot, Michael E.; Sternberg, Robert J.

    2006-01-01

    Practical intelligence as measured by tacit-knowledge inventories generally has shown a weak relation to other intelligence constructs. However, the use of assessments capturing specialized, job-related knowledge may obscure the generality of practical intelligence and its relation to general intelligence. This article presents three studies in…

  10. Community Introduction of Practice Parameters for Autistic Spectrum Disorders: Advancing Early Recognition

    ERIC Educational Resources Information Center

    Holzer, Laurent; Mihailescu, Raluca; Rodrigues-Degaeff, Catherine; Junier, Laurent; Muller-Nix, Carole; Halfon, Oliver; Ansermet, Francois

    2006-01-01

    Objectives: Within a strong interdisciplinary framework, improvement in the quality of care for children with autistic spectrum disorders through a 2 year implementation program of Practice Parameters, aimed principally at improving early detection and intervention. Method: We developed Practice Parameters (PPs) for Pervasive Developmental…

  11. Catching the Wave: Next Steps in Advancing the Vision-in-Practice Agenda

    ERIC Educational Resources Information Center

    Pekarsky, Daniel

    2008-01-01

    Building on insights of Seymour Fox, I explore the often-decisive role of "good timing" in the introduction of potentially powerful innovations (ideas, practices, etc.) into practical domains like education. After examining key readiness conditions that make for good timing, I argue that the field of Jewish education is in many ways now ready to…

  12. Evaluation of an Advanced-Practice Physical Therapist in a Specialty Shoulder Clinic: Diagnostic Agreement and Effect on Wait Times

    PubMed Central

    Robarts, Susan; Kennedy, Deborah; McKnight, Cheryl; MacLeod, Anne Marie; Holtby, Richard

    2013-01-01

    ABSTRACT Purpose: To examine the role of an advanced-practice physiotherapist (APP) with respect to (1) agreement with an orthopaedic surgeon on diagnosis and management of patients with shoulder problems; (2) wait times; and (3) satisfaction with care. Methods: This prospective study involved patients with shoulder complaints who were referred to a shoulder specialist in a tertiary care centre. Agreement was examined on seven major diagnostic categories, need for further examination and surgery, and type of surgical procedure. Wait times were compared between the APP- and surgeon-led clinics from referral date to date of initial consultation, date of final diagnostic test, and date of confirmed diagnosis and planned treatment. A modified and validated version of the Visit-Specific Satisfaction Instrument assessed satisfaction in seven domains. Kappa (κ) coefficients and bias- and prevalence-adjusted kappa (PABAK) values were calculated, and strength of agreement was categorized. Wait time and satisfaction data were examined using non-parametric statistics. Results: Agreement on major diagnostic categories varied from 0.68 (good) to 0.96 (excellent). Agreement with respect to indication for surgery was κ=0.75, p<0.001; 95% CI, 0.62–0.88 (good). Wait time for APP assessment was significantly shorter than wait time for surgeon consultation at all time points (p<0.001); the surgeon's wait time was significantly reduced over 3 years. High satisfaction was reported in all components of care received from both health care providers. Conclusions: Using experienced physiotherapists in an extended role reduces wait times without compromising patient clinical management and overall satisfaction. PMID:24381382

  13. Mixed Methods Survey of Zoonotic Disease Awareness and Practice among Animal and Human Healthcare Providers in Moshi, Tanzania

    PubMed Central

    Zhang, Helen L.; Mnzava, Kunda W.; Mitchell, Sarah T.; Melubo, Matayo L.; Kibona, Tito J.; Cleaveland, Sarah; Kazwala, Rudovick R.; Crump, John A.; Sharp, Joanne P.; Halliday, Jo E. B.

    2016-01-01

    Background Zoonoses are common causes of human and livestock illness in Tanzania. Previous studies have shown that brucellosis, leptospirosis, and Q fever account for a large proportion of human febrile illness in northern Tanzania, yet they are infrequently diagnosed. We conducted this study to assess awareness and knowledge regarding selected zoonoses among healthcare providers in Moshi, Tanzania; to determine what diagnostic and treatment protocols are utilized; and obtain insights into contextual factors contributing to the apparent under-diagnosis of zoonoses. Methodology/Results We conducted a questionnaire about zoonoses knowledge, case reporting, and testing with 52 human health practitioners and 10 livestock health providers. Immediately following questionnaire administration, we conducted semi-structured interviews with 60 of these respondents, using the findings of a previous fever etiology study to prompt conversation. Sixty respondents (97%) had heard of brucellosis, 26 (42%) leptospirosis, and 20 (32%) Q fever. Animal sector respondents reported seeing cases of animal brucellosis (4), rabies (4), and anthrax (3) in the previous 12 months. Human sector respondents reported cases of human brucellosis (15, 29%), rabies (9, 18%) and anthrax (6, 12%). None reported leptospirosis or Q fever cases. Nineteen respondents were aware of a local diagnostic test for human brucellosis. Reports of tests for human leptospirosis or Q fever, or for any of the study pathogens in animals, were rare. Many respondents expressed awareness of malaria over-diagnosis and zoonoses under-diagnosis, and many identified low knowledge and testing capacity as reasons for zoonoses under-diagnosis. Conclusions This study revealed differences in knowledge of different zoonoses and low case report frequencies of brucellosis, leptospirosis, and Q fever. There was a lack of known diagnostic services for leptospirosis and Q fever. These findings emphasize a need for improved diagnostic

  14. Providing for energy efficiency in homes and small buildings. Part I. Understanding and practicing energy conservation in buildings

    SciTech Connect

    Parady, W. Harold; Turner, J. Howard

    1980-06-01

    This is a training program to educate students and individuals in the importance of conserving energy and to provide for developing skills needed in the application of energy-saving techniques that result in energy-efficient buildings. A teacher guide and student workbook are available to supplement the basic guide, which contains three parts. Part I considers the following: understanding the importance of energy; developing a concern for conserving energy; understanding the use of energy in buildings; care and maintenance of energy-efficient buildings; and developing energy-saving habits. A bibliography is presented.

  15. Impact of an Online Medical Internet Site on Knowledge and Practice of Health Care Providers: A Mixed Methods Study of the Spinal Cord Injury Rehabilitation Evidence Project

    PubMed Central

    Noonan, Vanessa K; Townson, Andrea F; Higgins, Caroline E; Rogers, Jess; Wolfe, Dalton L

    2014-01-01

    Background It is not known whether ongoing access to a broad-based Internet knowledge resource can influence the practice of health care providers. We undertook a study to evaluate the impact of a Web-based knowledge resource on increasing access to evidence and facilitating best practice of health care providers. Objective The objective of this study was to evaluate (1) the impact of the Spinal Cord Injury Rehabilitation Evidence (SCIRE) project on access to information for health care providers and researchers and (2) how SCIRE influenced health care providers' management of clients. Methods A 4-part mixed methods evaluation was undertaken: (1) monitoring website traffic and utilization using Google Analytics, (2) online survey of users who accessed the SCIRE website, (3) online survey of targeted end-users, that is, rehabilitation health care providers known to work with spinal cord injury (SCI) clients, as well as researchers, and (4) focus groups with health care providers who had previously accessed SCIRE. Results The online format allowed the content for a relatively specialized field to have far reach (eg, 26 countries and over 6500 users per month). The website survey and targeted end-user survey confirmed that health care providers, as well as researchers perceived that the website increased their access to SCI evidence. Access to SCIRE not only improved knowledge of SCI evidence but helped inform changes to the health providers’ clinical practice and improved their confidence in treating SCI clients. The SCIRE information directly influenced the health providers’ clinical decision making, in terms of choice of intervention, equipment needs, or assessment tool. Conclusions A Web-based knowledge resource may be a relatively inexpensive method to increase access to evidence-based information, increase knowledge of the evidence, inform changes to the health providers’ practice, and influence their clinical decision making. PMID:25537167

  16. Weight Management-Related Assessment and Counseling by Primary Care Providers in an Area of High Childhood Obesity Prevalence: Current Practices and Areas of Opportunity

    PubMed Central

    Nelson, Jennifer M.; Vos, Miriam B.; Walsh, Stephanie M.; O'Brien, Lauren A.

    2015-01-01

    Abstract Background: Childhood obesity in Georgia exceeds the national rate. The state's pediatric primary care providers (PCPs) are well positioned to support behavior change, but little is known about provider perceptions and practices regarding this role. Purpose: The aim of this study was to assess and compare weight-management–related counseling perceptions and practices among Georgia's PCPs. Methods: In 2012–2013, 656 PCPs (265 pediatricians, 143 family practice physicians [FPs], and 248 nurse practitioners/physician assistants [NP/PAs]) completed a survey regarding weight-management–related practices at well-child visits before their voluntary participation in a free training on patient-centered counseling and child weight management. Data were analyzed in 2014. Likert scales were used to quantify responses from 1 (strongly disagree or never) to 5 (strongly agree or always). Responses of 4 and 5 responses were combined to denote agreement or usual practice. Chi-squared analyses tested for independent associations between pediatricians and others. Statistical significance was determined using two-sided tests and p value <0.05. Results: The majority of PCPs assessed fruit and vegetable intake (83%) and physical activity (78%), but pediatricians were more likely than FPs and NP/PAs to assess beverage intake (96% vs. 82–87%; p≤0.002) and screen time (86% vs. 74–75%; p≤0.003). Pediatricians were also more likely to counsel patients on lifestyle changes (88% vs. 71%; p<0.001) and to track progress (50% vs. 35–39%; p<0.05). Though all PCPs agreed that goal setting is an effective motivator (88%) and that behavior change increases with provider encouragement (85%), fewer were confident in their ability to counsel (72%). Conclusions: Our results show that many PCPS in Georgia, particularly pediatricians, have incorporated weight management counseling into their practice; however, important opportunities to strengthen these efforts by targeting known

  17. Providers issue brief: alternative providers.

    PubMed

    Rothouse, M

    1999-06-29

    Access by managed care plan enrollees, scope of practice issues and fee reimbursement by Medicaid and third parties such as insurance carriers is the engine that drives legislation recognizing alternative health care providers--chiropractors, acupuncturists, physical therapists, naturopaths, massage therapists, homeopaths, and dietitians and nutritionists. PMID:11073386

  18. Web based provider education for competency of scope of practice (Best Practice): Medicine Department Safe training is a computer based review program (de' medri).

    PubMed

    Tabriziani, Hossein; Hatcher, Myron; Heetebry, Irene

    2005-12-01

    Medicine Department Safe training is a computer based review program named de'medici and it is an employee training program. This annual review packet serves as a generic training tool. All health-care providers with direct patient care are required by state law to complete a group of 11 modules and pass a mandatory training test to assess proficiency in these areas. They include emergency preparedness, life and fire safety, electrical safety, working safety with hazardous materials, back safety, violence in the workplace, latex allergy prevention, preventing TB in the workplace, preventing AIDS and hepatitis B and C in the workplace, radiation safety, and age related care for health-care workers. PMID:16235813

  19. Mindfulness-Based Stress Reduction in Advanced Nursing Practice: A Nonpharmacologic Approach to Health Promotion, Chronic Disease Management, and Symptom Control.

    PubMed

    Williams, Hants; Simmons, Leigh Ann; Tanabe, Paula

    2015-09-01

    The aim of this article is to discuss how advanced practice nurses (APNs) can incorporate mindfulness-based stress reduction (MBSR) as a nonpharmacologic clinical tool in their practice. Over the last 30 years, patients and providers have increasingly used complementary and holistic therapies for the nonpharmacologic management of acute and chronic diseases. Mindfulness-based interventions, specifically MBSR, have been tested and applied within a variety of patient populations. There is strong evidence to support that the use of MBSR can improve a range of biological and psychological outcomes in a variety of medical illnesses, including acute and chronic pain, hypertension, and disease prevention. This article will review the many ways APNs can incorporate MBSR approaches for health promotion and disease/symptom management into their practice. We conclude with a discussion of how nurses can obtain training and certification in MBSR. Given the significant and growing literature supporting the use of MBSR in the prevention and treatment of chronic disease, increased attention on how APNs can incorporate MBSR into clinical practice is necessary.

  20. Expanding nurse practice in COPD: is it key to providing high quality, effective and safe patient care?

    PubMed

    Fletcher, Monica J; Dahl, Birthe H

    2013-06-01

    The prevalence of chronic obstructive pulmonary disease (COPD), a common and preventable chronic disease, is on the increase, and so are the financial and social burdens associated with it. The management of COPD is particularly challenging, as patients have complex health and social needs requiring life-long monitoring and treatment. In order to address these issues and reduce the burden imposed by COPD, the development of innovative disease management models is vital. Nurses are in a key position to assume a leading role in the management of COPD since they frequently represent the first point of contact for patients and are involved in all stages of care. Although evidence is still limited, an increasing number of studies have suggested that nurse-led consultations and interventions for the management of COPD have the potential to impact positively on the health and quality of life of patients. The role of nurses in the management of COPD around the world could be significantly expanded and strengthened. Providing adequate educational opportunities and support to nurses, as well as addressing funding issues and system barriers and recognising the importance of the expanding roles of nurses, is vital to the well-being of patients with long-term medical conditions such as COPD and to society as a whole, in order to reduce the burden of this disease.

  1. Arbovirus models to provide practical management tools for mosquito control and disease prevention in the Northern Territory, Australia.

    PubMed

    Jacups, Susan P; Whelan, Peter I; Harley, David

    2011-03-01

    Ross River virus (RRV) causes the most common human arbovirus disease in Australia. Although the disease is nonfatal, the associated arthritis and postinfection fatigue can be debilitating for many months, impacting on workforce participation. We sought to create an early-warning system to notify of approaching RRV disease outbreak conditions for major townships in the Northern Territory. By applying a logistic regression model to meteorologic factors, including rainfall, a postestimation analysis of sensitivity and specificity can create rainfall cut-points. These rainfall cut-points indicate the rainfall level above which previous epidemic conditions have occurred. Furthermore, rainfall cut-points indirectly adjust for vertebrate host data from the agile wallaby (Macropus agilis) as the life cycle of the agile wallaby is intricately meshed with the wet season. Once generated, cut-points can thus be used prospectively to allow timely implementation of larval survey and control measures and public health warnings to preemptively reduce RRV disease incidence. Cut-points are location specific and have the capacity to replace previously used models, which require data management and input, and rarely provide timely notification for vector control requirements and public health warnings. These methods can be adapted for use elsewhere.

  2. A Portrait of Advanced Placement Teachers' Practices. Research Report No. 2005-7. ETS RR-05-09

    ERIC Educational Resources Information Center

    Paek, Pamela L.; Ponte, Eva; Sigel, Irv; Braun, Henry; Powers, Don

    2005-01-01

    The Advanced Placement Program® (AP®) is dedicated to providing high school students opportunities to enroll in college-level courses while in high school. The advantages of such accelerated opportunities are both financial and educational. The AP Program is available internationally. As a result of its widespread availability, considerable effort…

  3. The Integration of Research by Nurse Educators: Advancing Practice through Professional Development Programs.

    ERIC Educational Resources Information Center

    Waddell, Janice; Durrant, Michele; Avery, Shirley

    1999-01-01

    A nurse preceptorship program used narrative to help participants explore the complexity of pediatric clinical practice. Through narratives they shared clinical decision making, knowledge, and skills, transforming knowing into story telling into learning. (SK)

  4. Conceptualizing Telehealth in Nursing Practice: Advancing a Conceptual Model to Fill a Virtual Gap.

    PubMed

    Nagel, Daniel A; Penner, Jamie L

    2016-03-01

    Increasingly nurses use various telehealth technologies to deliver health care services; however, there has been a lag in research and generation of empirical knowledge to support nursing practice in this expanding field. One challenge to generating knowledge is a gap in development of a comprehensive conceptual model or theoretical framework to illustrate relationships of concepts and phenomena inherent to adoption of a broad range of telehealth technologies to holistic nursing practice. A review of the literature revealed eight published conceptual models, theoretical frameworks, or similar entities applicable to nursing practice. Many of these models focus exclusively on use of telephones and four were generated from qualitative studies, but none comprehensively reflect complexities of bridging nursing process and elements of nursing practice into use of telehealth. The purpose of this article is to present a review of existing conceptual models and frameworks, discuss predominant themes and features of these models, and present a comprehensive conceptual model for telehealth nursing practice synthesized from this literature for consideration and further development. This conceptual model illustrates characteristics of, and relationships between, dimensions of telehealth practice to guide research and knowledge development in provision of holistic person-centered care delivery to individuals by nurses through telehealth technologies. PMID:25858897

  5. Assessment of young children's social-emotional development and psychopathology: recent advances and recommendations for practice.

    PubMed

    Carter, Alice S; Briggs-Gowan, Margaret J; Davis, Naomi Ornstein

    2004-01-01

    In this paper we have tried to document some of the recent advances in the conceptualization and assessment of early-emerging social-emotional and behavior problems, competencies, and psychopathology. Considerable evidence documents that young children evidence significant psychopathology (cf., Del Carmen & Carter, in press; Emde, 1999; Zeanah, 2001; Zeanah et al., 1997). Given the range of new assessment measures that have become available over the past 10 years, the field of young child mental health is poised for dramatic gains in knowledge. It is critical to conduct large-scale, longitudinal, epidemiological studies to inform our understanding of the course of psychopathological conditions within the context of a normative developmental framework. Multi-method, multi-informant assessment approaches are more essential in early childhood due to young children's inability to provide self-reports and the embedded nature of children's development in their caregiving contexts. Screening large representative samples affords the opportunity to ascertain unbiased clinically informative sub-samples for methodologically intensive sub-studies. These sub-studies can address the child's cognitive and linguistic developmental capacities as well as utilize observational methods to examine the relational context. This approach provides an opportunity to merge dimensional and diagnostic assessments and will yield critical information for disentangling continuities and discontinuities in normative and atypical development. The assessment methodology currently exists to routinely screen very young children for social-emotional and behavior problems as well as delays in the acquisition of competencies in pediatric settings as well as in early intervention programs. Yet, despite the likely long-term benefits and cost-saving potential of early identification and intervention services, short-term cost and knowledge barriers currently limit widespread implementation. Discussions with

  6. Advanced Mathematical Knowledge in Teaching Practice: Perceptions of Secondary Mathematics Teachers

    ERIC Educational Resources Information Center

    Zazkis, Rina; Leikin, Roza

    2010-01-01

    For the purpose of our research we define Advanced Mathematical Knowledge (AMK) as knowledge of the subject matter acquired during undergraduate studies at colleges or universities. We examine the responses of secondary school teachers about their usage of AMK in teaching. We find that the majority of teachers focus on the purposes and advantages…

  7. Meeting Students Where They Are: Advancing a Theory and Practice of Archives in the Classroom

    ERIC Educational Resources Information Center

    Saidy, Christina; Hannah, Mark; Sura, Tom

    2011-01-01

    This article uses theories of technical communication and archives to advance a pedagogy that includes archival production in the technical communication classroom. By developing and maintaining local classroom archives, students directly engage in valuable processes of appraisal, selection, collaboration, and retention. The anticipated outcomes…

  8. Multisectoral Strategies for Advancing Girls' Education: Principles and Practice. SAGE Technical Report.

    ERIC Educational Resources Information Center

    Williams, Howard

    This paper describes issues, experiences, and strategies used in developing successful multisectoral partnerships to advance girls' education, using Guinea and Morocco as examples. Chapter 1 introduces the issue, discussing barriers to girls' education and describing the multisectoral response to interrelated barriers. Chapter 2 defines the…

  9. 78 FR 28717 - Advancing Pay Equality in the Federal Government and Learning From Successful Practices

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-15

    ... Documents#0;#0; ] Memorandum of May 10, 2013 Advancing Pay Equality in the Federal Government and Learning... departments and agencies (agencies) affect the compensation of similarly situated men and women, and to... memorandum in the Federal Register. (Presidential Sig.) THE WHITE HOUSE, Washington, May 10, 2013. [FR...

  10. 19 CFR 181.92 - Definitions and general NAFTA advance ruling practice.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... calculating the net cost of the good or the value of an intermediate material; (v) Whether a good qualifies as... agent in connection with an advance ruling request may be required to present evidence of his or her... Mexico; (ii) Whether a good satisfies a regional value-content requirement under the transaction...

  11. 19 CFR 181.92 - Definitions and general NAFTA advance ruling practice.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... calculating the net cost of the good or the value of an intermediate material; (v) Whether a good qualifies as... agent in connection with an advance ruling request may be required to present evidence of his or her... Mexico; (ii) Whether a good satisfies a regional value-content requirement under the transaction...

  12. Journal club: an opportunity to advance the art and science of home health practice.

    PubMed

    Fowler, Susan B; Druist, Kim A; Dillon-Zwerdling, Lisa

    2011-01-01

    A journal club is more than a club. It is an opportunity for staff to gather, learn, share, brainstorm, challenge thinking and ways of doing business, and set future direction. These activities have the potential to advance the art and science of nursing and other disciplines. Developing and implementing a successful journal club requires planning, communication, facilitation, and evaluation.

  13. Strategies for Increasing Advanced Placement Participation for Underrepresented Students: Barriers, Practices, and Positive Outcomes

    ERIC Educational Resources Information Center

    Flores, Sergio; Gomez, Martin O.

    2011-01-01

    Some school leaders have viewed programs such as Advanced Placement (AP) as an attractive option to resolve the ongoing achievement gap problem. However, the ongoing debate in the field about maintaining the ostensible purity of the AP program versus diluting it with program expansion has hindered the full utilization of AP classes to close the…

  14. Advancing High-Quality Literacy Research in Juvenile Justice: Methodological and Practical Considerations

    ERIC Educational Resources Information Center

    Houchins, David E.; Jolivette, Kristine; Shippen, Margaret E.; Lambert, Richard

    2010-01-01

    Special education researchers have made noteworthy progress toward conceptualizing literacy research questions, designing quality studies, and disseminating the results of their research. These advancements have been made through the establishment and refinement of quality research indicators. Unfortunately, this progress has mostly eluded the…

  15. Violence risk assessment and psychological treatment in correctional and forensic settings: Advances in research and practice.

    PubMed

    Magaletta, Philip R; VandenBos, Gary R

    2016-08-01

    This article is an introduction to the special section "Correctional and Criminal Justice Psychology." The eight articles in this issue advance the goals of delivering and assessing psychological services within the legal and correctional systems and achieving lasting change in individuals, groups, and systems. (PsycINFO Database Record PMID:27504641

  16. W(h)ither human cardiac and body magnetic resonance at ultrahigh fields? technical advances, practical considerations, applications, and clinical opportunities.

    PubMed

    Niendorf, Thoralf; Paul, Katharina; Oezerdem, Celal; Graessl, Andreas; Klix, Sabrina; Huelnhagen, Till; Hezel, Fabian; Rieger, Jan; Waiczies, Helmar; Frahm, Jens; Nagel, Armin M; Oberacker, Eva; Winter, Lukas

    2016-09-01

    The objective of this study was to document and review advances and groundbreaking progress in cardiac and body MR at ultrahigh fields (UHF, B0 ≥ 7.0 T) with the goal to attract talent, clinical adopters, collaborations and resources to the biomedical and diagnostic imaging communities. This review surveys traits, advantages and challenges of cardiac and body MR at 7.0 T. The considerations run the gamut from technical advances to clinical opportunities. Key concepts, emerging technologies, practical considerations, frontier applications and future directions of UHF body and cardiac MR are provided. Examples of UHF cardiac and body imaging strategies are demonstrated. Their added value over the kindred counterparts at lower fields is explored along with an outline of research promises. The achievements of cardiac and body UHF-MR are powerful motivators and enablers, since extra speed, signal and imaging capabilities may be invested to overcome the fundamental constraints that continue to hamper traditional cardiac and body MR applications. If practical obstacles, concomitant physics effects and technical impediments can be overcome in equal measure, sophisticated cardiac and body UHF-MR will help to open the door to new MRI and MRS approaches for basic research and clinical science, with the lessons learned at 7.0 T being transferred into broad clinical use including diagnostics and therapy guiding at lower fields. Copyright © 2015 John Wiley & Sons, Ltd.

  17. W(h)ither human cardiac and body magnetic resonance at ultrahigh fields? technical advances, practical considerations, applications, and clinical opportunities.

    PubMed

    Niendorf, Thoralf; Paul, Katharina; Oezerdem, Celal; Graessl, Andreas; Klix, Sabrina; Huelnhagen, Till; Hezel, Fabian; Rieger, Jan; Waiczies, Helmar; Frahm, Jens; Nagel, Armin M; Oberacker, Eva; Winter, Lukas

    2016-09-01

    The objective of this study was to document and review advances and groundbreaking progress in cardiac and body MR at ultrahigh fields (UHF, B0 ≥ 7.0 T) with the goal to attract talent, clinical adopters, collaborations and resources to the biomedical and diagnostic imaging communities. This review surveys traits, advantages and challenges of cardiac and body MR at 7.0 T. The considerations run the gamut from technical advances to clinical opportunities. Key concepts, emerging technologies, practical considerations, frontier applications and future directions of UHF body and cardiac MR are provided. Examples of UHF cardiac and body imaging strategies are demonstrated. Their added value over the kindred counterparts at lower fields is explored along with an outline of research promises. The achievements of cardiac and body UHF-MR are powerful motivators and enablers, since extra speed, signal and imaging capabilities may be invested to overcome the fundamental constraints that continue to hamper traditional cardiac and body MR applications. If practical obstacles, concomitant physics effects and technical impediments can be overcome in equal measure, sophisticated cardiac and body UHF-MR will help to open the door to new MRI and MRS approaches for basic research and clinical science, with the lessons learned at 7.0 T being transferred into broad clinical use including diagnostics and therapy guiding at lower fields. Copyright © 2015 John Wiley & Sons, Ltd. PMID:25706103

  18. Providers' practice, recommendations and beliefs about HPV vaccination and their adherence to guidelines about the use of HPV testing, 2007 to 2010.

    PubMed

    Berkowitz, Z; Nair, N; Saraiya, M

    2016-06-01

    Human papillomavirus (HPV) vaccines prevent cervical pre-cancer lesion and can potentially reduce abnormal Papanicolaou (Pap) results among vaccinated females. However, current U.S. cervical screening guidelines recommend no change in screening initiation and frequency based on vaccination status. We examined providers' practices and beliefs about HPV vaccination to evaluate their adherence to guidelines. We used 4-year data (2007-2010) from two nationally representative samples totaling 2119 primary-care providers from the Cervical Cancer Screening Supplement to the National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS). Providers in each survey were stratified to obstetrician/gynecologist (OB/GYNs) and non-OB/GYNs. Descriptive statistics and chi-square tests were performed to assess differences between providers' types in each survey. Approximately 60% of providers believed that HPV vaccination will result in fewer abnormal Pap tests and fewer referrals to colposcopy and over 92% would not change their cervical cancer screening practices for fully vaccinated females. NAMCS OB/GYNs were more likely (p<0.05) than non-OB/GYNs to rarely/never use the number of sexual partners to determine who gets the HPV vaccine (68.4% vs. 59.1%), more likely to recommend the vaccine to females with history of abnormal Pap (79.6% vs. 68.4%) and to females with a history of HPV positive test result (75.3% vs. 62.8%). Consistent with guidelines, most providers would not change cervical cancer screening practices based on patients' vaccination history. However, some providers used inappropriate tests for making vaccination decisions. Improving HPV vaccine knowledge and recommendations for its use is warranted to implement a successful vaccine program.

  19. Toward a typology of confidentiality breaches in health care communication: an ethic of care analysis of provider practices and patient perceptions.

    PubMed

    Brann, Maria; Mattson, Marifran

    2004-01-01

    Confidentiality should be a fundamental right of patients in a health care setting. However, health care providers who take an oath to uphold confidentiality often neglect this basic patient right. Breaching confidential health information is a serious ethical problem and a communication issue that, historically, has received limited empirical, theoretical, or practical attention. The goals of this project were to frame this issue from an ethic of care perspective, define the concept of a confidentiality breach, identify the types of confidentiality breaches being communicated in health care organizations, and understand how patients perceive these breaches. Based on interviews with 51 patients and observations of health care providers, a definition and typology of confidentiality breaches emerged. Theoretical and practical implications also became evident.

  20. Advancing Organizational Cultural Competency With Dissemination and Implementation Frameworks: Towards Translating Standards into Clinical Practice.

    PubMed

    Ogbolu, Yolanda; Fitzpatrick, Grace A

    2015-01-01

    Substantial public health efforts have been activated to reduce health disparities and ensure health equity for patients through the provision of culturally and linguistically appropriate services; yet associated policies and standards are sluggishly translating into practice. Little attention and resources have been dedicated to translation of public health policies into practice settings. Dissemination and implementation is presented as an active, strategic approach to enhance uptake of public health standards; reviews dissemination and implementation concepts; poses a systematic model to adoption, implementation, and dissemination; and concludes with recommendations for hospital-based implementation teams and complementary interprofessional collaboration.