A Qualitative Inquiry Into the Challenges of Medical Education for Retention of General Practitioners in Rural and Underserved Areas of Iran

PubMed Central

2016-01-01

Objectives General practitioners (GPs) retention in rural and underserved areas highly effects on accessibility of healthcare facilities across the country. Education seems to be a critical factor that affects GPs retention. Thus, the present study aimed at inquiry into medical education challenges that limit their retention in rural and underserved areas. Methods A qualitative approach was applied for the aim of this study. Data were gathered via 28 semi-structured interviews with experts at different levels of Iran’s health system as well as GPs who retained and refused to retain working in rural settings. Interviews mainly were performed face-to-face and in some cases via telephone during 2015 and then coded and analyzed using content analysis approach. Results Iran’s medical education is faced with several challenges that were categorized in four main themes including student selection, medical students’ perception about their field of study, education setting and approach, curriculum of medical education. According to experts this challenges could results in making GP graduates disinterested for practicing in rural and underserved areas. Conclusions Challenges that were found could have negative effects on retention. Modification in student’s perception about rural practice could be done via changing education setting and approach and curriculum. These modifications could improve GPs retention in rural and underserved areas. PMID:27951631

Nurse practitioners in Taiwan: today and tomorrow.

PubMed

Wei, Ching-Wen; Tung, Heng-Hsin; Tsay, Shiow-Luan; Lin, Che-Wei

2012-03-01

To describe the barriers that nurse practitioners (NPs) face and their hopes for the future. The study used a qualitative research design, with 10 certified NPs who were recruited through convenience sampling. Data were collected through a face-to-face semi-structured interview, and content analysis was used to analyze the data. NPs in Taiwan are challenged by a number of barriers; however, they remain positive that their circumstances will improve. The results of this study suggest that there is a need for better communication between policymakers and NPs. Additionally, as recommended by the International Council of Nursing, there is a need for NPs to earn a master's degree and to have formal training prior to beginning work as an NP. Furthermore, to evaluate the NPs' performance, outcome studies need to be conducted. Implementing such recommendations should enable NPs to earn the respect and support of healthcare professionals and administrators. ©2012 The Author(s) Journal compilation ©2012 American Academy of Nurse Practitioners.

Working at the frontline in cases of elder abuse: 'it keeps me awake at night'.

PubMed

Cairns, Jane; Vreugdenhil, Anthea

2014-03-01

To explore the experiences of frontline health and welfare practitioners in working with older people experiencing abuse. In-depth interviews with 16 Tasmanian community-based health and welfare practitioners regarding their experiences of working in 49 recent cases of elder abuse. Interview transcripts were analysed using thematic analysis. All participants found working in cases of elder abuse challenging and the work itself was perceived as difficult, complex and at times dangerous. The cumulative effect of intimidating work contexts, practice dilemmas and a lack of support resulted in frustration and stress for many practitioners. Nevertheless, participants were committed to providing ongoing services and support for older people experiencing abuse. Frontline practitioners working in cases of elder abuse face significant challenges and could be better supported through strengthening organisational elder abuse policies, increased management support and more age-inclusive family violence support services. © 2013 The Authors. Australasian Journal on Ageing © 2013 ACOTA.

Using Online Modules in a Multi-Modality Teaching System: A High-Touch, High-Tech Approach to Geriatric Education

ERIC Educational Resources Information Center

Gainor, Sara Jane; Goins, R. Turner; Miller, Lee Ann

2004-01-01

Making geriatric education available to rural faculty/preceptors, students, and practitioners presents many challenges. Often the only options considered for educating those in the health professions about geriatrics are either traditional face-to-face courses or distance education programs. The purpose of this paper was to examine the use of…

Assisted migration: What it means to nursery managers and tree planters

Treesearch

Mary I. Williams; R. Kasten Dumroese

2014-01-01

Projections indicate that natural plant adaptation and migration may not keep pace with climate changes. This mismatch in rates will pose significant challenges for practitioners that select, grow, and outplant native tree species. Populations of native tree species planted today must be able to meet the climatic challenges they will face during this century. One...

The transition from resident to private practice--important financial decisions.

PubMed

Wherry, Jeffrey E; Thomalla, Kenneth

2008-02-01

A newly graduated resident faces many new challenges in the first year of practice. Foremost among these is how to handle the newfound wealth that typically accompanies the transition from residency to a successful practice. The ramifications of these decisions are not insignificant. This article explains the important financial considerations a new practitioner must face in the transition from resident to private practice.

PREVENT: a program of the National Training Initiative on Injury and Violence Prevention.

PubMed

Runyan, Carol W; Gunther-Mohr, Carol; Orton, Stephen; Umble, Karl; Martin, Sandra L; Coyne-Beasley, Tamera

2005-12-01

Training practitioners to use evidence-based approaches to the primary prevention of violence is challenging as a result of the dearth of well-evaluated intervention programs and the lack of familiarity of some practitioners in drawing critically on existing literature. An element of the National Training Initiative in Injury and Violence Prevention, the PREVENT (Preventing Violence Through Education, Networking, and Technical Assistance) program began in late 2003 to train practitioners to address multiple types of violence by encouraging more widespread use of evidence-based approaches to primary prevention. It is intended to reach practitioners involved in addressing violence against women, sexual violence, child maltreatment, youth violence, and suicide in varied community settings. The program uses a combination of varied types of face-to-face training and distance learning coupled with opportunities for networking and technical assistance. Ultimately the program intends to stimulate and facilitate changes in individual, organizational, and cultural awareness and practices fostering primary prevention of violence. The project employs formative, process, and impact evaluation techniques aimed at improving delivery of the training as well as tracking changes in individual and organizations.

The tobacco-using periodontal patient: The role of the dental practitioner in tobacco cessation and periodontal diseases management

PubMed Central

Chaffee, Benjamin W.; Couch, Elizabeth T.; Ryder, Mark I.

2016-01-01

Although the prevalence of tobacco use has declined in some parts of the world, tobacco use remains a persistent and, in some cases, growing problem that will continue to be a fundamental challenge facing dental practitioners in the decades ahead. The dental practitioner has a unique opportunity and professional obligation to be a positive influence in reducing the economic and social burden inflicted by tobacco use on dental and general health. In this article, the current non-invasive, evidence-based approaches are presented for the dental practitioner to help patients avoid tobacco initiation, to encourage and assist patients’ in tobacco cessation, and to address tobacco-induced damage to periodontal supporting tissues. PMID:27045430

Flipping the Objective Structured Clinical Examination: A Teaching Innovation in Graduate Nursing Education.

PubMed

Day, Cristi; Barker, Connie; Bell, Eva; Sefcik, Elizabeth; Flournoy, Deborah

Objective evaluation of distance-based family nurse practitioner (FNP) students can be challenging. One FNP program piloted a teaching innovation, the video-enhanced objective structured clinical examination (VE-OSCE) or "flip" of the traditional face-to-face OSCE, to assess student clinical performance in a controlled online environment using a teleconferencing platform. This project sought to assess the VE-OSCE design, implementation, and ability to identify FNP student learning needs.

Avoidable challenges of a nuclear medicine facility in a developing nation

PubMed Central

Adedapo, Kayode Solomon; Onimode, Yetunde Ajoke; Ejeh, John Enyi; Adepoju, Adewale Oluwaseun

2013-01-01

The role of nuclear medicine in disease management in a developing nation is as impactful as it is in other regions of the world. However, in the developing world, the practice of nuclear medicine is faced with a myriad of challenges, which can be easily avoided. In this review, we examine the many avoidable challenges to the practice of nuclear medicine in a developing nation. The review is largely based on personal experiences of the authors who are the pioneers and current practitioners of nuclear medicine in a typical developing nation. If the challenges examined in this review are avoided, the practice of nuclear medicine in such a nation will be more effective and practitioners will be more efficient in service delivery. Hence, the huge benefits of nuclear medicine will be made available to patients in such a developing nation. PMID:24379527

Technology Management within Product Lines in High Technology Markets

ERIC Educational Resources Information Center

Sarangee, Kumar R.

2009-01-01

Understanding the nuances of product line management has been of great interest to business scholars and practitioners. This assumes greater significance for firms conducting business in technologically dynamic industries, where they face certain challenges regarding the management of multiple, overlapping technologies within their product lines.…

Culturally Responsive Work with Indigenous Children and Youth

ERIC Educational Resources Information Center

Fulcher, Leon C.

2012-01-01

Educators and practitioners carry heavy obligations of responsibility for identifying knowledge and skills needed to assist those seeking to chart Response Ability Pathways toward reclaiming children, young people, and families who face some of society's greatest challenges. Teachers, social workers, and youth workers require dedicated education…

Ethical challenges facing veterinary professionals in Ireland: results from Policy Delphi with vignette methodology

PubMed Central

Magalhães-Sant'Ana, M.; More, S. J.; Morton, D. B.; Hanlon, A.

2016-01-01

Ethics is key to the integrity of the veterinary profession. Despite its importance, there is a lack of applied research on the range of ethical challenges faced by veterinarians. A three round Policy Delphi with vignette methodology was used to record the diversity of views on ethical challenges faced by veterinary professionals in Ireland. Forty experts, comprising veterinary practitioners, inspectors and nurses, accepted to participate. In round 1, twenty vignettes describing a variety of ethically challenging veterinary scenarios were ranked in terms of ethical acceptability, reputational risk and perceived standards of practice. Round 2 aimed at characterising challenges where future policy development or professional guidance was deemed to be needed. In round 3, possible solutions to key challenges were explored. Results suggest that current rules and regulations are insufficient to ensure best veterinary practices and that a collective approach is needed to harness workable solutions for the identified ethical challenges. Challenges pertaining mostly to the food chain seem to require enforcement measures whereas softer measures that promote professional discretion were preferred to address challenges dealing with veterinary clinical services. These findings can support veterinary representative bodies, advisory committees and regulatory authorities in their decision making, policy and regulation. PMID:27613779

Ethical challenges facing veterinary professionals in Ireland: results from Policy Delphi with vignette methodology.

PubMed

Magalhães-Sant'Ana, M; More, S J; Morton, D B; Hanlon, A

2016-10-29

Ethics is key to the integrity of the veterinary profession. Despite its importance, there is a lack of applied research on the range of ethical challenges faced by veterinarians. A three round Policy Delphi with vignette methodology was used to record the diversity of views on ethical challenges faced by veterinary professionals in Ireland. Forty experts, comprising veterinary practitioners, inspectors and nurses, accepted to participate. In round 1, twenty vignettes describing a variety of ethically challenging veterinary scenarios were ranked in terms of ethical acceptability, reputational risk and perceived standards of practice. Round 2 aimed at characterising challenges where future policy development or professional guidance was deemed to be needed. In round 3, possible solutions to key challenges were explored. Results suggest that current rules and regulations are insufficient to ensure best veterinary practices and that a collective approach is needed to harness workable solutions for the identified ethical challenges. Challenges pertaining mostly to the food chain seem to require enforcement measures whereas softer measures that promote professional discretion were preferred to address challenges dealing with veterinary clinical services. These findings can support veterinary representative bodies, advisory committees and regulatory authorities in their decision making, policy and regulation. British Veterinary Association.

“If Only Someone Had Told Me…”: Lessons From Rural Providers

PubMed Central

Chipp, Cody; Dewane, Sarah; Brems, Christiane; Johnson, Mark E.; Warner, Teddy D.; Roberts, Laura W.

2010-01-01

Purpose Health care providers face challenges in rural service delivery due to the unique circumstances of rural living. The intersection of rural living and health care challenges can create barriers to care that providers may not be trained to navigate, resulting in burnout and high turnover. Through the exploration of experienced rural providers’ knowledge and lessons learned, this study sought to inform future practitioners, educators, and policy makers in avenues through which to enhance training, recruiting, and maintaining a rural workforce across multiple health care domains. Methods Using a qualitative study design, 18 focus groups were conducted, with a total of 127 health care providers from Alaska and New Mexico. Transcribed responses from the question, “What are the 3 things you wish someone would have told you about delivering health care in rural areas?” were thematically coded. Findings Emergent themes coalesced into 3 overarching themes addressing practice-related factors surrounding the challenges, adaptations, and rewards of being a rural practitioner. Conclusion Based on the themes, a series of recommendations are offered to future rural practitioners related to community engagement, service delivery, and burnout prevention. The recommendations offered may help practitioners enter communities more respectfully and competently. They can also be used by training programs and communities to develop supportive programs for new practitioners, enabling them to retain their services and help practitioners integrate into the community. Moving toward an integrative paradigm of health care delivery wherein practitioners and communities collaborate in service delivery will be the key to enhancing rural health care and reducing disparities. PMID:21204979

Innovations and issues in the delivery of continuing education to nurse practitioners in rural and northern communities.

PubMed

Tilleczek, Kate; Pong, Raymond; Caty, Suzanne

2005-03-01

This paper addresses the need to provide rural nurse practitioners (NPs) with the distance education that is considered vital to the upgrading of their professional skills. The method of delivering the courses is a critical aspect of their success. The authors trace and describe the innovative delivery of the Rural Ontario Nurse Practitioner Continuing Education Initiative, from the initial needs assessment study through to the implementation and evaluation study. In each study, a multi-method action research model was used. The respondents showed a preference for face-to-face modalities that were perceived to be constrained by barriers. These barriers were subsequently addressed by the pilot project. Those living in rural areas recognized the benefits of information technologies. Implementation was effectively weighted on multiple modes of online course delivery and the use of constructivist pedagogy. The findings suggest that the delivery of continuing education to rural and remote NPs is still wrought with challenges.

The Challenge of Modern Church-Public Relations.

ERIC Educational Resources Information Center

Reagen, Michael V., Ed.; Chertow, Doris S., Ed.

Papers presented at the Institute on Modern Religious Communication Dilemmas, held at Syracuse University's Continuing Education Center for the Public Service in November 1971, are provided. The focus of the institute was the dilemmas facing modern church-public relations practitioners. The papers reproduced in this book provide a descriptive…

End of Asset Life Reinvestment Decision Support Tool (INFR2R11AT)

EPA Science Inventory

This “End of Asset Life” Reinvestment Decision-Support Tool is intended as a step by step guide for the asset management practitioner who faces the challenge of developing an investment strategy that represents the best integration of maintenance, operations, and capital investme...

A New World Ahead: Are We Ready?

ERIC Educational Resources Information Center

Henderson, Greg M.; Provo, Joanne

2006-01-01

There is no question that organization development (OD) scholars and practitioners are confronted with new and increasingly complex challenges in helping their clients cope with a tidal wave of continuous change. The questions they face today focus on the impact of leadership, technology, globalization, and the new generations entering the…

Adaptation by Design: A Context-Sensitive, Dialogic Approach to Interventions

ERIC Educational Resources Information Center

Kirshner, Ben; Polman, Joseph L.

2013-01-01

Applied researchers, whether working with the framework of design-based research or intervention science, face a similar implementation challenge: practitioners who enact their programs typically do so in varied, context-specific ways. Although this variability is often seen as a problem for those who privilege fidelity and standardization, we…

College Student Concerns: Perceptions of Student Affairs Practitioners

ERIC Educational Resources Information Center

Reynolds, Amy L.

2013-01-01

The purpose of this study was to increase awareness of the perceptions of student affairs professionals regarding the most frequent and challenging concerns facing college students today. Using the Delphi method, 159 entry-level and mid-level student affairs administrators from institutions across the country were surveyed about their perceptions…

Using the Internet for B2B Activities: A Review and Future Directions for Research.

ERIC Educational Resources Information Center

Gattiker, Urs E.; Perlusz, Stefano; Bohmann, Kristoffer

2000-01-01

Illustrates some of the challenges that electronic commerce practitioners and researchers face, focusing on business to business (B2B) transactions. Highlights include a conceptual framework of Web user behavior; purchasing context; socio-demographic characteristics; cultural factors; economic factors; attitudes toward information technology;…

Best Practices for Career Centers at Liberal Arts Colleges.

ERIC Educational Resources Information Center

Oatis-Skinner, Chris; Betz, Kim

1998-01-01

The Midwest Association of Colleges and Employers Liberal Arts and Sciences Group identifies practices for meeting four challenges faced by practitioners in career centers on liberal arts campuses. Ideas and suggestions are identified within the following categories: helping students assess job skills, involving faculty, assisting students with…

Defining and Measuring Literacy: Facing the Reality

ERIC Educational Resources Information Center

Ahmed, Manzoor

2011-01-01

Increasing recognition of a broadened concept of literacy challenges policy-makers and practitioners to re-define literacy operationally, develop and apply appropriate methods of assessing literacy and consider and act upon the consequent policy implications. This task is given a new urgency by the call of the Belem Framework for Action to…

Student-Facilitators as University Tutors: An Effective Approach to Sustainability Education

ERIC Educational Resources Information Center

Sloan, Thomas; Davila, Federico; Malbon, Eleanor

2013-01-01

Higher education institutions are considered by many to be pivotal in shaping the next generation of thinkers and practitioners required to further work towards addressing the sustainability challenges faced by contemporary societies. The extent to which higher education has embraced this responsibility is debateable. Notwithstanding, this article…

Community Colleges and the Media: Getting Effective Coverage for Your Institution.

ERIC Educational Resources Information Center

Thornton, Tim

2000-01-01

Looks at college marketing and promotion from the media's point of view, and addresses the challenges media personnel face in retrieving timely information from colleges and in establishing working relationships with marketing and public relations practitioners in community colleges. Describes what journalists expect from community colleges and…

Collaboration between social workers and dentists for care of people with special health needs (a commentary).

PubMed

Waldman, H Barry; Perlman, Steven P

2003-01-01

The difficulties faced by individuals with mental retardation, developmental and other disabilities in securing dental services are reviewed. The need for social workers to stimulate family members and other health care providers to collaborate with and challenge dental practitioners is emphasized.

Exploring the SoTL Landscape at the University of Saskatchewan

ERIC Educational Resources Information Center

Wuetherick, Brad; Yu, Stan; Greer, Jim

2016-01-01

This paper presents the results of a quantitative study that comprehensively assessed the level and extent to which the Scholarship of Teaching and Learning (SoTL) was being conducted amongst faculty and staff at the University of Saskatchewan, and identifies the barriers and challenges faced by SoTL practitioners.

The tobacco-using periodontal patient: role of the dental practitioner in tobacco cessation and periodontal disease management.

PubMed

Chaffee, Benjamin W; Couch, Elizabeth T; Ryder, Mark I

2016-06-01

Although the prevalence of tobacco use has declined in some parts of the world, tobacco use remains a persistent and, in some cases, growing problem that will continue to be a fundamental challenge facing dental practitioners in the decades ahead. Dental practitioners have a unique opportunity and professional obligation to be a positive influence in reducing the economic and social burden inflicted by tobacco use on dental and general health. In this article, the current noninvasive, evidence-based approaches are presented for dental practitioners to help patients avoid initiating tobacco use, to encourage and assist patients in ceasing tobacco use and to address tobacco-induced damage to periodontal supporting tissues. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Politics and public health ethics in practice: right and left meet right and wrong.

PubMed

Gollust, Sarah E; Baum, Nancy M; Jacobson, Peter D

2008-01-01

As public health practitioners are no doubt aware, public health practice and politics are closely linked. Although theoretical discussion of the emerging field of public health ethics has been rich, scholars have paid little attention to the relationship between ethical issues and politics in public health practice. We conducted semistructured interviews with 45 public health practitioners across a range of occupations (eg, health officers, medical directors, sanitarians, nurses, educators, and commissioners) working at 12 local health departments across Michigan and the state health department. Practitioners were asked to describe the ethical issues they faced in their daily practice. Ethical issues that resulted from the political environment emerged as one major category of ethical issues our interviewees described. This article illustrates how political issues engender ethical challenges in 4 main areas: public health agenda-setting, political pressures, political conflicts with best practices, and the scope of public health practice. The findings suggest that politics and public health ethics intrinsically intersect, because political pressures and priorities often impose ethical challenges that practitioners negotiate in their daily work.

School Psychology in Rural Contexts: Ethical, Professional, and Legal Issues

ERIC Educational Resources Information Center

Edwards, Lynn M.; Sullivan, Amanda L.

2014-01-01

Delivering psychological services in rural communities presents a number of unique challenges for practitioners relative to their peers in urban and suburban communities. In this article, the authors describe the current context of rural schools and examine the ethical and legal issues school psychologists may face when practicing in rural…

Critical Autobiography in the Professional Doctorate: Improving Students' Writing through the Device of Literature

ERIC Educational Resources Information Center

Eastman, Christine; Maguire, Kate

2016-01-01

This paper argues for a pedagogic practice to overcome the challenges that many professional practitioners face in undertaking a professional doctorate. Recent examination feedback on a professional doctoral programme of 300 candidates in the UK highlighted that a number of candidates often struggle to write persuasively, critically and…

Going Public: Writing about Research in Everyday Language. REL 2014-051

ERIC Educational Resources Information Center

Dynarski, Mark; Kisker, Ellen

2014-01-01

Communicating complex concepts to practitioners, policymakers, and other nontechnical readers is a challenge that all policy researchers face. Research in education uses many concepts from methodology and statistics. If researchers want to communicate their findings to an audience of other researchers, they can safely assume that their audience is…

Poststroke Depression: Social Workers' Role in Addressing an Underrecognized Psychological Problem for Couples Who Have Experienced Stroke

ERIC Educational Resources Information Center

McCarthy, Michael J.; Powers, Laurie E.; Lyons, Karen S.

2011-01-01

Depression is the most common psychological challenge faced by many individuals and families following stroke. Fortunately, poststroke depression is treatable, and even preventable, if social work and other rehabilitation practitioners understand the most common risk factors and become familiar with measures for assessing for depression among…

Learning Problems in Transnational Business Education and Training: The Case of the MBA in Thailand

ERIC Educational Resources Information Center

Pimpa, Nattavud

2009-01-01

The transnational Master of Business Administration (MBA) programme has been one of the most popular official business training programmes amongst Thai business practitioners. Although the numbers of transnational business schools and MBA programmes are rapidly increasing, the programmes face numerous challenges from both local and global factors.…

Conflicting Pressures That Impinge Upon the Operational Effectiveness of Institutional Researchers: Challenges to the Practitioner.

ERIC Educational Resources Information Center

Gubasta, Joseph L.

The numerous issues and problems facing college and university decisionmakers and the ever increasing information needs of external agency representatives place conflicting pressures on institutional research personnel, forcing them to make difficult decisions regarding the allocation of their resources. Outlined are several such pressures. It is…

Health Promoting Schools as Learning Sites for Physicians in-Training

ERIC Educational Resources Information Center

Dharamsi, Shafik; Woollard, Robert; Kendal, Paul; Okullo, Isaac; Macnab, Andrew J.

2014-01-01

Purpose: Although medical schools do well in preparing the next generation of practitioners to diagnose and clinically treat illness, they struggle in preparing them with capabilities in the areas of health promotion and disease prevention. Similarly, health promoting schools (HPS) face challenges in working to enhance the health and educational…

V for Voice: Strategies for Bolstering Communication Skills in Statistics

ERIC Educational Resources Information Center

Khachatryan, Davit; Karst, Nathaniel

2017-01-01

With the ease and automation of data collection and plummeting storage costs, organizations are faced with massive amounts of data that present two pressing challenges: technical analysis of the data themselves and communication of the analytics process and its products. Although a plethora of academic and practitioner literature have focused on…

Benefits and challenges of health information systems for operations research: an illustrative example to improve surgical scheduling.

PubMed

Chow, Vincent S; Huang, Wenhai; Puterman, Martin L

2009-01-01

Operations research (OR) is playing an increasing role in the support of many health care initiatives. However one of the main challenges facing OR practitioners is the availability and the integrity of operations data. Hospital information systems (HIS) are often designed with a clinical or accounting focus and may lack the data necessary for operational studies. In this paper, we illustrate the data processing methods and data challenges faced by our team during a study of surgical scheduling practices at the Vancouver Island Health Authority. We also provide some general recommendations to improve HIS from an operations perspective. In general, more integration between operations researchers and HIS specialists are required to support ongoing operational improvements in the health care sector.

Harmonizing professional, personal, and social responsibilities: Indian women dentists' perspectives.

PubMed

Nagda, Suhasini Jayantilal

2015-05-01

Women in Indian culture have a paradoxical status: on the one hand, goddesses are worshipped for power and prosperity; on the other hand, working women face challenges due to age-old beliefs and sociocultural norms. With 60% of the students enrolled in undergraduate dental education currently being women, there is a need to study the challenges these women are facing and how they tackle them. The aim of this survey study was to assess the barriers women dentists face in career advancement and how successfully they balance the personal, professional, and social aspects of their lives. Questionnaires, consisting of four qualitative and 24 quantitative items, were distributed to 500 women dentists: postgraduate residents and faculty members in dental colleges of Mumbai and Navi Mumbai, as well as private dental practitioners. Of the 500 women, 210 returned the survey, for an overall response rate of 42%. The results showed that 95% of the respondents believed they successfully balance the various spheres of their lives, but the most common challenges they faced continued to be traditional gender bias, dual professional and home responsibilities, and preconceived ideas about women.

The Future of the Humanities in Primary Schools--Reflections in Troubled Times

ERIC Educational Resources Information Center

Eaude, Tony; Butt, Graham; Catling, Simon; Vass, Peter

2017-01-01

This article reflects on the implications for practitioners, researchers and policy-makers of the future of the humanities in primary schools in the light of the challenges facing future generations. There is wide divergence in the four jurisdictions of the UK. The humanities are perceived as important, in principle, though curriculum frameworks…

Education, Technology, and the Asian-American Community: Forging a Unique Identity in the Face of Unique Challenges

ERIC Educational Resources Information Center

Subramony, Deepak Prem

2007-01-01

In an effort to mitigate our field's historic neglect of issues of cultural diversity, this article seeks to introduce Asian-Americans--a fascinating, important, and under-researched group of learners and technology users--to educational technology scholars and practitioners. It describes Asian-Americans' admirable levels of educational…

A Practitioner Review of the Great Leap in Mainland China's Tertiary VET

ERIC Educational Resources Information Center

Ren, Junqing; Gao, Xuesong; Su, Zhigang

2006-01-01

In this paper, we attempt to give an insider's perspective on mainland China's tertiary vocational education/training (VET) through reflecting upon its recent history, the social and economic conditions for its current growth and survival, and the challenges facing its future. We will take stock of four major problems that have been hindering the…

The Research-Informed Clinician: A Guide to Training the Next-Generation MFT

ERIC Educational Resources Information Center

Karam, Eli A.; Sprenkle, Douglas H.

2010-01-01

The gap between clinical research and practice is a major challenge facing marriage and family therapy (MFT) training programs. Until now, the answer to bridge this gap has primarily been the Boulder Scientist-Practitioner Model. Although realistic for doctoral students, it may not be a good fit for MFT master's students who have primarily…

Web Based Interactive Software in International Business: The Case of the Global Market Potential System Online (GMPSO[C])

ERIC Educational Resources Information Center

Janavaras, Basil J.; Gomes, Emanuel; Young, Richard

2008-01-01

This paper seeks to confirm whether students using the Global Market Potential System Online (GMPSO) web based software, (http://globalmarketpotential.com), for their class project enhanced their knowledge and understanding of international business. The challenge most business instructors and practitioners face is to determine how to bring the…

Studying the clinical encounter with the Adaptive Leadership framework.

PubMed

Bailey, Donald E; Docherty, Sharron L; Adams, Judith A; Carthron, Dana L; Corazzini, Kirsten; Day, Jennifer R; Neglia, Elizabeth; Thygeson, Marcus; Anderson, Ruth A

2012-08-01

In this paper we discuss the concept of leadership as a personal capability, not contingent on one's position in a hierarchy. This type of leadership allows us to reframe both the care-giving and organizational roles of nurses and other front-line clinical staff. Little research has been done to explore what leadership means at the point of care, particularly in reference to the relationship between health care practitioners and patients and their family caregivers. The Adaptive Leadership framework, based on complexity science theory, provides a useful lens to explore practitioners' leadership behaviors at the point of care. This framework proposes that there are two broad categories of challenges that patients face: technical and adaptive. Whereas technical challenges are addressed with technical solutions that are delivered by practitioners, adaptive challenges require the patient (or family member) to adjust to a new situation and to do the work of adapting, learning, and behavior change. Adaptive leadership is the work that practitioners do to mobilize and support patients to do the adaptive work. The purpose of this paper is to describe this framework and demonstrate its application to nursing research. We demonstrate the framework's utility with five exemplars of nursing research problems that range from the individual to the system levels. The framework has the potential to guide researchers to ask new questions and to gain new insights into how practitioners interact with patients at the point of care to increase the patient's ability to tackle challenging problems and improve their own health care outcomes. It is a potentially powerful framework for developing and testing a new generation of interventions to address complex issues by harnessing and learning about the adaptive capabilities of patients within their life contexts.

Challenges for IT-supported shared care: a qualitative analyses of two shared care initiatives for diabetes treatment in Denmark “I'll never use it” (GP5).

PubMed Central

Granlien, Maren Fich; Simonsen, Jesper

2007-01-01

Purpose To investigate the circumstances as to why it is so difficult in the primary care sector to implement IT based infrastructures supporting shared care. Case study The qualitative analysis includes two separate case studies of IT-supported shared care implemented in two different regions of Denmark throughout 2005. The study comprises 21 interviews and 35 hours of observations. The data were analysed through a coding process that led to the emergence of three main challenges impeding the organisational implementation of IT-supported shared care. Discussion and conclusion The two cases faced the same challenges that led to the same problem: The secondary care sector quickly adopted the system while the primary sector was far more sceptical towards using it. In both cases, we observe a discrepancy of needs satisfied, especially with regard to the primary care sector and its general practitioners which hinder bridging the primary sector (general practitioners) and the secondary sector (hospitals and outpatient clinics). Especially the needs associated with the primary sector were not being satisfied. We discovered three main challenges related to bridging the gap between the two sectors: (1) Poor integration with the general practitioners' existing IT systems; (2) low compatibility with general practitioners' work ethic; (3) and discrepancy between the number of diabetes patients and the related need for shared care. We conclude that development of IT-supported shared care must recognise the underlying and significant differences between the primary and secondary care sectors: If IT-supported shared care does not meet the needs of the general practitioners as well as the needs of the secondary care sector the initiative will fail. PMID:17627300

Exploring strategies to overcome extra-organisational challenges faced by community pharmacies in Sarawak, Malaysia.

PubMed

Kho, Boon Phiaw; Hassali, Mohamed Azmi; Lim, Ching Jou; Saleem, Fahad

2018-03-15

The aims of this research were to determine extra-organisational challenges (e.g. market competition, governing policies) faced by community pharmacies in Sarawak, the coping strategies employed to deal with these challenges and explore potential legislative changes that can attenuate the intensity of these challenges. Survey questionnaires (n = 184) were posted to all eligible community pharmacies in Sarawak, Malaysia. The questionnaire included sections on participants' demographic data, extra-organisational challenges faced, coping strategies employed and proposals to improve community pharmacy legislations. Items were constructed based on the findings of a prior qualitative research supplemented with relevant literature about these issues. High levels of homogeneity in responses were recorded on various extra-organisational challenges faced, particularly those economy-oriented. Strategic changes to counter these challenges were focused on pricing and product stocked, rather than services provision. Highly rated strategies included increasing discounts for customers (n = 54; 68%) and finding cheaper suppliers (n = 70; 88%). Legislative changes proposed that might increase their share of the pharmaceutical market were strongly supported by respondents, particularly about making it compulsory for general practitioners to provide patients the option to have their medicines dispensed in community pharmacies (n = 72; 90%). Current legislative conditions and Malaysian consumer mindset may have constrained the strategic choices of community pharmacies to deal with the strong extra-organisational challenges. A long-term multipronged approach to address these issues and increased involvement of community pharmacists themselves in this agenda are required to influence practice change. © 2018 Royal Pharmaceutical Society.

Full practice authority--effecting change and improving access to care: the Nevada journey.

PubMed

VanBeuge, Susan S; Walker, Tomas

2014-06-01

In 2013, Nevada shifted from a collaborative practice model to full practice authority. Given the challenges many states still face, this article provides an outline of the evolution of the "nurse practitioner" (NP) in Nevada. Reviewing the path Nevada took toward full practice authority, we hope to provide insight including lessons learned and opposition encountered to assist other states working toward full practice authority. Literature searches were conducted on PubMed and MEDLINE. Search terms included "autonomous practice," "nurse practitioner," and "full practice authority." Healthcare reform will require nurse practitioners committed to legislative change. Nurse practitioners have the knowledge and ability to affect the legislative process and improve patients' access to care. With careful planning, full engagement, and team building, making a statute change is possible and should be seriously considered in states still struggling with collaborative relationships. Nurse practitioners are well situated to provide primary care in the United States. Removing barriers to practice through statute change will empower NPs to effect positive change in our struggling healthcare system. ©2014 The Author(s) ©2014 American Association of Nurse Practitioners.

Taxonomy of Challenges for Digital Forensics.

PubMed

Karie, Nickson M; Venter, Hein S

2015-07-01

Since its inception, over a decade ago, the field of digital forensics has faced numerous challenges. Despite different researchers and digital forensic practitioners having studied and analysed various known digital forensic challenges, as of 2013, there still exists a need for a formal classification of these challenges. This article therefore reviews existing research literature and highlights the various challenges that digital forensics has faced for the last 10 years. In conducting this research study, however, it was difficult for the authors to review all the existing research literature in the digital forensic domain; hence, sampling and randomization techniques were employed to facilitate the review of the gathered literature. Taxonomy of the various challenges is subsequently proposed in this paper based on our review of the literature. The taxonomy classifies the large number of digital forensic challenges into four well-defined and easily understood categories. The proposed taxonomy can be useful, for example, in future developments of automated digital forensic tools by explicitly describing processes and procedures that focus on addressing specific challenges identified in this paper. However, it should also be noted that the purpose of this paper was not to propose any solutions to the individual challenges that digital forensics face, but to serve as a survey of the state of the art of the research area. © 2015 American Academy of Forensic Sciences.

Mid-Career Extension Graduates' Perceptions of the Impact of a Demand-Driven, Extension Curriculum in Ghana

ERIC Educational Resources Information Center

Kwarteng, Joseph A.; Boateng, Samuel Akuamoah

2012-01-01

One of the major challenges facing Africa today is ensuring that extension practitioners are well trained to enable them function effectively as facilitators of change at the farmers' level. The purpose of this study was to examine the effectiveness of a mid-career B. Sc. Agricultural Extension Curriculum in meeting the educational needs of…

Trauma to the Psyche and Soma: A Case Study of Posttraumatic Stress Disorder and Comorbid Problems Arising from a Road Traffic Collision

ERIC Educational Resources Information Center

Wald, Jaye; Taylor, Steven

2006-01-01

Randomized controlled studies have shown that cognitive-behavioral therapies are effective for treating various forms of posttraumatic stress disorder (PTSD), with most research focusing on combat or sexual-assault-related PTSD. A challenge currently facing researchers and practitioners is to develop specialized protocols for treating other forms…

The Conceptions of Work in the Accounting Profession in the Twenty-First Century from the Experiences of Practitioners

ERIC Educational Resources Information Center

Sin, Samantha; Reid, Anna; Dahlgren, Lars Owe

2011-01-01

The accounting profession, which has commercialised its services extensively in the past two to three decades, is facing the challenges of change. An early and concerted response to the changes in the scope of work was the emphasis on developing generic skills in accounting higher education. This study recognises the relevance of accounting…

Getting the Balance Right: The Challenge of Balancing Praise and Correction for Early School Years Children Who Exhibit Oppositional and Defiant Behaviour

ERIC Educational Resources Information Center

Fields, Barry

2012-01-01

Increasingly, early childhood practitioners are faced with children who present with significant levels of oppositional and defiant behaviour. The management of this behaviour is often difficult and stressful. Efforts to minimise disruptive behaviour and to encourage more prosocial behaviour have very much revolved around the teaching of…

Resident Physicians' Clinical Training and Error Rate: The Roles of Autonomy, Consultation, and Familiarity with the Literature

ERIC Educational Resources Information Center

Naveh, Eitan; Katz-Navon, Tal; Stern, Zvi

2015-01-01

Resident physicians' clinical training poses unique challenges for the delivery of safe patient care. Residents face special risks of involvement in medical errors since they have tremendous responsibility for patient care, yet they are novice practitioners in the process of learning and mastering their profession. The present study explores…

76 FR 41032 - Medicaid Program; Face-to-Face Requirements for Home Health Services; Policy Changes and...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-12

... practitioner or clinical nurse specialist (as those terms are defined in section 1861(aa)(5) of the Act) who is...-to-face encounter as a nurse practitioner or clinical nurse specialist, as those terms are defined in... following NPPs: A nurse practitioner or clinical nurse specialist (as those terms are defined in section...

Using physical objects with young children in 'face-to-face' and telehealth speech and language therapy.

PubMed

Ekberg, Stuart; Danby, Susan; Theobald, Maryanne; Fisher, Belinda; Wyeth, Peta

2018-03-23

Speech language therapists increasingly are using telehealth to enhance the accessibility of their services. It is unclear, however, how play-based therapy for children can be delivered via telehealth. In particular, modalities such as videoconferencing do not enable physical engagement between therapists and clients. The aim of our reported study was to understand how physical objects such as toys are used in similar and different ways across videoconferenced and "face-to-face" (hereafter, "in-person") therapy. We used conversation analytic methods to compare video-recorded therapy sessions for children delivered across in-person and telehealth settings. Utilising a broader corpus of materials, our analysis focused on four client-therapist dyads: two using videoconferencing, and two who met in-person. Both videoconferencing and in-person sessions enabled routine affordances and challenges for delivering therapy. Within in-person therapy, therapists made access to objects contingent upon the client producing some target expression. This contingency usually was achieved by restricting physical access to these objects. Restricting access to a toy was not necessary in videoconferenced therapy; therapists instead used techniques to promote engagement. When delivering play-based therapy via telehealth, our study demonstrates how practitioners adapt the intervention to suit the particular medium of its delivery. Implications for Rehabilitation Telehealth enhances equitable access for those who cannot physically access rehabilitation services. Telehealth modalities can create practical challenges, however, when delivering interventions such as play-based therapy. Practitioners should intentionally adapt telehealth interventions to suit the particular telehealth modality they are using.

Alternatives to the face-to-face consultation in general practice: focused ethnographic case study.

PubMed

Atherton, Helen; Brant, Heather; Ziebland, Sue; Bikker, Annemieke; Campbell, John; Gibson, Andy; McKinstry, Brian; Porqueddu, Tania; Salisbury, Chris

2018-04-01

NHS policy encourages general practices to introduce alternatives to the face-to-face consultation, such as telephone, email, e-consultation systems, or internet video. Most have been slow to adopt these, citing concerns about workload. This project builds on previous research by focusing on the experiences of patients and practitioners who have used one or more of these alternatives. To understand how, under what conditions, for which patients, and in what ways, alternatives to face-to-face consultations present benefits and challenges to patients and practitioners in general practice. Focused ethnographic case studies took place in eight UK general practices between June 2015 and March 2016. Non-participant observation, informal conversations with staff, and semi-structured interviews with staff and patients were conducted. Practice documents and protocols were reviewed. Data were analysed through charting and the 'one sheet of paper' mind-map method to identify the line of argument in each thematic report. Case study practices had different rationales for offering alternatives to the face-to-face consultation. Beliefs varied about which patients and health issues were suitable. Co-workers were often unaware of each other's practice; for example, practice policies for use of e-consultations systems with patients were not known about or followed. Patients reported benefits including convenience and access. Staff and some patients regarded the face-to-face consultation as the ideal. Experience of implementing alternatives to the face-to-face consultation suggests that changes in patient access and staff workload may be both modest and gradual. Practices planning to implement them should consider carefully their reasons for doing so and involve the whole practice team. © British Journal of General Practice 2018.

Alternatives to the face-to-face consultation in general practice: focused ethnographic case study

PubMed Central

Atherton, Helen; Brant, Heather; Ziebland, Sue; Bikker, Annemieke; Campbell, John; Gibson, Andy; McKinstry, Brian; Porqueddu, Tania; Salisbury, Chris

2018-01-01

Background NHS policy encourages general practices to introduce alternatives to the face-to-face consultation, such as telephone, email, e-consultation systems, or internet video. Most have been slow to adopt these, citing concerns about workload. This project builds on previous research by focusing on the experiences of patients and practitioners who have used one or more of these alternatives. Aim To understand how, under what conditions, for which patients, and in what ways, alternatives to face-to-face consultations present benefits and challenges to patients and practitioners in general practice. Design and setting Focused ethnographic case studies took place in eight UK general practices between June 2015 and March 2016. Method Non-participant observation, informal conversations with staff, and semi-structured interviews with staff and patients were conducted. Practice documents and protocols were reviewed. Data were analysed through charting and the ‘one sheet of paper’ mind-map method to identify the line of argument in each thematic report. Results Case study practices had different rationales for offering alternatives to the face-to-face consultation. Beliefs varied about which patients and health issues were suitable. Co-workers were often unaware of each other’s practice; for example, practice policies for use of e-consultations systems with patients were not known about or followed. Patients reported benefits including convenience and access. Staff and some patients regarded the face-to-face consultation as the ideal. Conclusion Experience of implementing alternatives to the face-to-face consultation suggests that changes in patient access and staff workload may be both modest and gradual. Practices planning to implement them should consider carefully their reasons for doing so and involve the whole practice team. PMID:29378697

Healing the healer: one step at a time.

PubMed

Gershon, J Casey

2014-03-01

Health care workers have the most challenging of professions. They are expected to work long hours while demonstrating compassion and care for the patients that they serve. Although health care practitioners are among the most disciplined of working professionals, they are often some of the unhealthiest of individuals, facing enormous amounts of stress in their lives. Healing the Healer: One Step at a Time is a 6-week health fitness program. It explores the unique challenges faced in the field of health care and teaches techniques to address those challenges head on. Healing the Healer uses Nordic walking as the exercise portion of the class. The case study examines the structure, purpose, and design of this 6-week course. Special attention is given to four basic sections: balance, pacing, joy, and discipline. The arguments presented in this article are theory based and supported by case study evidence.

The role and experiences of advanced nurse practitioners working in out of hours urgent care services in a primary care setting.

PubMed

Yuill, Jacci

2018-05-30

GPs' workload has increased significantly in recent years affecting their ability to provide high-quality services, and consequently there is increasing focus on nurses to provide a solution. There is little evidence of how advanced nurse practitioners (ANPs) experience their role in out of hours (OOH) services, and it is important to understand their perceptions of this and the challenges they may face in supporting service development and improvement. This article evaluates the role and experiences of ANPs working in an OOH urgent primary care service and identifies important factors that affect their roles. Positive factors enable job satisfaction, but challenges associated with knowledge base, perceptions, role definitions and isolation must be considered for quality and governance purposes. The article describes how supportive systems must be in place to enable mentorship, supervision programmes and development of this group of advanced practitioners. ©2018 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

Investing in Our Next Generation: A Funder's Guide to Addressing the Educational Opportunities and Challenges Facing English Language Learners

ERIC Educational Resources Information Center

Grantmakers for Education, 2010

2010-01-01

More than one in ten preK-12 students in the U.S. are English Language Learners (ELLs), yet a sizable achievement gap exists between these more than 5.3 million ELL students and their English-proficient peers. In June 2010, Grantmakers for Education (GFE) convened funders, researchers, policymakers and practitioners to examine the role of…

Why Are There Still so Few Men within Early Years in Primary Schools: Views from Male Trainee Teachers and Male Leaders?

ERIC Educational Resources Information Center

Mistry, Malini; Sood, Krishan

2015-01-01

One of the challenges facing the Early Years (EY) sector is how to encourage more male practitioners to counterbalance a largely feminised workforce. Using case studies of male trainees at different stages of their primary undergraduate Initial Teacher Training course at one university, we attempt to consider data why there is under-representation…

Building nurses' capacity to address health inequities: incorporating lesbian, gay, bisexual and transgender health content in a family nurse practitioner programme.

PubMed

Yingling, Charles T; Cotler, Karen; Hughes, Tonda L

2017-09-01

To describe our experience in incorporating lesbian, gay, bisexual and transgender health content into the family nurse practitioner curriculum at a Midwestern college of nursing in the United States. Globally, lesbian, gay, bisexual and transgender people face disparities in the domains of physical health, behavioural risks, mental health and victimisation. There remains a paucity of nursing research on most aspects of lesbian, gay, bisexual and transgender health and access to care. To date, nursing leadership and curricular bodies have not provided clear guidance on the role of nurse educators in preparing nursing students to provide care to lesbian, gay, bisexual and transgender people. Discursive paper describing the development of a lesbian, gay, bisexual and transgender health learning module for inclusion in a family nurse practitioner programme. We summarise health disparities experienced by lesbian, gay, bisexual and transgender people, describe the process of module development and outline the learning content included in the module. We also discuss challenges faced in incorporating lesbian, gay, bisexual and transgender content into nursing curricula. Despite the lack of formal direction from the nursing sector, nursing faculty should prepare nursing students to provide culturally sensitive and competent care to lesbian, gay, bisexual and transgender people. Our experience incorporating lesbian, gay, bisexual and transgender-specific content into the family nurse practitioner programme has proven to be positive for both students and faculty. Given their large numbers and presence across systems of care, nurses are uniquely positioned to address barriers to care faced by lesbian, gay, bisexual and transgender people. Modules such as the one described here can be used by nurse faculty to guide the inclusion of lesbian, gay, bisexual and transgender-specific content in family nurse practitioner or other nursing courses-as well as to guide the development of nursing competencies in the care of lesbian, gay, bisexual and transgender people. © 2016 John Wiley & Sons Ltd.

Outsourcing issues for nurse practitioner practices.

PubMed

Mackey, Thomas A; McNiel, Nancy O; Klingensmith, Kenneth

2004-01-01

Nurse practitioner managed practices face multiple business and clinical processes. While most practice managers are prepared as clinicians, they are not well prepared to deal with the daily multiple business infrastructure issues they face. To provide for increased efficiency and effectiveness, nurse practitioner practices should consider outsourcing context business functions.

Patient Communication in Health Care Settings: new Opportunities for Augmentative and Alternative Communication.

PubMed

Blackstone, Sarah W; Pressman, Harvey

2016-01-01

Delivering quality health care requires effective communication between health care providers and their patients. In this article, we call on augmentative and alternative communication (AAC) practitioners to offer their knowledge and skills in support of a broader range of patients who confront communication challenges in health care settings. We also provide ideas and examples about ways to prepare people with complex communication needs for the inevitable medical encounters that they will face. We argue that AAC practitioners, educators, and researchers have a unique role to play, important expertise to share, and an extraordinary opportunity to advance the profession, while positively affecting patient outcomes across the health care continuum for a large number of people.

Building leadership capacity in advanced nurse practitioners - the role of organisational management.

PubMed

Elliott, Naomi

2017-01-01

To highlight the organisation-level management's role in building leadership capacity in advanced nurse practitioners and the need for appropriate supports to increase their becoming leaders. Little is published about the role of organisation-level management in building leadership capacity and in developing the next generation of nurse leaders. In times of economic constraint, organisations need to focus their efforts on targeted leadership initiatives. Advanced nurse practitioners are ideally positioned to act as leaders both within and beyond the health care organisation. From the available research evidence, several support structures and mechanisms are identified as enablers for advanced nurse practitioners to enact their leadership role. Health care organisations need to include building leadership capacity as a priority in their strategic plan and take action to build-up the level of advanced nurse practitioner leadership. Nurse executives have a vital role in influencing the organisation's strategic plan and making a business case for prioritising leadership capacity building within advanced nurse practitioners. A challenge for nurse executives faced with competing service and leadership development demands, involves strategic decision-making regarding whether the advanced nurse practitioner's role is limited to service delivery or its potential in leading health care reforms is realised. © 2016 John Wiley & Sons Ltd.

Identifying Curriculum Design Patterns as a Strategy for Focusing Geoscience Education Research: A Proof of Concept Based on Teaching and Learning with Geoscience Data

ERIC Educational Resources Information Center

Kastens, Kim; Krumhansl, Ruth

2017-01-01

The geoscience education research (GER) enterprise faces a challenge in moving instructional resources and ideas from the well-populated domain of "practitioners' wisdom" into the research-tested domains of St. John and McNeal's pyramid of evidence (this volume). We suggest that the process could be accelerated by seeking out clusters of…

The role of women in nuclear - attracting public participation in regulatory decision-making process

NASA Astrophysics Data System (ADS)

Mohamad Jais, Azlina; Hassan, Najwa

2018-01-01

Public participation is vital in demonstrating transparency and enhancing effectiveness of a nuclear regulatory process. As such, it is necessary for nuclear practitioners to involve the public in key nuclear delivery milestones. This paper specifically discusses challenges faced in attracting public participation throughout the nuclear regulatory decision-making process, and highlights the roles of women in nuclear (WiN) in initiating the said public discourse.

Seeing the person? Disability theories and speech and language therapy.

PubMed

Jordan, L; Bryan, K

2001-01-01

The potential value of a framework enabling practitioners to conceptualise speech and language therapy from a range of perspectives engendered by different theories about disability is explored. Four disability research paradigms are used to categorise professional activities, whilst the 'individual' and 'social' models of disability are considered as alternative value systems. Challenges facing speech and language therapists in developing roles and services to embrace different perspectives are outlined.

Nurse practitioner role transition: a concept analysis.

PubMed

MacLellan, Lorna; Levett-Jones, Tracy; Higgins, Isabel

2015-07-01

Transitioning from registered nurse to nurse practitioner (NP) can be challenging personally and professionally. Insight into transition experiences may help validate the experiences of new NPs and provide greater understanding of the challenges faced during their professional journey. The purpose of this article is to report a concept analysis of transition from registered nurse to NP. The article provides new knowledge, understanding, and clarity about the concept of transition. Walker and Avants' framework for concept analysis was used to identify the attributes, antecedents, and consequences of the concept. A literature review of refereed journals was undertaken. Model cases from an ethnographic study conducted in Australia provide real life examples of the attributes of transition. Transitioning to the role of NP is complex and dependent on the individual and the attitudes of healthcare colleagues. Change and adaptation are required of both the NP and members of the healthcare team. Failure to adapt by either party undermines the potential for NPs to deliver improved health care. Mentorship along with a nurturing environment may be effective strategies for increasing the NP's self-confidence and ensuring a smooth and successful transition period. ©2014 American Association of Nurse Practitioners.

Emergency Medicine in Remote Regions.

PubMed

Renouf, Tia; Pollard, Megan

2016-09-09

Rural and remote places like Sable Island (Nova Scotia) or François (Newfoundland) pose a challenge in delivering both health care and appropriate education that today's learners need to practice in a rural setting. This education can be difficult to deliver to students far from academic centers. This is especially true for learners and practitioners at offshore locations like ships, oil installations, or in the air when patients are transported via fixed wing aircraft or helicopter. The following editorial provides a snapshot of the setting and the challenges faced while working as a physician on a ship, in remote regions.

Ethical challenges in connection with the use of coercion: a focus group study of health care personnel in mental health care.

PubMed

Hem, Marit Helene; Molewijk, Bert; Pedersen, Reidar

2014-12-04

In recent years, the attention on the use of coercion in mental health care has increased. The use of coercion is common and controversial, and involves many complex ethical challenges. The research question in this study was: What kind of ethical challenges related to the use of coercion do health care practitioners face in their daily clinical work? We conducted seven focus group interviews in three mental health care institutions involving 65 multidisciplinary participants from different clinical fields. The interviews were recorded and transcribed verbatim. We analysed the material applying a 'bricolage' approach. Basic ethical principles for research ethics were followed. We received permission from the hospitals' administrations and all health care professionals who participated in the focus group interviews. Health care practitioners describe ethical dilemmas they face concerning formal, informal and perceived coercion. They provide a complex picture. They have to handle various ethical challenges, not seldom concerning questions of life and death. In every situation, the dignity of the patient is at stake when coercion is considered as morally right, as well as when coercion is not the preferred intervention. The work of the mental health professional is a complicated "moral enterprise". The ethical challenges deserve to be identified and handled in a systematic way. This is important for developing the quality of health care, and it is relevant to the current focus on reducing the use of coercion and increasing patient participation. Precise knowledge about ethical challenges is necessary for those who want to develop ethics support in mental health care. Better communication skills among health care professionals and improved therapeutic relationships seem to be vital. A systematic focus on ethical challenges when dealing with coercion is an important step forward in order to improve health care in the mental health field.

The effectiveness of Nurse Practitioners working at a GP cooperative: a study protocol

PubMed Central

2012-01-01

Background In many countries out-of-hours care faces serious challenges, including shortage of general practitioners, a high workload, reduced motivation to work out of hours, and increased demand for out-of-hours care. One response to these challenges is the introduction of nurse practitioner as doctor substitutes, in order to maintain the (high) accessibility and safety of out of hours care. Although nurse practitioners have proven to provide equally safe and efficient care during daytime primary care, it is unclear whether substitution is effective and efficient in the more complex out of hours primary care. This study aims to assess the effects of substitution of care from general practitioners to nurse practitioners in an out of hours primary care setting. Design A quasi experimental study is undertaken at one “general practitioner cooperative” to offer out-of-hours care for 304.000 people in the South East of the Netherlands. In the experimental condition patient care is provided by a team of one nurse practitioner and four general practitioners; where the nurse practitioner replaces one general practitioner during one day of the weekend from 10 am to 5 pm. In the control condition patient care is provided by a team of five general practitioners during the other day of the weekend, also from 10 am to 5 pm. The study period last 15 months, from April 2011 till July 2012. Methods Data will be collected on number of different outcomes using a range of methods. Our primary outcome is substitution of care. This is calculated using the number and characteristics of patients that have a consultation at the GP cooperative. We compare the number of patients seen by both professionals, type of complaints, resource utilization (e.g. prescription, tests, investigations, referrals) and waiting times in the experimental condition and control condition. This data is derived from patient electronic medical records. Secondary outcomes are: patient satisfaction; general practitioners workload; quality and safety of care and barriers and facilitators. Discussion The study will provide evidence whether substitution of care in out-of-hours setting is safe and efficient and give insight into barriers and facilitators related to the introduction of nurse practitioners in out-of-hours setting. Trial registration ClinicalTrials.gov ID NCT01388374 PMID:22870898

The effectiveness of nurse practitioners working at a GP cooperative: a study protocol.

PubMed

Wijers, Nancy; Schoonhoven, Lisette; Giesen, Paul; Vrijhoef, Hubertus; van der Burgt, Regi; Mintjes, Joke; Wensing, Michel; Laurant, Miranda

2012-08-07

In many countries out-of-hours care faces serious challenges, including shortage of general practitioners, a high workload, reduced motivation to work out of hours, and increased demand for out-of-hours care. One response to these challenges is the introduction of nurse practitioner as doctor substitutes, in order to maintain the (high) accessibility and safety of out of hours care. Although nurse practitioners have proven to provide equally safe and efficient care during daytime primary care, it is unclear whether substitution is effective and efficient in the more complex out of hours primary care. This study aims to assess the effects of substitution of care from general practitioners to nurse practitioners in an out of hours primary care setting. A quasi experimental study is undertaken at one "general practitioner cooperative" to offer out-of-hours care for 304.000 people in the South East of the Netherlands. In the experimental condition patient care is provided by a team of one nurse practitioner and four general practitioners; where the nurse practitioner replaces one general practitioner during one day of the weekend from 10 am to 5 pm. In the control condition patient care is provided by a team of five general practitioners during the other day of the weekend, also from 10 am to 5 pm. The study period last 15 months, from April 2011 till July 2012. Data will be collected on number of different outcomes using a range of methods. Our primary outcome is substitution of care. This is calculated using the number and characteristics of patients that have a consultation at the GP cooperative. We compare the number of patients seen by both professionals, type of complaints, resource utilization (e.g. prescription, tests, investigations, referrals) and waiting times in the experimental condition and control condition. This data is derived from patient electronic medical records. Secondary outcomes are: patient satisfaction; general practitioners workload; quality and safety of care and barriers and facilitators. The study will provide evidence whether substitution of care in out-of-hours setting is safe and efficient and give insight into barriers and facilitators related to the introduction of nurse practitioners in out-of-hours setting. ClinicalTrials.gov ID NCT01388374.

Africa has unique and urgent barriers to cleft care: lessons from practitioners at the Pan-African Congress on Cleft Lip and Palate.

PubMed

Adetayo, Oluwaseun; Ford, Rachel; Martin, Mark

2012-01-01

The goals of this study were to delineate the protocols employed for managing patients with cleft lip and palate deformities, delineate the challenges facing practitioners and patients, and to determine the patient and physician barriers to cleft care delivery in the region. Survey questionnaires were administered to practitioners attending the second Pan-African Congress on Cleft Lip and Palate (PACCLIP), which took place in Ibadan, Nigeria, West Africa from February 4-7, 2007. The conference included 225 participants, representing 17 African countries Protocols for repair of cleft lip and palate deformities were varied, with Millard's and von Langenbeck's techniques being the preferred approach for the management of cleft lip and palate deformities, respectively. A large proportion of providers have limited access to core cleft care supporting teams, especially speech language pathologists, orthodontists, and audiologists. Several challenging barriers to cleft care were also identified at both the institutional and individual levels and are reported. Geographic separation in Africa presents a similar challenge due to isolationism as it does to surgeons in Europe. Specific to Africa are the increased barriers to care, and economic and financial hardship at various levels. A focus on funding, team building, infrastructural support, and patient education appear to be crucial in improving the care and lives of children with facial clefts in Africa.

Treating body, treating mind: The experiences of people with psychotic disorders and their general practitioners - Findings from the Australian National Survey of High Impact Psychosis.

PubMed

Waterreus, Anna; Morgan, Vera A

2018-06-01

To describe from the perspective of people living with psychotic illness their use of general practitioner services over a 12-month period and the experiences, attitudes and challenges general practitioners face providing health care to this population. A two-phase design was used. Phase 1, screening for psychosis, occurred in public specialised mental health services and non-government organisations within seven catchment sites across Australia. In Phase 2, 1825 people who were screened positive for psychosis were randomly selected for interview which included questions about frequency and reason for general practitioner contact in the 12 months prior to interview. General practitioners (1473) of consenting participants were also surveyed. Almost all (90.3%) survey participants had consulted a general practitioner in the 12-month period, on average 8.9 times, and 28.8% of attenders had consulted 12 times or more. The majority (83.5%) attended one general practitioner practice. Most (77.6%) general practitioners wanted to be involved in the mental health care of their patient. Although 69.1% said the management of their patient was not problematic for their practice, one in five general practitioners reported issues related to patient non-compliance with treatment and non-attendance at scheduled appointments; time constraints; and lack of feedback from treating mental health services. People with psychotic disorders consult general practitioners, some very frequently. Most Australian general practitioners believe they have a responsibility to review the physical and mental health of their patients. Improved communication between general practitioners and mental health services, and easier access to mental health support, may help general practitioners manage the complex mental, physical and social problems of their patients.

Challenges in international medicine: ethical dilemmas, unanticipated consequences, and accepting limitations.

PubMed

Iserson, Kenneth V; Biros, Michelle H; James Holliman, C

2012-06-01

While personal and organizational challenges occur in every area of health care, practitioners of international medicine face unique problems and dilemmas that are rarely discussed in training programs. Health professions schools, residency and fellowship programs, nongovernmental organizations (NGOs), and government programs have a responsibility to make those new to international medicine aware of the special circumstances that they may face and to provide methods for understanding and dealing with these circumstances. Standard "domestic" approaches to such challenges may not work in international medicine, even though these challenges may appear to be similar to those faced in other clinical settings. How should organizations ensure that well-meaning health intervention efforts do not cause adverse unintended sequelae? How should an individual balance respect for cultural uniqueness and local mores that may profoundly differ from his or her own beliefs, with the need to remain a moral agent true to one's self? When is acceptance the appropriate response to situations in which limitations of resources seem to preclude any good solution? Using a case-based approach, the authors discuss issues related to the four major international medicine domains: clinical practice (postdisaster response, resource limitations, standards of care), medical systems and systems development (prehospital care, wartime casualties, sustainable change, cultural awareness), teaching (instruction and local resources, professional preparation), and research (questionable funded studies, clinical trials, observational studies). It is hoped that this overview may help prepare those involved with international medicine for the challenges and dilemmas they may face and help frame their responses to these situations. © 2012 by the Society for Academic Emergency Medicine.

Specialization and competition in dental health services.

PubMed

Grytten, Jostein; Skau, Irene

2009-04-01

The number of specialists within dental health services has increased over the last few years. This raises the issue of how the services should be organized and funded. We describe the effect of one way of organizing the services, which is by relying on competition. In Norway, some oral specialists face real competition with general dental practitioners for the same patients (prosthetists, periodontists and endodontists), while other specialists do not (orthodontists and oral surgeons). The latter specialists have skills that give them exclusive possibilities to practice their profession. We find that competition can be effective for the specialists who experience real competition with general dental practitioners for patients. In situations where real competition does not exist, specialists can obtain market power and raise their fees. Our results are based on an analysis of a representative set of data from general dental practitioners and specialists in Norway. The specialities in which practitioners can exercise market power raise challenges related to the type of public policy that can reduce this market power in an appropriate way, and without involving too large costs for the authorities. (c) 2008 John Wiley & Sons, Ltd.

[Fax Survey to Elucidate the Information Needs of General Practitioners in Lower Saxony Regarding the Topic of Medical Implants].

PubMed

Schaper, M; Berndt, M; Schrimpf, C; Wilhelmi, M; Elff, M; Haverich, A; Wilhelmi, M

2016-12-01

Background: Medial implants help a multitude of patients to gain more health, mobility and thus, quality of life. In collaboration with a still growing expectation of life especially, i.e., within Western industrial countries, this has led to an increasing use of implants over the last years. However, although biomechanical characteristics of modern implant materials have improved considerably, one big challenge still exists - the implant-associated infection. Early diagnostic and therapeutic interventions could clearly mitigate this issue, but are general practitioners sufficiently informed regarding this topic? Material and Methods: In March 2013 and in close cooperation with the Lower Saxony association of general practitioners, we initiated a survey to elucidate the information demands of general practitioners regarding the topic of medical implants. A total of 939 members of the association were contacted via fax and 101 (10.8 %) responded. Based on the obtained data, we then evaluated which topics are most interesting for this group of medical professionals. Results: The survey clearly indicates that general practitioners request more general implant-related data, e.g., type and specification of an implant as well as its location within the individual patient and contact addresses of the implanting hospital, but also want more specific information regarding diagnostic and therapeutic strategies in the case of implant-associated complications. Conclusion: The present article reports in detail on the conducted fax survey and shows some initial strategies as to how the identified challenges might be faced. Georg Thieme Verlag KG Stuttgart · New York.

Early recognition of Cushing's disease: a case study.

PubMed

Iuliano, Sherry L; Laws, Edward R

2013-08-01

To present a case study of a 34-year-old woman with Cushing's disease and provide nurse practitioners (NPs) with the understanding of the clinical presentation needed for early recognition and treatment of the disease. A comprehensive review of published literature on Cushing's disease. Findings from history, physical examination, and diagnostic studies of a woman presenting to primary care NPs, physicians and other healthcare providers with multiple symptoms of Cushing's disease. Cushing's disease is the result of the pituitary gland producing excess amounts of adrenocorticotropic hormone (ACTH) causing the overproduction of cortisol. The disease is fairly rare and is seen mostly in women. Common chief complaints include increased facial hair, weight gain, amenorrhea, changes in the face, neck, and abdomen, with muscle wasting of the lower extremities. Untreated, diabetes mellitus and hypertension can occur and increase the patient's morbidity and mortality. Early recognition and appropriate referral can reverse the signs and symptoms over time and lead to a significantly improved quality of life. This case presented the challenges faced by NPs and physicians in diagnosing patients with Cushing's disease. ©2013 The Author(s) ©2013 American Association of Nurse Practitioners.

Using online modules is a multi-modality teaching system: a high-touch high-tech approach to geriatric education.

PubMed

Gainor, Sara Jane; Goins, R Turner; Miller, Lee Ann

2004-01-01

Making geriatric education available to rural faculty/preceptors, students, and practitioners presents many challenges. Often the only options considered for educating those in the health professions about geriatrics are either traditional face-to-face courses or distance education programs. The purpose of this paper was to examine the use of Web-based modules or courses and other distance learning technology in concert with traditional learning modalities. The Mountain State Geriatric Education Center explored the use of a multi-modal approach within a high-touch, high-tech framework. Our findings indicate the following: it is important to start where participants are ready to begin; flexibility and variety are needed; soliciting evaluative feedback from participants is valuable; there is a need to integrate distance learning with more traditional modalities; and a high-tech, high-touch approach provides a format which participants find acceptable, accessible, and attractive. This assertion does not rule out the use of technology for distance education but rather encourages educators to take advantage of a wide range of modalities, traditional and technological, to reach rural practitioners, faculty, and students.

Robust Fixed-Structure Controller Synthesis

NASA Technical Reports Server (NTRS)

Corrado, Joseph R.; Haddad, Wassim M.; Gupta, Kajal (Technical Monitor)

2000-01-01

The ability to develop an integrated control system design methodology for robust high performance controllers satisfying multiple design criteria and real world hardware constraints constitutes a challenging task. The increasingly stringent performance specifications required for controlling such systems necessitates a trade-off between controller complexity and robustness. The principle challenge of the minimal complexity robust control design is to arrive at a tractable control design formulation in spite of the extreme complexity of such systems. Hence, design of minimal complexitY robust controllers for systems in the face of modeling errors has been a major preoccupation of system and control theorists and practitioners for the past several decades.

Factors related to work and life satisfaction of veterinary practitioners in Germany.

PubMed

Kersebohm, Johanna C; Lorenz, Timo; Becher, Anne; Doherr, Marcus G

2017-01-01

Veterinary practitioners' working situation is both challenging and changing. They have higher levels of work-related stress and suicide risk than the general population. The proportion of women is increasing, and in Germany especially women and employed veterinarians are reported to be less satisfied than comparable subgroups of the general population. In this study we identified key factors associated with work and life satisfaction among veterinary practitioners in Germany. Questionnaire-based cross-sectional survey. All veterinary practitioners registered in Germany in 2016. There were 2549 respondents, of whom 1930 met the inclusion criteria for further analysis. They had a median age of 37 and the majority of respondents were women (79.3 per cent). Almost two-thirds (63.8 per cent) worked as employed veterinarian. Importance of different job characteristics measured in 5-point Likert items, work satisfaction measured on a 5-point Likert item and life satisfaction measured in 11-point Likert items. Facets such as satisfaction with leisure time, family life, health and standard of living, information on working conditions such as working time, income, as well as year of birth and other demographic data. A 'good working atmosphere' was the most relevant job characteristic for all veterinary practitioners. Work satisfaction of employed practitioners is closely linked to satisfaction with their colleagues. This link is less pronounced for self-employed practitioners. A 'reasonable salary' was the second and 'holidays and leisure time' was the third most important job characteristics for employed practitioners. A 'good working atmosphere' and 'family friendly arrangements' were statistically significantly more important for women than for men, while a 'reasonable salary' was more important for men. Our results indicate strong associations between levels of work satisfaction and various work-related factors in subgroups of veterinary practitioners in Germany that reduce life satisfaction. The strength of some associations differs between men and women, as well as between self-employed and employed veterinarians. Outgoing students should be better prepared for the challenging working conditions that they face in veterinary practice. Salary levels should be improved and the working conditions adapted to the respective subgroups in order to increase work and life satisfaction.

Knowledge and demand for medicinal plants used in the treatment and management of diabetes in Nyeri County, Kenya.

PubMed

Kamau, Loice N; Mbaabu, Mathiu P; Mbaria, James M; Karuri, Gathumbi P; Kiama, Stephen G

2016-08-02

Non communicable diseases are currently a major health challenge facing humanity. Nyeri County has one of the highest diabetes prevalence in Kenya (12.6%), compared to the country's prevalence of 5.6%. The purpose of the study was to document; diabetes knowledge, medicinal plants and demand for the services of traditional medicine practitioners, in the management and treatment of diabetes. A cross-sectional study was carried out in the six constituencies in Nyeri, using pre-tested semi-structured questionnaires. Thirty practicing traditional medicine practitioners were purposively selected for the study. Field observation and identification was carried out on all plants that were cited during the interview. Plant samples were collected and voucher specimen deposited in the University of Nairobi Herbarium in the - School of Biological Sciences. The study revealed 30 plant species in 28 genera and 23 families that are used by the traditional medicine practitioners to treat and manage diabetes. Demand for traditional medicine practitioners' services in the treatment of diabetes is low and often occurs when conventional drugs fail. Interaction with the TMPs unveiled significant diversity of potential anti diabetic medicinal plants and in-depth ethnobotanical knowledge that they possessed. Preference for traditional herbal medicine was low despite wide ethnobotanical knowledge in the face of high prevalence of diabetes in the locality. The findings form the basis of pharmacological studies for standardization of the documented ethnomedicine used in the treatment and management of diabetes in the study area. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

A qualitative study of patient experiences of Type 2 Diabetes care delivered comparatively by General Practice Nurses and Medical Practitioners.

PubMed

Boyle, Eileen; Saunders, Rosemary; Drury, Vicki

2016-07-01

To explore patient experiences of type 2 diabetes mellitus care delivered by general practice nurses in collaboration with the general practitioner. Australian general practice nurses are expanding their role in multidisciplinary type 2 diabetes care with limited research on patient perceptions of care provision within this collaborative model. Qualitative interpretive. Purposeful sampling was used to invite the patients (n = 10). Data were collected from semi-structured face-to-face interviews. Braun and Clarke's () inductive coding thematic analysis process was used to interpret the data. All participants experienced their General Practice Nurse consultation as a clinical assessment for their General Practitioner. While they appreciated the extra time with the General Practice Nurse, they were unsure of the purpose of the consultation beyond clinical assessment. They described the ongoing challenge of living with T2DM and identified a need for additional information and advice. The results suggest that the model of general practice nurse type 2 diabetes care has an important role to play in the delivery of effective ongoing care of patients. However, this role requires further development to ensure that it is understood by the patients as a role that not only conducts clinical assessments but also provides relevant education and self-management support as part of a collaborative approach to care delivery with General Practitioners. The findings are relevant to primary health care clinicians providing diabetes care to inform more relevant supportive care by general practice nurses. © 2016 John Wiley & Sons Ltd.

How could health information exchange better meet the needs of care practitioners?

PubMed

Kierkegaard, P; Kaushal, R; Vest, J R

2014-01-01

Health information exchange (HIE) has the potential to improve the quality of healthcare by enabling providers with better access to patient information from multiple sources at the point of care. However, HIE efforts have historically been difficult to establish in the US and the failure rates of organizations created to foster HIE have been high. We sought to better understand how RHIO-based HIE systems were used in practice and the challenges care practitioners face using them. The objective of our study were to so investigate how HIE can better meet the needs of care practitioners. We performed a multiple-case study using qualitative methods in three communities in New York State. We conducted interviews onsite and by telephone with HIE users and non-users and observed the workflows of healthcare professionals at multiple healthcare organizations participating in a local HIE effort in New York State. The empirical data analysis suggests that challenges still remain in increasing provider usage, optimizing HIE implementations and connecting HIE systems across geographic regions. Important determinants of system usage and perceived value includes users experienced level of available information and the fit of use for physician workflows. Challenges still remain in increasing provider adoption, optimizing HIE implementations, and demonstrating value. The inability to find information reduced usage of HIE. Healthcare organizations, HIE facilitating organizations, and states can help support HIE adoption by ensuring patient information is accessible to providers through increasing patient consents, fostering broader participation, and by ensuring systems are usable.

Challenges in managing patients in Australia with chronic hepatitis B: the General Practitioners' perspective.

PubMed

Wallace, Jack; Hajarizadeh, Behzad; Richmond, Jacqui; McNally, Stephen

2013-10-01

General Practitioners (GPs) are essential to reducing the impact of chronic hepatitis B (CHB) given their clinical management role where only 56% of people with the infection in Australia have been diagnosed. This qualitative study aimed to identify the challenges GPs face in effectively responding to CHB. Semi-structured interviews were conducted with 26 GPs self-identifying as having a 'high caseload' of patients and/or a particular interest in CHB. Participants were recruited from five jurisdictions and came from diverse ethnicities, clinical experience and practice profile. Interview data were analysed according to the principles of grounded theory. Patient and GP knowledge, a lack of community awareness, and language and cultural diversity impeded the GP response to CHB. Communication with specialists was reported as challenging with unclear referral pathways, limited feedback from specialists after referral, and poor liaison and support for managing people living with CHB. Regulations restricting GPs capacity to respond included the lack of prescribing opportunities, fear of Medicare auditing for screening the populations most at risk, and inadequate financial support given the complexity of CHB and the communities most affected by the infection. General Practitioners require additional skills and resources to support the effective management of people with CHB. These include improved awareness and knowledge about the infection, adequate financial resources to support patient management, and effective referral pathways and support. © 2013 The Authors. ANZJPH © 2013 Public Health Association of Australia.

A longitudinal online interprofessional education experience involving family nurse practitioner students and pharmacy students.

PubMed

Collins, Andrea; Broeseker, Amy; Cunningham, Jill; Cortes, Cyndi; Beall, Jennifer; Bigham, Amy; Chang, Jongwha

2017-03-01

Interprofessional education (IPE) continues to gain traction worldwide. Challenges integrating IPE into health profession programmes include finding convenient times, meeting spaces, and level-appropriate assignments for each profession. This article describes the implementation of a 21-month prospective cohort study pilot programme for the Master of Science in nursing family nurse practitioner (FNP) and doctor of pharmacy (PharmD) students at a private university in the United States. This IPE experience utilised a blended approach for the learning activities; these students had initial and final sessions where they met face-to-face, with asynchronous online activities between these two sessions. The online assignments, discussions, and quizzes during the pilot programme involved topics such as antimicrobial stewardship, hormone replacement therapy, human papilloma virus vaccination, prenatal counselling, emergency contraception, and effects of the Affordable Care Act on practice. The results suggested that the FNP students held more favourable attitudes about online IPE and that the PharmD students reported having a clearer understanding of their own roles and those of the other participating healthcare students. However, the students also reported wanting more face-to-face interaction during their online IPE experience. Implications from this study suggest that effective online IPE can be supported by ensuring educational parity between students regarding the various topics discussed and a consistent approach of the required involvement for all student groups is needed. In addition, given the students desire for more face-to-face interaction, it may be beneficial to offer online IPE activities for a shorter time period. It is anticipated that this study may inform other programmes that are exploring innovative approaches to provide IPE to promote effective collaboration in patient care.

'I could never have learned this in a lecture': transformative learning in rural health education.

PubMed

Prout, Sarah; Lin, Ivan; Nattabi, Barbara; Green, Charmaine

2014-05-01

Health indicators for rural populations in Australia continue to lag behind those of urban populations and particularly for Indigenous populations who make up a large proportion of people living in rural and remote Australia. Preparation of health practitioners who are adequately prepared to face the 'messy swamps' of rural health practice is a growing challenge. This paper examines the process of learning among health science students from several health disciplines from five Western Australian universities during 'Country Week': a one-week intensive experiential interprofessional education program in rural Western Australia. The paper weaves together strands of transformative theory of learning with findings from staff and student reflections from Country Week to explore how facilitated learning in situ can work to produce practitioners better prepared for rural health practice.

Testing Scientific Software: A Systematic Literature Review.

PubMed

Kanewala, Upulee; Bieman, James M

2014-10-01

Scientific software plays an important role in critical decision making, for example making weather predictions based on climate models, and computation of evidence for research publications. Recently, scientists have had to retract publications due to errors caused by software faults. Systematic testing can identify such faults in code. This study aims to identify specific challenges, proposed solutions, and unsolved problems faced when testing scientific software. We conducted a systematic literature survey to identify and analyze relevant literature. We identified 62 studies that provided relevant information about testing scientific software. We found that challenges faced when testing scientific software fall into two main categories: (1) testing challenges that occur due to characteristics of scientific software such as oracle problems and (2) testing challenges that occur due to cultural differences between scientists and the software engineering community such as viewing the code and the model that it implements as inseparable entities. In addition, we identified methods to potentially overcome these challenges and their limitations. Finally we describe unsolved challenges and how software engineering researchers and practitioners can help to overcome them. Scientific software presents special challenges for testing. Specifically, cultural differences between scientist developers and software engineers, along with the characteristics of the scientific software make testing more difficult. Existing techniques such as code clone detection can help to improve the testing process. Software engineers should consider special challenges posed by scientific software such as oracle problems when developing testing techniques.

Negotiation: a necessary art for dental practice.

PubMed

Fitzpatrick, William G; Renshaw, John; Batchelor, Paul

2012-01-01

This brief paper explains why the art of negotiation has become far more important for general dental practitioners. It explains that negotiations take place with patients, with practice staff, and with funding agencies such as Primary Care Trusts. It sets out the principles for successful negotiation and gives two examples of how they can be applied. It concludes that negotiation is a skill that can be learned and that it will be a key skill as the profession faces future challenges.

Challenges Faced by Social Workers as Members of Interprofessional Collaborative Health Care Teams

PubMed Central

Ambrose-Miller, Wayne; Ashcroft, Rachelle

2016-01-01

Interprofessional collaboration is increasingly being seen as an important factor in the work of social workers. A focus group was conducted with Canadian social work educators, practitioners, and students to identify barriers and facilitators to collaboration from the perspective of social work. Participants identified six themes that can act as barriers and facilitators to collaboration: culture, self-identity, role clarification, decision making, communication, and power dynamics. These findings carry important implications for interprofessional collaboration with social workers in health practice. PMID:27263200

42 CFR 405.2463 - What constitutes a visit.

Code of Federal Regulations, 2010 CFR

2010-10-01

... face-to-face encounter between a clinic or center patient and a physician, physician assistant, nurse practitioner, nurse midwife, visiting nurse, clinical psychologist, or clinical social worker. (ii) For FQHCs..., physician assistant, nurse practitioner, nurse midwife, or a visiting nurse; and for FQHCs only, a medical...

What is involved in medicines management across care boundaries? A qualitative study of healthcare practitioners' experiences in the case of acute kidney injury

PubMed Central

Morris, Rebecca L; Blakeman, Tom; Ashcroft, Darren M

2017-01-01

Objectives To examine the role of individual and collective cognitive work in managing medicines for acute kidney injury (AKI), this being an example of a clinical scenario that crosses the boundaries of care organisations and specialties. Design Qualitative design, informed by a realist perspective and using semistructured interviews as the data source. The data were analysed using template analysis. Setting Primary, secondary and intermediate care in England. Participants 12 General practitioners, 10 community pharmacists, 7 hospital doctors and 7 hospital pharmacists, all with experience of involvement in preventing or treating AKI. Results We identified three main themes concerning participants' experiences of managing medicines in AKI. In the first theme, challenges arising from the clinical context, AKI is identified as a technically complex condition to identify and treat, often requiring judgements to be made about renal functioning against the context of the patient's general well-being. In the second theme, challenges arising from the organisational context, the crossing of professional and organisational boundaries is seen to introduce problems for the coordination of clinical activities, for example by disrupting information flows. In the third theme, meeting the challenges, participants identify ways in which they overcome the challenges they face in order to ensure effective medicines management, for example by adapting their work practices and tools. Conclusions These themes indicate the critical role of cognitive work on the part of healthcare practitioners, as individuals and as teams, in ensuring effective medicines management during AKI. Our findings suggest that the capabilities underlying this work, for example decision-making, communication and team coordination, should be the focus of training and work design interventions to improve medicines management for AKI or for other conditions. PMID:28100559

An exploration of mammographers' attitudes towards the use of social media for providing breast screening information to clients.

PubMed

Scragg, B; Shaikh, S; Shires, G; Stein Hodgins, J; Mercer, C; Robinson, L; Wray, J

2017-08-01

Increasingly patients and clients of health services are using social media to locate information about medical procedures and outcomes. There is increasing pressure for health professionals to engage in on-line spaces to provide clear and accurate information to their patient community. Research suggests there are some anxieties on the part of practitioners to do this. This study aimed to explore the attitudes of the NHS breast screening programme workforce towards engaging in online discussions with clients about breast screening. 78 practitioners, representing a range of professional roles within the NHS Breast Screening Programme, attended one of 4 workshops. We used a Nominal Group Technique to identify and rank responses to the question: "What are the challenges that practitioners face in using SoME as part of their role?" Responses were categorised into themes. Participants were also asked to identify solutions to these challenges. Challenges: We identified two overarching themes: (1) Working within boundaries: which was further categorised into (a) Professional/legal accountability; (b) Information accuracy and (c)Time as a boundary, and (2) Support: further categorised into (a) Employer and (b) Manager. Solutions: These included: training in technical and interactional aspects of on-line communication and a responsibility to better understand employer and professional body SoMe policies. The study participants appeared willing and motivated to engage in SoMe. However, in keeping with the literature from other disciplines, a number of challenges need to be overcome for its use to be adopted more widely by breast screening professionals. Copyright © 2017 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.

Access to healthcare by psychiatrists, psychiatric trainees and overseas trained psychiatrists: findings from the RANZCP welfare study.

PubMed

Jenkins, Kym

2017-04-01

To understand the challenges faced by psychiatrists and psychiatry trainees in accessing healthcare. An online survey was distributed to all members (fellows, associates and affiliates) of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) and a number of focus groups were held across Australia and New Zealand. A total of 1051 members responded to the survey and nine focus groups were held. Almost all respondents indicated they had a personal general practitioner. However, there were varying factors affecting access to healthcare and the ability to take leave when unwell. There are numerous barriers facing RANZCP members in looking after their own health. Addressing these barriers will require action at multiple points in the system.

Systematic review protocol of interventions to improve the psychological well-being of general practitioners.

PubMed

Murray, Marylou; Murray, Lois; Donnelly, Michael

2015-09-22

The challenges and complexities faced by general practitioners are increasing, and there are concerns about their well-being. Consequently, attention has been directed towards developing and evaluating interventions and strategies to improve general practitioner well-being and their capacity to cope with workplace challenges. This systematic review aims to evaluate research evidence regarding the effectiveness of interventions designed to improve general practitioner well-being. Eligible studies will include programmes developed to improve psychological well-being that have assessed outcomes using validated tools pertaining to well-being and related outcomes. Only programmes that have been evaluated using controlled study designs will be reviewed. An appropriately developed search strategy will be applied to six electronic databases: the Cochrane Database of Systematic Reviews, MEDLINE, Embase, CINAHL, PsycINFO and Web of Science. Studies will be screened in two stages by two independent reviewers. A third reviewer will arbitrate when required. Pre-specified inclusion and exclusion criteria will be assessed during a pilot phase early on in the review process. The Cochrane data extraction form will be adapted and applied to each eligible study by two independent reviewers, and each study will be appraised critically using standardised checklists from the Cochrane Handbook. Methodological quality will be taken into account in the analysis of the data and the synthesis of results. A narrative synthesis will be undertaken if data is unsuited to a meta-analysis. The systematic review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidance. This will be the first systematic review on this topic, and the evidence synthesis will aid decision-making by general practitioners, policy makers and planners regarding ways in which to improve GP well-being. Findings will be disseminated at general practitioner meetings, conferences and in professional and peer-reviewed journals. PROSPERO CRD42015017899.

Linking Environmental Research and Practice: Lessons From The Integration of Climate Science and Water Management in the Western United States

NASA Astrophysics Data System (ADS)

Ferguson, D. B.; Rice, J.; Woodhouse, C. A.

2015-12-01

Efforts to better connect scientific research with people and organizations involved in environmental decision making are receiving increased interest and attention. Some of the challenges we currently face, however—including complex questions associated with climate change—present unique challenges because of their scale and scope. Focused research on the intersections between environment and society has provided substantial insight into dynamics of large-scale environmental change and the related impacts on people, natural resources, and ecosystems, yet our ability to connect this research to real-world decision making remains limited. Addressing these complex environmental problems requires broad cooperation between scientists and those who may apply research results in decision making, but there are few templates for guiding the growing number of scientists and practitioners now engaging in this kind of cooperative work. This presentation will offer a set of heuristics for carrying out collaborative work between scientists and practitioners. These heuristics were derived from research that examined the direct experiences of water resources professionals and climate researchers who have been working to integrate science and practice.

Legal issues affecting children with preexisting conditions during public health emergencies.

PubMed

Rutkow, Lainie; Vernick, Jon S; Wissow, Lawrence S; Tung, Gregory J; Marum, Felicity; Barnett, Daniel J

2013-06-01

Among the millions of children in the United States exposed to public health emergencies in recent years, those with preexisting health conditions face particular challenges. A public health emergency may, for example, disrupt treatment regimens or cause children to be separated from caregivers. Ongoing shortages of pediatricians and pediatric subspecialists may further exacerbate the risks that children with preexisting conditions face in disaster circumstances. The US Department of Homeland Security recently called for better integration of children's needs into all preparedness activities. To aid in this process, multiple legal concerns relevant to pediatricians and pediatric policymakers must be identified and addressed. Obtaining informed consent from children and parents may be particularly challenging during certain public health emergencies. States may need to invoke legal protections for children who are separated from caregivers during emergencies. Maintaining access to prescription medications may also require pediatricians to use specific legal mechanisms. In addition to practitioners, recommendations are given for policymakers to promote effective pediatric response to public health emergencies.

Physician-entrepreneurship: a user's manual, part 1: critical questions for early-stage medical ventures.

PubMed

Lexa, Frank James; Lexa, Frank J

2005-07-01

The medical field is one of the most exciting in America for entrepreneurs. Radiologists and other medical practitioners are in a unique position to take advantage of opportunities to invent and create innovative products and services. Physicians have led many of the most important revolutionary and evolutionary changes that have occurred in the field in the past 100 years. However, many radiologists find the process of entrepreneurship a daunting one and are often deterred from acting on their ideas. This article addresses the key issues and challenges that entrepreneurs face when embarking on new enterprises. Although most of these issues face all entrepreneurs at this stage, this article focuses on medical innovation and its particular challenges. This article concentrates on the kinds of questions that physician-entrepreneurs need to ask before jumping in, the types of common pitfalls that await those who don't address these issues, and some answers to seek if you are to beat the odds and succeed.

Wrestling with the complexity of evaluation for organizations at the boundary of science, policy and practice.

PubMed

Pitt, Ruth; Wyborn, Carina; Page, Glenn; Hutton, Jonathon; Virah Sawmy, Malika; Ryan, Melanie; Gallagher, Louise

2018-04-16

Boundary organizations have been promoted as a measure to improve the effectiveness of conservation efforts by building stronger relationships between scientists, policy makers, industry and practitioners (Cook et al. 2013). While their promise has been discussed in theory, the work of and expectations for boundary organizations are less defined in practice. Biodiversity conservation is characterized by complexity, uncertainty, dissent and tight budgets, so boundary organizations face the challenging task of demonstrating their value to diverse stakeholders. This paper examines the challenges that boundary organizations face when seeking to evaluate their work. While no 'off-the-shelf' solution is available for a given boundary organization, many lessons can be learned from the evaluation literature. This paper synthesizes key areas of decision making to underpin the choice of evaluation approaches, with the aim of encouraging more productive conversations about evaluation of boundary organizations and the projects they deliver. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

The anthropological approach challenges the conventional approach to bioethical dilemmas: a Kenyan Maasai perspective.

PubMed

Sharif, Thikra; Bugo, John

2015-06-01

The cultural background, religion and societal norms have a huge influence on the decision making process for physicians, patients and their families, when faced with medical ethical dilemmas. While the medical professionals, through their training, can rely on the principles of autonomy, justice, beneficence and non-maleficence to guide them, the patients can only draw from their personal and cultural experiences. To explore some of the challenges that face physicians when presented with ethical dilemmas. A review of the literature on the principles of medical ethics and the cultural practices of the Maasai tribe, as well as, interview, interaction and observation of the patients and family during patient. management. In the Maasai community in Kenya, where family is the center of all attention and decision-making, the listed ethical principles and rules have a very different understanding of the self-determination, and autonomy becomes collective rather than individualistic. Medical practitioners when faced with ethical medical dilemmas are neither comfortable in adopting the conventional bioethical guidelines, nor in offering a health care purely based on cultural and historical practice. In our set up, developing culturally relevant principles of bioethics appears to be the most effective solution in addressing medical ethical dilemmas.

How could Health Information Exchange Better Meet the Needs of Care Practitioners?

PubMed Central

Kaushal, R.; Vest, J.R.

2014-01-01

Summary Background Health information exchange (HIE) has the potential to improve the quality of healthcare by enabling providers with better access to patient information from multiple sources at the point of care. However, HIE efforts have historically been difficult to establish in the US and the failure rates of organizations created to foster HIE have been high. Objectives We sought to better understand how RHIO-based HIE systems were used in practice and the challenges care practitioners face using them. The objective of our study were to so investigate how HIE can better meet the needs of care practitioners. Methods We performed a multiple-case study using qualitative methods in three communities in New York State. We conducted interviews onsite and by telephone with HIE users and non-users and observed the workflows of healthcare professionals at multiple healthcare organizations participating in a local HIE effort in New York State. Results The empirical data analysis suggests that challenges still remain in increasing provider usage, optimizing HIE implementations and connecting HIE systems across geographic regions. Important determinants of system usage and perceived value includes users experienced level of available information and the fit of use for physician workflows. Conclusions Challenges still remain in increasing provider adoption, optimizing HIE implementations, and demonstrating value. The inability to find information reduced usage of HIE. Healthcare organizations, HIE facilitating organizations, and states can help support HIE adoption by ensuring patient information is accessible to providers through increasing patient consents, fostering broader participation, and by ensuring systems are usable. PMID:25589903

Transition to family practice in Turkey.

PubMed

Güneş, Evrim Didem; Yaman, Hakan

2008-01-01

Turkey's primary health care (PHC) system was established in the beginning of the 1960s and provides preventive and curative basic medical services to the population. This article describes the experience of the Turkish health system, as it tries to adapt to the European health system. It describes the current organization of primary health care and the family medicine model that is in the process of implementation and discusses implications of the transition for family physicians and the challenges faced in meeting the needs for health care staff. In Turkey a trend toward urbanization is evident and more staff positions in rural PHC centers are vacant. Shortages of physicians and an ineffective distribution of doctors are seen as a major problem. Family medicine gained popularity at the beginning of the 1990s, as a specialty with a 3-year postgraduate training program. Medical practitioners who are graduates of a 6-year medical training program and are already working in the PHC system are offered retraining courses. Better working conditions and higher salaries may be important incentives for medical practitioners to sign a contract with the social security institution of Turkey. The lack of well-trained primary care staff is an ongoing challenge. Attempts to retrain medical practitioners to act as family physicians show promising results. Shortness of physician and health professionals and lack of time and resources in primary health care are problems to overcome during this process.

Work in progress. Integrating physicians' services in the home.

PubMed Central

McWilliam, C. L.; Stewart, M.; Sangster, J.; Cohen, I.; Mitchell, J.; Sutherland, C.; Ryan, B.

2001-01-01

OBJECTIVE: While increasing acuity levels and the concomitant complexity of service demand that physicians be involved in in-home care, conflicting evidence and opinions do not show how this can best be achieved. DESIGN: A phenomenologic research design was used to obtain insights into the challenges and opportunities of integrating physicians' services into the usual in-home services in London, Ont. SETTING: Home care in London, Ont. PARTICIPANTS: Twelve participants included three patients, two family caregivers, two family physicians, the program's nurse practitioner, two case managers, and two community nurses. METHOD: In-depth interviews with a maximally varied purposeful sample of patients, caregivers, and providers were analyzed using immersion and crystallization techniques. MAIN FINDINGS: Findings revealed the potential for enhanced continuity of care and interdisciplinary team functioning. Having a nurse practitioner, interdisciplinary team-building exercises and meetings, regular face-to-face contact among all providers, support for family caregivers, and 24-hour coverage for physicians were found to be essential for success. CONCLUSION: Integration of services takes time, money, and sustained commitment, particularly when undertaken in geographically isolated communities. Informed choice and a fair remuneration system remain important considerations for family physicians. PMID:11785281

Testing Scientific Software: A Systematic Literature Review

PubMed Central

Kanewala, Upulee; Bieman, James M.

2014-01-01

Context Scientific software plays an important role in critical decision making, for example making weather predictions based on climate models, and computation of evidence for research publications. Recently, scientists have had to retract publications due to errors caused by software faults. Systematic testing can identify such faults in code. Objective This study aims to identify specific challenges, proposed solutions, and unsolved problems faced when testing scientific software. Method We conducted a systematic literature survey to identify and analyze relevant literature. We identified 62 studies that provided relevant information about testing scientific software. Results We found that challenges faced when testing scientific software fall into two main categories: (1) testing challenges that occur due to characteristics of scientific software such as oracle problems and (2) testing challenges that occur due to cultural differences between scientists and the software engineering community such as viewing the code and the model that it implements as inseparable entities. In addition, we identified methods to potentially overcome these challenges and their limitations. Finally we describe unsolved challenges and how software engineering researchers and practitioners can help to overcome them. Conclusions Scientific software presents special challenges for testing. Specifically, cultural differences between scientist developers and software engineers, along with the characteristics of the scientific software make testing more difficult. Existing techniques such as code clone detection can help to improve the testing process. Software engineers should consider special challenges posed by scientific software such as oracle problems when developing testing techniques. PMID:25125798

Talent management best practices: how exemplary health care organizations create value in a down economy.

PubMed

Groves, Kevin S

2011-01-01

: Difficult economic conditions and powerful workforce trends pose significant challenges to managing talent in health care organizations. Although robust research evidence supports the many benefits of maintaining a strong commitment to talent management practices despite these challenges, many organizations compound the problem by resorting to workforce reductions and limiting or eliminating investments in talent management. : This study examines how nationwide health care systems address these challenges through best practice talent management systems. Addressing important gaps in talent management theory and practice, this study develops a best practice model of talent management that is grounded in the contextual challenges facing health care practitioners. : Utilizing a qualitative case study that examined 15 nationwide health care systems, data were collected through semistructured interviews with 30 executives and document analysis of talent management program materials submitted by each organization. : Exemplary health care organizations employ a multiphased talent management system composed of six sequential phases and associated success factors that drive effective implementation. Based on these findings, a model of talent management best practices in health care organizations is presented. : Health care practitioners may utilize the best practice model to assess and enhance their respective talent management systems by establishing the business case for talent management, defining, identifying, and developing high-potential leaders, carefully communicating high-potential designations, and evaluating talent management outcomes.

State of Science: ergonomics and global issues.

PubMed

Thatcher, Andrew; Waterson, Patrick; Todd, Andrew; Moray, Neville

2018-02-01

In his 1993 IEA keynote address, Neville Moray urged the ergonomics discipline to face up to the global problems facing humanity and consider how ergonomics might help find some of the solutions. In this State of Science article we critically evaluate what the ergonomics discipline has achieved in the last two and a half decades to help create a secure future for humanity. Moray's challenges for ergonomics included deriving a value structure that moves us beyond a Westernised view of worker-organisation-technology fit, taking a multidisciplinary approach which engages with other social and biological sciences, considering the gross cross-cultural factors that determine how different societies function, paying more attention to mindful consumption, and embracing the complexity of our interconnected world. This article takes a socio-historical approach by considering the factors that influence what has been achieved since Moray's keynote address. We conclude with our own set of predictions for the future and priorities for addressing the challenges that we are likely to face. Practitioner Summary: We critically reflect on what has been achieved by the ergonomics profession in addressing the global challenges raised by Moray's 1993 keynote address to the International Ergonomics Association. Apart from healthcare, the response has largely been weak and disorganised. We make suggestions for priority research and practice that is required to facilitate a sustainable future for humanity.

Anaphylaxis challenges on the front line: perspectives from community medicine.

PubMed

Bennett, John R; Fromer, Leonard; Hayden, Mary Lou

2014-01-01

This report reflects a discussion from the multidisciplinary Partnership for Anaphylaxis Round Table meeting, held in November 2012, in Dallas, Texas. Community medicine participants included John R. Bennett, MD, an internist who practiced in Cumming, Georgia, and whose patients were adults; Leonard Fromer, MD, a family practitioner in Los Angeles, California, who was the medical director of a network of 600 medical groups, including pediatricians, internists, and family physicians, and who in his previous practice treated children and adults, many of them with severe allergies; and Mary Lou Hayden, MS, RN, FNP-BC, AE-C, a nurse practitioner who treated adults in a university employee health clinic and in an allergy clinic in Charlottesville, Virginia, and whose prior practice focused on allergy and immunology in children and adults. This discussion was moderated by Dr Bennett. Participants provided their perspectives as primary care providers (PCPs) concerning anaphylaxis, which has become a major public health concern. The rising prevalence of severe allergies and incidence of anaphylaxis and other severe allergic reactions among children and adults is shifting more care to PCPs. This discussion provides insights into challenges faced by PCPs in treating patients at risk for anaphylaxis in the community setting and provides potential solutions to those challenges. Copyright © 2014 Elsevier Inc. All rights reserved.

An overview of age estimation in forensic anthropology: perspectives and practical considerations.

PubMed

Márquez-Grant, Nicholas

2015-01-01

Information on methods of age estimation in physical anthropology, in particular with regard to age-at-death from human skeletal remains, is widely available in the literature. However, the practicalities and real challenges faced in forensic casework are not always highlighted. To provide a practitioner's perspective, regarding age estimation in forensic anthropology (both in the living as well as the dead), with an emphasis on the types of cases, the value of such work and its challenges and limitations. The paper reviews the current literature on age estimation with a focus on forensic anthropology, but it also brings the author's personal perspective derived from a number of forensic cases. Although much is known about what methods to use, but not always how to apply them, little attention has been given in the literature to the real practicalities faced by forensic anthropologists, for example: the challenges in different types of scenarios; how to report age estimations; responsibilities; and ethical concerns. This paper gathers some of these aspects into one overview which includes the value of such work and the practical challenges, not necessarily with the methods themselves, but also with regard to how these are applied in the different cases where age estimation is required.

Leading the rebirth of the rural obstetrician.

PubMed

Campbell, Alison M; Brown, James; Simon, David R; Young, Sari; Kinsman, Leigh

2014-12-11

To understand the factors influencing the decisions of rural general practitioners and GP registrars to practise obstetrics, and to understand the impact on these decisions of an innovative obstetric training and support program in the Gippsland region of Victoria. Qualitative approach using semistructured interviews conducted in July and August 2013 and inductive content analysis. Participants were identified from training records over the previous 5 years for the Gippsland GP obstetric training and support program. Two questions were posed during interviews: What challenges face rural GPs in practising obstetrics? What impact has the Gippsland GP obstetric program had on GP obstetric career decisions? Of 60 people invited to participate, 22 agreed. Interviews ranged in duration from 40 to 90 minutes. The major themes that emerged on the challenges facing rural GPs in practising obstetrics were isolation, work-life balance and safety. The major themes that emerged on the impact of the Gippsland GP obstetric program were professional support, structured training and effective leadership. Rural GP obstetricians are challenged by isolation, the impact of their job on work-life balance, and safety. The support, training and leadership offered by the Gippsland expanded obstetric training program helped doctors to deal with these challenges. The Gippsland model of training offers a template for GP obstetric procedural training programs for other rural settings.

Enhanced ergonomics approaches for product design: a user experience ecosystem perspective and case studies.

PubMed

Xu, Wei

2014-01-01

This paper first discusses the major inefficiencies faced in current human factors and ergonomics (HFE) approaches: (1) delivering an optimal end-to-end user experience (UX) to users of a solution across its solution lifecycle stages; (2) strategically influencing the product business and technology capability roadmaps from a UX perspective and (3) proactively identifying new market opportunities and influencing the platform architecture capabilities on which the UX of end products relies. In response to these challenges, three case studies are presented to demonstrate how enhanced ergonomics design approaches have effectively addressed the challenges faced in current HFE approaches. Then, the enhanced ergonomics design approaches are conceptualised by a user-experience ecosystem (UXE) framework, from a UX ecosystem perspective. Finally, evidence supporting the UXE, the advantage and the formalised process for executing UXE and methodological considerations are discussed. Practitioner Summary: This paper presents enhanced ergonomics approaches to product design via three case studies to effectively address current HFE challenges by leveraging a systematic end-to-end UX approach, UX roadmaps and emerging UX associated with prioritised user needs and usages. Thus, HFE professionals can be more strategic, creative and influential.

Challenges faced when identifying patients for combination immunotherapy.

PubMed

Ernstoff, Marc S; Gandhi, Shipra; Pandey, Manu; Puzanov, Igor; Grivas, Petros; Montero, Alberto; Velcheti, Vamsidhar; Turk, Mary Jo; Diaz-Montero, Claudia Marcela; Lewis, Lionel D; Morrison, Carl

2017-08-01

In 1996, Jim Allison demonstrated that blocking the immune regulatory molecule CTLA-4 with anit-CTLA4 antibody led to enhance tumor responses in mice. It would take an additional 15 years for human studies to confirm the potency and clinical efficacy of anti-CTLA4, ultimately leading to US FDA approval of the first checkpoint inhibitor, ipilimumab. Now with a plethora of immune-modulating agents demonstrating single agent safety and benefit across many tumor types, investigation on the optimal combination of immune-based therapies has begun in earnest. While there are many challenges, a central one is how to select which combination for which patient is the best. Here we review the current approaches that a practitioner can use to achieve this therapeutic goal.

How is cyber threat evolving and what do organisations need to consider?

PubMed

Borrett, Martin; Carter, Roger; Wespi, Andreas

Organisations and members of the public are becoming accustomed to the increasing velocity, frequency and variety of cyber-attacks that they have been facing over the last few years. In response to this challenge, it is important to explore what can be done to offer commercial and private users a reliable and functioning environment. This paper discusses how cyber threats might evolve in the future and seeks to explore these threats more fully. Attention is paid to the changing nature of cyber-attackers and their motivations and what this means for organisations. Finally, useful and actionable steps are provided, which practitioners can use to understand how they can start to address the future challenges of cyber security.

Expanding Medicaid managed care: the right choice for Texas?

PubMed

Reddy, Swapna; Finley, Marisa; Posey, Dan; Rohack, James J

2012-10-01

We set out to determine whether expanding Medicaid managed care in Texas is the solution to the challenges faced by the state of meeting the healthcare needs of a rapidly growing Medicaid population while addressing its own fiscal limitations. We reviewed the Texas Medicaid program, the potential effects of federal healthcare reform, and the state political climate through the perspectives (advantages and disadvantages) of the primary stakeholders: patients, practitioners, hospitals, and insurers. Research was performed through online, federal and state regulatory, and legislative review. In addition, we reviewed government and peer-reviewed reports and articles pertaining to issues related to Medicaid populations, healthcare practitioners, and hospitals that serve them. Each primary stakeholder had potential advantages and disadvantages associated with the expansion of Medicaid managed care. We conclude that expanding Medicaid managed care, if done in a manner responsive to the needs of recipients, can meet enrollees' healthcare needs while controlling the state's costs.

Exploring the self-compassion of health-care social workers: How do they fare?

PubMed

Lianekhammy, Joann; Miller, J Jay; Lee, Jacquelyn; Pope, Natalie; Barnhart, Sheila; Grise-Owens, Erlene

2018-05-03

Indubitably, the challenges facing health-care social workers are becoming increasingly complex. Whilst these problematic professional circumstances compound the need for self-compassion among health-care social workers, few studies, if any, have explicitly examined self-compassion among this practitioner group. This cross-sectional study explored self-compassion among a sample of practitioners (N = 138) in one southeastern state. Results indicate that health-care social workers in this sample engage in self-compassion only moderately. Further, occupational and demographic/life characteristics (e.g., age, years practicing social work, average hours worked per week, health status, and relationship status, among others) are able to predict self-compassion scores. After a terse review of relevant literature, this paper will explicate findings from this study, discuss relevant points derived from said findings, and identify salient implication for health-care social work praxis.

School-based pediatric physical therapists' perspectives on evidence-based practice.

PubMed

Schreiber, Joe; Stern, Perri; Marchetti, Gregory; Provident, Ingrid; Turocy, Paula Sammarone

2008-01-01

This study described the current knowledge, beliefs, attitudes, and practices of a group of school-based pediatric physical therapists regarding evidence-based practice (EBP). Five practitioners participated in this project. Each was interviewed individually and in a group and completed a quantitative survey. All of the participants had a positive attitude toward EBP and believed that it should be an important element of clinical practice. Knowledge and practice were more variable, with several individuals reporting a lack of confidence in this area and an inability to routinely implement EBP. These participants were more likely to rely on colleagues, interaction with their supervisor, and professional experience to aid in decision making than research evidence. Pediatric physical therapists face numerous challenges accessing, analyzing, and applying research evidence. It is critical for the profession to identify optimal ways to support practitioners in this aspect of clinical practice.

Unmet needs in obesity management: From guidelines to clinic.

PubMed

Ritten, Angela; LaManna, Jacqueline

2017-10-01

Despite the rather slow acceptance of obesity as a disease state, several obesity staging systems and weight-management guidelines have been developed and are in use, along with an ever-growing number of treatment options. Many primary care clinicians, including nurse practitioners (NPs), are at the forefront of clinical efforts to assist individuals with obesity, but face challenges due to lack of alignment and consensus among the various staging systems and guidelines. This is further complicated by shortfalls in clinical training related to obesity management and increasing complexities in reimbursement for obesity-related services. Unmet needs in the management of obesity thus stretch from guidelines to clinic. This article examines the principal barriers to effective management of individuals with obesity and considers how concerns might be overcome, with particular emphasis on the role of the NP. ©2017 American Association of Nurse Practitioners.

Enhancing the Relationship Between Regulators and Their Profession.

PubMed

Austin, Zubin

2017-01-01

Regulators face unique pressures to balance competing priorities related to patient safety, public accountability, and practitioners' expectations. Historically, the collegial model of self-regulation has been used as a tool for risk management, to recognize the importance of profession- and context-specific judgment in complex, ambiguous clinical situations. Increasingly, as public accountability concerns have grown dominant within regulatory bodies, this collegial model has shifted toward a more antagonistic relationship between the regulators and the regulated. Wilkie and Tzountzouris (2017) highlight one profession's journey toward embedding professionalism within regulatory practices and policies through application of a right-touch regulatory philosophy. Given the complexity of regulatory work, this shift required significant strategic and deliberative thinking. The challenges of facilitating this sort of cultural shift in the role of a regulator are significant, but so too are the potential gains associated with a more engaged relationship between regulators and their practitioners.

Supporting assistant practitioners during their training.

PubMed

Ripley, Kenneth; Hoad, Bridget

2016-07-27

Assistant practitioners, also known as associate practitioners, provide support to the registered healthcare workforce, practising with advanced knowledge and skills. Assistant practitioners require substantial training to obtain the skills and knowledge required for the role. This article identifies the challenges trainee assistant practitioners may encounter, and makes recommendations for how they can be best supported. The core areas where trainee assistant practitioners require support from their colleagues and mentors are workload, role clarity, mentoring, academic challenge and recognition as learners.

The Challenges of Practitioner Research: A Comparative Study of Singapore and NSW

ERIC Educational Resources Information Center

Ellis, Neville; Loughland, Tony

2016-01-01

Practitioner research is considered an integral form of professional learning for teachers but in its implementation it will often encounter significant challenges. This qualitative comparative case-study of teachers in Singapore and NSW investigated the range of challenges they encountered during their work as practitioner researchers. The study…

Managing chronic orofacial pain: A qualitative study of patients', doctors', and dentists' experiences.

PubMed

Peters, Sarah; Goldthorpe, Joanna; McElroy, Cheryl; King, Elizabeth; Javidi, Hanieh; Tickle, Martin; Aggarwal, Vishal R

2015-11-01

Persistent pain in the face, mouth, and jaws is a common presentation to dental and medical services. The aetiology remains unclear, but a growing evidence base recognizes the effectiveness of psychological rather than biomedical interventions. To understand how this approach might be implemented into clinical practice, knowledge is needed of patients' and clinicians' experience of chronic orofacial pain (COFP). The aim of this study was to explore the experience and understanding of COFP by patients and primary and secondary care medical and dental practitioners. Qualitative interview study. Audio-recorded semi-structured interviews with a purposive sample of 12 dentists, 11 general practitioners, and seven patients were thematically analysed. Clinicians and patients recognized the role that psychological factors could play in the development and maintenance of COFP, yet management and self-management strategies were largely limited to biomedical interventions. Achieving a diagnosis proved problematic but largely functional for both parties. GPs and dentists viewed COFP as a non-dental problem and felt inadequately equipped to manage the condition. GPs, unlike dentists, felt obligated to support patients using techniques for managing patients with other long-term conditions. Frustration at the current inadequacy of COFP management often led to conflict with (or disengagement from) the clinician-patient relationship. Current management of COFP is ineffective and unsatisfactory for patients and practitioners, which impacts on their relationship. Fundamental barriers to accessing and implementing psychological interventions for COFP arise from ineffective communication between physicians and patients, and between medical and dental practitioners. Statement of contribution What is already known on this subject? COFP is characterized by persistent pain in the face, mouth, or jaws that are not the result of organic disease or physical trauma. Patients with COFP present to both medical and dental services and receive sub-optimal care. No studies have examined the experiences of managing this problem from the perspectives of dentists, general practitioners and patients. What does this study add? Patients, dentists, and GPs recognize the role that psychological factors have in maintaining and addressing facial pain symptoms, yet principally manage it through biomedical interventions. Challenges exist over arriving at a diagnosis and managing the problem, and challenges are exacerbated by poor communication between doctors and medical services. Improvements are needed in liaison between medical and dental services and further training to support primary care clinicians to facilitate a stepped care approach to managing COFP. © 2015 The British Psychological Society.

Factors related to work and life satisfaction of veterinary practitioners in Germany

PubMed Central

Kersebohm, Johanna C; Lorenz, Timo; Becher, Anne; Doherr, Marcus G

2017-01-01

Objectives Veterinary practitioners’ working situation is both challenging and changing. They have higher levels of work-related stress and suicide risk than the general population. The proportion of women is increasing, and in Germany especially women and employed veterinarians are reported to be less satisfied than comparable subgroups of the general population. In this study we identified key factors associated with work and life satisfaction among veterinary practitioners in Germany. Design Questionnaire-based cross-sectional survey. Setting All veterinary practitioners registered in Germany in 2016. Participants There were 2549 respondents, of whom 1930 met the inclusion criteria for further analysis. They had a median age of 37 and the majority of respondents were women (79.3 per cent). Almost two-thirds (63.8 per cent) worked as employed veterinarian. Primary outcomes Importance of different job characteristics measured in 5-point Likert items, work satisfaction measured on a 5-point Likert item and life satisfaction measured in 11-point Likert items. Secondary outcomes Facets such as satisfaction with leisure time, family life, health and standard of living, information on working conditions such as working time, income, as well as year of birth and other demographic data. Results A ‘good working atmosphere’ was the most relevant job characteristic for all veterinary practitioners. Work satisfaction of employed practitioners is closely linked to satisfaction with their colleagues. This link is less pronounced for self-employed practitioners. A ‘reasonable salary’ was the second and ‘holidays and leisure time’ was the third most important job characteristics for employed practitioners. A ‘good working atmosphere’ and ‘family friendly arrangements’ were statistically significantly more important for women than for men, while a ‘reasonable salary’ was more important for men. Conclusions Our results indicate strong associations between levels of work satisfaction and various work-related factors in subgroups of veterinary practitioners in Germany that reduce life satisfaction. The strength of some associations differs between men and women, as well as between self-employed and employed veterinarians. Outgoing students should be better prepared for the challenging working conditions that they face in veterinary practice. Salary levels should be improved and the working conditions adapted to the respective subgroups in order to increase work and life satisfaction. PMID:29018534

Deep learning and face recognition: the state of the art

NASA Astrophysics Data System (ADS)

Balaban, Stephen

2015-05-01

Deep Neural Networks (DNNs) have established themselves as a dominant technique in machine learning. DNNs have been top performers on a wide variety of tasks including image classification, speech recognition, and face recognition.1-3 Convolutional neural networks (CNNs) have been used in nearly all of the top performing methods on the Labeled Faces in the Wild (LFW) dataset.3-6 In this talk and accompanying paper, I attempt to provide a review and summary of the deep learning techniques used in the state-of-the-art. In addition, I highlight the need for both larger and more challenging public datasets to benchmark these systems. Despite the ability of DNNs and autoencoders to perform unsupervised feature learning, modern facial recognition pipelines still require domain specific engineering in the form of re-alignment. For example, in Facebook's recent DeepFace paper, a 3D "frontalization" step lies at the beginning of the pipeline. This step creates a 3D face model for the incoming image and then uses a series of affine transformations of the fiducial points to "frontalize" the image. This step enables the DeepFace system to use a neural network architecture with locally connected layers without weight sharing as opposed to standard convolutional layers.6 Deep learning techniques combined with large datasets have allowed research groups to surpass human level performance on the LFW dataset.3, 5 The high accuracy (99.63% for FaceNet at the time of publishing) and utilization of outside data (hundreds of millions of images in the case of Google's FaceNet) suggest that current face verification benchmarks such as LFW may not be challenging enough, nor provide enough data, for current techniques.3, 5 There exist a variety of organizations with mobile photo sharing applications that would be capable of releasing a very large scale and highly diverse dataset of facial images captured on mobile devices. Such an "ImageNet for Face Recognition" would likely receive a warm welcome from researchers and practitioners alike.

Clinical reasoning and population health: decision making for an emerging paradigm of health care.

PubMed

Edwards, Ian; Richardson, Barbara

2008-01-01

Chronic conditions now provide the major disease and disability burden facing humanity. This development has necessitated a reorientation in the practice skills of health care professions away from hospital-based inpatient and outpatient care toward community-based management of patients with chronic conditions. Part of this reorientation toward community-based management of chronic conditions involves practitioners' understanding and adoption of a concept of population health management based on appropriate theoretical models of health care. Drawing on recent studies of expertise in physiotherapy, this article proposes a clinical reasoning and decision-making framework to meet these challenges. The challenge of population and community-based management of chronic conditions also provides an opportunity for physiotherapists to further clarify a professional epistemology of practice that embraces the kinds of knowledge and clinical reasoning processes used in physiotherapy practice. Three case studies related to the management of chronic musculoskeletal pain in different populations are used to exemplify the range of epistemological perspectives that underpin community-based practice. They illustrate the link between conceptualizations of practice problems and knowledge sources that are used as a basis for clinical reasoning and decision making as practitioners are increasingly required to move between the clinic and the community.

Youth Mental Health, Family Practice, and Knowledge Translation Video Games about Psychosis: Family Physicians' Perspectives.

PubMed

Ferrari, Manuela; Suzanne, Archie

2017-01-01

Family practitioners face many challenges providing mental healthcare to youth. Digital technology may offer solutions, but the products often need to be adapted for primary care. This study reports on family physicians' perspectives on the relevance and feasibility of a digital knowledge translation (KT) tool, a set of video games, designed to raise awareness about psychosis, marijuana use, and facilitate access to mental health services among youth. As part of an integrated knowledge translation project, five family physicians from a family health team participated in a focus group. The focus group delved into their perspectives on treating youth with mental health concerns while exploring their views on implementing the digital KT tool in their practice. Qualitative data was analyzed using thematic analysis to identify patterns, concepts, and themes in the transcripts. Three themes were identified: (a) challenges in assessing youth with mental health concerns related to training, time constraints, and navigating the system; (b) feedback on the KT tool; and, (c) ideas on how to integrate it into a primary care practice. Family practitioners felt that the proposed video game KT tool could be used to address youth's mental health and addictions issues in primary care settings.

A single issue program in an isolated area: mammography screening in Darwin, NT.

PubMed

McLean, M J; Condon, J R

1999-08-01

A process evaluation of the Northern Territory (NT) mammography program, NT Breast Screen (NTBS), during its initial 18 months of operation. The study was undertaken in Darwin, NT, from December 1994 to May 1996. Clinical outcomes were obtained by reviewing computerised and manual program records to determine waiting times for results, recall rates and cancer detection rates. Client satisfaction was assessed by a questionnaire sent to all women with normal results over a 12-week period. General practitioner satisfaction was assessed by a questionnaire sent to all general practitioners in the region who had one or more clients who had attended the service. During this time, 2,882 screening mammograms were performed; 98 women were recalled for assessment (3.4%). Breast cancer was detected in 10 women (3.5 per 1000 women screened). The program was well accepted by clients and general practitioners. Performance criteria were not met for waiting times for results. NTBS faced challenges because of its small and dispersed population, a lack of local radiologists with mammographic experience and the conflict with other pressing health issues, particularly in Aboriginal health. Despite these challenges, the program functioned effectively during its initial 18 months. Mammography screening programs in isolated areas can function effectively. The constraints encountered by NTBS are likely to apply to similar programs. Issues identified requiring further research are the psychological consequences of long waiting times for results, and the prioritisation of mammography for Aboriginal women.

Evaluation of a Pharmacist and Nurse Practitioner Smoking Cessation Program.

PubMed

Afzal, Zubair; Pogge, Elizabeth; Boomershine, Virginia

2017-08-01

To evaluate the efficacy of a smoking cessation program led by a pharmacist and a nurse practitioner. During a 6-month period, patients attended 7 one-on-one face-to-face smoking cessation counseling sessions with a pharmacist and 1 to 2 one-on-one face-to-face smoking cessation counseling sessions with a nurse practitioner. The primary outcome was smoking cessation point prevalence rates at months 1, 3, and 5 post-quit date. Secondary outcomes included medication adherence rates at months 1, 3, and 5 post-quit date, nicotine dependence at baseline versus program end, and patient satisfaction. Nine (47%) of 19 total participants completed the program. Seven of the 9 patients who completed the program were smoke-free upon study completion. Point prevalence rates at months 1, 3, and 5 post-quit date were 66%, 77%, and 77%, respectively, based on patients who completed the program. Medication adherence rates were 88.6%, 54.6%, and 75% at months 1, 3, and 5 post-quit date, respectively. Based on the Fagerstrom test, nicotine dependence decreased from baseline to the end of the study, 4.89 to 0.33 ( P < .001). Overall, participants rated the program highly. A joint pharmacist and nurse practitioner smoking cessation program can assist patients in becoming smoke-free.

Research and management priorities for Hawaiian forest birds

USGS Publications Warehouse

Paxton, Eben H.; Laut, Megan; Vetter, John P.; Kendall, Steve J.

2018-01-01

Hawai‘i's forest birds face a number of conservation challenges that, if unaddressed, will likely lead to the extinction of multiple species in the coming decades. Threats include habitat loss, invasive plants, non-native predators, and introduced diseases. Climate change is predicted to increase the geographic extent and intensity of these threats, adding urgency to implementation of tractable conservation strategies. We present a set of actionable research and management approaches, identified by conservation practitioners in Hawai'i, that will be critical for the conservation of Hawaiian forest birds in the coming years. We also summarize recent progress on these conservation priorities. The threats facing Hawai‘i's forest birds are not unique to Hawai‘i, and successful conservation strategies developed in Hawai‘i can serve as a model for other imperiled communities around the world, especially on islands.

How Do Pharmacists Develop into Advanced Level Practitioners? Learning from the Experiences of Critical Care Pharmacists.

PubMed

Seneviratne, Ruth E; Bradbury, Helen; Bourne, Richard S

2017-07-07

The national UK standards for critical care highlight the need for clinical pharmacists to practise at an advanced level (equivalent to Royal Pharmaceutical Society, Great Britain, Faculty Advanced Stage II (MFRPSII)) and above. Currently the UK is unable to meet the workforce capacity requirements set out in the national standards in terms of numbers of pharmacist working at advanced level and above. The aim of this study was to identify the strategies, barriers and challenges to achieving Advanced Level Practice (ALP) by learning from the experiences of advanced level critical care pharmacists within the UK. Eight participants were recruited to complete semi-structured interviews on their views and experiences of ALP. The interviews were analysed thematically and three overarching themes were identified; support, work-based learning and reflective practice. The results of this study highlight that to increase the number of MFRPSII level practitioners within critical care support for their ALP development is required. This support involves developing face-to-face access to expert critical care pharmacists within a national training programme. Additionally, chief pharmacists need to implement drivers including in house mentorship and peer review programmes and the need to align job descriptions and appraisals to the Royal Pharmaceutical Society, Great Britain, Advanced Practice Framework (APF).

How Do Pharmacists Develop into Advanced Level Practitioners? Learning from the Experiences of Critical Care Pharmacists

PubMed Central

Seneviratne, Ruth E.; Bradbury, Helen

2017-01-01

The national UK standards for critical care highlight the need for clinical pharmacists to practise at an advanced level (equivalent to Royal Pharmaceutical Society, Great Britain, Faculty Advanced Stage II (MFRPSII)) and above. Currently the UK is unable to meet the workforce capacity requirements set out in the national standards in terms of numbers of pharmacist working at advanced level and above. The aim of this study was to identify the strategies, barriers and challenges to achieving Advanced Level Practice (ALP) by learning from the experiences of advanced level critical care pharmacists within the UK. Eight participants were recruited to complete semi-structured interviews on their views and experiences of ALP. The interviews were analysed thematically and three overarching themes were identified; support, work-based learning and reflective practice. The results of this study highlight that to increase the number of MFRPSII level practitioners within critical care support for their ALP development is required. This support involves developing face-to-face access to expert critical care pharmacists within a national training programme. Additionally, chief pharmacists need to implement drivers including in house mentorship and peer review programmes and the need to align job descriptions and appraisals to the Royal Pharmaceutical Society, Great Britain, Advanced Practice Framework (APF). PMID:28970450

Ethical Diversity and the Role of Conscience in Clinical Medicine

PubMed Central

Genuis, Stephen J.; Lipp, Chris

2013-01-01

In a climate of plurality about the concept of what is “good,” one of the most daunting challenges facing contemporary medicine is the provision of medical care within the mosaic of ethical diversity. Juxtaposed with escalating scientific knowledge and clinical prowess has been the concomitant erosion of unity of thought in medical ethics. With innumerable technologies now available in the armamentarium of healthcare, combined with escalating realities of financial constraints, cultural differences, moral divergence, and ideological divides among stakeholders, medical professionals and their patients are increasingly faced with ethical quandaries when making medical decisions. Amidst the plurality of values, ethical collision arises when the values of individual health professionals are dissonant with the expressed requests of patients, the common practice amongst colleagues, or the directives from regulatory and political authorities. In addition, concern is increasing among some medical practitioners due to mounting attempts by certain groups to curtail freedom of independent conscience—by preventing medical professionals from doing what to them is apparently good, or by compelling practitioners to do what they, in conscience, deem to be evil. This paper and the case study presented will explore issues related to freedom of conscience and consider practical approaches to ethical collision in clinical medicine. PMID:24455248

Conducting research and collaborating with researchers: the experience of clinicians in a residential treatment center.

PubMed

Adelman, Robert W; Castonguay, Louis G; Kraus, David R; Zack, Sanno E

2015-01-01

This paper describes the experience of clinicians in conducting research and collaborating with academic researchers. As part of clinical routine of a residential program for adolescent substance abusers, empirical data have been collected to assess client's needs before and after treatment, improve clinical practice, and identify barriers to change. Some of the challenges faced and the benefits learned in conducting these studies are presented. In addition to highlighting the convergence of research interests between clinicians and academicians, the conclusion offers general recommendations to foster these partnerships and solidify the scientific-practitioner model.

The Journey to Interprofessional Collaborative Practice: Are We There Yet?

PubMed

Golom, Frank D; Schreck, Janet Simon

2018-02-01

Interprofessional collaborative practice (IPCP) is a service delivery approach that seeks to improve health care outcomes and the patient experience while simultaneously decreasing health care costs. The current article reviews the core competencies and current trends associated with IPCP, including challenges faced by health care practitioners when working on interprofessional teams. Several conceptual frameworks and empirically supported interventions from the fields of organizational psychology and organization development are presented to assist health care professionals in transitioning their teams to a more interprofessionally collaborative, team-based model of practice. Copyright © 2017 Elsevier Inc. All rights reserved.

Research influence on antimalarial drug policy change in Tanzania: case study of replacing chloroquine with sulfadoxine-pyrimethamine as the first-line drug

PubMed Central

Mubyazi, Godfrey M; Gonzalez-Block, Miguel A

2005-01-01

Introduction Research is an essential tool in facing the challenges of scaling up interventions and improving access to services. As in many other countries, the translation of research evidence into drug policy action in Tanzania is often constrained by poor communication between researchers and policy decision-makers, individual perceptions or attitudes towards the drug and hesitation by some policy decision-makers to approve change when they anticipate possible undesirable repercussions should the policy change as proposed. Internationally, literature on the role of researchers on national antimalarial drug policy change is limited. Objectives To describe the (a) role of researchers in producing evidence that influenced the Tanzanian government replace chloroquine (CQ) with sulfadoxine-pyrimethamine (SP) as the first-line drug and the challenges faced in convincing policy-makers, general practitioners, pharmaceutical industry and the general public on the need for change (b) challenges ahead before a new drug combination treatment policy is introduced in Tanzania. Methods In-depth interviews were held with national-level policy-makers, malaria control programme managers, pharmaceutical officers, general medical practitioners, medical research library and publications officers, university academicians, heads of medical research institutions and district and regional medical officers. Additional data were obtained through a review of malaria drug policy documents and participant observations were also done. Results In year 2001, the Tanzanian Government officially changed its malaria treatment policy guidelines whereby CQ – the first-line drug for a long time was replaced with SP. This policy decision was supported by research evidence indicating parasite resistance to CQ and clinical CQ treatment failure rates to have reached intolerable levels as compared to SP and amodiaquine (AQ). Research also indicated that since SP was also facing rising resistance trend, the need for a more effective drug was indispensable but for an interim 5–10 year period it was justifiable to recommend SP that was relatively more cost-effective than CQ and AQ. The government launched the policy change considering that studies (ethically approved by the Ministry of Health) on therapeutic efficacy and cost-effectiveness of artemisinin drug combination therapies were underway. Nevertheless, the process of communicating research results and recommendations to policy-making authorities involved critical debates between policy makers and researchers, among the researchers themselves and between the researchers and general practitioners, the speculative media reports on SP side-effects and reservations by the general public concerning the rationale for policy change, when to change, and to which drug of choice. Conclusion Changing national drug policy will remain a sensitive issue that cannot be done overnight. However, to ensure that research findings are recognised and the recommendations emanating from such findings are effectively utilized, a systematic involvement of all the key stakeholders (including policy-makers, drug manufacturers, media, practitioners and the general public) at all stages of research is crucial. It also matters how and when research information is communicated to the stakeholders. Professional organizations such as the East African Network on Malaria Treatment have potential to bring together malaria researchers, policy-makers and other stakeholders in the research-to-drug policy change interface. PMID:16242017

A Practitioner Friendly and Scientifically Robust Training Evaluation Approach

ERIC Educational Resources Information Center

Griffin, Richard

2012-01-01

Purpose: This article seeks to review the current state of workplace learning evaluation, to set out the rationale for evaluation along with the barriers that practitioners face when seeking to assess the effectiveness of training and development. Finally, it aims to propose a scientifically robust and practitioner friendly approach to evaluation.…

Schools of public health in low and middle-income countries: an imperative investment for improving the health of populations?

PubMed

Rabbani, Fauziah; Shipton, Leah; White, Franklin; Nuwayhid, Iman; London, Leslie; Ghaffar, Abdul; Ha, Bui Thi Thu; Tomson, Göran; Rimal, Rajiv; Islam, Anwar; Takian, Amirhossein; Wong, Samuel; Zaidi, Shehla; Khan, Kausar; Karmaliani, Rozina; Abbasi, Imran Naeem; Abbas, Farhat

2016-09-07

Public health has multicultural origins. By the close of the nineteenth century, Schools of Public Health (SPHs) began to emerge in western countries in response to major contemporary public health challenges. The Flexner Report (1910) emphasized the centrality of preventive medicine, sanitation, and public health measures in health professional education. The Alma Ata Declaration on Primary Health Care (PHC) in 1978 was a critical milestone, especially for low and middle-income countries (LMICs), conceptualizing a close working relationship between PHC and public health measures. The Commission on Social Determinants of Health (2005-2008) strengthened the case for SPHs in LMICs as key stakeholders in efforts to reduce global health inequities. This scoping review groups text into public health challenges faced by LMICs and the role of SPHs in addressing these challenges. The challenges faced by LMICs include rapid urbanization, environmental degradation, unfair terms of global trade, limited capacity for equitable growth, mass displacements associated with conflicts and natural disasters, and universal health coverage. Poor governance and externally imposed donor policies and agendas, further strain the fragile health systems of LMICs faced with epidemiological transition. Moreover barriers to education and research imposed by limited resources, political and economic instability, and unbalanced partnerships additionally aggravate the crisis. To address these contextual challenges effectively, SPHs are offering broad based health professional education, conducting multidisciplinary population based research and fostering collaborative partnerships. SPHs are also looked upon as the key drivers to achieve sustainable development goals (SDGs). SPHs in LMICs can contribute to overcoming several public health challenges being faced by LMICs, including achieving SDGs. Most importantly they can develop cadres of competent and well-motivated public health professionals: educators, practitioners and researchers who ask questions that address fundamental health determinants, seek solutions as agents of change within their mandates, provide specific services and serve as advocates for multilevel partnerships. Funding support, human resources, and agency are unfortunately often limited or curtailed in LMICs, and this requires constructive collaboration between LMICs and counterpart institutions from high income countries.

The role of the primary care practitioner in the treatment of eating disorders.

PubMed

Kreipe, Richard E; Yussman, Susan M

2003-02-01

This article addresses practical issues facing the primary care practitioner caring for an adolescent with an eating disorder. It is grounded in the four elements of successful treatment noted by Comerci: (1) recognizing the disorder and restoring physiologic stability early in its course, (2) establishing a trusting, therapeutic partnership with the adolescent, (3) involving the family in treatment, and (4) using an interdisciplinary team approach. Although primary care practitioners often have an established relationship with their patients, adolescents with eating disorders present special challenges. These adolescents tend to be bright, strong-willed, and wary of any recommendations to change their weight-control practices for fear that they will lose control. Their families are often distraught by the conflicts that arise as a result of the disordered eating behaviors and the fear that the condition is associated with significant morbidity and mortality. The article provides primary care clinicians with pragmatic ways to diagnose and initiate treatment and engage the patient and parents as active participants and members of the therapeutic team in the early phases of treatment. In addressing these principles, the authors combine the nurturant-authoritative approach described by Levenkron with the biopsychosocial model proposed by Engel.

Clinical Challenges in the Growing Medical Marijuana Field.

PubMed

Barker, Jonathan

2018-03-01

Unique clinical challenges arise with the growing number of patients who possess medical marijuana cards. Medical marijuana patients with mental disorders can have worsening symptoms with marijuana use. Often there is sparse continuity of care between the patient and the medical marijuana practitioner. Lack of communication between the patient's treating practitioners and the practitioner who has authorized the medical marijuana can be problematic. This article is a discussion of the new clinical challenges practitioners are likely to encounter with the growing number of medical marijuana patients. [Full article available at http://rimed.org/rimedicaljournal-2018-03.asp].

Clinical Challenges in the Growing Medical Marijuana Field.

PubMed

Barker, Jonathan

2018-02-02

Unique clinical challenges arise with the growing number of patients who possess medical marijuana cards. Medical marijuana patients with mental disorders can have worsening symptoms with marijuana use. Often there is sparse continuity of care between the patient and the medical marijuana practitioner. Lack of communication between the patient's treating practitioners and the practitioner who has authorized the medical marijuana can be problematic. This article is a discussion of the new clinical challenges practitioners are likely to encounter with the growing number of medical marijuana patients. [Full article available at http://rimed.org/rimedicaljournal-2018-02.asp].

Career Development Practitioners as Advocates for Transgender Individuals: Understanding Gender Transition

ERIC Educational Resources Information Center

Sangganjanavanich, Varunee Faii

2009-01-01

Assisting transgender individuals is a concern for career development practitioners because there is a lack of knowledge on this topic. The complexity of gender reassignment surgery brings challenges and unique needs to this population, throughout gender transition, and requires career development practitioners to understand these challenges and…

Barriers among Danish women and general practitioners to raising the issue of intimate partner violence in general practice: a qualitative study.

PubMed

Mørk, Trine; Andersen, Pernille Tanggaard; Taket, Ann

2014-06-03

Thirty-five percent of Danish women experience sexual or physical violence in their lifetime. However, health care professionals are not in the practice of asking about intimate partner violence (IPV) in Denmark. It is currently unknown what hinders general practitioners from asking about partner violence and how Danish women would perceive such an inquiry. This aspect has not previously been explored in Denmark. An exploratory study was conducted to examine what hinders general practitioners (GPs) from asking and what Danish women's views and attitudes are regarding being asked about IPV. Data were collected through individual and group interviews with a sample of three GPs and a diverse sample of 13 women, including both survivors of partner violence and those without any history of partner violence. An interpretative analysis was performed with the data. This study provides important knowledge regarding the barriers and attitudes towards inquiry about IPV in primary care in Denmark. Results indicate that Denmark is facing the same challenges when responding to survivors of IPV as other similar countries, including Sweden, Norway, the UK, USA, and Australia. Danish women want general practitioners to ask about violence in a respectful and non-judgemental manner. However, general practitioners are resistant towards such an inquiry and would benefit from training regarding how to respond to women who have been exposed to IPV. It is acceptable to inquire about IPV with women in Denmark in a non-judgemental and respectful way. Informing about IPV prevalence is important prior to the inquiry. However, general practitioners require more awareness and training before a favourable environment for this change in procedure can be created. Further large-scale research is needed to support the evidence generated by this small study.

Performance, emotion work, and transition: challenging experiences of complementary therapy student practitioners commencing clinical practice.

PubMed

Fixsen, Alison; Ridge, Damien

2012-09-01

Few researchers have explored the clinical experiences of complementary and alternative medical practitioners and students, including the emotion work they perform. In this article, using a constant comparison approach and a heuristic framework (a dramaturgical perspective), we analyze semistructured interviews with 9 undergraduate practitioners in training to examine challenges experienced when students first attend to patients. A feature of students' learning about clinical work concerned performance in a public arena and associated demands placed on the inchoate practitioner. Preliminary patient consultations represented a dramatic rite of passage and initiation into a transitional phase in professional identity. Juggling the roles of student and practitioner within an observed consultation led to anticipatory anxiety, impression management strategies, and conflict with other individuals. Of the coping strategies, participants regarded sharing and feedback from peer groups as most effective in examining and resolving the challenges of becoming a practitioner.

The vulnerablility for elder abuse among a sample of custodial grandfathers: an exploratory study.

PubMed

Bullock, Karen; Thomas, Rebecca L

2007-01-01

Older adults have been known to make sacrifices in their caregiving roles. Gerontology literature on custodial grandparents has primarily focused on grandmothers and the challenges they face when they assume primary care for grandchildren. Little is known about the risks that older men face when they become custodial grandparents. This article highlights types and warning signs of abuse, exploitation and neglect. Exploratory study was undertaken with a racially diverse group of custodial grandfathers to fill a gap in the literature about the vulnerability for elder abuse, exploitation and neglect as expressed by older Black, Latino and White custodial grandfathers. To provide a more inclusive understanding of elder abuse, areas of vulnerability were identified for consideration by practitioners, educators and researchers. The implications of this research point to the need to rethink elder abuse assessment, prevention and intervention strategies with older men.

Crossing boundaries to improve mental health in the Americas: international collaborative authorship.

PubMed

Killion, Chery M

2007-01-01

A nurse anthropologist with a background in international collaborations attended Project LEAD for two years, which enabled her to continue to serve as an advocate for the mentally ill in Belize. The anthropologist collaborated with a psychiatrist from Belize to develop a cross-cultural, cross-discipline publication, "Mental Health in Belize: A National Priority, " which highlights the work of psychiatric nurse practitioners in the country. The researcher learned to collaborate with her peer in Belize through face to face discussions and e-mail and overcame technological difficulties and cultural barriers to produce an international publication. Project LEAD gave the author a sense of self-discovery and self-knowledge, reinforced core values, and developed a frame of reference for leadership. The author also benefited from discussions by local, national, and international leaders on leadership in terms of its key components, contexts, challenges, triumphs, and styles.

Hospital staff views of prescribing and discharge communication before and after electronic prescribing system implementation.

PubMed

Mills, Pamela Ruth; Weidmann, Anita Elaine; Stewart, Derek

2017-12-01

Background Electronic prescribing system implementation is recommended to improve patient safety and general practitioner's discharge information communication. There is a paucity of information about hospital staff perspectives before and after system implementation. Objective To explore hospital staff views regarding prescribing and discharge communication systems before and after hospital electronic prescribing and medicines administration (HEPMA) system implementation. Setting A 560 bed United Kingdom district general hospital. Methods Semi-structured face-to-face qualitative interviews with a purposive sample of hospital staff involved in the prescribing and discharge communication process. Interviews transcribed verbatim and coded using the Framework Approach. Behavioural aspects mapped to Theoretical Domains Framework (TDF) to highlight associated behavioural change determinants. Main outcome measure Staff perceptions before and after implementation. Results Nineteen hospital staff (consultant doctors, junior doctors, pharmacists and advanced nurse practitioners) participated before and after implementation. Pre-implementation main themes were inpatient chart and discharge letter design and discharge communication process with issues of illegible and inaccurate information. Improved safety was anticipated after implementation. Post-implementation themes were improved inpatient chart clarity and discharge letter quality. TDF domains relevant to staff behavioural determinants preimplementation were knowledge (task or environment); skills (competence); social/professional roles and identity; beliefs about capabilities; environmental context and resources (including incidents). An additional two were relevant post-implementation: social influences and behavioural regulation (including self-monitoring). Participants described challenges and patient safety concerns pre-implementation which were mostly resolved post-implementation. Conclusion HEPMA implementation produced perceptions of patient safety improvement. TDF use enabled behaviour change analysis due to implementation, for example, staff adoption of behaviours to ensure general practitioners receive good quality discharge information.

Workshop on Advancing Experimental Rock Deformation Research: Scientific and Technical Needs

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tullis, Terry E.

A workshop for the experimental rock deformation community was held in Boston on August 16-19, 2012, following some similar but smaller preliminary meetings. It was sponsored primarily by the NSF, with additional support from the DOE, the SCEC, and in-kind support by the USGS. A white paper summarizing the active discussions at the workshop and the outcomes is available (https://brownbox.brown.edu/download.php?hash=0b854d11). Those attending included practitioners of experimental rock deformation, i.e., those who conduct laboratory experiments, as well as users of the data provided by practitioners, namely field geologists, seismologists, geodynamicists, earthquake modelers, and scientists from the oil and gas industry. Amore » considerable fraction of those attending were early-career scientists. The discussion initially focused on identifying the most important unsolved scientific problems in all of the research areas represented by the users that experiments would help solve. This initial session was followed by wide-ranging discussions of the most critical problems faced by practitioners, particularly by early-career scientists. The discussion also focused on the need for designing and building the next generation of experimental rock deformation equipment required to meet the identified scientific challenges. The workshop participants concluded that creation of an experimental rock deformation community organization is needed to address many of the scientific, technical, and demographic problems faced by this community. A decision was made to hold an organizational meeting of this new organization in San Francisco on December 1-2, 2012, just prior to the Fall Meeting of the AGU. The community has decided to name this new organization “Deformation Experimentation at the Frontier Of Rock and Mineral research” or DEFORM. As of May 1, 2013, 64 institutions have asked to be members of DEFORM.« less

Toward an interdisciplinary approach to understanding sensory function in autism spectrum disorder.

PubMed

Cascio, Carissa J; Woynaroski, Tiffany; Baranek, Grace T; Wallace, Mark T

2016-09-01

Heightened interest in sensory function in persons with autism spectrum disorder (ASD) presents an unprecedented opportunity for impactful, interdisciplinary work between neuroscientists and clinical practitioners for whom sensory processing is a focus. In spite of this promise, and a number of overlapping perspectives on sensory function in persons with ASD, neuroscientists and clinical practitioners are faced with significant practical barriers to transcending disciplinary silos. These barriers include divergent goals, values, and approaches that shape each discipline, as well as different lexical conventions. This commentary is itself an interdisciplinary effort to describe the shared perspectives, and to conceptualize a framework that may guide future investigation in this area. We summarize progress to date and issue a call for clinical practitioners and neuroscientists to expand cross-disciplinary dialogue and to capitalize on the complementary strengths of each field to unveil the links between neural and behavioral manifestations of sensory differences in persons with ASD. Joining forces to face these challenges in a truly interdisciplinary way will lead to more clinically informed neuroscientific investigation of sensory function, and better translation of those findings to clinical practice. Likewise, a more coordinated effort may shed light not only on how current approaches to treating sensory processing differences affect brain and behavioral responses to sensory stimuli in individuals with ASD, but also on whether such approaches translate to gains in broader characteristics associated with ASD. It is our hope that such interdisciplinary undertakings will ultimately converge to improve assessment and interventions for persons with ASD. Autism Res 2016, 9: 920-925. © 2016 International Society for Autism Research, Wiley Periodicals, Inc. © 2016 International Society for Autism Research, Wiley Periodicals, Inc.

Helping health and social care professionals to develop an 'inequalities imagination': a model for use in education and practice.

PubMed

Hart, Angie; Hall, Valerie; Henwood, Flis

2003-03-01

The 'inequalities imagination model' originated from our own research, and led to findings and recommendations regarding clinical and education issues. This article focuses on the creation of the model which, we suggest, could be used to facilitate the development of an 'inequalities imagination' in health and social care professionals. To describe and critically analyse the thinking that led to the concept of an 'inequalities imagination' and provide the framework for the theoretical model. Influencing concepts from the fields of social work, sociology, nursing and midwifery, and debates around antidiscriminatory and antioppressive practice, cultural safety, cultural competence and individualized care are analysed. INEQUALITIES IMAGINATION MODEL: Ideas generated from an analysis of the concepts of antidiscriminatory/anti-oppressive practice and from the research data led us to conceptualize a flexible model that incorporated issues of individual and structural agency and a broad definition of disadvantage. The literature review underpinning the theoretical framework means that the model has the potential to be truly interdisciplinary. Professional educators face a difficult task in preparing practitioners to work with clients in ways that take account of differences in background and lifestyle and which respect human rights and dignity. The model makes explicit a process that enables practitioners to think about their current practice and move towards a greater understanding and awareness of the way they work with disadvantaged clients, and ways in which they prepare others to do so. We suggest that professionals develop an 'inequalities imagination' in order to enhance equality of care. The development of an 'inequalities imagination' helps practitioners to bridge the gap between the challenges they face in day-to-day practice and what they need to achieve to aspire to provide equality of care to all.

What impact do students have on clinical educators and the way they practise?

PubMed

Waters, Lisa; Lo, Kristin; Maloney, Stephen

2017-07-11

The clinical education setting plays an important part in teaching students about the real world of clinical practice. Traditionally the educational relationship between student and clinical educator has been considered one-way, with students being the ones that benefit. This review focuses on the areas of clinician practice and behaviour that students are reported to influence through clinical placements and as such, determine the overall impact students can have on supervising clinicians. Electronic searches were conducted across MEDLINE, EMBASE, PsychINFO and CINAHL in July 2016. Retrieved articles were filtered to find those which presented data relating to students in the clinical setting. Data was extracted and analysed independently by two authors through thematic analysis. Twenty-eight studies met the inclusion criteria. Results showed that practitioners enjoy the act of teaching. Clinical student presence encourages clinicians to solidify their knowledge base, stimulates learning and causes them to re-evaluate their practice. Practitioner skills were further developed as a results of students. Clinical educator workload and time spent at work increased when a student was present with time management being the predominant challenge practitioners faced. Studies demonstrated that clinicians feel they benefit by students periodically becoming the teacher. Student placements in clinical practice cause an increase in practitioner workload and lengthen their work day. These perceived limitations are outweighed by the many benefits described by supervising clinicians. Providing clinical education can enrich both the practice, and the practitioner, and the aforementioned advantages should be highlighted when offering or considering the expansion of clinical placements.

A qualitative study of the barriers and enablers to fertility-awareness education in general practice.

PubMed

Hampton, Kerry D; Newton, Jennifer M; Parker, Rhian; Mazza, Danielle

2016-07-01

To understand the barriers and enablers to fertility-awareness education in general practice. Most women along with their primary care practitioners - general practitioners and practice nurses - believe that women should be educated about fertility-awareness when first reporting trouble conceiving. To date, no in-depth study has examined the enablers and challenges of this type of education in general practice. A descriptive exploratory qualitative study using deductive content analysis. General practitioners (N = 11) and practice nurses (N = 20) were recruited from general practices in three socioculturally diverse areas in Victoria, Australia. Data were collected through semistructured interviews based on the 12 domains of a theoretical behaviour change framework from April-August 2012. The participants' responses were organized into themes that fall under the framework domains. The biggest barriers to fertility-awareness education in general practice were short consultations and time constraints faced by general practitioners together with a lack of patient educational materials and remuneration to support its delivery. The biggest enablers were a greater use of nurses trained in fertility-awareness in a collaborative team care arrangement with general practitioners. This study has identified several important barriers and enablers to fertility-awareness education in general practice. Translation into practice of our findings is imperative as the first step in establishing a primary care model in fertility-awareness. This would fill an important gap in the primary care of infertile women and build capacity in general practice to reduce infertility through women's enhanced fertility knowledge. © 2016 John Wiley & Sons Ltd.

Non-Pharmacological Approaches to Reducing Negative Behavioral Symptoms: A Scoping Review

PubMed Central

Wong, Carin; Leland, Natalie E.

2017-01-01

Background The management of negative behavioral symptoms among residents with dementia is a challenge that nursing homes face in delivering quality care. Objective Examine evidence documenting non-pharmacological interventions that reduce negative behavioral symptoms among nursing home residents with dementia and the role occupational therapy practitioners have in this area. Method A scoping review was completed for intervention studies published from 1987 to 2014, targeting negative behavioral symptoms among nursing home residents over 60 years of age with dementia. Interventions were categorized based on the AOTA Occupational Therapy Practice Framework. Results Twenty-two studies met the inclusion criteria. Four types of interventions were identified: occupation-based interventions, context and environment interventions, exercise interventions, and daily routine-based interventions. Conclusion The non-pharmacological interventions were found to align with the scope of occupational therapy. This suggests that occupational therapy practitioners can contribute to the development and evaluation of non-pharmacological interventions aimed to reduce negative behavioral symptoms. PMID:27504691

Prevention of Contrast-Induced Nephropathy (CIN) in Interventional Radiology Practice

PubMed Central

Gupta, Rajan K.; Bang, Tami J.

2010-01-01

Contrast-induced nephropathy (CIN) is a widely recognized and clinically significant problem in patients undergoing an increasing number of minimally invasive procedures that require contrast administration. Contrast-induced nephropathy is the third most common cause of hospital-acquired renal failure and has significant prognostic implications on patient outcomes. Interventional practitioners are faced with challenging decisions regarding prophylaxis and patient management. The major risk factor for developing CIN is preexisting renal dysfunction, particularly in association with diabetes. Patients are considered to be at risk when estimated glomerular filtration rate (eGFR) or estimated creatinine clearance (eCCr) is less than 60. The cornerstone of prevention of CIN is appropriate risk stratification, intravenous hydration with normal saline or sodium bicarbonate, appropriate withholding of nephrotoxic medications, use of low or iso-osmolar contrast media, and various intraprocedural methods for iodinated contrast dose reduction. Although N-acetylcysteine administration is popular, it remains unproven. Practitioners must be familiar with prevention strategies and diagnosis of CIN to minimize its clinical impact. PMID:22550376

Genetics in primary health care and the National Policy on Comprehensive Care for People with Rare Diseases in Brazil: opportunities and challenges for professional education.

PubMed

Melo, Débora Gusmão; de Paula, Pamela Karen; de Araujo Rodrigues, Stephania; da Silva de Avó, Lucimar Retto; Germano, Carla Maria Ramos; Demarzo, Marcelo Marcos Piva

2015-07-01

As discoveries regarding the genetic contribution to disease have grown rapidly, health care professionals are expected to incorporate genetic and genomic perspectives into health education and practice. Genetic competencies common to all health professionals have been identified by the US National Coalition for Health Professional Education in Genetics (NCHPEG), which defined the knowledge, skills, and attitudes required to achieve these competencies. The aim of this study is to analyze genetic competencies of primary health care professionals in Brazil. It is a descriptive survey study, whereby doctors, nurses, and dentists were invited to participate by answering a questionnaire including 11 issues based on competencies established by the NCHPEG. Data were presented as percentages. Differences between groups of participants were assessed by the Fisher exact test, with the level of significance set at p < 0.05. Results showed that concerning knowledge, about 80 % of the participants recognized basic genetics terminology, but practitioners had difficulty in identifying patterns of inheritance. Regarding clinical skills, practitioners were able to recognize facial dysmorphias and identify situations where referral of patients to specialists was necessary. Nevertheless, there were challenges in the process of valuing and gathering information about family history. Regarding attitudes, 68.9 % of the participants thought about the comprehensiveness of care but faced challenges in counselling parents. The results of this study may contribute to developing an ongoing education program for primary health care professionals, leading to a strategy to overcome the challenges of including genetics in the Brazilian Unified Health System.

Practice pattern and professional issues of nurse practitioners in mechanical circulatory support programs in the United States: a survey report.

PubMed

Casida, Jesus M; Pastor, Jessica

2012-09-01

Few data-based reports about the role and work environment of advanced practice nurses, specifically nurse practitioners in mechanical circulatory support programs, have been published. To describe the practice pattern and professional issues confronted by nurse practitioners in the rapidly evolving and expanding mechanical circulatory support programs in the United States. A descriptive research design was employed using the data from the 2010 mechanical circulatory support nurses survey. Quantitative and qualitative data that pertained to the demographic and practice profiles as well as barriers and overall issues faced by the nurse practitioners in their clinical practice were analyzed. Nonrandom sample of 48 nurse practitioners from 95 mechanical circulatory support programs nationwide. The practice pattern of nurse practitioners in mechanical circulatory support programs is similar to the practice pattern reported for nurse practitioners in acute and critical care settings. However, only 44% and 10% of nurse practitioners in mechanical circulatory support programs are authorized to admit and transfer patients into and out of the hospital, respectively. High workload, lack of institutional support, knowledge deficit, role ambiguity, lack of professional recognition, and burnout were the common issues faced by the participants in their clinical practice. The results provide preliminary evidence on the practice pattern, restrictions, and work environment issues that may threaten the viability of an mechanical circulatory support program in which nurse practitioners play a crucial role. Implications for clinical practice, research, and policy development are discussed.

Instructor Time Requirements to Develop and Teach Online Courses

ERIC Educational Resources Information Center

Freeman, Lee A.

2015-01-01

How much time does it take to teach an online course? Does teaching online take more or less time than teaching face-to-face? Instructors, department chairs, deans, and program administrators have long believed that teaching online is more time-consuming than teaching face-to-face. Many research studies and practitioner articles indicate…

Ethical and professional challenges posed by patients with genetic concerns: a report of focus group discussions with genetic counselors, physicians, and nurses.

PubMed

Veach, P M; Bartels, D M; LeRoy, B S

2001-04-01

Ninety-seven physicians, nurses, and genetic counselors from four regions within the United States participated in focus groups to identify the types of ethical and professional challenges that arise when their patients have genetic concerns. Responses were taped and transcribed and then analyzed using the Hill et al. (1997, Counsel Psychol 25:517-522) Consensual Qualitative Research method of analysis. Sixteen major ethical and professional domains and 63 subcategories were identified. Major domains are informed consent; withholding information; facing uncertainty; resource allocation; value conflicts, directiveness/nondirectiveness; determining the primary patient; professional identity issues; emotional responses; diversity issues; confidentiality; attaining/maintaining proficiency; professional misconduct; discrimination; colleague error; and documentation. Implications for practitioners who deal with genetic issues and recommendations for additional research are given.

Transforming Dental Technology Education: Skills, Knowledge, and Curricular Reform.

PubMed

Bobich, Anita M; Mitchell, Betty L

2017-09-01

Dental technology is one of the core allied dental health professions supporting the practice of dentistry. By definition, it is the art, science, and technologies that enable the design and fabrication of dental prostheses and/or corrective devices to restore natural teeth and supporting structures to fulfill a patient's physiological and esthetic needs. Dental technology educational programs are faced with serious challenges, including rapid changes in technology, inadequate funding for educational programs, and the need to develop curricula that reflect current industry needs. Better communications between dental technologists and practitioners are needed to gain greater recognition of the contribution that technologists make to patient health. Amid these challenges, the technology workforce is dedicated to providing patients with the best possible restorative dental prostheses. This article was written as part of the project "Advancing Dental Education in the 21 st Century."

The Wharton Symposium: Facing the Issues.

ERIC Educational Resources Information Center

Sullivan, David M.

1982-01-01

A public relations practitioner reports enthusiastically on his return to the campus for an "intellectually-broadening" public relations symposium. He summarizes critical social and economic issues addressed by distinguished scholars and experienced practitioners. For journal availability, see CS 705 902. (PD)

Socio-economic and cultural vulnerabilities to cervical cancer and challenges faced by patients attending care at Tikur Anbessa Hospital: a cross sectional and qualitative study.

PubMed

Tadesse, Sara Kebede

2015-09-16

Cervical cancer is a leading cause of death among women in Ethiopia, affecting them at a time of their life when they are critical to social and economic stability. This study was mainly focused on assessing different socioeconomic and cultural related factors that make women vulnerable to cervical cancer and challenges women face in the process of diagnosis and treatment. To achieve the objective of the study both qualitative and quantitative methods were utilized.198 participants were enrolled in a cross- sectional survey and 10 in-depth interviews were conducted with patients in Tikur Anbessa Hospital. A consecutive sampling method was used to select participants in the survey while purposive sampling was employed to select participants in the qualitative design. For the population covered in the study, poverty along with other socio-cultural practices such as early marriage, high parity and to certain extent polygamy were identified as factors that increased the vulnerability of women to cervical cancer. In addition, the study has uncovered several challenges faced by cervical cancer patients in the diagnosis and treatment process. Three types of challenges that include, health care based, psychological and economic were identified. System and practitioner delay were found as the main hurdles within the variable of health care related challenges. What's more, the psychological challenges identified included, fear of recurrence, negative social attitude and distress associated with the side effects from treatments such as fecal & urinary leakage. Furthermore, inability of bearing costs related to treatment and accommodation were cited as the main economic challenges. The study showed various socio-economic and cultural vulnerabilities that expose women to cervical cancer and the challenges encountered by cervical cancer patients after their diagnosis. Addressing this issue largely lies in strengthening primary and secondary preventive mechanisms, providing public education about safer sex practices, family planning and eliminating cultural practices such as early marriage and polygamy in connection to cervical cancer. Furthermore, improving the diagnostic and treatment procedures and facilities is also a crucial component that needs due emphasis in the fight against cervical cancer.

Challenges in knowledge translation: the early years of Cancer Care Ontario's Program in Evidence-Based Care.

PubMed

Browman, G P

2012-02-01

Cancer Care Ontario's Program in Evidence-Based Care (pebc) was formalized in 1997 to produce clinical practice guidelines for cancer management for the Province of Ontario. At the time, the gap between guideline development and implementation was beginning to be acknowledged. The Program implemented strategies to promote use of guidelines. The program had to overcome numerous social challenges to survive. Prospective strategies useful to practitioners-including participation, transparent communication, a methodological vision, and methodology skills development offerings-were used to create a culture of research-informed oncology practice within a broad community of practitioners.Reactive strategies ensured the survival of the program in the early years, when some within the influential academic community and among decision-makers were skeptical about the feasibility of a rigorous methodologic approach meeting the fast turnaround times necessary for policy. The paper details the pebc strategies within the context of what was known about knowledge translation (kt) at the time, and it tries to identify key success factors. Many of the barriers faced in the implementation of kt-and the strategies for overcoming them-are unavailable in the public domain because the relevant reporting does not fit the traditional paradigm for publication. Telling the "stories behind the story" should be encouraged to enhance the practice of kt beyond the science.

Youth Mental Health, Family Practice, and Knowledge Translation Video Games about Psychosis: Family Physicians’ Perspectives

PubMed Central

Ferrari, Manuela; Suzanne, Archie

2017-01-01

Objective Family practitioners face many challenges providing mental healthcare to youth. Digital technology may offer solutions, but the products often need to be adapted for primary care. This study reports on family physicians’ perspectives on the relevance and feasibility of a digital knowledge translation (KT) tool, a set of video games, designed to raise awareness about psychosis, marijuana use, and facilitate access to mental health services among youth. Method As part of an integrated knowledge translation project, five family physicians from a family health team participated in a focus group. The focus group delved into their perspectives on treating youth with mental health concerns while exploring their views on implementing the digital KT tool in their practice. Qualitative data was analyzed using thematic analysis to identify patterns, concepts, and themes in the transcripts. Results Three themes were identified: (a) challenges in assessing youth with mental health concerns related to training, time constraints, and navigating the system; (b) feedback on the KT tool; and, (c) ideas on how to integrate it into a primary care practice. Conclusions Family practitioners felt that the proposed video game KT tool could be used to address youth’s mental health and addictions issues in primary care settings. PMID:29056980

South Africa and the 21st Century Power Partnership (Fact Sheet). 21st Century Power Partnership; 21st Century Power Partnership

DOE Office of Scientific and Technical Information (OSTI.GOV)

None

Established in 2012, the 21CPP South Africa Programme is a global initiative that connects South African stakeholders with an international community of expertise. The overall goal of this program is to support South Africa’s power system transformation by accelerating the transition to a reliable, financially robust, and low-carbon power system. 21CPP activities focus on achieving positive outcomes for all participants, especially addressing critical questions and challenges facing system planners, regulators, and operators. In support of this goal, 21CPP taps into deep networks of expertise among leading industry practitioners.

Veterans' informal caregivers in the "sandwich generation": a systematic review toward a resilience model.

PubMed

Smith-Osborne, Alexa; Felderhoff, Brandi

2014-01-01

Social work theory advanced the formulation of the construct of the sandwich generation to apply to the emerging generational cohort of caregivers, most often middle-aged women, who were caring for maturing children and aging parents simultaneously. This systematic review extends that focus by synthesizing the literature on sandwich generation caregivers for the general aging population with dementia and for veterans with dementia and polytrauma. It develops potential protective mechanisms based on empirical literature to support an intervention resilience model for social work practitioners. This theoretical model addresses adaptive coping of sandwich- generation families facing ongoing challenges related to caregiving demands.

Sustainability Efforts of One Oil Company in Niger Delta of Nigeria

NASA Astrophysics Data System (ADS)

Anosike, Charles Afam

Environmental degradation and socioeconomic dilemma continue to stigmatize oil production in the Niger Delta of Nigeria. Sustainability programs of oil companies often determine the improvement of living conditions in the region. This explanatory qualitative case study, guided by systems thinking theory and sustainable value framework, explored practitioners' perceptions of sustainability programs to identify its impact on business and the host communities. The research question was designed to address how sustainability efforts of a single oil company in the Niger Delta contributed to the business performance and the livelihood of the local people. Research data were gathered from a sample of 20 experienced sustainability practitioners of the oil company, partnering nonprofit organizations, and community leaders through face-to-face semistructured interviews. Data were segmented and categorized. The data analysis process revealed several themes regarding the challenges and shortfalls of sustainability programs in the region. The oil company's understanding of sustainability as programs and projects focused on preserving resources for future generations was not evident in practice. Findings from the study suggested the need for improved inclusiveness of people in driving sustainability projects. Inclusive sustainability should enhance the oil company's contemplation mechanism to ensure eco-saving thinking and processes, which could result in improved quality of life and business performance in the region. The research findings underscore the need for oil multinational corporations (MNCs) to use a business lens in viewing sustainability to achieve sustainable value.

The South African Experience of Conservation and Social Forestry Outreach Nurseries

NASA Astrophysics Data System (ADS)

Botha, Jenny; Witkowski, Ed T. F.; Cock, Jacklyn

2006-11-01

Outreach nurseries are favored conservation and social forestry tools globally, but, as with many integrated conservation and development programs (ICDPs), they do not always produce anticipated results. A synopsis of the experience of South African practitioners is provided in this study of 65 outreach nurseries. South African outreach nurseries frequently include financial objectives, creating additional challenges in simultaneously attaining conservation and socioeconomic goals. Progress was hindered by biophysical problems (e.g., lack of water, poor soils, etc.) as well as the harsh socioeconomic conditions facing most communities in which nurseries had been established. Attaining financial viability was challenging. Business management skills were often restricted, and few viability studies included adequate market research. Costs to community participants were usually high, and benefits were limited. Conservation objectives were frequently lost in the struggle to attain financial viability. The management of social processes also proved challenging. Although small scale and relatively straightforward compared with many ICDPs, nurseries usually require substantial institutional support, including a range of technical, business, and development services. Project time frames need to be reconsidered, as practitioners estimate that it takes 5-10 years for nurseries to start meeting objectives, and donors and implementing agencies often operate on 2-3-year project cycles. Detailed viability studies are essential, incorporating a social probe and an assessment of potential impacts of projects on community participants. Progress needs to be continuously evaluated to enable institutions and community participants to adapt to changing conditions as well as ensure that the spectrum of objectives are being achieved.

The South African experience of conservation and social forestry outreach nurseries.

PubMed

Botha, Jenny; Witkowski, Ed T F; Cock, Jacklyn

2006-11-01

Outreach nurseries are favored conservation and social forestry tools globally, but, as with many integrated conservation and development programs (ICDPs), they do not always produce anticipated results. A synopsis of the experience of South African practitioners is provided in this study of 65 outreach nurseries. South African outreach nurseries frequently include financial objectives, creating additional challenges in simultaneously attaining conservation and socioeconomic goals. Progress was hindered by biophysical problems (e.g., lack of water, poor soils, etc.) as well as the harsh socioeconomic conditions facing most communities in which nurseries had been established. Attaining financial viability was challenging. Business management skills were often restricted, and few viability studies included adequate market research. Costs to community participants were usually high, and benefits were limited. Conservation objectives were frequently lost in the struggle to attain financial viability. The management of social processes also proved challenging. Although small scale and relatively straightforward compared with many ICDPs, nurseries usually require substantial institutional support, including a range of technical, business, and development services. Project time frames need to be reconsidered, as practitioners estimate that it takes 5-10 years for nurseries to start meeting objectives, and donors and implementing agencies often operate on 2-3-year project cycles. Detailed viability studies are essential, incorporating a social probe and an assessment of potential impacts of projects on community participants. Progress needs to be continuously evaluated to enable institutions and community participants to adapt to changing conditions as well as ensure that the spectrum of objectives are being achieved.

A fuzzy model for achieving lean attributes for competitive advantages development using AHP-QFD-PROMETHEE

NASA Astrophysics Data System (ADS)

Roghanian, E.; Alipour, Mohammad

2014-06-01

Lean production has become an integral part of the manufacturing landscape as its link with superior performance and its ability to provide competitive advantage is well accepted among academics and practitioners. Lean production helps producers in overcoming the challenges organizations face through using powerful tools and enablers. However, most companies are faced with restricted resources such as financial and human resources, time, etc., in using these enablers, and are not capable of implementing all these techniques. Therefore, identifying and selecting the most appropriate and efficient tool can be a significant challenge for many companies. Hence, this literature seeks to combine competitive advantages, lean attributes, and lean enablers to determine the most appropriate enablers for improvement of lean attributes. Quality function deployment in fuzzy environment and house of quality matrix are implemented. Throughout the methodology, fuzzy logic is the basis for translating linguistic judgments required for the relationships and correlation matrix to numerical values. Moreover, for final ranking of lean enablers, a multi-criteria decision-making method (PROMETHEE) is adopted. Finally, a case study in automotive industry is presented to illustrate the implementation of the proposed methodology.

A letter on the state of general practice in England.

PubMed

Majeed, Azeem

2015-01-01

The last few years have been a time of considerable change for general practitioners in England. In 2004, general practitioners negotiated a new contract with the United Kingdom's National Health Service. In came a new pay for performance scheme, along with the option of opting out of after-hours primary care. General practitioners' pay increased and job satisfaction improved. However, rather than then entering a period of stability, general practitioners subsequently found themselves facing even more changes in their working practices. Workload has increased, new responsibilities for commissioning health services have been given to general practitioners, and their income has fallen.

Challenges and leadership strategies for managers of nurse practitioners.

PubMed

Reay, Trish; Golden-Biddle, Karen; Germann, Kathy

2003-11-01

The aim of this paper is to report on the findings from our research into the recent introduction of nurse practitioners in Alberta, Canada. Through an organizational research perspective, we identify the critical role of health care managers in developing a sustainable nurse practitioner role. Previous literature has focused on nurse practitioners themselves as the key factor in their integration into the health care system. Although they are qualified and organizationally well placed, managers of nurse practitioners have been overlooked as a critical part of implementation strategies. We interviewed 25 nurse practitioners and seven of their managers. Through our data analysis we identified three major challenges for managers: (1) clarifying the reallocation of tasks; (2) managing altered working relationships within the team; (3) continuing to manage the team in an evolving situation. Associated with these challenges, we propose leadership strategies that managers may find useful as they work through the consequences of introducing the nurse practitioner role. These strategies are: * encourage all team members to sort out 'who does what'; * ensure that task reallocation preserves job motivating properties; * give consideration to how tasks have been allocated when issues identified as 'personal conflict' arise; * pay attention to all perspectives of the working relationships within the team; * facilitate positive relationships between team members; * lead from a 'balcony' perspective; * work with the team to develop goals that are not over focused on the nurse practitioner; * regularly share with other managers the experiences and lessons learned in introducing nurse practitioners. For managers to be most effective, they need to address three challenges that are of a managerial, not clinical, nature. By implementing specific leadership strategies, managers of nurse practitioners can facilitate the introduction of the new role and improve its sustainability in health organizations.

Exploring Canadian Physicians' Experiences Providing Medical Assistance in Dying: A Qualitative Study.

PubMed

Khoshnood, Narges; Hopwood, Marie-Clare; Lokuge, Bhadra; Kurahashi, Allison; Tobin, Anastasia; Isenberg, Sarina; Husain, Amna

2018-05-15

MAiD allows a practitioner to administer or prescribe medication for the purpose of ending a patient's life. In 2016, Canada was the latest country, following several European countries and American states, to legalize physician-assisted death. Although some studies report on physician attitudes towards MAiD or describe patient characteristics, there are few that explore the professional challenges faced by physicians who provide MAiD. To explore the professional challenges faced by Canadian physicians who provide MAiD. Sixteen physicians from across Canada who provide MAiD completed in-depth, semi-structured telephone interviews. An inductive thematic analysis approach guided data collection and the iterative, interpretive analysis of interview transcripts. Three members of the research team systematically co-coded interview transcripts and the emerging themes were developed with the broader research team. NVivo was used to manage the coded data. Participants described three challenges associated with providing MAiD: 1) their relationships with other MAiD providers were enhanced and relationships with objecting colleagues were sometimes strained, 2) they received inadequate financial compensation for time, and, 3) they experienced increased workload, resulting in sacrifices to personal time. Although these providers did not intend to stop providing MAiD at the time of the interview, they indicated their concerns about whether they would be able to sustain this service over time. Physicians described relationship, financial, and workload challenges to providing MAiD. We provide several recommendations to address these challenges and help ensure the sustainability of MAiD in countries that provide this service. Copyright © 2018. Published by Elsevier Inc.

Additional Insights Into Problem Definition and Positioning From Social Science Comment on "Four Challenges That Global Health Networks Face".

PubMed

Quissell, Kathryn

2017-09-10

Commenting on a recent editorial in this journal which presented four challenges global health networks will have to tackle to be effective, this essay discusses why this type of analysis is important for global health scholars and practitioners, and why it is worth understanding and critically engaging with the complexities behind these challenges. Focusing on the topics of problem definition and positioning, I outline additional insights from social science theory to demonstrate how networks and network researchers can evaluate these processes, and how these processes contribute to better organizing, advocacy, and public health outcomes. This essay also raises multiple questions regarding these processes for future research. © 2018 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Capability challenges of facility management (FM) personnel toward sustainability agenda

NASA Astrophysics Data System (ADS)

Halim, Ahmad Ilyas Ahmad; Sarpin, Norliana; Kasim, Narimah Binti; Zainal, Rozlin Binti

2017-10-01

The industries business play a significant role to contribute toward economic growth in develop and developing country. However, they always face serious problems such as time overrun, waste generation, and cost overrun during their operation and maintenance. Traditional practice is found unable to control that situation. These challenges accent the need for practitioners to rethink and improve their process management. This show that industries business has major potential when applying sustainable development by focusing on three pillars (economic, environment, and social). By adopting sustainability, it can reduce energy consumption and waste, while increasing productivity, financial return and corporate standing in community. FM personnel are most suitable position to lead organizations toward sustainability implementation. However, lack of skill and capability among FM personnel to achieve sustainable goal had become barrier that need to overcome. This paper focus to identify capability challenges of FM personnel toward sustainability. A multiple researches were conducted and data were gathered through literature review from previous studies.

Ethnopharmacological survey on medicinal plants used in snakebite treatments in Western and Sabaragamuwa provinces in Sri Lanka.

PubMed

Dharmadasa, R M; Akalanka, G C; Muthukumarana, P R M; Wijesekara, R G S

2016-02-17

Sri Lanka has a great diversity of snake species. In this relation, over 40,000 cases of snakebite accidents are reported annually from different agro-ecological regions of the country. Since more than 95% of victims rely on traditional treatments, there is an urgent necessity to improve the system. Traditional knowledge on snakebite treatments has been passed on from generation to generation within families. Unfortunately, there has been a limited update of information on pertinent issues related to this subject. In the present study we conducted a comprehensive survey on the types of medicinal plant materials, including the specific plant parts that are available for this purpose. In addition, various treatment types, frequency index, heavily used and rare materials, family wise distribution, challenges faced by traditional practitioners and future prospects were also explored. The present survey covered two provinces with a high population of traditional practitioners for snakebites treatment in Sri Lanka.Information was gathered from a total of seventy-four (74) traditional practitioners from the Sabaragamuwa and Western provinces. A questionnaire was prepared and pre-tested by 10-15 respondents prior to the survey. Actual data were gathered through face-to-face interviews. Collected data were tabulated and analyzed. A total of 341 different plant species belonging to 99 families were documented. The highest number of plants was reported from the family Fabaceae (32 species). This was followed by Malvaceae (16 species), Asteraceae (15 species), Rutaceae (13 species Apocyanaceae (14 species), Lamiaceae (11 species), Poaceae, Euphorbaceae and Phyllanthaceae (10 species per each) respectively. Different parts of the plant such as leaves (53.67%), barks (26.10%), entire plant (14.08%), roots (10.26%), bulbs (8.80%), seeds (7.62%), fruits (6.45%), buds (5.87%), flowers (3.23%) stems (2.93%) and latex (2.05%) were used for the preparation of nine different types of formulae. These formulae include oral administration (172 plant species), external bandaging (167 plant species), oiling for external application (34 plant species), steaming (33 plant species), creaming for wounds (6 plant species), nasal treatments (40 plant species), head treatments (23 plant species), treatment for eyes (4 plant species) and washing of wounds (9 plant species). Moreover, plants used for the different snake types, constraints faced by traditional practitioners, and their constructive suggestions were also discussed. A pioneering attempt was made to exploit local knowledge on snakebite treatments for the conservation of valued medicinal plants and to promote primary health care needs in Sabaragamuwa and Western provinces in Sri Lanka. The documented plants together with the traditional knowledge could be effectively utilized for the isolation and characterization of antivenom for different snake species. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Negotiating Competing Goals in the Development of an Urban Ecology Practitioner Inquiry Community

NASA Astrophysics Data System (ADS)

Piazza, Peter; McNeill, Katherine L.

2013-11-01

Teacher learning communities are hailed by many as vehicles for reforming and elevating the professional status of teaching. While much research explores teacher community as a venue for measurable gains, our research examines the orientation of practitioner inquiry toward critical debate about effective instruction. Specifically, our study focuses on a group of middle and high school teachers who worked with a nonprofit organization to engage students in urban environmental field investigations. Teachers met regularly as a community with the common goal of teaching urban ecology in an outdoor setting. We collected interview data from members of the teacher community, and we observed teacher interaction during a meeting of the practitioner inquiry group. Interview results indicated that while the nonprofit aimed to support collaborative dialogue and self-critique, participants saw the community mainly as a venue for pursuing short-term goals, such as receiving new resources or socializing with colleagues. Observation data, however, suggested that the community was taking early steps toward building an environment oriented toward critical discussion. Juxtaposing results from our interviews and observations, we discuss the challenges communities face when they seek to develop shared beliefs and deal openly with conflict. Ultimately, we suggest that organizers of collaborative learning environments should work to actively develop structures for building the organizational trust necessary to support civil critique.

Effective professional networking.

PubMed

Goolsby, Mary Jo; Knestrick, Joyce M

2017-08-01

The reasons for nurse practitioners to develop a professional network are boundless and are likely to change over time. Networking opens doors and creates relationships that support new opportunities, personal development, collaborative research, policy activism, evidence-based practice, and more. Successful professional networking involves shared, mutually beneficial interactions between individuals and/or individuals and groups, regardless of whether it occurs face to face or electronically. This article combines nuggets from the literature with guidance based on the authors' combined experience in networking activities at the local, national, and international levels. ©2017 American Association of Nurse Practitioners.

Identifying public health competencies relevant to family medicine.

PubMed

Harvey, Bart J; Moloughney, Brent W; Iglar, Karl T

2011-10-01

Public health situations faced by family physicians and other primary care practitioners, such as severe acute respiratory syndrome (SARS) and more recently H1N1, have resulted in an increased interest to identify the public health competencies relevant to family medicine. At present there is no agreed-on set of public health competencies delineating the knowledge and skills that family physicians should possess to effectively face diverse public health challenges. Using a multi-staged, iterative process that included a detailed literature review, the authors developed a set of public health competencies relevant to primary care, identifying competencies relevant across four levels, from "post-MD" to "enhanced." Feedback from family medicine and public health educator-practitioners regarding the set of proposed "essential" competencies indicated the need for a more limited, feasible set of "priority" areas to be highlighted during residency training. This focused set of public health competencies has begun to guide relevant components of the University of Toronto's Family Medicine Residency Program curriculum, including academic half-days; clinical experiences, especially identifying "teachable moments" during patient encounters; resident academic projects; and elective public health agency placements. These competencies will also be used to guide the development of a family medicine-public health primer and faculty development sessions to support family medicine faculty facilitating residents to achieve these competencies. Once more fully implemented, an evaluation will be initiated to determine the degree to which these public health competencies are being achieved by family medicine graduates, especially whether they attained the knowledge, skills, and confidence necessary to effectively face diverse public health situations-from common to emergent. Copyright © 2011 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Ethical Issues in Continuing Professional Education.

ERIC Educational Resources Information Center

Lawler, Patricia Ann

2000-01-01

Continuing professional education practitioners often face ethical dilemmas regarding their obligations to multiple stakeholders and issues arising in new arenas such as the workplace, distance education, and collaboration with business. Codes of ethics can guide practice, but practitioners should also identify their personal core values system…

Evidence-Based Practice: The Psychology of EBP Implementation.

PubMed

Rousseau, Denise M; Gunia, Brian C

2016-01-01

Evidence-based practice (EBP) is an approach used in numerous professions that focuses attention on evidence quality in decision making and action. We review research on EBP implementation, identifying critical underlying psychological factors facilitating and impeding its use. In describing EBP and the forms of evidence it employs, we highlight the challenges individuals face in appraising evidence quality, particularly that of their personal experience. We next describe critical EBP competencies and the challenges underlying their acquisition: foundational competencies of critical thinking and domain knowledge, and functional competencies such as question formulation, evidence search and appraisal, and outcome evaluation. We then review research on EBP implementation across diverse fields from medicine to management and organize findings around three key contributors to EBP: practitioner ability, motivation, and opportunity to practice (AMO). Throughout, important links between psychology and EBP are highlighted, along with the contributions psychological research can make to further EBP development and implementation.

Overcoming challenges faced by breastfeeding mothers.

PubMed

Amir, Lisa H; Bearzatto, Anita

2016-08-01

Women who are breastfeeding often consult their general practitioner (GP) with concerns about nipple and breast pain, or the adequacy of their milk supply. Common concerns for their breastfed infant include slow weight gain, 'fussiness' with breastfeeding and 'funny stools'. This article offers suggestions for clinicians to support breastfeeding women and their infants. Good attachment to the breast is important to reduce nipple pain and trauma, and to ensure adequate breast drainage and ongoing milk supply. Other causes of nipple pain include vasospasm, dermatitis and infection. Breast pain may be due to blocked ducts, mastitis or abscess. Very early mastitis may be treated by improved emptying. Slow weight gain in a breastfed infant may indicate a medical problem or low supply of breast milk. Some infants have breastfeeding challenges because they are small or premature, or from anatomical issues affecting feeding. In such cases, further help from a lactation consultant may be beneficial.

US military primary care: problems, solutions, and implications for civilian medicine.

PubMed

Mundell, Benjamin F; Friedberg, Mark W; Eibner, Christine; Mundell, William C

2013-11-01

The US Military Health System (MHS), which is responsible for providing care to active and retired members of the military and their dependents, faces challenges in delivering cost-effective, high-quality primary care while maintaining a provider workforce capable of meeting both peacetime and wartime needs. The MHS has implemented workforce management strategies to address these challenges, including "medical home" teams for primary care and other strategies that expand the roles of nonphysician providers such as physician assistants, nurse practitioners, and medical technicians. Because these workforce strategies have been implemented relatively recently, there is limited evidence of their effectiveness. If they prove successful, they could serve as a model for the civilian sector. However, because the MHS model features a broad mix of provider types, changes to civilian scope-of-practice regulations for nonphysician providers would be necessary before the civilian provider mix could replicate that of the MHS.

Between two roles - Experiences of newly trained nurse practitioners in surgical care in Sweden: A qualitative study using repeated interviews.

PubMed

Jangland, Eva; Yngman Uhlin, Pia; Arakelian, Erebouni

2016-11-01

The position of Nurse Practitioner is a new role in Nordic countries. The transition from a registered nurse to the Nurse Practitioner role has been reported to be a personal challenge. This study, guided by the Nordic theoretical model for use in the education of advanced practice nurses, represents a unique opportunity to describe this transition for newly graduated Nurse Practitioners in an interprofessional surgical care team in Sweden. The aim was to explore how the first Nurse Practitioners in surgical care experienced the transition into a new role and what competences they used in the team. Eight new Nurse Practitioners with parallel work in clinical practice were interviewed twice around the time of their graduation. The qualitative analyses show that the participants integrated several central competences, but the focus in this early stage in their new role was on direct clinical praxis, consultation, cooperation, case management, and coaching. Transition from the role of clinical nurse specialist to nurse practitioner was a challenging process in which the positive response from patients was a driving force for the new Nurse Practitioners. The participants felt prepared for and determined to solve the challenging situations they approached working in the interprofessional team. Copyright © 2016 Elsevier Ltd. All rights reserved.

Traditional, complementary, and alternative medicine approaches to mental health care and psychological wellbeing in India and China.

PubMed

Thirthalli, Jagadisha; Zhou, Liang; Kumar, Kishore; Gao, Jie; Vaid, Henna; Liu, Huiming; Hankey, Alex; Wang, Guojun; Gangadhar, Bangalore N; Nie, Jing-Bao; Nichter, Mark

2016-07-01

India and China face the same challenge of having too few trained psychiatric personnel to manage effectively the substantial burden of mental illness within their population. At the same time, both countries have many practitioners of traditional, complementary, and alternative medicine who are a potential resource for delivery of mental health care. In our paper, part of The Lancet and Lancet Psychiatry's Series about the China-India Mental Health Alliance, we describe and compare types of traditional, complementary, and alternative medicine in India and China. Further, we provide a systematic overview of evidence assessing the effectiveness of these alternative approaches for mental illness and discuss challenges in research. We suggest how practitioners of traditional, complementary, and alternative medicine and mental health professionals might forge collaborative relationships to provide more accessible, affordable, and acceptable mental health care in India and China. A substantial proportion of individuals with mental illness use traditional, complementary, and alternative medicine, either exclusively or with biomedicine, for reasons ranging from faith and cultural congruence to accessibility, cost, and belief that these approaches are safe. Systematic reviews of the effectiveness of traditional, complementary, and alternative medicine find several approaches to be promising for treatment of mental illness, but most clinical trials included in these systematic reviews have methodological limitations. Contemporary methods to establish efficacy and safety-typically through randomised controlled trials-need to be complemented by other means. The community of practice built on collaborative relationships between practitioners of traditional, complementary, and alternative medicine and providers of mental health care holds promise in bridging the treatment gap in mental health care in India and China. Copyright © 2016 Elsevier Ltd. All rights reserved.

Factors influencing property selection for conservation revolving funds.

PubMed

Hardy, Mathew J; Fitzsimons, James A; Bekessy, Sarah A; Gordon, Ascelin

2018-04-01

Finding sustainable ways to increase the amount of private land protected for biodiversity is challenging for many conservation organizations. In some countries, organizations use revolving-fund programs, whereby land is purchased and then sold to conservation-minded owners under condition they enter into a conservation covenant or easement. The sale proceeds are used to purchase, protect, and sell additional properties, incrementally increasing the amount of protected private land. Because the effectiveness of this approach relies on selecting appropriate properties, we explored factors currently considered by practitioners and how these are integrated into decision making. We conducted exploratory, semistructured interviews with managers from each of the 5 major revolving funds in Australia. Responses indicated although conservation factors are important, financial and social factors are also highly influential. A major determinant was whether the property could be resold within a reasonable period at a price that replenishes the fund. To facilitate resale, often selected properties include the potential for the construction of a dwelling. Practitioners face with clear trade-offs between conservation, financial, amenity, and other factors in selecting properties and 3 main challenges: recovering the costs of acquisition, protection, and resale; reselling the property; and meeting conservation goals. Our findings suggest the complexity of these decisions may constrain revolving-fund effectiveness. Drawing from participant responses, we identified potential strategies to mitigate these risks, such as providing adequate recreational space without jeopardizing ecological assets. We suggest managers could benefit from a shared-learning and adaptive approach to property selection given the commonalities between programs. Understanding how practitioners deal with complex decisions in the implementation of revolving funds helps identify future research to improve the performance of this conservation tool. © 2017 Society for Conservation Biology.

Relationships between dental personnel and non-dental primary health care providers in rural and remote Queensland, Australia: dental perspectives.

PubMed

Stuart, Jackie; Hoang, Ha; Crocombe, Len; Barnett, Tony

2017-06-19

Collaboration between dental practitioners and non-dental primary care providers has the potential to improve oral health care for people in rural and remote communities, where access to oral health services is limited. However, there is limited research on collaboration between these professional disciplines. The purpose of this paper was to explore the relationships between dental practitioners and non-dental primary care providers from rural and remote areas of Queensland and to identify strategies that could improve collaboration between these disciplines from the perspective of dental participants. Semi-structured interviews were conducted between 2013 and 2015 with visiting, local and regional dental practitioners (n = 12) who had provided dental services to patients from eight rural and remote Queensland communities that did not have a resident dentist. Participants were purposely recruited through a snow ball sampling technique. Interview data were analysed using thematic analysis with the assistance of QSR Nvivo v.10. Four major themes emerged from the data: (1) Communication between dental practitioners and rural primary care providers; (2) Relationships between dental and primary care providers; (3) Maintenance of professional dualism; (4) Strategies to improve interprofessional relationships (with subthemes: face to face meetings; utilisation of technology; oral health training for primary care providers; and having a community based oral health contact person). Participants observed that there was a lack of communication between the dental providers who saw patients from these rural communities and the primary care providers who worked in each community. This was attributed to poor communication, the high turnover of staff and the siloed behaviours of some practitioners. Visiting dental practitioners were likely to have stronger professional relationships with hospital nursing, administrative and allied health care staff who were often long term residents of the community. The findings suggest that there was little relationship between the dental personnel and primary care providers. Interprofessional collaboration between dental care providers and non-dental rural primary care providers in the rural and remote communities sampled could be improved by having regular face to face meetings between practitioners from across the health disciplines, providing oral health education to primary care providers, establishing and maintaining effective communication and referral pathways, and exploring a greater role for tele-dentistry.

Aspiring Pain Practitioners in India: Assessing Challenges and Building Opportunities.

PubMed

Bhatnagar, Sushma; Patel, Anuradha; Raja, Srinivasa N

2018-01-01

Pain medicine is a developing specialty, aimed at relieving pain and suffering, enhancing function, and improving the quality of life of patients. Pain is often ignored, under-reported and mismanaged by health-care providers. Aspiring pain physicians in India face many challenges and barriers in advancing their specialty. The objective of this study is to determine the challenges in establishing a pain practice in India and to discuss the opportunities and strategies to overcome these barriers. Face-to-face interactive sessions were held with 60 aspiring pain physicians of India who were chosen as registrants to an International Association for the Study of Pain-Indian Society for Study of Pain multidisciplinary evidence-based pain management program conducted at Delhi and Mumbai. The available opportunities, practical issues and the hurdles in becoming a pain specialist were analyzed and summarized in this commentary. The major barriers identified were: (1) Inadequate knowledge and absence of structured, educational and training courses, (2) bureaucratic hurdles, and (3) concerns of opioid misuse and addiction. The opportunities for personal growth and that of the specialty that could be utilized include the creation of a pain resource team, increasing community awareness, changing attitudes of other physicians toward pain specialty, and research and evidence building of the effectiveness of pain management strategies. India needs a structured teaching and training program in the area of pain medicine that is affiliated by the Medical Council of India or other reputed boards of medical education and certification. There is an urgent need to include pain management in the undergraduate and postgraduate medical curriculum. Enhancing community level awareness by public health education campaigns, developing networks of pain physicians, and appropriate marketing of the specialty is needed to make pain medicine recognized and utilized as a valuable specialty.

"Saying no is no easy matter" A qualitative study of competing concerns in rationing decisions in general practice

PubMed Central

Carlsen, Benedicte; Norheim, Ole Frithjof

2005-01-01

Background The general practitioner in Norway is expected to ensure equity and effectiveness through fair rationing. At the same time, due to recent reforms of the Norwegian health care sector, both the role of economic incentives and patient autonomy have been strengthened. Studies indicate that modern general practitioners, both in Norway and in other countries are uncomfortable with the gatekeeper role, but there is little knowledge about how general practitioners experience rationing in practice. Methods Through focus group interviews with Norwegian general practitioners, we explore physicians' attitudes toward factors of influence on medical decision making and how rationing dilemmas are experienced in everyday practice. Results Four major concerns appeared in the group discussions: The obligation to ration health care, professional autonomy, patient autonomy, and competition. A central finding was that the physicians find rationing difficult because saying no in face to face relations often is felt uncomfortable and in conflict with other important objectives for the general practitioner. Conclusion It is important to understand the association between using economic incentives in the management of health care, increasing patient autonomy, and the willingness among physicians to contribute to efficient, fair and legitimate resource allocation. PMID:16281967

Diagnosis of dementia by medical practitioners: a national study among older adults in Singapore.

PubMed

Chong, Siow Ann; Abdin, Edimansyah; Vaingankar, Janhavi; Ng, Li Ling; Subramaniam, Mythily

2016-12-01

Dementia is inevitably associated with an ageing population which has tremendous public health, social and economic implications. Yet the extant evidence suggests that the diagnosis of dementia in general is neither timely nor accurate. The aim of this present study was to establish the prevalence of dementia as diagnosed by medical practitioners in Singapore and its associated factors. The analysis is based on a national epidemiological study of older adults in Singapore which had established the prevalence of dementia using the 10/66 protocol. It was a community based survey, and face-to-face interviews were conducted with 2565 respondents (a response rate of 66%) and 2421 informants. In all, 3% of the respondents were diagnosed by a medical practitioner to have dementia of which 11.5% were diagnosed by general practitioners. Only 30.3% were prescribed medications specifically for dementia. Those with comorbid depression were more likely to be diagnosed to have dementia. The apparent low rate of diagnosis by medical practitioners is in line with studies done in the West. There is a need to elucidate the reasons underlying this under-diagnosis in order to better address this gap.

Computer and cell phone access for individuals with mobility impairments: an overview and case studies.

PubMed

Burgstahler, Sheryl; Comden, Dan; Lee, Sang-Mook; Arnold, Anthony; Brown, Kayla

2011-01-01

Computers, telephones, and assistive technology hold promise for increasing the independence, productivity, and participation of individuals with disabilities in academic, employment, recreation, and other activities. However, to reach this goal, technology must be accessible to, available to, and usable by everyone. The authors of this article share computer and telephone access challenges faced by individuals with neurological and other impairments, assistive technology solutions, issues that impact product adoption and use, needs for new technologies, and recommendations for practitioners and researchers. They highlight the stories of three individuals with neurological/mobility impairments, the technology they have found useful to them, and their recommendations for future product development.

Effect of music on anxiety, stress, and depression levels in patients undergoing coronary angiography.

PubMed

Moradipanah, F; Mohammadi, E; Mohammadil, A Z

2009-01-01

Control of stress and anxiety and the promotion of comfort are challenges facing health practitioners involved in catheterization. The aim of this case-control study was to examine the effect of music on the levels of anxiety, stress, and depression experienced by patients undergoing coronary angiography, as measured by the 21-item Depression Anxiety Stress Scales. Differences in pre- and post-intervention scores demonstrated that there were significant decreases in mean scores of state anxiety (P = 0.006), stress (P = 0.001) and depression P = 0.02) in the intervention group, who listened to 20 minutes of relaxing music, as compared with the control group who had 20 minutes of bed rest.

Bridging Troubled Waters: Historians, Natural Resource Litigation, and the Expert Witness Phenomenon.

PubMed

Brescia, Michael M

2015-02-01

This special issue of The Public Historian examines the nature and scope of the historian's role as a consultant and expert witness in natural resource litigation. The introductory essay identifies the major issues and challenges that historians face when they bring their knowledge, skills, and professional best standards into law offices and courtrooms, while also positing a conceptual framework for public history practitioners to better understand and appreciate the larger stakes in conducting research for environmental litigation. The author delineates his own experience as an expert in certain water rights cases in the American Southwest where knowledge of the Spanish and Mexican civil law of property is essential.

The development of computer ethics: contributions from business ethics and medical ethics.

PubMed

Wong, K; Steinke, G

2000-04-01

In this essay, we demonstrate that the field of computer ethics shares many core similarities with two other areas of applied ethics. Academicians writing and teaching in the area of computer ethics, along with practitioners, must address ethical issues that are qualitatively similar in nature to those raised in medicine and business. In addition, as academic disciplines, these three fields also share some similar concerns. For example, all face the difficult challenge of maintaining a credible dialogue with diverse constituents such as academicians of various disciplines, professionals, policymakers, and the general public. Given these similarities, the fields of bioethics and business ethics can serve as useful models for the development of computer ethics.

The changing role of history in restoration ecology

USGS Publications Warehouse

Eric Higgs,; Falk, Donald A.; Guerrini, Anita; Hall, Marcus; Harris, Jim; Hobbs, Richard J.; Jackson, Stephen T.; Rhemtulla, Jeanine M.; Throop, William

2014-01-01

In the face of rapid environmental and cultural change, orthodox concepts in restoration ecology such as historical fidelity are being challenged. Here we re-examine the diverse roles played by historical knowledge in restoration, and argue that these roles remain vitally important. As such, historical knowledge will be critical in shaping restoration ecology in the future. Perhaps the most crucial role in shifting from the present version of restoration ecology (“v1.0”) to a newer formulation (“v2.0”) is the value of historical knowledge in guiding scientific interpretation, recognizing key ecological legacies, and influencing the choices available to practitioners of ecosystem intervention under conditions of open-ended and rapid change.

Present Company Excepted or Accepted?: Recognizing Each Other's Faces in Educational Leadership's Scholarship and Practice

ERIC Educational Resources Information Center

Place, A. William; Lindle, Jane Clark

2006-01-01

Purpose: The persisting tension over the relative importance of theory and practice creates a crevasse between scholars and practitioners. The purpose here is to problematize divisions between cultural norms found among scholars and practitioners. Design/methodology/approach: Both authors, higher education scholars, experienced temporary…

Authenticity and TV Shows: A Multidimensional Analysis Perspective

ERIC Educational Resources Information Center

Al-Surmi, Mansoor

2012-01-01

Television shows, especially soap operas and sitcoms, are usually considered by English as a second language practitioners as a source of authentic spoken conversational materials presumably because they reflect the linguistic features of natural conversation. However, practitioners are faced with the dilemma of how to assess whether such…

Authentic ESL Spoken Materials: Soap Opera and Sitcom versus Natural Conversation

ERIC Educational Resources Information Center

Al-Surmi, Mansoor Ali

2012-01-01

TV shows, especially soap operas and sitcoms, are usually considered by ESL practitioners as a source of authentic spoken conversational materials presumably because they reflect the linguistic features of natural conversation. However, practitioners might be faced with the dilemma of how to evaluate whether such conversational materials reflect…

Student Complaints and Appeals: The Practitioner's View

ERIC Educational Resources Information Center

Buckton, Liz

2008-01-01

This article explores the issues facing practitioners working in the field of student complaints and appeals (including academic appeals). It is a reflective study which examines some general and historical issues, using anonymised case studies where appropriate and highlighting the diversity of practice across the sector. The author observes that…

Advising patients on the use of complementary and alternative medicine.

PubMed

Jonas, W B

2001-09-01

Complementary and alternative medicine (CAM) is an area of great public interest and activity, both nationally and worldwide. Many alternative medical practices have existed for hundreds, even thousands of years. Patients and professionals are turning to CAM for a variety of reasons. Most have tried conventional medicine for a particular (usually chronic) medical condition and have found the results inadequate. Some are concerned over the side effects of conventional therapies. Some are seeking out a more "holistic" orientation in health care where they can address body, mind, and spirit. A continuing challenge will be how to address CAM services that are based on time, practitioner-patient interactions, and self-care, using modern standards of evidence, education, licensing, and reimbursement. For most CAM therapies, there is insufficient research to say definitively that it works and CAM research is especially limited in the area of cancer. Given that situation, the questions (but not answers) facing the medical practitioner are clear-cut. Should the practitioner await the definitive results of formal Phase III randomized clinical trials, or should the practitioner rely on limited data, seeking out evidence that makes physiological sense and small trials that seem to offer some benefit to the patient? When and at what point do you discourage, permit, or recommend an available alternative therapy? The answers are not simple. There may be differences of opinion and values among the patient, the practitioner, and the organizations that pay for a therapy. CAM areas should be approached with every patient who enters the office recognizing that there are precautions to consider when patients are using, or plan to use, such therapies. This paper presents a broad survey of what complementary and alternative medicine is from the perspectives of both the public as user and the conventional medical practitioner, as well as provides examples of issues pertinent to understanding and evaluating research in CAM. The past is back and the future will involve integration of modern and ancient ways.

Barriers among Danish women and general practitioners to raising the issue of intimate partner violence in general practice: a qualitative study

PubMed Central

2014-01-01

Background Thirty-five percent of Danish women experience sexual or physical violence in their lifetime. However, health care professionals are not in the practice of asking about intimate partner violence (IPV) in Denmark. It is currently unknown what hinders general practitioners from asking about partner violence and how Danish women would perceive such an inquiry. This aspect has not previously been explored in Denmark. An exploratory study was conducted to examine what hinders general practitioners (GPs) from asking and what Danish women’s views and attitudes are regarding being asked about IPV. Methods Data were collected through individual and group interviews with a sample of three GPs and a diverse sample of 13 women, including both survivors of partner violence and those without any history of partner violence. An interpretative analysis was performed with the data. Results This study provides important knowledge regarding the barriers and attitudes towards inquiry about IPV in primary care in Denmark. Results indicate that Denmark is facing the same challenges when responding to survivors of IPV as other similar countries, including Sweden, Norway, the UK, USA, and Australia. Danish women want general practitioners to ask about violence in a respectful and non-judgemental manner. However, general practitioners are resistant towards such an inquiry and would benefit from training regarding how to respond to women who have been exposed to IPV. Conclusions It is acceptable to inquire about IPV with women in Denmark in a non-judgemental and respectful way. Informing about IPV prevalence is important prior to the inquiry. However, general practitioners require more awareness and training before a favourable environment for this change in procedure can be created. Further large-scale research is needed to support the evidence generated by this small study. PMID:24893567

A survey on medicinal materials used in traditional systems of medicine in Sri Lanka.

PubMed

Kankanamalage, T N M; Dharmadasa, R M; Abeysinghe, D C; Wijesekara, R G S

2014-08-08

Sri Lanka has rich traditional systems of medicine, which cater to 60-70% of the rural population׳s primary health care needs. However, development of existing systems has been hindered by the unavailability of up-to-date information on medicinal materials and other related issues. For streamlining purposes, we investigated the present-day scenario of country׳s medicinal plant industry by gathering up-to-date information on the types of raw materials required, their aggregate quantities, heavily used and rare materials, family wise distribution, challenges faced by stakeholders as well as other pertinent issues. The present survey covered the selected government Ayurveda hospitals, traditional and Ayurveda practitioners, large and small-scale herbal drug and cosmetic manufactures, importers, collectors and Ayurveda commissioners throughout the country. A systematic questionnaire was distributed and face-to-face interviews were conducted. Collected data were tabulated and analyzed. A diverse range of medicinal materials, including 290 species (64.73%) from dried plants, 59 (13.17%) from fresh plants, 69 (15.40%) from minerals, 18 (4.02%) from animal sources and 12 (2.68%) from other sources were recorded. A total of 302 plant species belonging to 95 families, dominated by Leguminosae family, was listed. Out of these, 46 species belonging to 35 families were used intensively. A large portion of herbal materials was of completely local origin (71.13%) while 26% were imported and the rest (2.87%) can be obtained by both routes. Leaves were the most highly used part of the plant (22.2%). High price, poor quality, insufficient or totally absence of continuous supply and adulteration were the main constraints faced by the stakeholders. The unavailability of systematic cultivation and processing protocols, incorrect identification, and lack of proper quality control methodologies were identified as major challenges of the industry. The present study revealed a currently bleak scenario of the medicinal material industry in Sri Lanka. The results clearly demonstrated the need to implement a national strategy to address the major challenges faced by different stakeholders. Information generated through this study could be effectively incorporated for the formulation of a sustainable development strategy for this industry. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Implementing a public-private mix model for tuberculosis treatment in urban Pakistan: lessons and experiences.

PubMed

Naqvi, S A; Naseer, M; Kazi, A; Pethani, A; Naeem, I; Zainab, S; Fatmi, Z

2012-06-01

Six towns of Karachi, Pakistan. 1) To strengthen the capacity of general practitioners (GPs) in providing tuberculosis (TB) treatment through DOTS; and 2) to enhance collaboration between the public and private sectors in TB management and case reporting. A quasi-experimental study design was adopted to ensure enrolment of TB patients through trained GPs with the support of laboratory networks and to improve the case detection rate. The following challenges were faced during implementation of the model in urban settings: no systematic list of GPs was available; the majority of the GPs were untrained health practitioners working in squatter settlements, where formally trained GPs are most needed; the motivation of GPs with high patient loads is very low; and access to a laboratory is difficult. Of 35 patients enrolled in the first quarter (third quarter 2009), 87% completed their treatment successfully. Public-private mix (PPM) DOTS is feasible in the cities of Pakistan. However, the cost, time and effort required to establish the programme is higher than in many other developing countries.

A Review on overboard CEOR discharged produced water treatment and remediation

NASA Astrophysics Data System (ADS)

Rawindran, H.; Krishnan, S.; Sinnathambi, C. M.

2017-06-01

Produced water is a waste by-product generated during oil and gas recovery operations. It contains the mixture of organic and inorganic compounds. Produced water management is a challenge faced by the petroleum practitioners worldwide. Build-up of chemical wastes from produced water causes huge footprint, which results in high CapEx and OpEx. Different technologies are practiced by various practitioners to treat the produced waste water. However, the constituents removed by each technology and the degree of organic compound removal has to be considered to identify the potential and effective treatment technologies for offshore industrial applications. Current produced water technologies and their successful applications have advantages and disadvantages and can be ranked on the basis of several factors, such as their discharge limit into water bodies, reinjection in producing well, or for any miscellaneous beneficial use. This paper attempts to provide a review of existing physical and chemical treatment technologies used for management of produced water. Based on our analysis, suitable methods will be recommended for offshore waste water treatment technologies.

The management of advanced practitioner preparation: a work-based challenge.

PubMed

Livesley, Joan; Waters, Karen; Tarbuck, Paul

2009-07-01

This paper explores the collaborative development of a Master's level advanced practice programme in the context of the radical reform and remodelling of the UK's National Health Service. Some of the educational, managerial and practice challenges are discussed. Changes to education and training in response to key strategic reviews undertaken by the Greater Manchester Strategic Health Authority (North West of England) established a need to develop nurses and allied health care practitioners to advanced practitioner level. This paper considers how employers, commissioners and educationalists worked together to produce a Master's level programme to prepare nurses and other health care practitioners for sustainable advanced practice roles. Developing innovative and effective curricula to meet the needs of post graduate students from varied backgrounds preparing to practice in different contexts with different client groups is challenging. However, the development of individual learning pathways and work-based learning ensures that the student's work and intended advanced practice role remains at the centre of their learning. Analysis of each student's knowledge and skill deficits alongside an analysis of the organization's readiness to support them as qualified advanced practitioners (APs) is instrumental in ensuring that organizations are ready to support practitioners in new roles. Work-based learning and collaboration between students, employers and higher education institutions can be used to enable managers and students to unravel the network of factors which affect advanced practice in health and social care. Additionally, collaborative working can help to create opportunities to develop strategies that will facilitate change. Implications for nursing management Sustainable change concerned with the introduction of advanced practitioner roles present a real challenge for managers at a strategic and operational level. Commissioning flexible, collaborative and service-led educational programmes can assist in ensuring that change is sustainable and produce practitioners who are fit for practice, purpose and award.

Broadening Our Understanding and Assessment of Personal and Social Responsibility: A Challenge to Researchers and Practitioners

ERIC Educational Resources Information Center

Trosset, Carol

2013-01-01

Higher education literature has focused narrowly on social responsibility to the exclusion of personal responsibility. This chapter challenges higher education researchers and practitioners to include behaviors related to personal responsibility in their research and educational agendas.

"It's a small price to pay for life": faecal occult blood test (FOBT) screening for colorectal cancer, perceived barriers and facilitators.

PubMed

Reeder, Anthony I

2011-03-25

To clarify perceptions influencing FOBT screening participation among the NZ European target population. Participants (30 female, 20 male; 50-71 years) recruited through urban (Auckland, Wellington, Christchurch) GP surgeries for in-depth, face-to-face interviews (digitally recorded and professionally transcribed verbatim). A pragmatic approach focused on aggregating transcript content. Participants believed early CRC lacked distinguishing signs and symptoms, but was treatable and suitable for screening, although slow development may undermine any sense of urgency. FOBT inaccuracies caused concern, particularly false negatives, but ongoing testing could reduce anxiety. Specimen collection was awkward, challenged social norms and individual squeamishness, but provided peace of mind, was painless, simple and private without high cost technological or professional involvement. Lacking preventive attitudes and experience of health responsibilities and screening, men were less likely to participate than women. CRC lacked public profile, highlighting government responsibility, before programme implementation, to resource high-profile education, largely through TV. General practitioner support and promotion was seen as critical. Inadequate health system capacity and resourcing was problematic. Despite challenging barriers, participants identified opportunities to increase FOBT screening participation, especially promotion to raise CRC profile, overcome perceived normative barriers and build self-efficacy. Adequate resourcing is essential to support appropriate promotion and timely programme delivery.

Ensuring continuing fitness to practice in the pharmacy workforce: Understanding the challenges of revalidation.

PubMed

Schafheutle, Ellen Ingrid; Hassell, Karen; Noyce, Peter R

2013-01-01

Revalidation is about assuring that health practitioners remain up to date and fit to practice, and demonstrating that they continue to meet the requirements of their professional regulator. To critically discuss issues that need to be considered when designing a system of revalidation for pharmacy professionals. Although providing international context, the article focuses in particular on Great Britain (GB), where both pharmacists (Phs) and pharmacy technicians (PTs) are regulated. Following a brief historical overview, the article draws on emerging evidence in context. Revalidation may involve discrete periodic assessment or a continuous process of assessment against clearly identified standards. The evolving scope of pharmacy practice involves increasingly clinical roles and also practitioners in nonpatient-facing roles. The potential risk to patients and the public may require consideration. Although revalidation, or systems for recertification/relicensure, exist in numerous jurisdictions, most center on the collection of continuing education credits; continuous professional development and reflective practice are increasingly found. Revalidation may involve assessment of other sources, such as appraisals or monitoring visits. Existing revalidation systems are coordinated centrally, but particularly in larger jurisdictions, like GB, where approximately 67,000 pharmacy professionals are regulated, some responsibility may need to be devolved. This would require engagement with employers and contracting organizations to ensure suitability and consistency. Existing systems, such as company appraisals, are unfit for the assessment of fitness to practice owing to a focus on organizational/business targets. Certain groups of pharmacy professionals may pose particular challenges, such as self-employed locums, pharmacy owners, those working in different sectors, or returning after a break. To ensure proportionality, it must be considered whether the same standards and/or sources of evidence should apply to all pharmacy professionals, either dependent on whether they are patient facing, their scope of practice, or whether Phs and PTs should be treated differently. Copyright © 2013 Elsevier Inc. All rights reserved.

I don't think general practice should be the front line: Experiences of general practitioners working with refugees in South Australia

PubMed Central

Johnson, David R; Ziersch, Anna M; Burgess, Teresa

2008-01-01

Introduction Many refugees arrive in Australia with complex health needs. In South Australia (SA), providing initial health care to refugees is the responsibility of General Practitioners (GPs) in private practice. Their capacity to perform this work effectively for current newly arrived refugees is uncertain. The aim of this study was to document the challenges faced by GPs in private practice in SA when providing initial care to refugees and to discuss the implications of this for policy relating to optimising health care services for refugees. Methods Semi-structured interviews with twelve GPs in private practice and three Medical Directors of Divisions of General Practice. Using a template analysis approach the interviews were coded and analysed thematically. Results Multiple challenges providing care to refugees were found including those related to: (1) refugee health issues; (2) the GP-refugee interaction; and (3) the structure of general practice. The Divisions also reported challenges assisting GPs to provide effective care related to a lack of funding and awareness of which GPs required support. Although respondents suggested a number of ways that GPs could be assisted to provide better initial care to refugees, strong support was voiced for the initial care of refugees to be provided via a specialist refugee health service. Conclusion GPs in this study were under-resourced, at both an individual GP level as well as a structural level, to provide effective initial care for refugees. In SA, there are likely to be a number of challenges attempting to increase the capacity of GPs in private practice to provide initial care. An alternative model is for refugees with multiple and complex health care needs as well as those with significant resettlement challenges to receive initial health care via the existing specialist refugee health service in Adelaide. PMID:18687150

Human Resource Development Scholar-Practitioners: Connecting the Broken Divide of Research and Practice

ERIC Educational Resources Information Center

Banks, Claretha H.; Wang, Jia; Zheng, Wei; McLean, Laird

2007-01-01

The challenge of combining research and practice in HRD [Human Resource Development] led to continuing debate concerning who are scholar-practitioners and how they combine research and practice in the workplace. A study of seven scholar-practitioners provides some answers for HRD scholar-practitioners on connecting research and practice. The…

Impact of Training on General Practitioner's Knowledge, Attitude and Practices Regarding Emergency Contraception in Hyderabad.

PubMed

Bibi, Seema; Mustafa Abbasi, Razia; Awan, Shazia; Ara Qazi, Roshan; Ashfaque, Sanober

2013-09-01

To elaborate the impact of family planning training on general practitioners' knowledge, attitude and practices regarding emergency contraception. A cross sectional survey involving 270 general practitioners was conducted in Hyderabad from 1(st) Oct to 31(st) Dec 2010. Participants were divided into two groups on the basis of attending family planning training course after graduation and were interviewed face to face. Data was noted on questionnaire asking their knowledge, attitude and practices regarding emergency contraception. Data was analyzed on SPSS version 11. Student t-test was applied to compare the proportions among two groups. Out of 270 general practitioners, male & female participants were 132 (48.9%) and 138 (51.1%) respectively. Mean experience as private general practitioner was 7.48 + 7.6 years. One third of the participants 84 (31.1%) have attended five days training course on family planning in the past, while 186 (69.9%) did not have any training. Source of training was government institutes 46(17%) and non government organization in 38 (14.1%) cases. Significant positive difference was noted on emergency contraception knowledge, attitude and use in group who attended family planning training. Educational intervention has a positive impact on health care provider's knowledge, attitude and practices of emergency contraception.

The Future of Health Care in the Kurdistan Region - Iraq: Toward an Effective, High-Quality System with an Emphasis on Primary Care.

PubMed

Moore, Melinda; Anthony, C Ross; Lim, Yee-Wei; Jones, Spencer S; Overton, Adrian; Yoong, Joanne K

2014-01-01

At the request of the Kurdistan Regional Government (KRG), RAND researchers undertook a yearlong analysis of the health care system in the Kurdistan Region of Iraq, with a focus on primary care. RAND staff reviewed available literature on the Kurdistan Region and information relevant to primary care; interviewed a wide range of policy leaders, health practitioners, patients, and government officials to gather information and understand their priorities; collected and studied all available data related to health resources, services, and conditions; and projected future supply and demand for health services in the Kurdistan Region; and laid out the health financing challenges and questions. In this volume, the authors describe the strengths of the health care system in the Kurdistan Region as well as the challenges it faces. The authors suggest that a primary care-oriented health care system could help the KRG address many of these challenges. The authors discuss how such a system might be implemented and financed, and they make recommendations for better utilizing resources to improve the quality, access, effectiveness, and efficiency of primary care.

The growth of gerontology and geriatrics in Mexico: Past, present, and future

PubMed Central

Rivera-Hernandez, Maricruz; Cerqueda, Sergio Flores; Ramírez, José Carlos García

2017-01-01

Life expectancy is increasing in Mexico, creating new opportunities and challenges in different areas, including gerontology and geriatric education and research. Although in the European Union there are more than 3,000 institutions that focus on aging research, in Latin America there are only 250 programs where theoretical and practical knowledge is taught. In Mexico, the number of institutions that offer gerontology and geriatric education is relatively small. One of the major concerns is that Mexico is not adequately prepared to optimally deal with the aging of its population. Thus, the main challenge that Mexico faces is to train practitioners, researchers, and policy makers to be able to respond to the aging priorities of this country. The goal of this review is to investigate the literature regarding 60 years in the fields of gerontology and geriatrics in Mexico. Even when programs have evolved within the past decades, there are some challenges to gerontological and geriatric education and aging research in Mexico. The implications for Mexico are discussed, as well as opportunities for moving these fields forward. PMID:27754821

Automotive HMI design and participatory user involvement: review and perspectives.

PubMed

François, Mathilde; Osiurak, François; Fort, Alexandra; Crave, Philippe; Navarro, Jordan

2017-04-01

Automotive human-machine interface (HMI) design is facing new challenges due to the technological advances of the last decades. The design process has to be adapted in order to address human factors and road safety challenges. It is now widely accepted that user involvement in the HMI design process is valuable. However, the current form of user involvement in industry remains at the stages of concept assessment and usability tests. Moreover, the literature in other fields (e.g. information systems) promotes a broader user involvement with participatory design (i.e. the user is fully involved in the development process). This article reviews the established benefits of participatory design and reveals perspectives for automotive HMI quality improvement in a cognitive ergonomic framework. Practitioner Summary: Automotive HMI quality determines, in part, drivers' ability to perform primary driving tasks while using in-vehicle devices. User involvement in the design process is a key point to contribute to HMI quality. This article reports the potential benefits of a broad involvement from drivers to meet automotive HMI design challenges.

The growth of gerontology and geriatrics in Mexico: Past, present, and future.

PubMed

Rivera-Hernandez, Maricruz; Flores Cerqueda, Sergio; García Ramírez, José Carlos

2017-01-01

Life expectancy is increasing in Mexico, creating new opportunities and challenges in different areas, including gerontology and geriatric education and research. Although in the European Union there are more than 3,000 institutions that focus on aging research, in Latin America there are only 250 programs where theoretical and practical knowledge is taught. In Mexico, the number of institutions that offer gerontology and geriatric education is relatively small. One of the major concerns is that Mexico is not adequately prepared to optimally deal with the aging of its population. Thus, the main challenge that Mexico faces is to train practitioners, researchers, and policy makers to be able to respond to the aging priorities of this country. The goal of this review is to investigate the literature regarding 60 years in the fields of gerontology and geriatrics in Mexico. Even when programs have evolved within the past decades, there are some challenges to gerontological and geriatric education and aging research in Mexico. The implications for Mexico are discussed, as well as opportunities for moving these fields forward.

Robot deployment in long-term care : Case study on using a mobile robot to support physiotherapy.

PubMed

Gerling, K; Hebesberger, D; Dondrup, C; Körtner, T; Hanheide, M

2016-06-01

Healthcare systems in industrialized countries face the challenge of providing care for a growing number of elderly people. Information technology has the possibility of facilitating this process by providing support for nursing staff and improving the well-being of the elderly through a variety of support systems. Little is known about the challenges that arise from the deployment of technology in care settings; however, the integration of technology into care is one of the core determinants of successful support. This article presents the challenges and options associated with the integration of technology into care using the example of a mobile robot to support physiotherapy for elderly people with cognitive impairment in the European project Spatio-Temporal Representations and Activities for Cognitive Control in Long-Term Scenarios (STRANDS). This article presents the technical challenges associated with the introduction of robots in the context of care as well as the perspectives of physiotherapists involved and an overview of information and experiences gained. It is hoped that this will provide useful information for the work of researchers and practitioners wishing to integrate robotic aids into the caregiving process.

Overcoming Challenges in School-Wide Survey Administration.

PubMed

Rasberry, Catherine N; Rose, India; Kroupa, Elizabeth; Hebert, Andrew; Geller, Amanda; Morris, Elana; Lesesne, Catherine A

2018-01-01

School-based surveys provide a useful method for gathering data from youth. Existing literature offers many examples of data collection through school-based surveys, and a small subset of literature describes methodological approaches or general recommendations for health promotion professionals seeking to conduct school-based data collection. Much less is available on real-life logistical challenges (e.g., minimizing disruption in the school day) and corresponding solutions. In this article, we fill that literature gap by offering practical considerations for the administration of school-based surveys. The protocol and practical considerations outlined in the article are based on a survey conducted with 11,681 students from seven large, urban public high schools in the southeast United States. We outline our protocol for implementing a school-based survey that was conducted with all students school-wide, and we describe six types of key challenges faced in conducting the survey: consent procedures, scheduling, locating students within the schools, teacher failure to administer the survey, improper administration of the survey, and minimizing disruption. For each challenge, we offer our key lessons learned and associated recommendations for successfully implementing school-based surveys, and we provide relevant tools for practitioners planning to conduct their own surveys in schools.

A practical approach to evidence-based dentistry: VI: How to use a systematic review.

PubMed

Carrasco-Labra, Alonso; Brignardello-Petersen, Romina; Glick, Michael; Guyatt, Gordon H; Azarpazhooh, Amir

2015-04-01

Dental practitioners face new clinical challenges on a daily basis. New treatment options and diagnostic tools are disseminated quickly, and the volume of articles and new evidence is overwhelming. Systematic reviews summarize and synthesize the available evidence related to diagnosis, therapy, prognosis, and harm for clinicians, patients, and decision makers. Such reviews represent one of the most powerful tools to translate knowledge into action. The critical appraisal of this type of study involves assessing the risk of bias, results, and applicability of such study. The authors provide guidance for clinicians to critically appraise systematic reviews and apply the findings in clinical practice. Copyright © 2015 American Dental Association. Published by Elsevier Inc. All rights reserved.

Climate Change, Health, and Communication: A Primer.

PubMed

Chadwick, Amy E

2016-01-01

Climate change is one of the most serious and pervasive challenges facing us today. Our changing climate has implications not only for the ecosystems upon which we depend, but also for human health. Health communication scholars are well-positioned to aid in the mitigation of and response to climate change and its health effects. To help theorists, researchers, and practitioners engage in these efforts, this primer explains relevant issues and vocabulary associated with climate change and its impacts on health. First, this primer provides an overview of climate change, its causes and consequences, and its impacts on health. Then, the primer describes ways to decrease impacts and identifies roles for health communication scholars in efforts to address climate change and its health effects.

New Sociotechnical Insights in Interaction Design

NASA Astrophysics Data System (ADS)

Abdelnour-Nocera, José; Mørch, Anders I.

New challenges are facing interaction design. On one hand because of advances in technology - pervasive, ubiquitous, multimodal and adaptive computing - are changing the nature of interaction. On the other, web 2.0, massive multiplayer games and collaboration software extends the boundaries of HCI to deal with interaction in settings of remote communication and collaboration. The aim of this workshop is to provide a forum for HCI practitioners and researchers interested in knowledge from the social sciences to discuss how sociotechnical insights can be used to inform interaction design, and more generally how social science methods and theories can help to enrich the conceptual framework of systems development and participatory design. Position papers submissions are invited to address key aspects of current research and practical case studies.

Cure violence: a public health model to reduce gun violence.

PubMed

Butts, Jeffrey A; Roman, Caterina Gouvis; Bostwick, Lindsay; Porter, Jeremy R

2015-03-18

Scholars and practitioners alike in recent years have suggested that real and lasting progress in the fight against gun violence requires changing the social norms and attitudes that perpetuate violence and the use of guns. The Cure Violence model is a public health approach to gun violence reduction that seeks to change individual and community attitudes and norms about gun violence. It considers gun violence to be analogous to a communicable disease that passes from person to person when left untreated. Cure Violence operates independently of, while hopefully not undermining, law enforcement. In this article, we describe the theoretical basis for the program, review existing program evaluations, identify several challenges facing evaluators, and offer directions for future research.

Therapeutic decisions in the presence of decayed permanent first molars in young subjects: a descriptive inquiry.

PubMed

Sayagh, Millewa; Maniere-Ezvan, Armelle; Vernet, Cindy; Muller-Bolla, Michèle

2012-09-01

The aim of this exhaustive descriptive epidemiological study was to determine the clinical approach to be adopted by practitioners specializing exclusively in pediatric odontology and by orthodontists when confronted with decayed molars in children and adolescents. A questionnaire was sent out to all corresponding practitioners (n=2076). Six questions related to treatment decisions taken when faced with decayed permanent first molars (unfavorable short or middle-term prognosis) in patients needing, or not, orthodontic care. The Chi(2) test was used to compare responses. Thirty-eight per cent of pedodontists (n=38) and 12.5% (n=246) of orthodontists answered the questionnaire. Faced with a permanent first molar with an unfavorable middle-term prognosis, 75.7% needed criteria to help them reach their treatment decision. In decreasing order of importance, these criteria were: presence of the third molar, patient motivation, inter-arch relationship, patient's oral hygiene, facial type, anterior jaw-teeth discrepancy and the number of molars to be extracted. Faced with a permanent first molar requiring extraction and when orthodontic treatment was not required, 31.7% of practitioners decided to close the maxillary space immediately as opposed to 13.4% who closed the space at the mandible. In the presence of a single decayed first molar, 68.7% of practitioners did not extract the antagonist or contralateral first molars. These treatment decisions were not always unanimous and call for a combined approach between dental surgeon and orthodontist. Copyright © 2012. Published by Elsevier Masson SAS.

Challenges facing the veterinary profession in Ireland: 3. emergency and casualty slaughter certification.

PubMed

Magalhães-Sant'Ana, Manuel; More, Simon J; Morton, David B; Hanlon, Alison J

2017-01-01

Veterinarians are faced with significant conflicts of interest when issuing certificates for the transport and slaughter of acutely injured and casualty livestock. In a recent Policy Delphi study, emergency and casualty slaughter certification was a key concern identified by veterinary professionals in Ireland. In this case study (the third in a series of three resulting from a research workshop exploring challenges facing the veterinary profession in Ireland; the other two case studies investigate clinical veterinary services and the on-farm use of veterinary antimicrobials), we aim to provide a value-based reflection on the constraints and opportunities for best practice in emergency and casualty slaughter certification in Ireland. Using a qualitative focus group approach, this study gathered evidence from relevant stakeholders, namely a representative from the regulatory body, local authority veterinarians with research experience in emergency slaughter, an animal welfare research scientist, official veterinarians from the competent authority, a private veterinary practitioner, and a member of a farming organisation. Results revealed a conflict between the responsibility of private veterinary practitioners (PVPs) to safeguard the welfare of acutely injured bovines on-farm and the client's commercial concerns. As a consequence, some PVPs may feel under pressure to certify, for example, an acutely injured animal for casualty slaughter instead of recommending either on-farm emergency slaughter or disposal by the knackery service. Among Official Veterinarians, there are concerns about the pressure within processing plants to accept acutely injured livestock as casualty animals. Confusion pertaining to legislation and definition of fitness to travel also contribute to these dilemmas. Conflicts of interest arise due to the gap between governance and provision to facilitate on-farm emergency slaughter of livestock. Increased availability and acceptance of on-farm emergency slaughter by Food Business Operators (FBOs) would mitigate the need to certify acutely injured animals fit for transport and slaughter and thereby safeguard animal welfare. In the absence of nationwide availability and acceptance of on-farm emergency slaughter by FBOs, consideration should be given to methods to encourage all those involved in the food chain to prioritise animal welfare when in conflict with the commercial value of the animal. Training and guidelines for PVPs on the regulatory landscape and ethical decision-making should become available. The reintroduction of the fallen animal scheme should be considered to support farm animal welfare.

Perceptions and attitudes towards exercise among Chinese elders - the implications of culturally based self-management strategies for effective health-related help seeking and person-centred care.

PubMed

Liu, Zhenmi; Speed, Shaun; Beaver, Kinta

2015-04-01

Encouraging the uptake of physical activity among a culturally diverse elderly population presents a challenge for health-care providers across the world. Little is known about the health-care needs of these populations, for example the increasingly ageing group of Chinese elders in many parts of the world who are now facing later life and increasing challenges to their health. This study aimed to explore behaviours and attitudes towards exercise among older Chinese immigrants in the UK to provide insights into the health of Chinese populations in the UK and elsewhere. A Grounded Theory approach using purposive and theoretical sampling with in-depth semi-structured interviews. Chinese elders were recruited from Chinese communities in the North West of England. Thirty-three participants were interviewed face-to-face and audio-recorded. Participants self-managed exercise based on cultural perceptions of health and ingrained Chinese values. Professional support and information was lacking and relied on folk norms rather than person-centred recommendations for healthy living. Inappropriate exercise regimes could act as a substitute for seeking health-related advice when exercise was often used as a self-monitored barometer to assess their perceived health status. Chinese elders may undertake inappropriate exercise, leading to high-risk situations, if appropriate professional information is not provided. Health-care practitioners should devote attention to understanding Chinese elders' attitudes towards exercise, as this may ultimately lead to successful health promotion activities. A person-centred approach that acknowledges and works with self-management practices is advocated. © 2012 John Wiley & Sons Ltd.

Computer vision and soft computing for automatic skull-face overlay in craniofacial superimposition.

PubMed

Campomanes-Álvarez, B Rosario; Ibáñez, O; Navarro, F; Alemán, I; Botella, M; Damas, S; Cordón, O

2014-12-01

Craniofacial superimposition can provide evidence to support that some human skeletal remains belong or not to a missing person. It involves the process of overlaying a skull with a number of ante mortem images of an individual and the analysis of their morphological correspondence. Within the craniofacial superimposition process, the skull-face overlay stage just focuses on achieving the best possible overlay of the skull and a single ante mortem image of the suspect. Although craniofacial superimposition has been in use for over a century, skull-face overlay is still applied by means of a trial-and-error approach without an automatic method. Practitioners finish the process once they consider that a good enough overlay has been attained. Hence, skull-face overlay is a very challenging, subjective, error prone, and time consuming part of the whole process. Though the numerical assessment of the method quality has not been achieved yet, computer vision and soft computing arise as powerful tools to automate it, dramatically reducing the time taken by the expert and obtaining an unbiased overlay result. In this manuscript, we justify and analyze the use of these techniques to properly model the skull-face overlay problem. We also present the automatic technical procedure we have developed using these computational methods and show the four overlays obtained in two craniofacial superimposition cases. This automatic procedure can be thus considered as a tool to aid forensic anthropologists to develop the skull-face overlay, automating and avoiding subjectivity of the most tedious task within craniofacial superimposition. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Challenges in implementing individual placement and support in the Australian mental health service and policy context.

PubMed

Stirling, Yolande; Higgins, Kate; Petrakis, Melissa

2018-02-01

Objective Although Australia's service and policy context differs from that of the US, studies have highlighted potential for individual placement and support (IPS) to support competitive employment outcomes for people with severe and persistent mental illness. The aim of the present study was to explore why the model is not yet widely available. Methods A document analysis was conducted to discern reasons for challenges in implementation of IPS practice principles within the Australian service context. Results The document analysis illustrated that although policy acknowledges the importance of increasing employment rates for people with severe and persistent mental illness, consistent measures, change indicators, direction and time frames are lacking in policy and strategy documentation. Further, IPS principles are not consistently evident in guiding operational documentation that government-funded Disability Employment Services (DES) programs are mandated to adhere to. Conclusions For IPS to be readily implemented, it is necessary for government to offer support to agencies to partner and formal endorsement of the model as a preferred approach in tendering processes. Obligations and processes must be reviewed to ensure that model fidelity is achievable within the Australian Commonwealth policy and service context for programs to achieve competitive employment rates comparable to the most successful international programs. What is known about the topic? The IPS model has been established as the most efficacious approach to support people with severe and persistent mental ill health to gain and sustain employment internationally, yet little is known as to why this model has had very limited uptake in the Australian adult mental health service and policy context. What does this paper add? This paper provides an investigation into the achievability of IPS within DES philosophical and contractual arrangements. What are the implications for practitioners? Mental health practitioners are typically skilled in their understanding of individual or micro-level challenges faced by consumers in achieving vocational goals: working with symptoms, medication side effects, motivation and anxiety. The present study was designed to offer practitioners an increased understanding of service-level factors, because these present considerable challenges to achieving sustained employment. This paper is a call for greater advocacy towards better integration of employment and mental health service delivery in the Australian policy and practice context.

Sexual health: the role of sexual health services among homeless young women living in Toronto, Canada.

PubMed

Oliver, Vanessa; Cheff, Rebecca

2012-05-01

Recent statistics indicate limited condom use, high STI (sexually transmitted infection) rates, and a general lack of knowledge about reproductive and sexual health among homeless youth. This research focuses on the experiences of homeless female and transgendered youth, providing an insider's perspective on shaping sexual health interventions. This qualitative research is based on life history interviews and participant observation with eight homeless young women who reflect the diversity of the homeless population in Toronto, Ontario, Canada. Their particularized sexual experiences and health-seeking behaviors illustrate the range of issues faced by this community, speaking to the efficacy of current health promotion strategies. Too often faced with judgmental health and social service providers who they perceive to undermine their agency and empowerment, these women highlight the challenges they face when seeking sexual and reproductive health services and information. In addition to speaking to the struggles and frustrations they face in regard to their sexual health and the services with which they choose to interact, the women provide suggestions for improved care. From these, the authors include key recommendations for the provision of culturally competent, sex-positive, and nonjudgmental health services with the hope that health practitioners and promoters can learn from these experiences, both positive and negative, when caring for and supporting young women living in exceptional circumstances.

What do practitioners think? A qualitative study of a shared care mental health and nutrition primary care program

PubMed Central

Paquette-Warren, Jann; Vingilis, Evelyn; Greenslade, Jaimi; Newnam, Sharon

2006-01-01

Abstract Objective To develop an in-depth understanding of a shared care model from primary mental health and nutrition care practitioners with a focus on program goals, strengths, challenges and target population benefits. Design Qualitative method of focus groups. Setting/Participants The study involved fifty-three practitioners from the Hamilton Health Service Organization Mental Health and Nutrition Program located in Hamilton, Ontario, Canada. Method Six focus groups were conducted to obtain the perspective of practitioners belonging to various disciplines or health care teams. A qualitative approach using both an editing and template organization styles was taken followed by a basic content analysis. Main findings Themes revealed accessibility, interdisciplinary care, and complex care as the main goals of the program. Major program strengths included flexibility, communication/collaboration, educational opportunities, access to patient information, continuity of care, and maintenance of practitioner and patient satisfaction. Shared care was described as highly dependent on communication style, skill and expertise, availability, and attitudes toward shared care. Time constraint with respect to collaboration was noted as the main challenge. Conclusion Despite some challenges and variability among practices, the program was perceived as providing better patient care by the most appropriate practitioner in an accessible and comfortable setting. PMID:17041680

Dissemination: Bringing Translational Research to Completion

PubMed Central

Park, Daniel J.; Burke, Janice P.

2013-01-01

Despite the availability of innovative health care research, a gap exists between research-generated knowledge and the utilization of that knowledge in real-world practice settings. This article examines the transition from research to implementation in the context of the dissemination of A. Jean Ayres’ sensory integration procedures and of the challenges currently facing the University of Southern California Well Elderly Studies research team. Drawing from the emerging field of implementation science, this article discusses how researchers can develop an implementation plan to more easily translate evidence into practice. Such plans should address the intervention’s reach (i.e., its capacity to penetrate into the intended target population), the settings for which it is applicable, the leaders who will encourage practitioner uptake, stakeholder groups, and challenges to dissemination. By taking action to ensure the more effective dissemination of research-generated knowledge, researchers can increase the likelihood that their interventions will lead to improvements in practice and more effective care for consumers. PMID:23433273

Theranostic quantum dots for crossing blood–brain barrier in vitro and providing therapy of HIV-associated encephalopathy

PubMed Central

Xu, Gaixia; Mahajan, Supriya; Roy, Indrajit; Yong, Ken-Tye

2013-01-01

The blood–brain barrier (BBB) is a complex physiological checkpoint that restricts the free diffusion of circulating molecules from the blood into the central nervous system. Delivering of drugs and other active agents across the BBB is one of the major technical challenges faced by scientists and medical practitioners. Therefore, development of novel methodologies to address this challenge holds the key for both the diagnosis and treatment of brain diseases, such as HIV-associated encephalopathy. Bioconjugated quantum dots (QDs) are excellent fluorescent probes and nano-vectors, being designed to transverse across the BBB and visualize drug delivery inside the brain. This paper discusses the use of functionalized QDs for crossing the blood–brain barrier and treating brain disease. We highlight the guidelines for using in vitro BBB models for brain disease studies. The theranostic QDs offers a strategy to significantly improve the effective dosages of drugs to transverse across the BBB and orientate to the targets inside the brain. PMID:24298256

Provision of nutrition support therapies in the recent Iraq and Afghanistan conflicts.

PubMed

Stankorb, Susan M; Ramsey, Casside; Clark, Heidi; Osgood, Tamara

2014-10-01

This article describes the experience of nutrition support practitioners, specifically dietitians, providing care to combat casualties. It provides a brief overview of dietitians' induction into armed service but focuses primarily on their role in providing nutrition support during the most recent conflicts in Iraq and Afghanistan. The current system of combat casualty care is discussed with specific emphasis on providing early and adequate nutrition support to U.S. combat casualties from injury, care in theater combat support hospitals (CSHs)/expeditionary medical support (EMEDs), and en route care during critical care air transport (CCAT) up to arrival at treatment facilities in the United States. The article also examines practices and challenges faced in the CSHs/EMEDs providing nutrition support to non-U.S. or coalition patients. Over the past decade in armed conflicts, dietitians, physicians, nurses, and other medical professionals have risen to challenges, have implemented systems, and continue working to optimize treatment across the spectrum of combat casualty care.

Addressing the paradox of the team innovation process: A review and practical considerations.

PubMed

Thayer, Amanda L; Petruzzelli, Alexandra; McClurg, Caitlin E

2018-01-01

Facilitating team innovation is paramount to promoting progress in the science, technology, engineering, and math fields, as well as advancing national health, safety, prosperity, and welfare. However, innovation teams face a unique set of challenges due to the novelty and uncertainty that is core to the definition of innovation, as well as the paradoxical nature of idea generation and idea implementation processes. These and other challenges must be overcome for innovation teams to realize their full potential for producing change. The purpose of this review is, thus, to provide insight into the unique context that these teams function within and provide an integrative, evidence-based, and practically useful, organizing heuristic that focuses on the most important considerations for facilitating team innovation. Finally, we provide practical guidance for psychologists, organizations, practitioners, scientists, educators, policymakers, and others who employ teams to produce novel, innovative solutions to today's problems. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Using Decision Analysis to Improve Malaria Control Policy Making

PubMed Central

Kramer, Randall; Dickinson, Katherine L.; Anderson, Richard M.; Fowler, Vance G.; Miranda, Marie Lynn; Mutero, Clifford M.; Saterson, Kathryn A.; Wiener, Jonathan B.

2013-01-01

Malaria and other vector-borne diseases represent a significant and growing burden in many tropical countries. Successfully addressing these threats will require policies that expand access to and use of existing control methods, such as insecticide-treated bed nets and artemesinin combination therapies for malaria, while weighing the costs and benefits of alternative approaches over time. This paper argues that decision analysis provides a valuable framework for formulating such policies and combating the emergence and re-emergence of malaria and other diseases. We outline five challenges that policy makers and practitioners face in the struggle against malaria, and demonstrate how decision analysis can help to address and overcome these challenges. A prototype decision analysis framework for malaria control in Tanzania is presented, highlighting the key components that a decision support tool should include. Developing and applying such a framework can promote stronger and more effective linkages between research and policy, ultimately helping to reduce the burden of malaria and other vector-borne diseases. PMID:19356821

"I Don't Want to Be an Ostrich": Managing Mothers' Uncertainty during BRCA1/2 Genetic Counseling.

PubMed

Fisher, Carla L; Roccotagliata, Thomas; Rising, Camella J; Kissane, David W; Glogowski, Emily A; Bylund, Carma L

2017-06-01

Families who face genetic disease risk must learn how to grapple with complicated uncertainties about their health and future on a long-term basis. Women who undergo BRCA 1/2 genetic testing describe uncertainty related to personal risk as well as their loved ones', particularly daughters', risk. The genetic counseling setting is a prime opportunity for practitioners to help mothers manage uncertainty in the moment but also once they leave a session. Uncertainty Management Theory (UMT) helps to illuminate the various types of uncertainty women encounter and the important role of communication in uncertainty management. Informed by UMT, we conducted a thematic analysis of 16 genetic counseling sessions between practitioners and mothers at risk for, or carriers of, a BRCA1/2 mutation. Five themes emerged that represent communication strategies used to manage uncertainty: 1) addresses myths, misunderstandings, or misconceptions; 2) introduces uncertainty related to science; 3) encourages information seeking or sharing about family medical history; 4) reaffirms or validates previous behavior or decisions; and 5) minimizes the probability of personal risk or family members' risk. Findings illustrate the critical role of genetic counseling for families in managing emotionally challenging risk-related uncertainty. The analysis may prove beneficial to not only genetic counseling practice but generations of families at high risk for cancer who must learn strategic approaches to managing a complex web of uncertainty that can challenge them for a lifetime.

Examining the Changing Landscape of School Psychology Practice: A Survey of School-Based Practitioners regarding Response to Intervention

ERIC Educational Resources Information Center

Sullivan, Amanda L.; Long, Lori

2010-01-01

As Response to Intervention (RtI) approaches become more common in educational systems throughout the country, it is increasingly important to identify how practitioners perceive these changes and how they obtain the skills necessary to face emergent roles and responsibilities. In this exploratory study, a national sample of 557 school…

20 years of local ecological public health: the experience of Sandwell in the English West Midlands.

PubMed

Middleton, J; Saunders, P

2015-10-01

A long-term picture of the economy and living conditions of Sandwell, an area of England's industrial Midlands, is presented to explore how these underpin and influence its 'health economy'. Sandwell's experience illustrates how public health actors have to tackle industrial and other factors which shape human health. The paper explores how the ecological public health perspective has helped inform the modern public health task in an area such as Sandwell. Some lessons are offered, including: the need to understand the specific economic legacy of a local area (in Sandwell, principally one of polluting and then declining manufacturing industries); the continuing story of infection control; the complexity of tackling poor diet; and the importance of the built environment and town planning. Faced by such challenges, local public health action represents, in effect, an attempt to transcend unecological public health. This can be exciting, innovative and ultimately successful; but it also means being prepared to face daunting and politically charged obstacles and superior national or international forces over which local public health practitioners conventionally have little leverage. The paper argues that, in such unequal power circumstances, public health practitioners have to draw on the creativity within the local population and build a facilitative alliance of formal and informal pro-public health actors. Despite the confounding odds and ever-present stretched resources, the Sandwell experience gives grounds for optimism, being a story of constant creativity and effective local alliances. Copyright © 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Critical Thinking Disposition of Nurse Practitioners in Taiwan.

PubMed

Hsu, Hsiu-Ying; Chang, Shu-Chen; Chang, Ai-Ling; Chen, Shiah-Lian

2017-09-01

Critical thinking disposition (CTD) is crucial for nurse practitioners who face complex patient care scenarios. This study explored the CTD of nurse practitioners and related factors. The study was a cross-sectional descriptive design. A purposive sample was recruited from a medical center and its hospital branches in central Taiwan. A structured questionnaire was used to collect data from 210 nurse practitioners. The participants obtained the highest average score on systematicity and analyticity. CTD had a significant positive correlation with fundamental knowledge readiness, professional knowledge readiness, and confidence in making clinical decisions. Professional knowledge readiness, education level, and on-the-job training predicted the score of the participants on overall CTD. On-the-job training and education level may influence the CTD of nurse practitioners. Providing formal or on-the-job continuing education training to nurse practitioners may help enhance their CTD. J Contin Educ Nurs. 2017;48(9):425-430. Copyright 2017, SLACK Incorporated.

Perspectives on reflexology: A qualitative approach.

PubMed

Embong, Nurul Haswani; Soh, Yee Chang; Ming, Long Chiau; Wong, Tin Wui

2017-07-01

Reflexology is the systematic practice of applying some pressure to particular points on the feet and hands to impact on health of related parts of the body. To explore the practitioners' perspectives of reflexology in Malaysia. Data was collected using face-to-face semi-structured interviews with practitioners in Malaysia. The interviews were conducted in the Malay language and recorded. Interview conversations were translated and transcribed verbatim. Responses relating to different themes were identified in each of the interviews and a coding frame was developed. For each theme, the relevant data enabled a description of the range of views and experiences. Data collection and analysis were conducted concurrently and recruitment was stopped when saturation had been reached. All respondents gave written consent for their participation. The findings show that reflexology treatment nowadays has been accepted as one of the ways to maintain general health. Practitioners believe that reflexology is able to detect some problems in to the body, which can make patients aware of a health condition and seek further treatment. However, if reflexology is not performed correctly, it may cause negative effects such as pain and bruises. Some practitioners voiced concern that illegal activities are taking place in unethical reflexology centers. Empowering the practitioner as a professional would help gain the public's trust and confidence in their treatment. Strict enforcement of regulation related to illegal conduct in reflexology centers will improve people's perception of the practice.

A focus group study of the use of video-recorded simulated objective structured clinical examinations in nurse practitioner education.

PubMed

Barratt, Julian

2010-05-01

The objective structured clinical examination (OSCE) is a common method of clinical skills assessment used for advanced nurse practitioner students across the United Kingdom. The purpose of an advanced nursing OSCE is to assess a nurse practitioner student's competence and safety in the performance of commonly used advanced clinical practice skills. Students often feel nervous when preparing for and participating in an OSCE. Consideration of these identified anxieties led to the development of an alternative method of meeting students' OSCE learning and preparation needs; namely video-recorded simulated OSCEs. Video-recording was appealing for the following reasons: it provides a flexible usage of staff resources and time; OSCE performance mistakes can be rectified; it is possible to use the same video-recordings with multiple cohorts of students, and the recordings can be made conveniently available for students with video streaming on internet-based video-sharing sites or virtual learning environments. The aim of the study was to explore the value of using such recordings amongst nurse practitioner students, via online and face-to-face focus groups, to see if they are a suitable OSCE educational preparation technique. The study findings indicate that simulated OSCE video-recordings are an effective method for supporting nurse practitioner educational development. Copyright 2009 Elsevier Ltd. All rights reserved.

Recommendations on vaccination for Asian small animal practitioners: a report of the WSAVA Vaccination Guidelines Group.

PubMed

Day, M J; Karkare, U; Schultz, R D; Squires, R; Tsujimoto, H

2015-02-01

In 2012 and 2013, the World Small Animal Veterinary Association (WSAVA) Vaccination Guidelines Group (VGG) undertook fact-finding visits to several Asian countries, with a view to developing advice for small companion animal practitioners in Asia related to the administration of vaccines to dogs and cats. The VGG met with numerous first opinion practitioners, small animal association leaders, academic veterinarians, government regulators and industry representatives and gathered further information from a survey of almost 700 veterinarians in India, China, Japan and Thailand. Although there were substantial differences in the nature and magnitude of the challenges faced by veterinarians in each country, and also differences in the resources available to meet those challenges, overall, the VGG identified insufficient undergraduate and postgraduate training in small companion animal microbiology, immunology and vaccinology. In most of the countries, there has been little academic research into small animal infectious diseases. This, coupled with insufficient laboratory diagnostic support, has limited the growth of knowledge concerning the prevalence and circulating strains of key infectious agents in most of the countries visited. Asian practitioners continue to recognise clinical infections that are now considered uncommon or rare in western countries. In particular, canine rabies virus infection poses a continuing threat to animal and human health in this region. Both nationally manufactured and international dog and cat vaccines are variably available in the Asian countries, but the product ranges are small and dominated by multi-component vaccines with a licensed duration of immunity (DOI) of only 1 year, or no description of DOI. Asian practitioners are largely unaware of current global trends in small animal vaccinology or of the WSAVA vaccination guidelines. Consequently, most practitioners continue to deliver annual revaccination with both core and non-core vaccines to adult animals, with little understanding that "herd immunity" is more important than frequent revaccination of individual animals within the population. In this paper, the VGG presents the findings of this project and makes key recommendations for the Asian countries. The VGG recommends that (1) Asian veterinary schools review and increase as needed the amount of instruction in small animal vaccinology within their undergraduate curriculum and increase the availability of pertinent postgraduate education for practitioners; (2) national small animal veterinary associations, industry veterinarians and academic experts work together to improve the scientific evidence base concerning small animal infectious diseases and vaccination in their countries; (3) national small animal veterinary associations take leadership in providing advice to practitioners based on improved local knowledge and global vaccination guidelines; (4) licensing authorities use this enhanced evidence base to inform and support the registration of improved vaccine product ranges for use in their countries, ideally with DOI for core vaccines similar or equal to those of equivalent products available in western countries (i.e. 3 or 4 years). The VGG also endorses the efforts made by Asian governments, non-governmental organisations and veterinary practitioners in working towards the goal of global elimination of canine rabies virus infection. In this paper, the VGG offers both a current pragmatic and future aspirational approach to small animal vaccination in Asia. As part of this project, the VGG delivered continuing education to over 800 Asian practitioners at seven events in four countries. Accompanying this document is a list of 80 frequently asked questions (with answers) that arose during these discussions. The VGG believes that this information will be of particular value to Asian veterinarians as they move towards implementing global trends in small companion animal vaccinology. © 2014 WSAVA.

General practice on-the-job training in Chinese urban community: a qualitative study on needs and challenges.

PubMed

Zhao, Yali; Chen, Rui; Wang, Bo; Wu, Tao; Huang, Yafang; Guo, Aimin

2014-01-01

On-the-job training is an important strategy for general practitioners to deliver appropriately community health services in China. The development of basic professional competence for general practitioners is the main goal of on-the-job training program. The aim of this study was to explore the needs of and the challenges to on-the-job training for general practitioners, and to provide advices for policy-makers to carry out this program more effectively. We conducted 3 nominal group techniques, 17 in-depth interviews and 3 focus groups to identify the status of, needs of and challenges to on-the-job training for general practitioners in Liaoning, Ningxia, and Fujian provinces from September 2011 until December 2011. Audiotapes and transcripts were analyzed to identify major themes. Content analysis of the data was completed from January 2012 to March 2012. Basic theoretical knowledge and clinical skills were the main needs for general practitioners during on-the-job training. The challenges during training included the time contradiction between work and training, deficiencies of qualified preceptors, and lack of training funds. Participants gave recommendations how to resolve the above problems. In order to improve the outcomes of general practice on-the-job training, it is necessary for government officials to resolve the contradiction between work and training, train preceptors continuously, and increase financial support in the training program.

The outcome competency framework for practitioners in infection prevention and control: use of the outcome logic model for evaluation.

PubMed

Burnett, E; Curran, E; Loveday, H P; Kiernan, M A; Tannahill, M

2014-01-01

Healthcare is delivered in a dynamic environment with frequent changes in populations, methods, equipment and settings. Infection prevention and control practitioners (IPCPs) must ensure that they are competent in addressing the challenges they face and are equipped to develop infection prevention and control (IPC) services in line with a changing world of healthcare provision. A multifaceted Framework was developed to assist IPCPs to enhance competence at an individual, team and organisational level to enable quality performance and improved quality of care. However, if these aspirations are to be met, it is vital that competency frameworks are fit for purpose or they risk being ignored. The aim of this unique study was to evaluate short and medium term outcomes as set out in the Outcome Logic Model to assist with the evaluation of the impact and success of the Framework. This study found that while the Framework is being used effectively in some areas, it is not being used as much or in the ways that were anticipated. The findings will enable future work on revision, communication and dissemination, and will provide intelligence to those initiating education and training in the utilisation of the competences.

Practice management: observations, issues, and empirical evidence.

PubMed

Wong, H M; Braithwaite, J

2001-02-01

The primary objective of this study is to provide objective, empirical, evidence-based practice management information. This is a hitherto under-researched area of considerable interest for both the practitioner and educator. A questionnaire eliciting a mix of structured and free text responses was administered to a random sample of 480 practitioners who are members of the American Academy of Periodontology. Potential respondents not in private practice were excluded and the next listed person substituted. The results provide demographic and descriptive information about some of the main issues and problems facing practice managers, central to which are information technology (IT), financial, people management, and marketing. Human resource and marketing management appear to represent the biggest challenges. Periodontists running practices would prefer more information, development, and support in dealing with IT, finance, marketing, and people management. The empirical evidence reported here suggests that although tailored educational programs on key management issues at both undergraduate and postgraduate levels have become ubiquitous, nevertheless some respondents seek further training opportunities. Evidence-based practice management information will be invaluable to the clinician considering strategic and marketing planning, and also for those responsible for the design and conduct of predoctoral and postdoctoral programs.

Managing polycystic ovary syndrome: what our patients are telling us.

PubMed

Crete, Joan; Adamshick, Pamela

2011-12-01

Women with polycystic ovary syndrome (PCOS) experience symptoms such as irregular menses, hirsutism, and acne, and are at heightened risk for developing obesity, metabolic syndrome, diabetes mellitus, infertility, and some cancers. Data also indicate an inverse correlation between PCOS and health-related quality-of-life indicators and self-image. The purpose of this study was to describe the lived experience of women with PCOS in the management of their disorder and the meaning of that experience for them. This qualitative study was conducted using a phenomenological approach based on the guidelines of Van Manen. Individual, semistructured interviews were completed with 10 participants who were diagnosed with PCOS and managed by a health care practitioner(s) within the past 5 years. Data were analyzed using the process of hermeneutic phenomenological reflection. The four major themes that described women's lived experience of managing PCOS were frustration, confusion, searching, and gaining control. Women with PCOS face many challenges in managing their disorder and desire to gain control, balance, and well-being through a comprehensive treatment plan. The findings have implications for health care providers in addressing quality of life issues and overall health outcomes.

The outcome competency framework for practitioners in infection prevention and control: use of the outcome logic model for evaluation

PubMed Central

Curran, E; Loveday, HP; Kiernan, MA; Tannahill, M

2013-01-01

Healthcare is delivered in a dynamic environment with frequent changes in populations, methods, equipment and settings. Infection prevention and control practitioners (IPCPs) must ensure that they are competent in addressing the challenges they face and are equipped to develop infection prevention and control (IPC) services in line with a changing world of healthcare provision. A multifaceted Framework was developed to assist IPCPs to enhance competence at an individual, team and organisational level to enable quality performance and improved quality of care. However, if these aspirations are to be met, it is vital that competency frameworks are fit for purpose or they risk being ignored. The aim of this unique study was to evaluate short and medium term outcomes as set out in the Outcome Logic Model to assist with the evaluation of the impact and success of the Framework. This study found that while the Framework is being used effectively in some areas, it is not being used as much or in the ways that were anticipated. The findings will enable future work on revision, communication and dissemination, and will provide intelligence to those initiating education and training in the utilisation of the competences. PMID:28989348

Participation rates in the selection of population controls in a case-control study of colorectal cancer using two recruitment methods.

PubMed

Castaño-Vinyals, Gemma; Nieuwenhuijsen, Mark J; Moreno, Víctor; Carrasco, Estela; Guinó, Elisabet; Kogevinas, Manolis; Villanueva, Cristina M

2011-01-01

Low participation rates in the selection of population controls are an increasing concern for the validity of case-control studies worldwide. We conducted a pilot study to assess two approaches to recruiting population controls in a study of colorectal cancer, including a face-to-face interview and blood sample collection. In the first approach, persons identified through a population roster were invited to participate through a telephone call by an interviewer telephoning on behalf of our research center. In the second approach, individuals were identified from the lists of selected family practitioners and were telephoned on behalf of the family practitioner. When the second method was used, participation rates increased from 42% to 57% and the percentage of refusals decreased from 47% to 13%. The reasons for refusing to participate did not differ significantly between the two methods. Contact through the family practitioner yielded higher response rates in population controls in the study area. 2010 SESPAS. Published by Elsevier Espana. All rights reserved.

Promoting the nurse practitioner by using a marketing approach.

PubMed

Gallagher, S M

1996-03-01

Being good at what you do is not enough. Despite strong evidence that the nurse practitioner delivers cost-efficient and outcome-based care, few consumers really understand the nurse practitioner's scope of practice. With the current rapidly changing status of health care, the nurse practitioner is presented with many opportunities. Strategies that ensure survival and growth are critical to longevity. Marketing strategies can offer solutions to these challenges. The 4 P's of marketing are discussed as an approach to promote the role of the nurse practitioner.

Challenges in covering health disparities in local news media: an exploratory analysis assessing views of journalists.

PubMed

Wallington, Sherrie Flynt; Blake, Kelly D; Taylor-Clark, Kalahn; Viswanath, K

2010-10-01

News coverage of health topics influences knowledge, attitudes, and behaviors at the individual level, and agendas and actions at the institutional and policy levels. Because disparities in health often are the result of social inequalities that require community-level or policy-level solutions, news stories employing a health disparities news frame may contribute to agenda-setting among opinion leaders and policymakers and lead to policy efforts aimed at reducing health disparities. This study objective was to conduct an exploratory analysis to qualitatively describe barriers that health journalists face when covering health disparities in local media. Between June and October 2007, 18 journalists from television, print, and radio in Boston, Lawrence, and Worcester, Massachusetts, were recruited using a purposive sampling technique. In-depth, semi-structured interviews were conducted by telephone, and the crystallization/immersion method was used to conduct a qualitative analysis of interview transcripts. Our results revealed that journalists said that they consider several angles when developing health stories, including public impact and personal behavior change. Challenges to employing a health disparities frame included inability to translate how research findings may impact different socioeconomic groups, and difficulty understanding how findings may translate across racial/ethnic groups. Several journalists reported that disparities-focused stories are "less palatable" for some audiences. This exploratory study offers insights into the challenges that local news media face in using health disparities news frames in their routine coverage of health news. Public health practitioners may use these findings to inform communication efforts with local media in order to advance the public dialogue about health disparities.

a Review on State-Of Face Recognition Approaches

NASA Astrophysics Data System (ADS)

Mahmood, Zahid; Muhammad, Nazeer; Bibi, Nargis; Ali, Tauseef

Automatic Face Recognition (FR) presents a challenging task in the field of pattern recognition and despite the huge research in the past several decades; it still remains an open research problem. This is primarily due to the variability in the facial images, such as non-uniform illuminations, low resolution, occlusion, and/or variation in poses. Due to its non-intrusive nature, the FR is an attractive biometric modality and has gained a lot of attention in the biometric research community. Driven by the enormous number of potential application domains, many algorithms have been proposed for the FR. This paper presents an overview of the state-of-the-art FR algorithms, focusing their performances on publicly available databases. We highlight the conditions of the image databases with regard to the recognition rate of each approach. This is useful as a quick research overview and for practitioners as well to choose an algorithm for their specified FR application. To provide a comprehensive survey, the paper divides the FR algorithms into three categories: (1) intensity-based, (2) video-based, and (3) 3D based FR algorithms. In each category, the most commonly used algorithms and their performance is reported on standard face databases and a brief critical discussion is carried out.

Teaching epidemiology in the digital age: considerations for academicians and their students.

PubMed

Caron, Rosemary M

2013-09-01

The way in which we prepare future public health professionals is changing because of the digital age. Online education is expanding the accessibility of public health training to students and practitioners with diverse backgrounds. Online courses offer many advantages for students, including flexible schedules, elimination of commuting time, and fostering interactions among students and the instructor. A few disadvantages of online courses for the student can include a feeling of isolation, difficulty adjusting to the time-intensive nature, and the required self-discipline to regularly tend to online course materials that immature and working students can find challenging. For faculty who are faced with teaching epidemiology in these changing times of the traditional face-to-face classroom and the virtual classroom, the core teaching principles of this science of public health remain unchanged, yet how they are delivered in the online environment adds a layer of complexity not previously encountered. This paper presents practical considerations for faculty who will be teaching online and their students who will be learning online. In addition, a framework for an online epidemiology course is presented as a model by which faculty interested in teaching epidemiology online can modify the course structure, content, and assessment tools to fit their needs. Copyright © 2013 Elsevier Inc. All rights reserved.

Telepractice: The Australian Experience in an International Context

ERIC Educational Resources Information Center

McCarthy, Melissa; Duncan, Jill; Leigh, Greg

2012-01-01

Telepractice is emerging as a viable alternative to traditional "face-to-face" service as practitioners seek to meet the diverse needs of children who are deaf or hard of hearing and their families. Telepractice provides the opportunity for many countries to expand their reach and viability within their own borders as well as the…

Risk in Schooling: The Contribution of Qualitative Research to Our Understanding of the Overrepresentation of Minorities in Special Education

ERIC Educational Resources Information Center

Harry, Beth; Fenton, Patrice

2016-01-01

This article reviews 15 qualitative studies examining factors contributing to the overrepresentation of minorities in special education. Eleven studies constituted numerical surveys of practitioner perspectives, with additional questions that were analyzed qualitatively. Four studies relied on face-to-face interviews or qualitative surveys,…

42 CFR 410.38 - Durable medical equipment: Scope and conditions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... assessment, evaluate, and/or treat the beneficiary for the medical condition that supports the need for each... length of need, and the physician or treating practitioner's signature and the date the prescription was...) Beneficiaries discharged from a hospital do not need to receive a separate face-to-face examination as long as...

42 CFR 410.38 - Durable medical equipment: Scope and conditions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... assessment, evaluate, and/or treat the beneficiary for the medical condition that supports the need for each... length of need, and the physician or treating practitioner's signature and the date the prescription was...) Beneficiaries discharged from a hospital do not need to receive a separate face-to-face examination as long as...

The experiences and challenges faced by rehabilitation community service therapists within the South African Primary Healthcare health system

PubMed Central

2017-01-01

Background Twenty-two years after the promulgation of a plethora of progressive health policies since 1994, the South African public health system reflects a number of stumbling blocks regarding implementation. Rehabilitation professionals are not sufficiently equipped nor allowed the opportunity to comprehensively implement Primary Healthcare (PHC) from a bottom-up approach, thus engaging communities. Training on addressing social health determinants and their impact on ill-health and health outcomes is inadequate. The inadequate understanding of the advocacy role that rehabilitation professionals could play in addressing social health determinants remains a challenge in healthcare. Rehabilitation, a pillar of PHC, remains poorly understood in terms of its role within the health system. Aim We argue for rehabilitation as a vehicle for addressing social determinants of health with community service practitioners playing a critical role in addressing the inequities within the healthcare package. Setting The article reflects the opportunities and challenges faced by rehabilitation community service therapists in the delivery of rehabilitation services in a rural area of the Eastern Cape province of South Africa. Methods A single case study from the perspective of a researcher was used to explore the experience and reflection of the first author during her community service as an occupational therapist. Results The case study highlights some existing gaps within the delivery of rehabilitation services in the rural Eastern Cape. A community service package with a specific approach towards addressing social determinants of health for persons with disability at a community level is suggested. Conclusion Advocating for a rehabilitation service package to shift to community-based levels is critical. It is envisaged that a community-based approach will facilitate an understanding of the barriers faced by persons with disabilities as constituting disability, thus facilitating learning about the disabling consequences of the rural environment coupled with the system as experienced by persons with disabilities. PMID:29062760

Developing marketing strategies for university teaching hospitals.

PubMed

Fink, D J

1980-07-01

University teaching hospitals face increasing competition from community hospitals, expanding regulation of health care, a rising tide of consumerism, and in many cases a declining urban population base. These problems, which may threaten the teaching hospital's ability to continue tertiary care, teaching, and research functions, may be solved with the aid of new marketing strategies. In developing its marketing strategy, a hospital must assess its strengths and weaknesses, specify its goals in measurable terms, implement tactics to achieve these goals, and evaluate its marketing program. The strategies should be directed toward achieving better relationships with institutions, practitioners, and surrounding communities and increasing patient, visitor, and employee satisfaction. A wide variety of programs can be used to reach these goals and to help teaching hospitals meet the competitive challenges of this decade.

Human Histologic Evidence of Reosseointegration Around an Implant Affected with Peri-implantitis Following Decontamination with Sterile Saline and Antiseptics: A Case History Report.

PubMed

Fletcher, Paul; Deluiz, Daniel; Tinoco, Eduardo Mb; Ricci, John L; Tarnow, Dennis P; Tinoco, Justine Monnerat

The treatment of peri-implant disease is one of the most controversial topics in implant dentistry. The multifactorial etiology and the myriad proposed techniques for managing the problem make successful decontamination of an implant surface affected by peri-implantitis one of the more unpredictable challenges dental practitioners have to face. This article presents the first known published case report demonstrating human histologic evidence of reosseointegration using a plastic curette for mechanical debridement and dilute sodium hypochlorite, hydrogen peroxide, and sterile saline for chemical detoxification. Guided bone regeneration in the infrabony component of the peri-implantitis lesion was accomplished using calcium sulfate and bovine bone as grafting materials and a porcine collagen barrier for connective tissue and epithelial exclusion.

But is it [History of] Medicine? Twenty Years in the History of the Healing Arts of China

PubMed Central

Lo, Vivienne

2009-01-01

Summary This article sets out to give an account of changes to the map of the history of Chinese medicine in the last 20 years. Concentrating mainly on English language secondary sources, it charts shifting aspirations for social history of medicine in China, the impact of anthropology and the tensions between local and large-scale histories. On the one hand, there is a focus on cultural difference, and the articulation of unique styles of perception, where practitioner historians are seen to have an advantage. On the other, historians of China are shown to be facing the challenge of writing in a global context. The paper acknowledges the importance of the transmission of knowledge and practice across social, cultural and geographical boundaries as well as through time.

Moving evidence-based drug abuse prevention programs from basic science to practice: "bridging the efficacy-effectiveness interface".

PubMed

August, Gerald J; Winters, Ken C; Realmuto, George M; Tarter, Ralph; Perry, Cheryl; Hektner, Joel M

2004-01-01

This article examines the challenges faced by developers of youth drug abuse prevention programs in transporting scientifically proven or evidence-based programs into natural community practice systems. Models for research on the transfer of prevention technology are described with specific emphasis given to the relationship between efficacy and effectiveness studies. Barriers that impede the successful integration of efficacy methods within effectiveness studies (e.g., client factors, practitioner factors, intervention structure characteristics, and environmental and organizational factors) are discussed. We present a modified model for program development and evaluation that includes a new type of research design, the hybrid efficacy-effectiveness study that addresses program transportability. The utility of the hybrid study is illustrated in the evaluation of the Early Risers "Skills for Success" prevention program.

Music and the reduction of post-operative pain.

PubMed

Dunn, Kelly

The prevention and treatment of post-operative pain, and the promotion of comfort are the challenges facing practitioners working in the recovery room setting. Surgical pain produces autonomic, psychological, immunological and behavioural responses that can delay or inhibit normal healing. Nurses spend more time with patients experiencing pain than any other healthcare professional. Therefore, they are in an ideal position to consider other pain-relieving strategies to complement the analgesics currently used. The studies reviewed cannot prove that music is effective in reducing post-operative pain, because the research methodology in the majority is poor. Patients, experience of listening to music post-operatively was positive, aiding distraction and increasing comfort. This shows the difference between inconsistent results for the objective measures of pain and what the patient is reporting.

The qualitative interview and challenges for clinicians undertaking research: a personal reflection.

PubMed

Fisher, Karin

2011-01-01

Drawing on my doctoral experience the aim of this article is to present my transition from practitioner to novice researcher and the challenges I encountered when undertaking qualitative in-depth interviews. The contents of my research diary were coded for words, sentences and paragraphs and were then grouped into themes and subsequently organised into concepts and categories. The analysis identified one core category: 'changing states: learning to become a researcher'. The related categories included 'guessing responses', 'confusing boundaries' and 'revealing hidden concepts'. These concepts provide a description of how I learnt to become a researcher and became a changed state. The paper provides practitioners with practical examples of my transition from practitioner to novice researcher. I offer some tips for practitioners who wish to undertake research in their clinical role.

Financial viability, benefits and challenges of employing a nurse practitioner in general practice.

PubMed

Helms, Christopher; Crookes, Jo; Bailey, David

2015-04-01

This case study examines the financial viability, benefits and challenges of employing a primary healthcare (PHC) nurse practitioner (NP) in a bulk-billing healthcare cooperative in the Australian Capital Territory. There are few empirical case reports in the Australian literature that demonstrate financial sustainability of this type of healthcare professional in primary healthcare. This case study demonstrates that the costs of employing a PHC-NP in general practice are offset by direct and indirect Medicare billings generated by the PHC-NP, resulting in a cost-neutral healthcare practitioner. The success of this model relies on bidirectional collaborative working relationships amongst general practitioners and NPs. PHC-NPs should have a generalist scope of practice and specialist expertise in order to maximise their utility within the general practice environment.

Practitioners' Views on Involving Young Children in Decision Making: Challenges for the Children's Rights Agenda

ERIC Educational Resources Information Center

Hudson, Kim

2012-01-01

This article presents the key findings and discussion from a research project and subsequent report: "Involving young children in decision making: An exploration of practitioners' views". This research explored early childhood practitioners'--childcare workers, kindergarten, pre-primary and grade 1-2 teachers--views on decision making…

Practitioners Who Work with Parents with Intellectual Disability: Stress, Coping and Training Needs

ERIC Educational Resources Information Center

Clayton, Olivia; Chester, Andrea; Mildon, Robyn; Matthews, Jan

2008-01-01

Background: Challenges for practitioners who work with parents with intellectual disability arise from several sources. The purpose of the current study was to identify the stressors experienced by practitioners who work with parents with intellectual disability in Australia, investigate coping strategies and explore training needs so as to inform…

The Organizational Context of Research-Minded Practitioners: Challenges and Opportunities

ERIC Educational Resources Information Center

McBeath, Bowen; Austin, Michael J.

2015-01-01

If some practitioners are more research minded than others, then promising approaches for bridging the research to practice gap may be developed by describing research-minded practitioners and examining how to locate and support them. This article follows this basic logic in providing an overview of organizational development and practitioner…

Early Childhood Practitioner Involvement in Functional Behavioral Assessment and Function-Based Interventions: A Literature Review

ERIC Educational Resources Information Center

Wood, Brenna K.; Drogan, Robin R.; Janney, Donna M.

2014-01-01

Reviewers analyzed studies published from 1990 to 2012 to determine early childhood practitioner involvement in functional behavioral assessment (FBA) and function-based behavioral intervention plans (BIP) for children with challenging behavior, age 6 and younger. Coding of 30 studies included practitioner involvement in FBA and BIP processes,…

An initial investigation on the challenges of managing construction workforce in Saudi Arabia

NASA Astrophysics Data System (ADS)

Al-Emad, N.; Rahman, I. A.

2017-11-01

Most of the construction workers in Saudi Arabia are foreigners from several countries having different knowledge, skills and cultures. These create challenges to administer the workers in ensuring project success. This paper presents an initial investigation to uncover the challenges faced by construction professionals in managing construction workforce in Saudi Arabia. It describes insight processes of handling the workforce during planning stage, recruitment procedures and construction stage based on interview with senior manager who are well experienced in handling mega construction projects in Saudi Arabia. The interview was carried out in semi structured mode where the interviewee was given ample time to express the experiences encountered in dealing the workforce issue. This preliminary work able to identify among important issues related to construction workers are restrictions to non-Muslim skilled workers, limited visa quota, being away from family, delay in salary payment, cheating of workers skill’s status, safety issues, communication barriers and living conditions. Hence, these issues require quality leadership attributes such as continuous empathy with workers, respectful, trustful, sincere, reliable, good communication skills and problem solving skills. These findings are useful to construction practitioners and also research work related to construction leadership in handling worker’s issues.

General Practice On-the-Job Training in Chinese Urban Community: A Qualitative Study on Needs and Challenges

PubMed Central

Wang, Bo; Wu, Tao; Huang, Yafang; Guo, Aimin

2014-01-01

Background On-the-job training is an important strategy for general practitioners to deliver appropriately community health services in China. The development of basic professional competence for general practitioners is the main goal of on-the-job training program. The aim of this study was to explore the needs of and the challenges to on-the-job training for general practitioners, and to provide advices for policy-makers to carry out this program more effectively. Methods We conducted 3 nominal group techniques, 17 in-depth interviews and 3 focus groups to identify the status of, needs of and challenges to on-the-job training for general practitioners in Liaoning, Ningxia, and Fujian provinces from September 2011 until December 2011. Audiotapes and transcripts were analyzed to identify major themes. Content analysis of the data was completed from January 2012 to March 2012. Results Basic theoretical knowledge and clinical skills were the main needs for general practitioners during on-the-job training. The challenges during training included the time contradiction between work and training, deficiencies of qualified preceptors, and lack of training funds. Participants gave recommendations how to resolve the above problems. Conclusions In order to improve the outcomes of general practice on-the-job training, it is necessary for government officials to resolve the contradiction between work and training, train preceptors continuously, and increase financial support in the training program. PMID:24728399

Geography of primary mental health care through the Better Access initiative in South Australia 2006-2010.

PubMed

Carson, Dean; Bidargaddi, Niranjan; Schrader, Geoffrey; Allison, Stephen; Jones, Gabrielle Margaret; Bastiampillai, Tarun; Strobel, Jörg

2016-06-01

To examine how the rates of the use of particular face-to-face primary mental health care services changed in the first 4 years (2006-2010) of the Better Access initiative in both urban and rural regions of South Australia. Time-series analysis of the number of psychology session, psychiatry assessment and general practitioner care plan services recorded in Medicare Australia data. South Australia. Pre-existing data set of South Australian residents who accessed Medicare between 2006 and 2010 MAIN OBJECTIVE MEASURE: Number of services per 100 000 population (service rate). Psychology session service rates increased in all regions, but continued to follow a 'location gradient', being higher in areas closer to Adelaide and lower in areas more distant from Adelaide. Psychiatry assessment service rates increased in Adelaide but did not change in other regions. Rates in remote areas were subject to substantial variation over time. General practitioner care plan service rates increased in Adelaide and in the Riverland, but declined in the Murray Mallee region. Overall, service rates increased in Adelaide and nearby regions, but the results for rural and remote regions were mixed. Possible explanations for the geographical variability include population characteristics (such as socio-economic status), methods of service delivery (visiting practitioners, telepsych), the relative proportion of total health services provided by general practitioners versus other practitioners, or real variations in the need for primary mental health services. © 2015 National Rural Health Alliance Inc.

Integrating E-Learning into Postgraduate Radiotherapy and Oncology Education: A Case Study

ERIC Educational Resources Information Center

Probst, Heidi; Eddy, David; Doughty, Jo; Hodgson, Denyse

2009-01-01

Training health professionals within university environments has traditionally focused on face-to-face methods. Practitioners working within the UK National Health Service (NHS) have found it difficult to gain leave from work to attend for study due to the demands of the NHS and staff shortages. In response, the authors developed a distance…

Learners' Perceptions of Online Elements in a Beginners' Language Blended Course--Implications for CALL Design

ERIC Educational Resources Information Center

Pulker, Hélène; Vialleton, Elodie

2015-01-01

Much research has been done on blended learning and the design of tasks most appropriate for online environments and computer-mediated communication. Increasingly, language teachers and Second Language Acquisition (SLA) practitioners recognise the different nature of communications in online settings and in face-to-face settings; teachers do not…

Working in a 'third space': a closer look at the hybridity, identity and agency of nurse practitioners.

PubMed

Chulach, Teresa; Gagnon, Marilou

2016-03-01

Nurse practitioners (NPs), as advanced practice nurses, have evolved over the years to become recognized as an important and growing trend in Canada and worldwide. In spite of sound evidence as to the effectiveness of NPs in primary care and other care settings, role implementation and integration continue to pose significant challenges. This article utilizes postcolonial theory, as articulated by Homi Bhabha, to examine and challenge traditional ideologies and structures that have shaped the development, implementation and integration of the NP role to this day. Specifically, we utilize Bhabha's concepts of third space, hybridity, identity and agency in order to further conceptualize the nurse practitioner role, to examine how the role challenges some of the inherent assumptions within the healthcare system and to explore how development of each to these concepts may prove useful in integration of nurse practitioners within the healthcare system. Our analysis casts light on the importance of a broader, power structure analysis and illustrates how colonial assumptions operating within our current healthcare system entrench, expand and re-invent, as well as mask the structures and practices that serve to impede nurse practitioner full integration and contributions. Suggestions are made for future analysis and research. © 2015 John Wiley & Sons Ltd.

Silencing Bilingualism: A Day in a Life of a Bilingual Practitioner

ERIC Educational Resources Information Center

Robertson, Leena H.; Drury, Rose; Cable, Carrie

2014-01-01

Based on sociocultural theories of learning, this paper draws on findings from a research project "a day in a life of a bilingual practitioner". It explores how two multilingual practitioners in English early years settings supported the learning of young 3-4 year-old children, and their parents and teachers. The paper challenges the…

EXPLICIT: a feasibility study of remote expert elicitation in health technology assessment.

PubMed

Grigore, Bogdan; Peters, Jaime; Hyde, Christopher; Stein, Ken

2017-09-04

Expert opinion is often sought to complement available information needed to inform model-based economic evaluations in health technology assessments. In this context, we define expert elicitation as the process of encoding expert opinion on a quantity of interest, together with associated uncertainty, as a probability distribution. When availability for face-to-face expert elicitation with a facilitator is limited, elicitation can be conducted remotely, overcoming challenges of finding an appropriate time to meet the expert and allowing access to experts situated too far away for practical face-to-face sessions. However, distance elicitation is associated with reduced response rates and limited assistance for the expert during the elicitation session. The aim of this study was to inform the development of a remote elicitation tool by exploring the influence of mode of elicitation on elicited beliefs. An Excel-based tool (EXPLICIT) was developed to assist the elicitation session, including the preparation of the expert and recording of their responses. General practitioners (GPs) were invited to provide expert opinion about population alcohol consumption behaviours. They were randomised to complete the elicitation by either a face-to-face meeting or email. EXPLICIT was used in the elicitation sessions for both arms. Fifteen GPs completed the elicitation session. Those conducted by email were longer than the face-to-face sessions (13 min 30 s vs 10 min 26 s, p = 0.1) and the email-elicited estimates contained less uncertainty. However, the resulting aggregated distributions were comparable. EXPLICIT was useful in both facilitating the elicitation task and in obtaining expert opinion from experts via email. The findings support the opinion that remote, self-administered elicitation is a viable approach within the constraints of HTA to inform policy making, although poor response rates may be observed and additional time for individual sessions may be required.

The Responses of Medical General Practitioners to Unreasonable Patient Demand for Antibiotics--A Study of Medical Ethics Using Immersive Virtual Reality.

PubMed

Pan, Xueni; Slater, Mel; Beacco, Alejandro; Navarro, Xavi; Bellido Rivas, Anna I; Swapp, David; Hale, Joanna; Forbes, Paul Alexander George; Denvir, Catrina; Hamilton, Antonia F de C; Delacroix, Sylvie

2016-01-01

Dealing with insistent patient demand for antibiotics is an all too common part of a General Practitioner's daily routine. This study explores the extent to which portable Immersive Virtual Reality technology can help us gain an accurate understanding of the factors that influence a doctor's response to the ethical challenge underlying such tenacious requests for antibiotics (given the threat posed by growing anti-bacterial resistance worldwide). It also considers the potential of such technology to train doctors to face such dilemmas. Twelve experienced GPs and nine trainees were confronted with an increasingly angry demand by a woman to prescribe antibiotics to her mother in the face of inconclusive evidence that such antibiotic prescription is necessary. The daughter and mother were virtual characters displayed in immersive virtual reality. The specific purposes of the study were twofold: first, whether experienced GPs would be more resistant to patient demands than the trainees, and second, to investigate whether medical doctors would take the virtual situation seriously. Eight out of the 9 trainees prescribed the antibiotics, whereas 7 out of the 12 GPs did so. On the basis of a Bayesian analysis, these results yield reasonable statistical evidence in favor of the notion that experienced GPs are more likely to withstand the pressure to prescribe antibiotics than trainee doctors, thus answering our first question positively. As for the second question, a post experience questionnaire assessing the participants' level of presence (together with participants' feedback and body language) suggested that overall participants did tend towards the illusion of being in the consultation room depicted in the virtual reality and that the virtual consultation taking place was really happening.

Project ECHO Telementoring Intervention for Managing Chronic Pain in Primary Care: Insights from a Qualitative Study.

PubMed

Carlin, Leslie; Zhao, Jane; Dubin, Ruth; Taenzer, Paul; Sidrak, Hannah; Furlan, Andrea

2017-09-27

Family physicians in Canada receive little training in chronic pain management; concomitantly, they face increasing pressure to reduce their prescribing of opioids. Project ECHO Ontario Chronic Pain/Opioid Stewardship (ECHO) is a telementoring intervention for primary care practitioners that enhances their pain management skills. This qualitative study reports participants' experiences and assessment of ECHO. An opportunistic sample of multidisciplinary primary care providers attending one of three residential weekend workshops participated in focus group discussions. University or hospital facilities in Toronto, Thunder Bay, and Kingston, Ontario, Canada. Seventeen physicians and 20 allied health professionals. Six focus group discussions were conducted at three different sites during 2014 and 2015. Transcripts were analyzed using a qualitative-descriptive approach involving analytic immersion in the data, reflection, and achieving consensus around themes discerned from transcribed discussions. Findings resolved into five main themes: 1) challenges of managing chronic pain in primary care; 2) ECHO participation and improvement in patient-provider interaction and participant knowledge; 3) the diffusion of knowledge gained through ECHO to participants' colleagues and patients; 4) ECHO participation generating a sense of community; and 5) disadvantages associated with participating in ECHO. Managing patients with chronic pain in primary care can be difficult, particularly in remote or underserved practices. Project ECHO offers guidance to primary care practitioners for their most challenging patients, promotes knowledge acquisition and diffusion, and stimulates the development of a "community of practice." © 2017 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Understanding nurse practitioner autonomy.

PubMed

Weiland, Sandra A

2015-02-01

This Gadamerian hermeneutic study was undertaken to understand the meaning of autonomy as interpreted by nurse practitioners (NPs) through their lived experiences of everyday practice in primary health care. A purposive sample of nine NPs practicing in primary health care was used. Network sampling achieved a broad swath of primary care NPs and practice settings. Data were collected by face-to-face interviews. Because NP autonomy is concerned with gender and marginalization, Gilligan's feminist perspective was utilized during interpretive analysis. Having Genuine NP Practice was the major theme, reflecting the participants' overall meaning of their autonomy. Practicing alone with the patient provided the context within which participants shaped the meaning of Having Genuine NP Practice. Having Genuine NP Practice had four subthemes: relationships, self-reliance, self-empowerment, and defending the NP role. The understanding of Having Genuine NP Practice will enable NPs to articulate their autonomy clearly and better influence healthcare reform. Implications for advanced practice nursing education include integrating findings into classroom discussion to prompt self-reflection of what autonomy means and socialization to the NP role. ©2014 American Association of Nurse Practitioners.

Implementing an anti-smoking program in rural-remote communities: challenges and strategies.

PubMed

Tall, Julie A; Brew, Bronwyn K; Saurman, Emily; Jones, Therese C

2015-01-01

Rural-remote communities report higher smoking rates and poorer health outcomes than that of metropolitan areas. While anti-smoking programs are an important measure for addressing smoking and improving health, little is known of the challenges faced by primary healthcare staff implementing those programs in the rural-remote setting. The aim of this study was to explore the challenges and strategies of implementing an anti-smoking program by primary healthcare staff in rural-remote Australia. Guided by a phenomenological approach, semi-structured interviews and focus groups were conducted with health service managers, case managers and general practitioners involved in program implementation in Australian rural-remote communities between 2008 and 2010. Program implementation was reported to be challenged by limited primary and mental healthcare resources and client access to services; limited collaboration between health services; the difficulty of accessing staff training; high levels of community distress and disadvantage; the normalisation of smoking and its deleterious impact on smoking abstinence among program clients; and low morale among health staff. Strategies identified to overcome challenges included appointing tobacco-dedicated staff; improving health service collaboration, access and flexibility; providing subsidised pharmacotherapies and boosting staff morale. Findings may assist health services to better tailor anti-smoking programs for the rural-remote setting, where smoking rates are particularly high. Catering for the unique challenges of the rural-remote setting is necessary if anti-smoking programs are to be efficacious, cost-effective and capable of improving rural-remote health outcomes.

Champions' perspectives on implementing the National Lesbian, Gay, Bisexual, Transgender and Intersex Ageing and Aged Care Strategy in Queensland.

PubMed

McPhail, Ruth; Fulop, Liz

2016-01-01

Objective The National Lesbian, Gay, Bisexual, Transgender and Intersex (LGBTI) Ageing and Aged Care Strategy was introduced by the Commonwealth Government in 2012. The present study explored perceptions of the first Aged Care Champions (trained employees) of the opportunities, challenges and barriers to implementing the Strategy in Queensland. Methods The present study was an exploratory study of Champions who were nominated by their providers to build capacity around the Strategy for introduction into their organisations. The Champions (n = 62) were surveyed before commencing their training programs. Quantitative and qualitative material was collected on how the Champions perceived the introduction of the six standards within their organisation. Results Champions perceived that there were opportunities to improve inclusivity, leverage organisational support and increase training and support to staff. Key challenges identified were internal attitudes and values, a lack of resources and a need for training and networking. Significant barriers included a lack of management support, resistant staff and pre-existing prejudicial values. Conclusions Providers and practitioners can leverage the opportunity to increase organisational levels of inclusivity, demonstrate organisational support to improve outcomes for clients and stakeholders and, importantly, provide staff training and development critical to the successful implementation of the Strategy. What is known about the topic? Many LGBTI elders have faced a lived history of oppression and discrimination and have special health care needs. As they age, their needs for greater levels of care increase, but for many so to do their concerns about receiving equitable treatment. What does this paper add? The National LGBTI Ageing and Aged Care Strategy was introduced to address the concerns and needs of LGBTI elders and ensure inclusive and supportive care. This study explores the opportunities, challenges and barriers as perceived by employees trained to introduce the Strategy into their services in Queensland. The present study is the first to explore the introduction of the Strategy from employees' perspectives. What are the implications for practitioners? In the present study, the opportunity for increasing inclusivity, levels of support and training and development were explored from an employee perspective, giving voice to this group of practitioners. Challenges, including current attitudes and values of staff and management, as well as a lack of resources and making connections and networks, are identified. Finally, barriers to the implementation of the Strategy are outlined, including levels of support, staff resistance, values and past negative histories of many LGBTI elders.

Partnership Matters in Health Services Research: A Mixed Methods Study of Practitioners' Involvement in Research and Subsequent Use of Evidence-Based Interventions

ERIC Educational Resources Information Center

Spector, Anya Y.; Pinto, Rogério M.

2017-01-01

Health and social service practitioners have not readily incorporated research-based behavioral interventions in HIV prevention practice due to lack of awareness, lack of training, and challenges translating research findings into practice. Practitioners' involvement in research is associated with their willingness to use research to guide…

Challenges and strategies to improve the availability and geographic accessibility of physicians in Portugal.

PubMed

de Oliveira, Ana Paula Cavalcante; Dussault, Gilles; Craveiro, Isabel

2017-03-23

Shortages of physicians in remote, rural and other underserved areas and lack of general practitioners limit access to health services. The aims of this article are to identify the challenges faced by policy and decision-makers in Portugal to guarantee the availability and geographic accessibility to physicians in the National Health Service and to describe and analyse their causes, the strategies to tackle them and their results. We also raise the issue of whether research evidence was used or not in the process of policy development. We analysed policy and technical documents, peer-reviewed papers and newspaper articles from 1995 to 2015 through a structured search of government websites, Portuguese online newspapers and PubMed and Virtual Health Library (Biblioteca Virtual em Saúde (BVS)) databases; key informants were consulted to validate and complement the documentary search. The challenges faced by decision-makers to ensure access to physicians were identified as a forecasted shortage of physicians, geographical imbalances and maldistribution of physicians by level of care. To date, no human resources for health policy has been formulated, in spite of most documents reviewed stating that it is needed. On the other hand, various isolated and ad hoc strategies have been adopted, such as incentives to choose family health as a specialty or to work in an underserved region and recruitment of foreign physicians through bilateral agreements. Health workforce research in Portugal is scarce, and therefore, policy decisions regarding the availability and accessibility of physicians are not based on evidence. The policy interventions described in this paper should be evaluated, which would be a good starting point to inform health workforce policy development.

The British Columbia Emergency Medicine Network: A Paradigm Shift in a Provincial System of Emergency Care.

PubMed

Abu-Laban, Riyad B; Drebit, Sharla; Lindstrom, Ronald R; Archibald, Chantel; Eggers, Kim; Ho, Kendall; Khazei, Afshin; Lund, Adam; MacKinnon, Carolyn; Markham, Ray; Marsden, Julian; Martin, Ed; Christenson, Jim

2018-01-04

As generalists, emergency practitioners face challenges in providing state-of-the-art care owing to the broad spectrum of practice and the rapid rate of new knowledge generation. Networks have become increasingly prevalent in health care, and it was in this backdrop, and the resulting opportunity to advance evidence-informed emergency care in the Canadian province of British Columbia (BC), that a new "Emergency Medicine Network" (EM Network) was launched in 2017. The EM Network consists of four programs, each led by a physician with expertise and a track record in the domain: (1) Clinical Resources; (2) Innovation; (3) Continuing Professional Development; and (4) Real-time Support. This paper provides an overview of the EM Network, including its background, purpose, programs, anticipated evolution, and impact on the BC health care system.

The British Columbia Emergency Medicine Network: A Paradigm Shift in a Provincial System of Emergency Care

PubMed Central

Abu-Laban, Riyad B; Lindstrom, Ronald R; Archibald, Chantel; Eggers, Kim; Ho, Kendall; Khazei, Afshin; Lund, Adam; MacKinnon, Carolyn; Markham, Ray; Marsden, Julian; Martin, Ed; Christenson, Jim

2018-01-01

As generalists, emergency practitioners face challenges in providing state-of-the-art care owing to the broad spectrum of practice and the rapid rate of new knowledge generation. Networks have become increasingly prevalent in health care, and it was in this backdrop, and the resulting opportunity to advance evidence-informed emergency care in the Canadian province of British Columbia (BC), that a new “Emergency Medicine Network” (EM Network) was launched in 2017. The EM Network consists of four programs, each led by a physician with expertise and a track record in the domain: (1) Clinical Resources; (2) Innovation; (3) Continuing Professional Development; and (4) Real-time Support. This paper provides an overview of the EM Network, including its background, purpose, programs, anticipated evolution, and impact on the BC health care system. PMID:29531875

Divorce and Childhood Chronic Illness: A Grounded Theory of Trust, Gender, and Third-Party Care Providers.

PubMed

Russell, Luke T; Coleman, Marilyn; Ganong, Lawrence H; Gayer, Debra

2016-05-01

Divorced parents face distinct challenges in providing care for chronically ill children. Children's residence in two households necessitates the development of family-specific strategies to ensure coparents' supervision of regimen adherence and the management of children's health care. Utilizing a risk and resilience perspective, a grounded theory study was conducted with 14 divorced parents of children with chronic illnesses. The importance of trust, gender, and relationships with third-party care providers emerged as key themes related to the development of effective coparenting relationships for maintaining children's health. Divorced parents were best able to support the management of their children's chronic conditions when care providers operated as neutral third parties and intermediaries. Collaborative family care may require health care practitioners to avoid being drawn into contentious inter-parental conflicts. © The Author(s) 2016.

Economic constraints and quality assurance in mental health services: sensitive indicators.

PubMed

el-Guebaly, N; Papineau, D

1984-03-01

Clinicians in the field of mental health are met with the dual challenge of increased accountability and shrinking resources. Funds are often allocated through the use of crude administrative monitors. This is of little solace to the clinician faced with unmet patients' wants and needs. A set of clinical monitors is outlined requiring the practitioner's cooperation. The presentation of an accurate composite picture is a must in the process of resource allocation. Such clinical monitors include the analysis of characteristics of patients such as the repeaters at emergency, "the revolving door" pool of patients and those falling in between networks. Reviews of waiting lists and lengths of stay, an evaluation of nursing care variables, the auditing of the choice of therapeutic modalities and the use of restraints are other suggested contributors to the assessment of service needs.

48 CFR 1480.903 - Award in the face of challenge.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 5 2014-10-01 2014-10-01 false Award in the face of challenge. 1480.903 Section 1480.903 Federal Acquisition Regulations System DEPARTMENT OF THE INTERIOR... Award in the face of challenge. (a) Award of a contract in the face of challenge may be made on the...

48 CFR 1480.903 - Award in the face of challenge.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 5 2013-10-01 2013-10-01 false Award in the face of challenge. 1480.903 Section 1480.903 Federal Acquisition Regulations System DEPARTMENT OF THE INTERIOR... Award in the face of challenge. (a) Award of a contract in the face of challenge may be made on the...

Psychodynamic Treatment of the Criminal Offender: Making the Case for Longer-Term Treatment in a Longer-Term Setting.

PubMed

Mulay, Abby L; Kelly, Elspeth; Cain, Nicole M

2017-01-01

In recent years, prisons and jails have become de facto psychiatric hospitals, responsible for the care and treatment of individuals with serious mental illness. Historically, cognitive-behaviorally informed therapeutic approaches have been the treatment of choice among mental health practitioners in correctional settings. However, inmate-clients often present with complex diagnostic issues that are arguably better served by long-term treatment options, such as psychodynamic psychotherapy. We first review the nature of psychotherapy in the correctional setting, as well as treatment barriers and challenges faced by both mental health providers and inmate-clients. We then review treatment studies that examine the efficacy of various therapeutic techniques in correctional/forensic contexts. Finally, we argue that, due to the complex nature of psychopathology, average length of time incarcerated, and treatment issues that arise in this multifaceted and challenging setting, mental health treatment providers should consider providing psychodynamic treatment modalities when working with incarcerated individuals. We also argue that more research is needed to examine the efficacy of these treatment approaches with inmate-clients.

Challenges And Lessons Learned From Communities Using Evidence To Adopt Strategies To Improve Healthy Food Environments.

PubMed

Willems Van Dijk, Julie A; Catlin, Bridget; Cofsky, Abbey; Carroll, Carrie

2015-11-01

Communities across the United States are increasingly tackling the complex task of changing their local environments and cultures to improve access to and consumption of healthy food. Communities that have received the Robert Wood Johnson Foundation Culture of Health Prize have deployed numerous evidence-informed strategies to enhance their local food environments. Their experiences can provide lessons for other communities working to improve health. In this article we examine how the prize-winning communities worked in a multidisciplinary collective manner to implement evidence-based strategies, deployed suites of strategies to expand the reach of food-related work, balanced evidence against innovation, and measured their own progress. Most of the communities also faced challenges in using evidence effectively to implement strategies to promote healthy food environments. Policy makers can accelerate the adoption of evidence-informed approaches related to food and health by embedding them in program standards and funding requirements. Establishing opportunities for ongoing training to enhance community practitioners' evaluation skills and collaborative leadership would also improve the effectiveness of community implementation of these strategies. Project HOPE—The People-to-People Health Foundation, Inc.

Is the "flipped" pedagogical model the answer to the challenges of rural nursing education?: A discussion paper?

PubMed

Anolak, Helena; Coleman, Andrew; Sugden, Paul

2018-07-01

Rural Australian health services face significant challenges such as aging populations, access and retention of services and health practitioners as well as difficulties with staff training due to geographic isolation. Educational pedagogy, through a 'flipped' or 'flipped' classroom method has become popular in nursing literature whereby discussion surrounding its effectiveness, ability to increase performance, address learning outcomes and resolve the education-clinical practice divide is currently being explored. Several reviews that look specifically at the validity and implementation of the flipped classroom pedagogy into nursing education demonstrate a need for further scientific research. Current literature examines the in-class on campus implementation of the methodology but rarely does it consider the advantages or ways of implementing such a method in a rural off campus nursing learning environment. The use of technology is not the solution unless supported by interaction to develop practical situational skills. The authors consider advantages and disadvantages and identify central problems for the effective implementation of 'flipped' in off-campus rural nursing education. Copyright © 2018 Elsevier Ltd. All rights reserved.

A collaborative approach to improving and expanding an experiential education program.

PubMed

Cox, Cheryl E; Lindblad, Adrienne J

2012-04-10

The lessons learned from a collaboration between a faculty of pharmacy and a practice site that involved implementation of an innovative experiential placement model are described, as well as the broader impact of the project on other practice sites, the faculty of pharmacy's experiential education program, and experiential placement capacity. The partnerships and collaborative strategies formed were key to the implementation and evaluation of a pharmacy student clinical teaching unit pilot program and integration of concepts used in the unit into the advanced pharmacy practice experience (APPE) program to enhance capacity and quality. The university-practice partnerships have made it possible to promote the delegation of responsibility and accountability for patient care to students, challenge the anticipated workload burden for preceptors, question the optimal length of an APPE placement, and highlight the value of higher student-to-preceptor ratios that facilitate peer-assisted learning (PAL) and optimize the practice learning experiences for preceptors and students. Collaboration in experiential education between universities and practice sites can provide opportunities to address challenges faced by practitioners and academics alike.

Stability in shifting sands: contemporary leadership roles in critical care.

PubMed

Endacott, R; Boulanger, C; Chamberlain, W; Hendry, J; Ryan, H; Chaboyer, W

2008-10-01

Contemporary nursing leadership roles in critical care are a reflection of the changing environment in which critical care is provided. In the UK, critical care nursing faces challenges in the form of: reduced number and seniority of medical staff cover for acute wards; mandated responsibility for management of patients outside of critical care units, without corresponding responsibility for managing staff; increased public and political awareness of deficits in critical care; increased use of Assistant Practitioners; and emphasis on longer-term outcomes from intensive care. New leadership roles have met these challenges head on with two main foci: patient management across the acute/critical care interface and hospital wide policies and practice. The leadership roles examined in this paper highlight three underpinning goals: improved quality and safety of patient care; improved communication between professionals; and empowerment of junior nurses and doctors. There has been considerable investment in strategic leadership roles for critical care nursing; evidence is developing of the return on this investment for patient and service outcomes. Consideration must now be given to the preparation, mentorship and development of leadership roles for the next generation of nurse leaders.

Adapting cognitive behavioral therapy to meet the needs of Chinese clients: Opportunities and challenges.

PubMed

Guo, Feng; Hanley, Terry

2015-06-01

With the growing influence of China (Chinese people/culture) on the world's politics, economy, and culture, the psychological wellbeing of Chinese people is becoming increasingly important for both researchers and practitioners. Despite this, the cultural responsiveness of many conventional psychotherapeutic models has often been brought into question. In contrast, cognitive behavioral therapy (CBT) is rapidly becoming one of the most popular approaches in the mental health service industry and has been successfully adapted into many different cultural contexts. The current article is a theoretical discussion of the opportunities and challenges that CBT faces with respect to how it might meet the cultural needs and preferences of Chinese clients. Suggestions for successful cultural adaptation are offered based on existing research and practices. It is concluded that many features of CBT appear to match well with the Chinese cultural perspective. However, despite this promising start further work is needed to focus specifically on its practical effectiveness for Chinese clients. © 2015 The Authors. PsyCh Journal published by Institute of Psychology, Chinese Academy of Sciences and Wiley Publishing Asia Pty Ltd.

The new era of postgraduate certified general practice training in Japan.

PubMed

Takamura, Akiteru

2016-09-01

This paper describes the background to, and the recent evolution of general practice as a recognised medical specialism in Japan (2015), and the evolution of a system of training to support this development. We, the general practitioners (GPs) in Japan have not been recognised as one body of medical specialists and have been training in our own way. A new certified training system will commence in 2018, authorised by a new third organisation, the Japanese Medical Specialty Board. An effective educational system has been developed for medical graduates that have a career intention in general practice that is distinct from other basic medical fields, but collaborates with them. A challenge exists to provide clarity to the Japanese population about what the specialty of general practice is, and what professionals in general practice can do for them. Japan currently has approximately 500 certified GPs and it is unclear at present what numbers will eventually be required. This paper reviews some of the challenges facing the development of general practice from the perspective of the Japan Primary Care Association.

NURSE PRACTITIONERS. THE ROAD LESS TRAVELLED.

PubMed

Dragon, Natalie

2016-11-01

With the Australian healthcare system struggling to keep up with surging demand, nurse practitioners are ideally placed and suited to fulfill the role for which they were envisioned. Natalie Dragon looks at the challenges to realize the NP potential.

Recognizing the clinical manifestations of acromegaly: case studies.

PubMed

Iuliano, Sherry L; Laws, Edward R

2014-03-01

To present case studies of a 36-year-old woman and a 73-year-old man who presented with the syndrome of acromegaly, and to provide primary care nurse practitioners (NPs) with the understanding of the clinical and laboratory features needed for early recognition and treatment of this fascinating disease. A comprehensive review of published literature on acromegaly is presented. The findings discussed include the history, physical examination, and diagnostic studies of two patients presenting in different ways. They both saw multiple healthcare providers, and had symptoms and signs eventually leading to the diagnosis of acromegaly. Acromegaly is the result of excessive amounts of growth hormone (GH) and insulin-like growth factor type 1 (IGF-1), almost always caused by a benign adenoma of the pituitary gland. This leads to coarse facial features, soft tissue swelling (including the tongue), enlargement of the hands and feet, respiratory problems, hypertension, diabetes mellitus, carpal tunnel syndrome, and osteoarthritis. Early recognition and appropriate referral can reverse some of the signs and symptoms over time, and lead to decreased mortality and a markedly improved quality of life. These cases exemplify the challenges faced by NPs and other healthcare providers in diagnosing patients with acromegaly. ©2013 The Author(s) ©2013 American Association of Nurse Practitioners.

Forensic services, public mental health policy, and financing: charting the course ahead.

PubMed

Pinals, Debra A

2014-01-01

High-quality forensic evaluations can be critical for criminal cases brought before the court. In addition, forensic practitioners and mental health and forensic administrators have increasingly taken a broader view of the revolving door between the mental health and criminal justice systems. More attention is now paid to why individuals with mental disorders, including co-occurring substance use, come into the criminal justice system and the challenges that they face on re-entry into the community. In particular, individuals who receive care across civil, forensic, and correctional systems are at especially increased risk of disrupted health care access and coverage. With health care reform on the horizon, it is important to understand public financing and its impact on forensic services for this crossover population. This article is a review of historical and future trends in public mental health funding focused on Medicaid and other federal resources, the movement toward community-based services, and the impact of these areas on forensic practice and forensic systems. Tensions between recovery principles and legal mandates are also addressed as community services are emphasized, even in forensic contexts. This article calls forensic practitioners to action and offers suggested areas of focus for training to increase knowledge of public mental health funding, policy, and practice from a forensic perspective.

Developing Tomorrow's Integrated Community Health Systems: A Leadership Challenge for Public Health and Primary Care

PubMed Central

Welton, William E.; Kantner, Theodore A.; Katz, Sheila Moriber

1997-01-01

As the nation's health system moves away from earlier models to one grounded in population health and market-based systems of care, new challenges arise for public health professionals, primary care practitioners, health plan and institutional managers, and community leaders. Among the challenges are the need to develop creative concepts of organization and accountability and to assure that dynamic, system-oriented structures support the new kind of leadership that is required. Developing tomorrow's integrated community health systems will challenge the leadership skills and integrative abilities of public health professionals, primary care practitioners, and managers. These leaders and their new organizations must, in turn, assume increased accountability for improving community health. PMID:9184684

In-depth interviews with state public health practitioners on the United States National Physical Activity Plan

PubMed Central

2013-01-01

Background The United States National Physical Activity Plan (NPAP; 2010), the country’s first national plan for physical activity, provides strategies to increase population-level physical activity to complement the 2008 physical activity guidelines. This study examined state public health practitioner awareness, dissemination, use, challenges, and recommendations for the NPAP. Methods In 2011–2012, we interviewed 27 state practitioners from 25 states. Interviews were recorded and transcribed verbatim. Transcripts were coded using a standard protocol, verified and reconciled by an independent coder, and input into qualitative software to facilitate development of common themes. Results NPAP awareness was high among state practitioners; dissemination to local constituents varied. Development of state-level strategies and goals was the most frequently reported use of the NPAP. Some respondents noted the usefulness of the NPAP for coalitions and local practitioners. Challenges to the plan included implementation cost, complexity, and consistency with other policies. The most frequent recommendation made was to directly link examples of implementation activities to the plan. Conclusions These results provide early evidence of NPAP dissemination and use, along with challenges encountered and suggestions for future iterations. Public health is one of eight sectors in the NPAP. Further efforts are needed to understand uptake and use by other sectors, as well as to monitor long-term relevance, progress, and collaboration across sectors. PMID:23731829

Dissemination and use of a participatory ergonomics guide for workplaces.

PubMed

Van Eerd, Dwayne; King, Trevor; Keown, Kiera; Slack, Tesha; Cole, Donald C; Irvin, Emma; Amick, Benjamin C; Bigelow, Philip

2016-06-01

Musculoskeletal disorders (MSDs) result in lost-time injury claims and lost productivity worldwide, placing a substantial burden on workers and workplaces. Participatory ergonomics (PE) is a popular approach to reducing MSDs; however, there are challenges to implementing PE programmes. Using evidence to overcome challenges may be helpful but the impacts of doing so are unknown. We sought to disseminate an evidence-based PE tool and to describe its use. An easy-to-use, evidence-based PE Guide was disseminated to workplace parties, who were surveyed about using the tool. The greatest barrier to using the tool was a lack of time. Reported tool use included for training purposes, sharing and integrating the tool into existing programmes. New actions related to tool use included training, defining team responsibilities and suggesting programme implementation steps. Evidence-based tools could help ergonomists overcome some challenges involved in implementing injury reduction programmes such as PE. Practitioner Summary Practitioners experience challenges implementing programmes to reduce the burden of MSDs in workplaces. Implementing participatory interventions requires multiple workplace parties to be 'on-board'. Disseminating and using evidence-based guides may help to overcome these challenges. Using evidence-based tools may help ergonomics practitioners implement PE programmes.

Health communication cards as a tool for behaviour change.

PubMed

Matteson, Carrie L; Merth, Thomas D N; Finegood, Diane T

2014-01-01

Individuals seeking healthcare treatment in the context of obesity often experience difficulty engaging in discussions around their health and face challenges finding consensus with practitioners on care plans that best suit their lives. The complex set of biological, social, and environmental variables that have contributed to the higher prevalence of obesity are well illustrated in the foresight obesity system map. Effectively understanding and addressing key variables for each individual has proven to be difficult, with clinicians facing barriers and limited resources to help address patients' unique needs. However, productive discussions inspired by patient centered care may be particularly effective in promoting behaviour change. Tools based on systems science that facilitate patient centered care and help identify behaviour change priorities have not been developed to help treat adult obesity. This project created and pilot tested a card based clinical communication tool designed to help facilitate conversations with individuals engaged in health behaviour change. The health communication cards were designed to help direct conversation between patients and healthcare providers toward issues relevant to the individual. Use of the cards to facilitate patient driven conversations in clinical care may help to streamline conversations, set realistic care plan goals, and improve long term rates of compliance.

Tobacco Use among Foster Youth: Evidence of Health Disparities

PubMed Central

Braciszewski, Jordan M.; Colby, Suzanne M.

2015-01-01

Youth aging out of foster care face a challenging road to independence. Following exposure to myriad risk factors such as abuse, neglect, parental substance use, and severe housing mobility, supportive services decrease upon exit from care, often increasing risk for substance use, homelessness, and unemployment. Although tobacco use is also highly prevalent, little attention has been paid to screening, assessment, and treatment of tobacco use in this vulnerable group. The current study (N = 116) reports on tobacco use prevalence, consequences, and co-occurrence with other substances in a sample of youth (ages 18 to 19) exiting the foster care system. In the face of an overall decrease in tobacco use among general population adolescents and young adults, results suggest disproportionate levels of lifetime, recent, and daily use among foster youth. Prevalence of recent tobacco use (46%) is nearly triple national rates, while daily smoking (32%) is almost four times that of general population young adults. Tobacco users were more likely than non-users to drink (70% vs. 40%) and to smoke marijuana (72% vs. 25%). We strongly encourage researchers and practitioners to increase attention to this tobacco-related health disparity. PMID:26478645

The science between tsunami science and evacuation decisions

NASA Astrophysics Data System (ADS)

McCaughey, J.; Dewi, P. R.; Mundzir, I.; Rosemary, R.; Safrina, L.; Daly, P.; Patt, A.

2014-12-01

The science of rare natural hazards provides us an opportunity that our ancestors lacked: the chance to learn what hazards we could face, and how reliable any particular precursor may or may not be. Connecting hazard science to societal learning is far too complex a challenge for our intuitions to be of much use. Instead, we need to use evidence - the science of science communication - to identify what actually works. As practitioners, we first worked with NGOs and local governments in coastal Sumatran communities to develop tsunami evacuation guidance that is consistent with the science of tsunamis and suitable for the communities that face the threat. This work identified important practical questions that social science can address: how do people decide whether to evacuate, and how do hazard knowledge and experience influence this? How acceptable are false alarms? What modes of communicating tsunami science and its uncertainties may lead to greater willingness to evacuate, and greater acceptance of false alarms? Which parts of the vast body of research on communication, risk perception, and decision-making might be significant in these contexts? We are beginning research at the household level that will address these questions and feed back into our continuing science-communication practice.

From Online Student to Online Instructor: Assistive Strategies

ERIC Educational Resources Information Center

McKnight, Jodi

2012-01-01

With the influx of online learning opportunities, online students and instructors are faced with a variety of challenges. Online students face the same challenges as do face-to-face learners, but by facing them in an online context, the interpretations of those challenges can lead to the success or failure of their overall educational experience.…

Qualitative study to conceptualise a model of interprofessional collaboration between pharmacists and general practitioners to support patients' adherence to medication

PubMed Central

Rathbone, Adam P; Mansoor, Sarab M; Krass, Ines; Hamrosi, Kim; Aslani, Parisa

2016-01-01

Objectives Pharmacists and general practitioners (GPs) face an increasing expectation to collaborate interprofessionally on a number of healthcare issues, including medication non-adherence. This study aimed to propose a model of interprofessional collaboration within the context of identifying and improving medication non-adherence in primary care. Setting Primary care; Sydney, Australia. Participants 3 focus groups were conducted with pharmacists (n=23) and 3 with GPs (n=22) working in primary care. Primary and secondary outcome measures Qualitative investigation of GP and pharmacist interactions with each other, and specifically around supporting their patients’ medication adherence. Audio-recordings were transcribed verbatim and transcripts thematically analysed using a combination of manual and computer coding. Results 3 themes pertaining to interprofessional collaboration were identified (1) frequency, (2) co-collaborators and (3) nature of communication which included 2 subthemes (method of communication and type of communication). While the frequency of interactions was low, the majority were conducted by telephone. Interactions, especially those conducted face-to-face, were positive. Only a few related to patient non-adherence. The findings are positioned within contemporary collaborative theory and provide an accessible introduction to models of interprofessional collaboration. Conclusions This work highlighted that successful collaboration to improve medication adherence was underpinned by shared paradigmatic perspectives and trust, constructed through regular, face-to-face interactions between pharmacists and GPs. PMID:26983948

Is carbon farming an effective climate mitigation option?

NASA Astrophysics Data System (ADS)

Zelikova, T. J.; Funk, J.; Deich, N.; Amador, G.; Jacobson, R.

2017-12-01

"Carbon farming" refers to agricultural and land management practices that store carbon in soils and biomass. Carbon-farming techniques can include crop rotation, cover crops, no-till practices, and the application of compost to build up soil organic matter. Carbon farming also improves agricultural production and sustainability, while mitigating climate change. Despite well-documented benefits of carbon farming, these practices continue to be underutilized outside of experimental settings. One barrier to the widespread use of carbon farming is the challenge of fitting these practices into ongoing commercial operations, while managing the consequent market uncertainties across the value chain. To help address this barrier, we are working with landowners and local groups to establish demonstration "test beds" that can build experience among land managers and help resolve market uncertainties. We specifically focus on demonstrating the commercial viability of management practices that can enhance soil health, catalyzing economic and environmental synergies that come from healthy soils. Each test bed has a commercial agricultural operation at its center, and we bring together researchers, local groups, corporate partners, and key policymakers who can support wider adoption of these agricultural techniques. Early challenges have included finding commercial farms willing to shift their practices and face uncertain outcomes. A transition to new practices usually involves changes in equipment, scheduling, activities, and monitoring that have implications for the entire farm operation, its resources, and its bottom line. At the same time, practitioners have difficulty quantifying the carbon benefits they provide, due to persistent uncertainties, even with the benefit of decades of experimental research. We are building a network of farmers who are implementing carbon farming practices and addressing these challenges, step by step. We envision our test beds becoming hubs that support a community of practitioners who can show the value of this work in real-world commercial operations, supported by rigorous science. By bringing together the necessary elements of each test bed, we aim to facilitate widespread integration of carbon storage activities into the agricultural sector.

Doing "Good Work": Negotiating Possibilities in Ethical Challenges

ERIC Educational Resources Information Center

Burge, Elizabeth J.

2009-01-01

In this article, the author takes a look at how reflective and courageous practitioners show their critical and constructive thinking for handling the intellectual and interpersonal complexities of ethical analysis. The author also discusses six lessons practitioners need to learn.

The Business Management Preceptorship within the Nurse Practitioner Program.

ERIC Educational Resources Information Center

Wing, Donna Marie

1998-01-01

A nurse practitioner business preceptorship provides students with knowledge of basic business, accounting, finance, economics, marketing, and reimbursement. A lack of qualified faculty can be offset with adjunct business faculty. Selection of placement sites should provide challenging management experiences. (SK)

The business management preceptorship within the nurse practitioner program.

PubMed

Wing, D M

1998-01-01

Changes in health care reimbursement practices have affected the way in which primary health care is provided. To be successful, nurse practitioners must have a proficient understanding of basic business functions, including accounting, finance, economics, marketing, and reimbursement practices. Yet, many graduates of nurse practitioner programs are not adequately prepared to make fundamental business decisions. Therefore, it is essential that nurse practitioner faculty provide learning experiences on primary practice business. Because the preceptor experience is an integral aspect of nurse practitioner education, a business preceptorship provides students with pragmatic knowledge of the clinical practice within a business framework. The University of Indianapolis School of Nursing offers a nurse practitioner business preceptorship. The implementation, challenges, and positive outcomes of the course are discussed in this article.

Challenges and Innovations in Surveying the Governmental Public Health Workforce

PubMed Central

Shah, Gulzar; Rider, Nikki; Beck, Angela; Castrucci, Brian C.; Harris, Jenine K.; Sellers, Katie; Varda, Danielle; Ye, Jiali; Erwin, Paul C.; Brownson, Ross C.

2016-01-01

Surveying governmental public health practitioners is a critical means of collecting data about public health organizations, their staff, and their partners. A greater focus on evidence-based practices, practice-based systems research, and evaluation has resulted in practitioners consistently receiving requests to participate in myriad surveys. This can result in a substantial survey burden for practitioners and declining response rates for researchers. This is potentially damaging to practitioners and researchers as well as the field of public health more broadly. We have examined recent developments in survey research, especially issues highly relevant for public health practice. We have also proposed a process by which researchers can engage with practitioners and practitioner groups on research questions of mutual interest. PMID:27715307

Between harm reduction, loss and wellness: on the occupational hazards of work

PubMed Central

2013-01-01

Those working in the fields of harm reduction, healthcare, and human services must cope with a range of stresses, including post traumatic stress and vicarious trauma. Pain and loss are just a part of the job. So is dealing with premature death as a result of HIV, hypertension, and even overdose. Faced with a range of challenges, some workers in the field even turn to self-medication. For some, it is about pleasure; for others it is about alleviating suffering. In recent years, several leaders in the AIDS and harm reduction fields have died ahead of their time. Some stopped taking their medications; others overdosed. Rather than weakness or pathology, French sociologist Emile Durkheim saw self-destructive behavior as a byproduct of social disorganization and isolation, as a way of contending with a breakdown of social bonds and alienation. There are any number of reasons why such behavior becomes part of work for those involved with battling the dueling epidemics of Hepatitis C, HIV, and related concerns. Forms of stress related to this work include secondary trauma, compassion fatigue, organizational conflict, burnout, complications of direct services, and lack of funding. Faced with day-to- day struggles over poverty, punitive welfare systems, drug use, the war on drugs, high risk behavior, structural violence, and illness, many in the field are left to wonder how to strive for wellness when taking on so much pain. For some, self-injury and self-medication are ways of responding. Building on ethnographic methods, this reflective analysis considers the stories of those who have suffered, as well as a few of the ways those in the field cope with harm and pain. The work considers the moral questions we face when we see our friends and colleagues suffer. It asks how we as practitioners strive to create a culture of wellness and support in the fields of harm reduction, healthcare, and human services. Through a brief review of losses and literature thereof, the essay considers models of harm reduction practice that emphasize health, pleasure and sustainability for practitioners. PMID:23548032

Between harm reduction, loss and wellness: on the occupational hazards of work.

PubMed

Shepard, Benjamin C

2013-04-01

Those working in the fields of harm reduction, healthcare, and human services must cope with a range of stresses, including post traumatic stress and vicarious trauma. Pain and loss are just a part of the job. So is dealing with premature death as a result of HIV, hypertension, and even overdose. Faced with a range of challenges, some workers in the field even turn to self-medication. For some, it is about pleasure; for others it is about alleviating suffering. In recent years, several leaders in the AIDS and harm reduction fields have died ahead of their time. Some stopped taking their medications; others overdosed. Rather than weakness or pathology, French sociologist Emile Durkheim saw self-destructive behavior as a byproduct of social disorganization and isolation, as a way of contending with a breakdown of social bonds and alienation. There are any number of reasons why such behavior becomes part of work for those involved with battling the dueling epidemics of Hepatitis C, HIV, and related concerns. Forms of stress related to this work include secondary trauma, compassion fatigue, organizational conflict, burnout, complications of direct services, and lack of funding. Faced with day-to- day struggles over poverty, punitive welfare systems, drug use, the war on drugs, high risk behavior, structural violence, and illness, many in the field are left to wonder how to strive for wellness when taking on so much pain. For some, self-injury and self-medication are ways of responding. Building on ethnographic methods, this reflective analysis considers the stories of those who have suffered, as well as a few of the ways those in the field cope with harm and pain. The work considers the moral questions we face when we see our friends and colleagues suffer. It asks how we as practitioners strive to create a culture of wellness and support in the fields of harm reduction, healthcare, and human services. Through a brief review of losses and literature thereof, the essay considers models of harm reduction practice that emphasize health, pleasure and sustainability for practitioners.

Technology-enabled academic detailing: computer-mediated education between pharmacists and physicians for evidence-based prescribing.

PubMed

Ho, Kendall; Nguyen, Anne; Jarvis-Selinger, Sandra; Novak Lauscher, Helen; Cressman, Céline; Zibrik, Lindsay

2013-09-01

Academic detailing (AD) is the practice of specially trained pharmacists with detailed medication knowledge meeting with physicians to share best practices of prescribing. AD has demonstrated efficacy in positively influencing physicians' prescribing behavior. Nevertheless, a key challenge has been that physicians in rural and remote locations, or physicians who are time challenged, have limited ability to participate in face-to-face meetings with academic detailers, as these specially trained academic detailers are primarily urban-based and limited in numbers. To determine the feasibility of using information technologies to facilitate communication between academic detailers and physicians (known as Technology-Enabled Academic Detailing or TEAD) through a comparison to traditional face-to-face academic detailing (AD). Specifically, TEAD is compared to AD in terms of the ability to aid physicians in acquiring evidence-informed prescribing information on diabetes-related medications, measured in terms of time efficiency, satisfaction of both physicians and pharmacists, and quality of knowledge exchange. General Practitioner Physicians (n=105) and pharmacists (n=12) were recruited from across British Columbia. Pharmacists were trained to be academic detailers on diabetes medication usage. Physicians were assigned to one of four intervention groups to receive four academic detailing sessions from trained pharmacists. Intervention groups included: (1) AD only, (2) TEAD only, (3) TEAD crossed over to AD at midpoint, and (4) AD crossed over to TEAD at midpoint. Evaluation included physician-completed surveys before and after each session, pharmacist logs after each detailing session, interviews and focus groups with physicians and pharmacists at study completion, as well as a technical support log to record all phone calls and emails from physicians and pharmacists regarding any technical challenges during the TEAD sessions, or usage of the web portal. Because recruitment was very low for the cross over groups, we analyzed the results in two groups instead: AD only and TEAD only. 354 sessions were conducted (AD=161, TEAD=193). Of these, complete data were available for 300 sessions, which were included in analysis (AD=133, TEAD=167). On average, TEAD sessions were 49min long, and AD sessions 81min long. Overall, physicians enjoyed both modalities of academic detailing (AD and TEAD) because they received information that both reinforced their existing diabetes knowledge and also provided new prescribing insights and approaches. The results suggest that TEAD is an acceptable alternative to AD for providing physicians advice about prescribing. TEAD is more time efficient, facilitates effective knowledge exchange and interprofessional collaboration, and can reach those physicians virtually where face-to-face AD is not possible or practical. Due to logistics, physicians were allocated, rather than randomized, to receive AD and/or TEAD. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Toward a better understanding of the future of the solo medical practitioner in health care industry: a conceptual review.

PubMed

Erdem, S A; Lacombe, B

1998-01-01

Even a brief conceptual review of the current developments in the health care industry indicates that the future of independent medical practitioners is rather challenging. It may be necessary for these parties to pursue proactive and aggressive marketing strategies to be able to compete with the managed care organizations. Accordingly, this paper outlines some of the current trends in health care marketing as they relate to the ongoing changes to which solo medical practitioners need to respond. It is hoped that the review of the issues raised in this paper can provide an initial basis for a better understanding of some of the challenges to come up with more comprehensive and effective strategy decisions.

Adult Dental Trauma: What Should the Dental Practitioner Know?

PubMed

Chauhan, Ravi; Rasaratnam, Lakshmi; Alani, Aws; Djemal, Serpil

2016-05-01

The management of adult dental trauma can be a daunting challenge for practitioners at any level. Like medical emergencies, initial management can have a large influence on prognosis. It is important that practitioners understand the basic principles of managing the acute presentations of dental trauma. This article aims to illustrate a step-by-step approach in order to improve the management within general dental practice for better outcomes for patients.

Measuring job satisfaction of advanced nurse practitioners and advanced midwife practitioners in the Republic of Ireland: a survey.

PubMed

O'Keeffe, Anne Paula; Corry, Margarita; Moser, Debra K

2015-01-01

To describe the level of job satisfaction of advanced nurse practitioners (ANP) and advanced midwife practitioners in the Republic of Ireland (RoI). Job satisfaction is related to productivity, performance, turnover and health, and thus is a challenge for nursing and healthcare organisations. Job satisfaction data were collected from 47 ANPs using the Misener Nurse Practitioner Job Satisfaction Scale. High levels of global job satisfaction were reported. All ANPs reported satisfaction with autonomy, sense of accomplishment, challenge, social interaction and status in the organisation. Lower levels of job satisfaction were attributed to the amount of involvement in research (55%), opportunities to receive compensation for services provided outside normal working hours (55%), the amount (44%) and the quality of administrative support (51%), and the opportunity to negotiate bonuses and resources in return for productivity (36%). Advanced nurse practitioners in RoI have high levels of job satisfaction with areas relating to clinical practice but are dissatisfied with areas that lead to empowerment within organisations. Efforts to improve the negotiating and leadership skills of ANPs may improve job satisfaction. Enhancing inter-professional collegial relationships and improving managerial recognition of the role within nursing are key areas to be targeted to promote job satisfaction of ANPs. © 2013 John Wiley & Sons Ltd.

Research and Discovery Science and the Future of Dental Education and Practice.

PubMed

Polverini, Peter J; Krebsbach, Paul H

2017-09-01

Dental graduates of 2040 will face new and complex challenges. If they are to meet these challenges, dental schools must develop a research and discovery mission that will equip graduates with the new knowledge required to function in a modern health care environment. The dental practitioner of 2040 will place greater emphasis on risk assessment, disease prevention, and health maintenance; and the emerging discipline of precision medicine and systems biology will revolutionize disease diagnosis and reveal new targeted therapies. The dental graduate of 2040 will be expected to function effectively in a collaborative, learning health care system and to understand the impact of health care policy on local, national, and global communities. Emerging scientific fields such as big data analytics, stem cell biology, tissue engineering, and advanced biomimetics will impact dental practice. Despite all the warning signs indicating how the changing scientific and heath care landscape will dramatically alter dental education and dental practice, dental schools have yet to reconsider their research and educational priorities and clinical practice objectives. Until dental schools and the practicing community come to grips with these challenges, this persistent attitude of complacency will likely be at the dental profession's peril. This article was written as part of the project "Advancing Dental Education in the 21 st Century."

Survey of systematic review authors in dentistry: challenges in methodology and reporting.

PubMed

Major, Michael P; Warren, Sharon; Flores-Mir, Carlos

2009-04-01

The study reported in this article had three objectives: 1) identify the challenges faced by authors of dental systematic reviews (SR) during the process of literature search and selection; 2) determine whether dental SR authors' responses to survey questions about their study methodology were consistent with the reported published methodology; and 3) assess whether dental SR authors' evidence-based publication experience was associated with reported methodology. Seventy-eight authors (53 percent) of dental SRs out of 147 potential authors published from 2000 to 2006 responded to an online survey. According to the respondents, the most challenging aspects of literature search and selection were the initial design and performing extended literature searches. Agreement between the protocol identified by SR authors on the survey and the actual protocol described in their publications was fair to moderate. There were virtually no correlations between authors' publication experience, systematic review literature search, and selection thoroughness except for the number of past SRs published, and no differences in thoroughness between SRs written by clinicians (dental practitioners in the community) and dental school faculty members. Dental SR authors do not appear to fully appreciate the importance of extensive literature searches as central to the validity of their systematic review methods and potential findings.

Global Software Development with Cloud Platforms

NASA Astrophysics Data System (ADS)

Yara, Pavan; Ramachandran, Ramaseshan; Balasubramanian, Gayathri; Muthuswamy, Karthik; Chandrasekar, Divya

Offshore and outsourced distributed software development models and processes are facing challenges, previously unknown, with respect to computing capacity, bandwidth, storage, security, complexity, reliability, and business uncertainty. Clouds promise to address these challenges by adopting recent advances in virtualization, parallel and distributed systems, utility computing, and software services. In this paper, we envision a cloud-based platform that addresses some of these core problems. We outline a generic cloud architecture, its design and our first implementation results for three cloud forms - a compute cloud, a storage cloud and a cloud-based software service- in the context of global distributed software development (GSD). Our ”compute cloud” provides computational services such as continuous code integration and a compile server farm, ”storage cloud” offers storage (block or file-based) services with an on-line virtual storage service, whereas the on-line virtual labs represent a useful cloud service. We note some of the use cases for clouds in GSD, the lessons learned with our prototypes and identify challenges that must be conquered before realizing the full business benefits. We believe that in the future, software practitioners will focus more on these cloud computing platforms and see clouds as a means to supporting a ecosystem of clients, developers and other key stakeholders.

Priority setting in developing countries health care institutions: the case of a Ugandan hospital

PubMed Central

Kapiriri, Lydia; Martin, Douglas K

2006-01-01

Background Because the demand for health services outstrips the available resources, priority setting is one of the most difficult issues faced by health policy makers, particularly those in developing countries. However, there is lack of literature that describes and evaluates priority setting in these contexts. The objective of this paper is to describe priority setting in a teaching hospital in Uganda and evaluate the description against an ethical framework for fair priority setting processes – Accountability for Reasonableness. Methods A case study in a 1,500 bed national referral hospital receiving 1,320 out patients per day and an average budget of US$ 13.5 million per year. We reviewed documents and carried out 70 in-depth interviews (14 health planners, 40 doctors, and 16 nurses working at the hospital). Interviews were recorded and transcribed. Data analysis employed the modified thematic approach to describe priority setting, and the description was evaluated using the four conditions of Accountability for Reasonableness: relevance, publicity, revisions and enforcement. Results Senior managers, guided by the hospital strategic plan make the hospital budget allocation decisions. Frontline practitioners expressed lack of knowledge of the process. Relevance: Priority is given according to a cluster of factors including need, emergencies and patient volume. However, surgical departments and departments whose leaders "make a lot of noise" are also prioritized. Publicity: Decisions, but not reasons, are publicized through general meetings and circulars, but this information does not always reach the frontline practitioners. Publicity to the general public was through ad hoc radio programs and to patients who directly ask. Revisions: There were no formal mechanisms for challenging the reasoning. Enforcement: There were no mechanisms to ensure adherence to the four conditions of a fair process. Conclusion Priority setting decisions at this hospital do not satisfy the conditions of fairness. To improve, the hospital should: (i) engage frontline practitioners, (ii) publicize the reasons for decisions both within the hospital and to the general public, and (iii) develop formal mechanisms for challenging the reasoning. In addition, capacity strengthening is required for senior managers who must accept responsibility for ensuring that the above three conditions are met. PMID:17026761

What next for environmental health?

PubMed

Dhesi, Surindar; Lynch, Zena

2016-07-01

The aim of the wider research was to explore Health and Wellbeing Boards (HWBs) during their early development stages, with a focus on health inequalities and the role of environmental health (EH). This article presents empirical findings relating to challenges facing the EH profession in the new English public health (PH) system and offers new practical suggestions as to how they might be overcome in relation to educating and training the new generation of EH practitioners (EHPs). Four case study HWBs in the Midlands and North of England were followed for 18 months from early 2012. In addition, EHPs and managers from each English region were interviewed. In total, 50 semi-structured interviews were carried out, around 55 h of HWB meetings were observed, and documents associated with HWBs such as strategies and minutes of meetings were collected. Data were analysed thematically, both inductively and deductively, using Atlas.ti. EH is largely invisible in the new PH system due to a variety of internal and external factors, including existing skill sets and practices. There is a new imperative to move away from reliance on statutory functions for funding and to engage with wider PH issues and colleagues, requiring new skills of evaluation and a change in perception from being 'doers' to include a greater role as 'thinkers'. This is being recognised by EHPs and managers, who are seeking ways to adapt to these new expectations. Recent changes to the English PH system have led to a period of reflection and the beginnings of adaptation in EH to overcome new challenges. Linked to this is a need for graduate training to prepare new practitioners to think critically, to thrive and become high-level managers of the future, while being technically competent. We suggest a new, enhanced role for Chartered Institute of Environmental Health (CIEH)-accredited universities in securing the future of the profession by supporting new graduates. Specifically, a mentoring scheme could be introduced for the practical training element for new practitioners. This would help to embed criticality and evaluation in practice, provide consistency in training, and overcome the disconnect between academia and practice. © Royal Society for Public Health 2015.

Harm reduction as a strategy for supporting people who self-harm on mental health wards: the views and experiences of practitioners.

PubMed

James, Karen; Samuels, Isaac; Moran, Paul; Stewart, Duncan

2017-05-01

Harm reduction has had positive outcomes for people using sexual health and substance misuse services. Clinical guidance recommends these approaches may be appropriately adopted by mental health practitioners when managing some people who self-harm. There has, however, been very little research in this area. We explored practitioners' views of harm reduction as a strategy for supporting people who self-harm. The Self Harm Antipathy Scale (SHAS) was administered to a random sample of 395 mental health practitioners working on 31 wards in England, semi-structured interviews were then conducted with 18 survey respondents. Practitioners who had implemented the approach reported positive outcomes including a reduction in incidence and severity of self-harm and a perceived increase in empowerment of service users. Practitioners with no experience of using harm reduction were concerned that self-harm would increase in severity, and were unsure how to assess and manage risk in people under a harm reduction care plan. Some fundamentally disagreed with the principle of harm reduction for self-harm because it challenged their core beliefs about the morality of self-harm, or the ethical and potential legal ramifications of allowing individuals to harm themselves. This study was conducted solely with practitioners working on inpatient units. The majority of staff interviewed had no experience of harm reduction and so their concerns may not reflect challenges encountered by practitioners in clinical practice. Harm reduction is being used to support people who self-harm within inpatient psychiatry and some practitioners report potential benefits of this approach. However, this raises particularly complex practical, ethical and legal issues and further research is needed to assess the safety, acceptability and efficacy of the approach. Crown Copyright © 2017. Published by Elsevier B.V. All rights reserved.

The state of human dimensions capacity for natural resource management: needs, knowledge, and resources

USGS Publications Warehouse

Sexton, Natalie R.; Leong, Kirsten M.; Milley, Brad J.; Clarke, Melinda M.; Teel, Tara L.; Chase, Mark A.; Dietsch, Alia M.

2013-01-01

The social sciences have become increasingly important in understanding natural resource management contexts and audiences, and are essential in design and delivery of effective and durable management strategies. Yet many agencies and organizations do not have the necessary resource management. We draw on the textbook definition of HD: how and why people value natural resources, what benefits people seek and derive from those resources, and how people affect and are affected by those resources and their management (Decker, Brown, and Seimer 2001). Clearly articulating how HD information can be used and integrated into natural resource management planning and decision-making is an important challenge faced by the HD field. To address this challenge, we formed a collaborative team to explore the issue of HD capacity-building for natural resource organizations and to advance the HD field. We define HD capacity as activities, efforts, and resources that enhance the ability of HD researchers and practitioners and natural managers and decision-makers to understand and address the social aspects of conservation.Specifically, we sought to examine current barriers to integration of HD into natural resource management, knowledge needed to improve HD capacity, and existing HD tools, resources, and training opportunities. We conducted a needs assessment of HD experts and practitioners, developed a framework for considering HD activities that can contribute both directly and indirectly throughout any phase of an adaptive management cycle, and held a workshop to review preliminary findings and gather additional input through breakout group discussions. This paper provides highlights from our collaborative initiative to help frame and inform future HD capacity-building efforts and natural resource organizations and also provides a list of existing human dimensions tools and resources.

The drive for universal healthcare in South Africa: views from private general practitioners.

PubMed

Surender, Rebecca; Van Niekerk, Robert; Hannah, Bridget; Allan, Lucie; Shung-King, Maylene

2015-07-01

To address problems of inadequate public health services, escalating private healthcare costs and widening health inequalities, the South Africa (SA) Government has launched a bold new proposal to introduce a universal, comprehensive and integrated system for all SAs; National Health Insurance. Though attention has been devoted to the economics of universal coverage less attention has been paid to other potential challenges, in particular the important role played by the clinicians tasked with implementing the reforms. However, historical and comparative analysis reveals that whenever health systems undergo radical reform, the medical profession is instrumental in determining its nature and outcomes. Moreover, early indications suggest many SA private general practitioners (GPs) are opposed to the measures--and it is not yet known whether they will comply with the proposals. This study therefore analyses the dynamics and potential success of the reforms by directly examining the perceptions of the SA medical profession, in particular private-sector GPs. It draws on a conceptual framework which argues that understanding human motivation and behaviour is essential for the successful design of social policy. Seventy-six interviews were conducted with clinicians in the Eastern Cape Province in 2012. The findings suggest that the SA government will face significant challenges in garnering the support of private GPs. Concerns revolved around remuneration, state control, increased workload, clinical autonomy and diminished quality of care and working conditions. Although there were as yet few signs of mobilization or agency by private clinicians in the policy process, the findings suggests that it will be important for the government to directly address their concerns in order to ensure a stable transition and successful implementation of the reforms. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

Barriers and Motivators for Referral of Patients with Suspected Lynch Syndrome to Cancer Genetic Services: A Qualitative Study

PubMed Central

Tan, Yen Y.; Fitzgerald, Lisa J.

2014-01-01

This article explores the views of general practitioners and specialists on their referral of patients with suspected Lynch syndrome to cancer genetic services. Using a purposive maximum variation sampling strategy, we conducted semi-structured interviews face-to-face with 28 general practitioners and specialists in public or private hospitals and specialist clinics between March and August 2011. General practitioners and specialists were recruited in a major metropolitan area in Australia. Interview transcripts were reviewed by two independent researchers, and thematic analysis was performed using NVivo10 software. The main barriers and motivators identified were: (1) clinician-related (e.g., familiarity with Lynch syndrome and family history knowledge); (2) patient-related (e.g., patients’ interests and personal experience with cancer); and (3) organizational-related (e.g., access to services, guidelines and referral pathway). Referral of patients with suspected Lynch syndrome to cancer genetic services is motivated and hindered by a range of individual, interpersonal and organizational factors. In order to improve the care and quality of life of patients and family with suspected Lynch syndrome, further research is needed to develop supportive tools for clinicians. PMID:25562140

Oral and maxillofacial surgery: what are the French specificities?

PubMed

Herlin, Christian; Goudot, Patrick; Jammet, Patrick; Delaval, Christophe; Yachouh, Jacques

2011-05-01

Oral and maxillofacial surgery has expanded rapidly over the past century. Recognition in France has grown since the first face transplantation in the world performed by Professor Bernard Devauchelle. This speciality, which seems to correspond to a narrow scope of services, actually involves oral, plastic, reconstructive, and cosmetic surgeries of the face. French training for maxillofacial surgeons differs from the Anglo-Saxon course of study. After examining surveys carried out in Great Britain, the United States, and Brazil, the perception of this speciality in the general public and among regular correspondents (general practitioners and dental practitioners) was ascertained. More than 4,000 questionnaires were sent to health care workers and patients attending dental practices. The returned questionnaires concerning recognition of this profession in France were analyzed. Evaluating awareness of maxillofacial surgery among practitioners and the public was of particular interest because it can overlap with several other specialities (ear, nose, and throat; plastic surgery; odontology). The questionnaire included the 20 items used in other similar studies so the results could be compared. Several fields of expertise were identified in maxillofacial surgery, in particular traumatology, surgery for facial birth defects, and orthognathic surgery. Moreover, dental practitioners were found to be the most regular correspondents of maxillofacial surgeons compared with general practitioners. Compared with Anglo-Saxon and Brazilian peers, French recognition of maxillofacial surgery was better. Despite encouraging results, maxillofacial surgery remains a somewhat obscure speciality for health care workers and the general public. Better awareness is necessary for this speciality to become the reference in facial surgery. Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Review: how do hospital organizational structure and processes affect quality of care?: a critical review of research methods.

PubMed

Hearld, Larry R; Alexander, Jeffrey A; Fraser, Irene; Jiang, H Joanna

2008-06-01

Interest in organizational contributions to the delivery of care has risen significantly in recent years. A challenge facing researchers, practitioners, and policy makers is identifying ways to improve care by improving the organizations that provide this care, given the complexity of health care organizations and the role organizations play in influencing systems of care. This article reviews the literature on the relationship between the structural characteristics and organizational processes of hospitals and quality of care. The review uses Donabedian's structure-process-outcome and level of analysis frameworks to organize the literature. The results of this review indicate that a preponderance of studies are conducted at the hospital level of analysis and are predominantly focused on the organizational structure-quality outcome relationship. The article concludes with recommendations of how health services researchers can expand their research to enhance one's understanding of the relationship between organizational characteristics and quality of care.

MANTIS: a phylogenetic framework for multi-species genome comparisons.

PubMed

Tzika, Athanasia C; Helaers, Raphaël; Van de Peer, Yves; Milinkovitch, Michel C

2008-01-15

Practitioners of comparative genomics face huge analytical challenges as whole genome sequences and functional/expression data accumulate. Furthermore, the field would greatly benefit from a better integration of this wealth of data with evolutionary concepts. Here, we present MANTIS, a relational database for the analysis of (i) gains and losses of genes on specific branches of the metazoan phylogeny, (ii) reconstructed genome content of ancestral species and (iii) over- or under-representation of functions/processes and tissue specificity of gained, duplicated and lost genes. MANTIS estimates the most likely positions of gene losses on the true phylogeny using a maximum-likelihood function. A user-friendly interface and an extensive query system allow to investigate questions pertaining to gene identity, phylogenetic mapping and function/expression parameters. MANTIS is freely available at http://www.mantisdb.org and constitutes the missing link between multi-species genome comparisons and functional analyses.

Developing content for an interprofessional training on fear of cancer recurrence (FCR): Key informant interviews of healthcare professionals, researchers and cancer survivors.

PubMed

Berrett-Abebe, Julie; Cadet, Tamara; Vitello, Joan; Maramaldi, Peter

2018-04-10

Growing numbers of cancer survivors are receiving healthcare through primary care practitioners, who often lack cancer-specific expertise to effectively treat survivors' concerns. Addressing that gap, this study aimed to develop content for a training on fear of cancer recurrence (FCR), a common concern in survivorship. Grounded in naturalistic inquiry, 42 key-informant interviews were conducted, transcribed, and analyzed for themes. Participants were healthcare professionals, researchers, and cancer survivors Results: Results included themes ranging from: rich conceptualizations of FCR, opportunities and challenges for addressing FCR in healthcare settings, interventions to address FCR, and important information to include in a training on FCR. This paper provides content for an interprofessional training and highlights the importance of developing trainings for interprofessional teams, given identified barriers that physicians face in addressing FCR and other psychosocial concerns of survivors in primary care.

Maxillary second molar impaction in the adjacent ectopic third molar: Report of five rare cases

PubMed Central

Souki, Bernardo Q.; Cheib, Paula L.; de Brito, Gabriela M.; Pinto, Larissa S. M. C.

2015-01-01

Maxillary second molar impaction in the adjacent ectopic third molar is a rare condition that practitioners might face in the field of pediatric dentistry and orthodontics. The early diagnosis and extraction of the adjacent ectopic third molar have been advocated, and prior research has reported a high rate of spontaneous eruption following third molar removal. However, some challenges in the daily practice are that the early diagnosis of this type of tooth impaction is difficult with conventional radiographic examination, and sometimes the early surgical removal of the maxillary third molar must be postponed because of the risks of damaging the second molar. The objective of this study is to report a case series of five young patients with maxillary second molar impaction and to discuss the difficulty of early diagnosis with the conventional radiographic examination, and unpredictability of self-correction. PMID:26321848

A Comparison of Three Online Recruitment Strategies for Engaging Parents

PubMed Central

Dworkin, Jodi; Hessel, Heather; Gliske, Kate; Rudi, Jessie H.

2017-01-01

Family scientists can face the challenge of effectively and efficiently recruiting normative samples of parents and families. Utilizing the Internet to recruit parents is a strategic way to find participants where they already are, enabling researchers to overcome many of the barriers to in-person recruitment. The present study was designed to compare three online recruitment strategies for recruiting parents: e-mail Listservs, Facebook, and Amazon Mechanical Turk (MTurk). Analyses revealed differences in the effectiveness and efficiency of data collection. In particular, MTurk resulted in the most demographically diverse sample, in a short period of time, with little cost. Listservs reached a large number of participants and resulted in a comparatively homogeneous sample. Facebook was not successful in recruiting a general sample of parents. Findings provide information that can help family researchers and practitioners be intentional about recruitment strategies and study design. PMID:28804184

Challenges in small animal parturition--timing elective and emergency cesarian sections.

PubMed

Smith, F O

2007-08-01

Given the societal emphasis placed on the deliberate breeding of purebred animals, the practitioner today is faced with issues relative to successful parturition in these animals. Today, the serious hobby breeder expects to use planned breeding management to result in a high conception and pregnancy rate and survival rates of offspring that may exceed published parameters. These clients may elect to schedule cesarean section to maximize puppy survival and assure that they have access to quality veterinary care. Using a combination of hormone assays, temperature changes in the dam and carefully timed and documented breeding management, a cesarean section can be planned. Emergency cesarean sections will still be required for the bitch that experiences dystocia or a medical condition that warrants intervention. Timed cesarean section results in a favorable medical outcome for the dam and litter and a better financial outcome for the owner.

When a drip becomes a flood: Lessons learned from Target Corporation's first large-scale business disruption.

PubMed

Hirsch, Kimberly D; Strawser, Bryan E

Business continuity practitioners routinely determine which teams in their companies are critical and undertake extensive and rigorous planning processes. But what happens when a business is faced with an unanticipated long-term disruption that primarily affects non-critical teams? How can a company use the essential principles of business continuity and crisis management in order to respond? This paper explores a 2013 business disruption experienced by Target Corporation at one of its headquarters locations caused by a leak in the water line for an ice machine. Challenges encountered and reviewed include supporting non-critical teams, leadership of a multi-week business disruption and how remote work technologies have changed traditional continuity alternative workspace solution planning. Lessons learned from this activation are presented with implications for business continuity and emergency management planning that are applicable to any industry.

A Comparison of Three Online Recruitment Strategies for Engaging Parents.

PubMed

Dworkin, Jodi; Hessel, Heather; Gliske, Kate; Rudi, Jessie H

2016-10-01

Family scientists can face the challenge of effectively and efficiently recruiting normative samples of parents and families. Utilizing the Internet to recruit parents is a strategic way to find participants where they already are, enabling researchers to overcome many of the barriers to in-person recruitment. The present study was designed to compare three online recruitment strategies for recruiting parents: e-mail Listservs, Facebook, and Amazon Mechanical Turk (MTurk). Analyses revealed differences in the effectiveness and efficiency of data collection. In particular, MTurk resulted in the most demographically diverse sample, in a short period of time, with little cost. Listservs reached a large number of participants and resulted in a comparatively homogeneous sample. Facebook was not successful in recruiting a general sample of parents. Findings provide information that can help family researchers and practitioners be intentional about recruitment strategies and study design.

Men's mental health: a call to social workers.

PubMed

Shafer, Kevin; Wendt, Douglas

2015-04-01

Substantial attention is paid to the mental health needs of women and children by social work researchers, educators, and practitioners--and with good reason, as these are two vulnerable populations in U.S. society. However, the status of men's mental health; its resulting effect on individuals, families, and communities; and the various challenges associated with it are often overlooked by social workers. The authors document the prevalence of common mental health issues among men in the United States, the unique problems that men face, and help-seeking behaviors. They also discuss how social work is in an exceptional position to help men, and the systemic effects that social work practice with men can have. The authors assert that helping improve men's mental health is critical for social work, particularly given its values recognizing the dignity and worth of all individuals. Their goal is to raise awareness and spark an open dialogue about social work practice with men.

Clinical innovation for promoting family care in paediatric intensive care: demonstration, role modelling and reflective practice.

PubMed

Tomlinson, Patricia S; Thomlinson, Elizabeth; Peden-McAlpine, Cynthia; Kirschbaum, Mark

2002-04-01

To explore family caregiving problems in paediatric crisis care and methods that could be applied to move the abstraction of family care to development of specific family interventions. Family centred care has been accepted as the ideal philosophy for holistic health care of children, but methods for its implementation are not well established. In paediatric health crises, family care requires special sensitivity to family needs and a type of complex nursing care for which many practitioners are not sufficiently prepared. Developing family sensitive models of intervention and finding a strategy for transfer of this knowledge to clinical practice is an important challenge facing family nursing today. Social learning theory provides a rich background to explore these issues. Specific techniques of role modelling and reflective practice are suggested as effective approaches to teach family sensitive care in clinical settings where families are part of the care environment.

Neonatal Feeding Behavior as a Complex Dynamical System.

PubMed

Goldfield, Eugene C; Perez, Jennifer; Engstler, Katherine

2017-04-01

The requirements of evidence-based practice in 2017 are motivating new theoretical foundations and methodological tools for characterizing neonatal feeding behavior. Toward that end, this article offers a complex dynamical systems perspective. A set of critical concepts from this perspective frames challenges faced by speech-language pathologists and allied professionals: when to initiate oral feeds, how to determine the robustness of neonatal breathing during feeding and appropriate levels of respiratory support, what instrumental assessments of swallow function to use with preterm neonates, and whether or not to introduce thickened liquids. In the near future, we can expect vast amounts of new data to guide evidence-based practice. But unless practitioners are able to frame these issues in a systems context larger than the individual child, the availability of "big data" will not be effectively translated to clinical practice. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Behavioral flexibility as a mechanism for coping with climate change

USGS Publications Warehouse

Beever, Erik; Hall, L. Embere; Varner, Johanna; Loosen, Anne E.; Dunham, Jason B.; Gahl, Megan K.; Smith, Felisa A.; Lawler, Joshua J.

2017-01-01

Of the primary responses to contemporary climate change – “move, adapt, acclimate, or die” – that are available to organisms, “acclimate” may be effectively achieved through behavioral modification. Behavioral flexibility allows animals to rapidly cope with changing environmental conditions, and behavior represents an important component of a species’ adaptive capacity in the face of climate change. However, there is currently a lack of knowledge about the limits or constraints on behavioral responses to changing conditions. Here, we characterize the contexts in which organisms respond to climate variability through behavior. First, we quantify patterns in behavioral responses across taxa with respect to timescales, climatic stimuli, life-history traits, and ecology. Next, we identify existing knowledge gaps, research biases, and other challenges. Finally, we discuss how conservation practitioners and resource managers can incorporate an improved understanding of behavioral flexibility into natural resource management and policy decisions.

Ethical and legal perspectives on the medical practitioners use of social media.

PubMed

Kubheka, Brenda

2017-04-25

Use of social media has increased exponentially throughout the world. Social media provides a platform for building social and professional relationships that can be used by all, including healthcare professionals. Alongside the benefits of creating networks and spreading information wider and faster than is possible with traditional communication channels, however, it presents ethical and legal challenges. For health professionals, it poses a threat to confidentiality and privacy owed to patients, colleagues and employers. It is vital for health professionals to acknowledge that the same ethical and legal standards apply both online and offline, and that they are accountable to professional bodies and the law for their online activities. This article seeks to explore the ethical and legal pitfalls facing health professionals using social media platforms. Importantly, it seeks to create awareness about the cyberpsychology phenomenon called the 'online disinhibition effect', responsible for lowering restraint during online activities.

The orthodontic-periodontic interrelationship in integrated treatment challenges: a systematic review.

PubMed

Gkantidis, N; Christou, P; Topouzelis, N

2010-05-01

Orthodontic treatment aims at providing an acceptable functional and aesthetic occlusion with appropriate tooth movements. These movements are strongly related to interactions of teeth with their supportive periodontal tissues. In recent years, because of the increased number of adult patients seeking orthodontic treatment, orthodontists frequently face patients with periodontal problems. Aesthetic considerations, like uneven gingival margins or functional problems resulting from inflammatory periodontal diseases should be considered in orthodontic treatment planning. Furthermore, in cases with severe periodontitis, orthodontics may improve the possibilities of saving and restoring a deteriorated dentition. In modern clinical practice, the contribution of the orthodontist, the periodontist and the general dentist is essential for optimized treatment outcomes. The purpose of this systematic review is to highlight the relationship between orthodontics and periodontics in clinical practice and to improve the level of cooperation between dental practitioners. Potentials and limitations that derive from the interdisciplinary approach of complex orthodontic-periodontal clinical problems are discussed.

Web Content Management Systems: An Analysis of Forensic Investigatory Challenges.

PubMed

Horsman, Graeme

2018-02-26

With an increase in the creation and maintenance of personal websites, web content management systems are now frequently utilized. Such systems offer a low cost and simple solution for those seeking to develop an online presence, and subsequently, a platform from which reported defamatory content, abuse, and copyright infringement has been witnessed. This article provides an introductory forensic analysis of the three current most popular web content management systems available, WordPress, Drupal, and Joomla! Test platforms have been created, and their site structures have been examined to provide guidance for forensic practitioners facing investigations of this type. Result's document available metadata for establishing site ownership, user interactions, and stored content following analysis of artifacts including Wordpress's wp_users, and wp_comments tables, Drupal's "watchdog" records, and Joomla!'s _users, and _content tables. Finally, investigatory limitations documenting the difficulties of investigating WCMS usage are noted, and analysis recommendations are offered. © 2018 American Academy of Forensic Sciences.

Bringing Instructional Strategies Home: Reaching Families Online

ERIC Educational Resources Information Center

Curtiss, Sarah L.; Pearson, Jamie N.; Akamoglu, Yusuf; Fisher, Kim W.; Snodgrass, Melinda R.; Meyer, Lori E.; Meadan, Hedda; Halle, James W.

2016-01-01

Online family education can be challenging but rewarding for both families and practitioners. Parents of children with disabilities are integral in fostering children's early development and in promoting independence across the life span. Practitioners and parents working collaboratively can enhance this development. Collaboration between parents…

Diabetes and hypertension guidelines and the primary health care practitioner in Barbados: knowledge, attitudes, practices and barriers--a focus group study.

PubMed

Adams, O Peter; Carter, Anne O

2010-12-03

Audits have shown numerous deficiencies in the quality of hypertension and diabetes primary care in Barbados, despite distribution of regional guidelines. This study aimed to evaluate the knowledge, attitudes and practices, and the barriers faced by primary care practitioners in Barbados concerning the recommendations of available diabetes and hypertension guidelines. Focus groups using a moderator's manual were conducted at all 8 public sector polyclinics, and 5 sessions were held for private practitioners. Polyclinic sessions were attended by 63 persons (17 physicians, 34 nurses, 3 dieticians, 3 podiatrists, 5 pharmacists, and 1 other), and private sector sessions by 20 persons (12 physicians, 1 nurse, 3 dieticians, 2 podiatrists and 2 pharmacists). Practitioners generally thought they gave a good quality of care. Commonwealth Caribbean Medical Research Council 1995 diabetes and 1998 hypertension guidelines, and the Ministry of Health 2001 diabetes protocol had been seen by 38%, 32% and 78% respectively of polyclinic practitioners, 67%, 83%, and 33% of private physicians, and 25%, 0% and 38% of non-physician private practitioners. Current guidelines were considered by some to be outdated, unavailable, difficult to remember and lacking in advice to tackle barriers. Practitioners thought that guidelines should be circulated widely, promoted with repeated educational sessions, and kept short. Patient oriented versions of the guidelines were welcomed. Patient factors causing barriers to ideal outcome included denial and fear of stigma; financial resources to access an appropriate diet, exercise and monitoring equipment; confusion over medication regimens, not valuing free medication, belief in alternative medicines, and being unable to change habits. System barriers included lack of access to blood investigations, clinic equipment and medication; the lack of human resources in polyclinics; and an uncoordinated team approach. Patients faced cultural barriers with regards to meals, exercise, appropriate body size, footwear, medication taking, and taking responsibility for one's health; and difficulty getting time off work to attend clinic. Guidelines need to be promoted repeatedly, and implemented with strategies to overcome barriers. Their development and implementation must be guided by input from all providers on the primary health care team.

Orientation program for hospital-based nurse practitioners.

PubMed

Bahouth, Mona N; Esposito-Herr, Mary Beth

2009-01-01

The transition from student to practicing clinician is often a challenging and difficult period for many nurse practitioners. Newly graduated nurse practitioners commonly describe feelings of inadequacy in assuming clinical responsibilities, lack of support by team members, unclear expectations for the orientation period, and role isolation. This article describes the formal nurse practitioner orientation program implemented at the University of Maryland Medical Center, a large urban academic medical center, to facilitate the transition of new nurse practitioners into the workforce. This comprehensive program incorporates streamlined administrative activities, baseline didactic and simulation-based critical care education, ongoing and focused peer support, access to formalized resources, and individualized clinical preceptor programs. This formalized orientation program has proven to be one of the key variables to successful integration of nurse practitioners into our acute care clinical teams.

The research, policy and practice interface: reflections on using applied social research to promote equity in health in Malawi.

PubMed

Theobald, Sally; Nhlema-Simwaka, Bertha

2008-09-01

The case for research to promote equity in health in resource poor contexts such as Malawi is compelling. In Malawi, nearly half of all the people with tuberculosis cannot afford to access free tuberculosis services. In this scenario, there is a clear need to understand the multiple barriers poor women and men face in accessing services and pilot interventions to address these in a way that engages policy makers, practitioners and communities. This paper provides a critical reflection on our experience as applied social researchers working at the REACH (Research for Equity and Community Health) Trust in Malawi. Our work largely uses qualitative research methodologies as a tool for applied social research to explore the equity dimensions of health services in the country. We argue that a key strength of qualitative research methods and analysis is the ability to bring the perceptions and experiences of marginalised groups to policy makers and practitioners. The focus of this paper is two-fold. The first focus lies in synthesising the opportunities and challenges we have encountered in promoting the use of applied social research, and in particular qualitative research methods, on TB and HIV in Malawi. The second focus is on documenting and reflecting on our experiences of using applied social research to promote gender equity in TB/HIV policy and practice in Malawi. In this paper, we reflect on the strategic frameworks we have used in the Malawian context to try and bring the voices of poor women and men to policy makers and practitioners and hence intensify the research to policy and practice interface.

Assessing the components of adaptive capacity to improve conservation and management efforts under global change

USGS Publications Warehouse

Nicotra, Adrienne; Beever, Erik; Robertson, Amanda; Hofmann, Gretchen; O’Leary, John

2015-01-01

Natural-resource managers and other conservation practitioners are under unprecedented pressure to categorize and quantify the vulnerability of natural systems based on assessment of the exposure, sensitivity, and adaptive capacity of species to climate change. Despite the urgent need for these assessments, neither the theoretical basis of adaptive capacity nor the practical issues underlying its quantification has been articulated in a manner that is directly applicable to natural-resource management. Both are critical for researchers, managers, and other conservation practitioners to develop reliable strategies for assessing adaptive capacity. Drawing from principles of classical and contemporary research and examples from terrestrial, marine, plant, and animal systems, we examined broadly the theory behind the concept of adaptive capacity. We then considered how interdisciplinary, trait- and triage-based approaches encompassing the oft-overlooked interactions among components of adaptive capacity can be used to identify species and populations likely to have higher (or lower) adaptive capacity. We identified the challenges and value of such endeavors and argue for a concerted interdisciplinary research approach that combines ecology, ecological genetics, and eco-physiology to reflect the interacting components of adaptive capacity. We aimed to provide a basis for constructive discussion between natural-resource managers and researchers, discussions urgently needed to identify research directions that will deliver answers to real-world questions facing resource managers, other conservation practitioners, and policy makers. Directing research to both seek general patterns and identify ways to facilitate adaptive capacity of key species and populations within species, will enable conservation ecologists and resource managers to maximize returns on research and management investment and arrive at novel and dynamic management and policy decisions.

Assessing the components of adaptive capacity to improve conservation and management efforts under global change.

PubMed

Nicotra, Adrienne B; Beever, Erik A; Robertson, Amanda L; Hofmann, Gretchen E; O'Leary, John

2015-10-01

Natural-resource managers and other conservation practitioners are under unprecedented pressure to categorize and quantify the vulnerability of natural systems based on assessment of the exposure, sensitivity, and adaptive capacity of species to climate change. Despite the urgent need for these assessments, neither the theoretical basis of adaptive capacity nor the practical issues underlying its quantification has been articulated in a manner that is directly applicable to natural-resource management. Both are critical for researchers, managers, and other conservation practitioners to develop reliable strategies for assessing adaptive capacity. Drawing from principles of classical and contemporary research and examples from terrestrial, marine, plant, and animal systems, we examined broadly the theory behind the concept of adaptive capacity. We then considered how interdisciplinary, trait- and triage-based approaches encompassing the oft-overlooked interactions among components of adaptive capacity can be used to identify species and populations likely to have higher (or lower) adaptive capacity. We identified the challenges and value of such endeavors and argue for a concerted interdisciplinary research approach that combines ecology, ecological genetics, and eco-physiology to reflect the interacting components of adaptive capacity. We aimed to provide a basis for constructive discussion between natural-resource managers and researchers, discussions urgently needed to identify research directions that will deliver answers to real-world questions facing resource managers, other conservation practitioners, and policy makers. Directing research to both seek general patterns and identify ways to facilitate adaptive capacity of key species and populations within species, will enable conservation ecologists and resource managers to maximize returns on research and management investment and arrive at novel and dynamic management and policy decisions. © 2015 Society for Conservation Biology.

Engaging social work practitioners in research: challenges and opportunities.

PubMed

Gitterman, Alex

2014-10-01

Contemporary emphasis on measuring and evaluating observable, behavioral outcomes reflects a major change in the profession toward greater empirical basis for social work practice. This intellectual and methodological shift has created a gap between practitioners and researchers. While social work practitioners definitely should be more knowledgeable and receptive to interventions that have proven to be effective in helping people, social work academics must pay more attention to the realities of social work practitioners who struggle daily with expanding caseloads, ever-increasing time pressures to help clients whose lives are embedded in poverty, unemployment, oppression, racism, homelessness, and violence.

How do nurse practitioners work in primary health care settings? A scoping review.

PubMed

Grant, Julian; Lines, Lauren; Darbyshire, Philip; Parry, Yvonne

2017-10-01

This scoping review explores the work of nurse practitioners in primary health care settings in developed countries and critiques their contribution to improved health outcomes. A scoping review design was employed and included development of a research question, identification of potentially relevant studies, selection of relevant studies, charting data, collating, summarising and reporting findings. An additional step was added to evaluate the methodological rigor of each study. Data sources included literature identified by a search of electronic databases conducted in September 2015 (CINAHL, Informit, Web of Science, Scopus and Medline) and repeated in July 2016. Additional studies were located through hand searching and authors' knowledge of other relevant studies. 74 articles from eight countries were identified, with the majority emanating from the United States of America. Nurse practitioners working in communities provided care mostly in primary care centres (n=42), but also in community centres (n=6), outpatient departments (n=6), homes (n=5), schools (n=3), child abuse clinics (n=1), via communication technologies (n=6), and through combined face-to-face and communication technologies (n=5). The scope of nurse practitioner work varied on a continuum from being targeted towards a specific disease process or managing individual health and wellbeing needs in a holistic manner. Enhanced skills included co-ordination, collaboration, education, counselling, connecting clients with services and advocacy. Measures used to evaluate outcomes varied widely from physiological data (n=25), hospital admissions (n=10), use of health services (n=15), self-reported health (n=13), behavioural change (n=14), patient satisfaction (n=17), cost savings (n=3) and mortality/morbidity (n=5). The majority of nurse practitioners working in community settings did so within a selective model of primary health care with some examples of nurse practitioners contributing to comprehensive models of primary health care. Nurse practitioners predominantly worked with populations defined by an illness with structured protocols for curative and rehabilitative care. Nurse practitioner work that also incorporated promotive activities targeted improving social determinants of health for people rendered vulnerable due to ethnicity, Aboriginal identity, socioeconomic disadvantage, remote location, gender and aging. Interventions were at individual and community levels with outcomes including increased access to care, cost savings and salutogenic characteristics of empowerment for social change. Copyright © 2017 Elsevier Ltd. All rights reserved.

Assessment of Institutional and Personnel-Related Challenges Facing Educational Programme for the Mentally Challenged Persons at Kaimosi Special School, Kenya

ERIC Educational Resources Information Center

Mmbwanga, Daniel M.; Matemba, Collins K.; Bota, Kennedy N.

2015-01-01

The mentally challenged child (MC) can achieve a lot if the right environment and curriculum are designed for him/her. However, the realization of the desirable outcomes faces many challenges. The objective of the study was to examine institutional and personnel-related challenges facing education programs for the MC persons at Kaimosi Special…

Assisted or Hastened Death: The Healthcare Practitioner’s Dilemma

PubMed Central

MacLeod, Rod D; Wilson, Donna M; Malpas, Phillipa

2012-01-01

Assisting or hastening death is a dilemma with many ethical as well as practical issues facing healthcare practitioners in most countries worldwide now. Various arguments for and against assisted dying have been made over time but the call from the public for the legalisation of euthanasia and assisted suicide has never been stronger. While some studies have documented the reluctance of medical and other healthcare professionals to be involved in the practice of assisted dying or euthanasia, there is still much open debate in the public domain. Those who have the most experience of palliative care are strongest in their opposition to hastening death. This paper explores salient practical and ethical considerations for healthcare practitioners associated with assisting death, including a focus on examining the concepts of autonomy for patients and healthcare practitioners. The role of the healthcare practitioner has clearly and undoubtedly changed over time with advances in healthcare practices but the duty of care has not changed. The dilemmas for healthcare practitioners thus who have competent patients requesting hastened death extends far beyond acting within a country’s laws as they go to the very heart of the relationship between the practitioner and patient. PMID:23121745

Cultivating creativity in conservation science.

PubMed

Aslan, Clare E; Pinsky, Malin L; Ryan, Maureen E; Souther, Sara; Terrell, Kimberly A

2014-04-01

Conservation practitioners and scientists are often faced with seemingly intractable problems in which traditional approaches fail. While other sectors (e.g., business) frequently emphasize creative thinking to overcome complex challenges, creativity is rarely identified as an essential skill for conservationists. Yet more creative approaches are urgently needed in the effort to sustain Earth's biodiversity. We identified 4 strategies to develop skills in creative thinking and discuss underlying research and examples supporting each strategy. First, by breaking down barriers between disciplines and surrounding oneself with unfamiliar people, concepts, and perspectives, one can expand base knowledge and experiences and increase the potential for new combinations of ideas. Second, by meeting people where they are (both literally and figuratively), one exposes oneself to new environments and perspectives, which again broadens experiences and increases ability to communicate effectively with stakeholders. Third, by embracing risk responsibly, one is more likely to develop new, nontraditional solutions and be open to high-impact outcomes. Finally, by following a cycle of learning, struggle, and reflection, one can trigger neurophysiological changes that allow the brain to become more creative. Creativity is a learned trait, rather than an innate skill. It can be actively developed at both the individual and institutional levels, and learning to navigate the relevant social and practical barriers is key to the process. To maximize the success of conservation in the face of escalating challenges, one must take advantage of what has been learned from other disciplines and foster creativity as both a professional skill and an essential component of career training and individual development. © 2013 Society for Conservation Biology.

Developing a national programme for textiles and clothing recovery.

PubMed

Bukhari, Mohammad Abdullatif; Carrasco-Gallego, Ruth; Ponce-Cueto, Eva

2018-04-01

Textiles waste is relatively small in terms of weight as compared to other waste streams, but it has a large impact on human health and environment, and its rate is increasing due to the 'fast fashion' model. In this paper, we examine the French national programme for managing post-consumer textiles and clothing through a case study research. To date, France is the only country in the world implementing an extended producer responsibility (EPR) policy for end-of-use clothing, linen and shoes. The case highlights the benefits of using an EPR policy and provides interesting insights about the challenges faced by the textiles waste sector. For instance, the EPR policy has contributed to a threefold increase in the collection and recycling rates of post-consumer textiles since 2006. In addition, the material recovery rate of the post-consumer textiles can reach 90%, 50% of which can be directly reused. However, the 'reuse' stream is facing some challenges because its main market is in Africa and many African countries are considering banning the import of used textiles to encourage a competitive textiles industry locally and internationally. The EPR policy shows a great potential to identify new markets for 'reuse' and to improve the textiles waste sector. Such an EPR policy also could drive societies to financially support innovation and research to provide feasible solutions for fashion producers to adopt eco-design and design for recycling practices. This paper provides guidance for policy makers, shareholders, researchers and practitioners interested in diverting post-consumer textiles and clothing waste from landfills and promoting circular textiles transition.

At a Crossroads: Family Medicine Education in China.

PubMed

Wu, Dan; Lam, Tai Pong

2017-02-01

China is engaged in efforts to train 300,000 family doctors by 2020 to meet its population's health care needs. This Article discusses the family doctor shortage, compares family medicine training programs, examines the distributional challenges faced by these programs, and proposes directions for further experimentation. Despite an increasing number of family doctors, they represented only 5.6% of all doctors in 2013. Currently, three training programs run concurrently-the post-transfer training, residency training, and designated family medicine undergraduate education programs. These programs face several challenges. First, the educational qualifications of primary care practitioners (PCPs) vary greatly between rural and urban regions. From 2005 to 2013, the percentage of PCPs with three or more years of medical training in urban areas was at least 20.0% higher than in rural areas. Second, regional disparities in the number of family doctors for every 10,000 people exist. The richer eastern part of China has a ratio of 1.51 family doctors for every 10,000 people, nearly double that of central (0.70) and western China (0.86). Third, better-educated doctors are most likely going to prefer to work in hospitals, which offer a lucrative career path with higher pay and social status. Intervention packages that combine student selection policies that look at place of origin and career intent with other incentive strategies are worth implementing. Adequate clinical exposure and regular, rigorous evaluations are crucial for enhancing training quality. China should strike a balance in the distribution of family doctors between the richer and poorer areas to ensure equity.

Replacing the Sofa with the Spotlight: Interrogating the Therapeutic Value of Personal Testimony within Community-Based Theatre

ERIC Educational Resources Information Center

Leffler, Elliot

2012-01-01

Julie Salverson, a Canadian scholar-practitioner, has long challenged the assumption that personal storytelling within Community-Based Theatre is necessarily therapeutic. Salverson critiques an "aesthetic of injury," arguing that theatre practitioners have foregrounded personal narratives in a way that reinscribes a "victim…

Education for Sustainable Development: Connecting the Dots for Sustainability

ERIC Educational Resources Information Center

Gokool-Ramdoo, Sushita; Rumjaun, Anwar Bhai

2017-01-01

Critical pedagogy, practitioner experience and a regulatory perspective are employed to scrutinize the notion of Education for Sustainable Development (ESD) as it occurs in the literature. They promote understanding of the challenges impeding the completion of unfinished ESD businesses. In response to practitioner-expressed needs, this paper…

Structured Ethical Reflection in Practitioner Inquiry: Theory, Pedagogy, and Practice

ERIC Educational Resources Information Center

Stevens, Douglas M.; Brydon-Miller, Mary; Raider-Roth, Miriam

2016-01-01

Practitioner inquiry provides a powerful tool for improving practice and addressing critical issues in classrooms, schools, and broader communities. However, it also raises unique ethical challenges that often go unrecognized and unresolved. Structured Ethical Reflection (SER) provides teacher researchers with a process for identifying core values…

Cultural Considerations for Social Service Agencies Working with Muslim Clients

ERIC Educational Resources Information Center

Graham, John R.; Bradshaw, Cathryn; Trew, Jennifer L.

2010-01-01

Social service agencies and practitioners are continually challenged to provide services that are effective for, and reflective of, cultural and religious diversity. Qualitative interviews were conducted with 50 social work practitioners in four Canadian cities to gain insight into methods of practice that are culturally sensitive for work with…

A systematic review of professional supervision experiences and effects for allied health practitioners working in non-metropolitan health care settings

PubMed Central

Ducat, Wendy H; Kumar, Saravana

2015-01-01

Introduction In regional, rural, and remote settings, allied health professional supervision is one organizational mechanism designed to support and retain the workforce, provide clinical governance, and enhance service delivery. A systematic approach to evaluating the evidence of the experience and effects of professional supervision for non-metropolitan allied health practitioners and their service delivery is needed. Methods Studies investigating the experience and effects of professional supervision across 17 allied health disciplines in non-metropolitan health services were systematically searched for using standardized keywords across seven databases. The initial search identified 1,574 references. Of these studies, five met inclusion criteria and were subject to full methodological appraisal by both reviewers. Two studies were primarily qualitative with three studies primarily quantitative in their approach. Studies were appraised using McMaster critical appraisal tools and data were extracted and synthesized. Results Studies reported the context specific benefits and challenges of supervision in non-metropolitan areas and the importance of supervision in enhancing satisfaction and support in these areas. Comparison of findings between metropolitan and non-metropolitan settings within one study suggested that allied health in non-metropolitan settings were more satisfied with supervision though less likely to access it and preferred supervision with other non-metropolitan practitioners over access to more experienced supervisors. One study in a regional health service identified the lack of an agreed upon definition and functions of supervision when supervisors from diverse allied health disciplines were surveyed. While methodologically weak, all studies reported positive perceptions of supervision across professionals, supervisors, and managers. This is in accordance with previous research in the wider supervision literature. Discussion Considering the large pool of studies retrieved for further investigation, few of these met inclusion criteria demonstrating the paucity of primary research in this area. Increased training, policies, and implementation frameworks to ensure the definition and functions of supervision are agreed upon across the allied health disciplines in non-metropolitan areas is needed. Furthermore, systematic evaluation of supervision implementation in non-metropolitan settings, investigation of the experience and effects of distance based supervision (versus face-to-face), and increased rigor in research studies investigating non-metropolitan allied health profession supervision is needed. PMID:26347446

[Interprofessional education for patient-centred practice: development of outcome-focused competencies for a Bachelor Programme Interprofessional Health Care].

PubMed

Mahler, Cornelia; Karstens, Sven; Roos, Marco; Szecsenyi, Joachim

2012-01-01

Health care systems in Germany and around the world are faced with demographic change and the need of providing health services in increasingly complex health care surroundings. A highly qualified workforce is needed to face the challenges ahead and to coordinate health care. In addition, there is evidence that interprofessional education strengthens interprofessional collaboration which can lead to improved health outcomes. The University of Heidelberg, Medical Faculty, decided to develop a bachelor programme integrating specific health professions and interprofessional qualifications into the curriculum. The manuscript describes the identification process of the outcome-focused competencies for this bachelor degree. The six-step curriculum model by Kern et al. was applied. An expert panel identified major tasks and health care fields for which the students should be qualified for. These results were transferred into a questionnaire and distributed among targeted learners as well as practitioners, experts and employers in different health care fields for relevance ratings. Also, individuals were interviewed to receive additional information and to generate further ideas. Thirteen different practice fields, five tasks and thirteen topics common to all health care professions were collected. The subsequent survey comprising 66 items was completed by 139 targeted learners as well as 82 practitioners and experts. All identified practice fields were rated as relevant for future professional life. Top ratings were "supervising procedures" (targeted learners) and "interprofessional communication and coordination" (practitioners, experts and employers). The results were discussed and consented in the expert panel and learner outcomes/objectives were categorized according to the CanMED roles. A thorough needs assessment was performed setting the foundation for the further development of the curriculum. The identified competencies are in line with the five core competencies defined by the WHO which are necessary for interprofessional collaboration: patient-centred care, partnering, quality improvement, information and communication technology, and public health perspective. The application of the CanMED framework proved to be suitable. It may be used as common terminology to help define interfaces with curricula of other health professions. The interprofessional development of the bachelor programme fostered a deeper understanding between health professionals and can therefore be regarded as a first step in improving interprofessional collaboration. Copyright © 2012. Published by Elsevier GmbH.

Understanding Leadership in Schools Facing Challenging Circumstances: A Chilean Case Study

ERIC Educational Resources Information Center

Ahumada, Luis; Galdames, Sergio; Clarke, Simon

2016-01-01

During the last 10 years, research into schools facing challenging circumstances has attracted the attention of researchers around the world. The aim of this study was to understand the challenges that school leaders face as they per form their work, the nature of the context in which these challenges arise, the strategies school leaders adopt to…

Effectiveness of distance learning strategies for continuing professional development (CPD) for rural allied health practitioners: a systematic review.

PubMed

Berndt, Angela; Murray, Carolyn M; Kennedy, Kate; Stanley, Mandy J; Gilbert-Hunt, Susan

2017-07-12

Allied health professionals working in rural areas face unique challenges, often with limited access to resources. Accessing continuing professional development is one of those challenges and is related to retention of workforce. Effectiveness of distance learning strategies for continuing professional development in rural allied healthcare workers has not been evaluated. We searched 17 databases and the grey literature up to September 2016 following the PRISMA guidelines. Any primary studies were included that focussed on allied health and distance delivery regardless of education topic or study design. Two independent reviewers extracted data and critically appraised the selected studies. The search returned 5257 results. With removal of duplicate references, we reviewed 3964 article titles and abstracts; n = 206 appeared potentially eligible and were scrutinised via full text screening; n = 14 were included. Studies were published between 1997 and 2016, were of varied methodological quality and were predominantly from Australia, USA and Canada with a focus on satisfaction of learners with the delivery method or on measures of educational outcomes. Technologies used to deliver distance education included video conference, teleconference, web based platforms and virtual reality. Early papers tended to focus more on the technology characteristics than educational outcomes. Some studies compared technology based delivery to face to face modes and found satisfaction and learning outcomes to be on par. Only three studies reported on practice change following the educational intervention and, despite a suggestion there is a link between the constructs, none measured the relationship between access to continuing professional development and workforce retention. Technology based options of delivery have a high utility, however the complex inter-relatedness of time, use, travel, location, costs, interactivity, learning outcomes and educational design suggest a need for more sophisticated consideration by educational providers. Registration with PROSPERO 30 June 2016: CRD42016041588 .

Can incident reporting improve safety? Healthcare practitioners' views of the effectiveness of incident reporting.

PubMed

Anderson, Janet E; Kodate, Naonori; Walters, Rhiannon; Dodds, Anneliese

2013-04-01

Recent critiques of incident reporting suggest that its role in managing safety has been over emphasized. The objective of this study was to examine the perceived effectiveness of incident reporting in improving safety in mental health and acute hospital settings by asking staff about their perceptions and experiences. Qualitative research design using documentary analysis and semi-structured interviews. Two large teaching hospitals in London; one providing acute and the other mental healthcare. Sixty-two healthcare practitioners with experience of reporting and analysing incidents. Incident reporting was perceived as having a positive effect on safety, not only by leading to changes in care processes but also by changing staff attitudes and knowledge. Staff discussed examples of both instrumental and conceptual uses of the knowledge generated by incident reports. There are difficulties in using incident reports to improve safety in healthcare at all stages of the incident reporting process. Differences in the risks encountered and the organizational systems developed in the two hospitals to review reported incidents could be linked to the differences we found in attitudes to incident reporting between the two hospitals. Incident reporting can be a powerful tool for developing and maintaining an awareness of risks in healthcare practice. Using incident reports to improve care is challenging and the study highlighted the complexities involved and the difficulties faced by staff in learning from incident data.

Exposure-Based CBT for Older Adults After Fall Injury: Description of a Manualized, Time-Limited Intervention for Anxiety

PubMed Central

Jayasinghe, Nimali; Sparks, Martha A.; Kato, Kaori; Wilbur, Kaitlyn; Ganz, Sandy B.; Chiaramonte, Gabrielle R.; Stevens, Bradford L.; Barie, Philip S.; Lachs, Mark S.; O’Dell, Michael; Evans, Arthur T.; Bruce, Martha L.; Difede, JoAnn

2014-01-01

Fall accidents among older adults can be devastating events that, in addition to their physical consequences, lead to disabling anxiety warranting the attention of mental health practitioners. This article presents “Back on My Feet,” an exposure-based cognitive-behavioral therapy (CBT) protocol that is designed for older adults with posttraumatic stress disorder (PTSD), subthreshold PTSD, or fear of falling resulting from a traumatic fall. The protocol can be integrated into care once patients have been discharged from hospital or rehabilitation settings back to the community. Following a brief description of its development, the article presents a detailed account of the protocol, including patient evaluation and the components of the eight home-based sessions. The protocol addresses core symptoms of avoidance, physiological arousal/anxiety, and maladaptive thought patterns. Because older patients face different coping challenges from younger patients (for whom the majority of evidence-based CBT interventions have been developed), the discussion ends with limitations and special considerations for working with older, injured patients. The article offers a blueprint for mental health practitioners to address the needs of patients who may present with fall-related anxiety in primary care and other medical settings. Readers who wish to develop their expertise further can consult the online appendices, which include a clinician manual and patient workbook, as well as guidance on additional resources. PMID:25364226

Nursing in Ghana: A Search for Florence Nightingale in an African City.

PubMed

Adu-Gyamfi, Samuel; Brenya, Edward

2016-01-01

Nursing in Ghana is a crucial subject that permeates almost every issue in the society especially the field of hospital care. To a large extent, the frontiers of nursing have expanded since the time of Florence Nightingale. Globally some studies have been done to study nursing icons like her. The values in nursing practice however continue to preoccupy our minds. The need to accentuate the gains made by historical figures in nursing in present times as well as the nature of interactions between practitioners and patients continues to be of paramount concern to many across the globe and Ghana in particular. This study does an analysis of existing literature on Florence Nightingale and the nature of nursing in Ghana from the colonial times. Additionally, it analyzes responses concerning the activities of nurses and their interactions with patients in Kumasi. The varied information has been thematically pieced together to make inferences that are of great interest to nursing practitioners, policy makers, administrators, and educators among others. The findings to the study suggest among other things that the challenges faced by the nursing institution in modern times are similar to those of the earlier period. The study calls for the emulation of the positive ideas of Florence Nightingale to promote the interest of patients, a core objective championed by a revered nurse.

Kathleen Mears Memorial Lecture: personal accountability: your key to survival in health care reform.

PubMed

Galloway, Sabrina G

2014-09-01

Over the past thirty years the rising cost of healthcare has produced changes in reimbursement strategies. Continually, pressures are placed on the practitioners to reduce the length of the patient hospital stay and provide services in a high quality, risk free, cost effective manner. Following the implementation of diagnostic related groups (DRGs) in the 1980s and Managed Care in the 1990s we are now faced with embracing and surviving the Affordable Health Care Act-H.R.3590 (HHS 2013) that is linking reimbursement to quality outcomes. In short, financial constraints in the funding of health care will once more alter the patterns of delivery and challenge the practitioners to maintain superior care. As Neurodiagnostic Professionals this new reform offers another opportunity to review our process of care and the Neurodiagnostic labs role in the delivery of healthcare. For success, close examination of routine workflows, recognizing and solving existing delivery limitations, developing team care coordination, and increasing the neurodiagnostic professionals profile within the work environment will be required. Embracing your role in this overall process will most likely demand more paperwork, changing protocols, learning and implementing new policies, accepting new work schedules, implementing new quality standards, and pursuing additional education or credentials. Unlike never before more emphasis will be placed on measuring and reporting on the quality of the care we deliver in our labs, intensive care units, and operating rooms.

Nursing in Ghana: A Search for Florence Nightingale in an African City

PubMed Central

Adu-Gyamfi, Samuel; Brenya, Edward

2016-01-01

Nursing in Ghana is a crucial subject that permeates almost every issue in the society especially the field of hospital care. To a large extent, the frontiers of nursing have expanded since the time of Florence Nightingale. Globally some studies have been done to study nursing icons like her. The values in nursing practice however continue to preoccupy our minds. The need to accentuate the gains made by historical figures in nursing in present times as well as the nature of interactions between practitioners and patients continues to be of paramount concern to many across the globe and Ghana in particular. This study does an analysis of existing literature on Florence Nightingale and the nature of nursing in Ghana from the colonial times. Additionally, it analyzes responses concerning the activities of nurses and their interactions with patients in Kumasi. The varied information has been thematically pieced together to make inferences that are of great interest to nursing practitioners, policy makers, administrators, and educators among others. The findings to the study suggest among other things that the challenges faced by the nursing institution in modern times are similar to those of the earlier period. The study calls for the emulation of the positive ideas of Florence Nightingale to promote the interest of patients, a core objective championed by a revered nurse. PMID:27382644

Challenges Facing a Deaf Family Member Concerning a Loved One’s Dying

PubMed Central

Kehl, Karen A.; Gartner, Constance M.

2010-01-01

Individuals who are Deaf face challenges both similar and unique from those faced by hearing individuals when a family member is dying. This study was guided by the question “What are the challenges faced by a Deaf family member when a loved one is dying?” Methods - This qualitative study is guided by critical theory and an interpretive perspective. Robert, a college-educated older adult who has been Deaf from birth was interviewed in American Sign Language using a death history format. Results – There are challenges for Deaf family members that affect communication with both the dying person and health care professionals. Patient-family communication issues included physical challenges and financial challenges. Lack of cultural competence concerning the Deaf community created challenges communicating with professionals. Decision-making was also a challenge. Conclusions These findings provide a framework for future research concerning the needs of Deaf individuals facing the end of life and provide guidance for clinicians. PMID:19910395

Challenges to Providing Fetal Anomaly Testing in a Cross-Cultural Environment: Experiences of Practitioners Caring for Aboriginal Women.

PubMed

Rumbold, Alice R; Wild, Kayli J; Maypilama, Elaine Lawurrpa; Kildea, Sue V; Barclay, Lesley; Wallace, Euan M; Boyle, Jacqueline A

2015-12-01

Across Australia there are substantial disparities in uptake of antenatal testing for fetal anomalies, with very low uptake observed among Aboriginal women. The reasons behind these disparities are unclear, although poorer access to testing has been reported in some communities. We interviewed health care practitioners to explore the perceived barriers to providing fetal anomaly screening to Aboriginal women. In 2009 and 2010, in-depth interviews were undertaken with 59 practitioners in five urban and remote sites across the Northern Territory (NT) of Australia. Data were analyzed thematically. Maximum variation sampling, independent review of findings by multiple analysts, and participant feedback were undertaken to strengthen the validity of findings. Participants included midwives (47%), Aboriginal health practitioners (AHP) (32%), general practitioners (12%), and obstetricians (9%); almost all (95%) were female. Participants consistently reported difficulties counseling women. Explaining the concept of "risk" (of abnormalities and the screening test result) was identified as particularly challenging, because of a perceived lack of an equivalent concept in Aboriginal languages. While AHPs could assist with overcoming language barriers, they are underutilized. Participants also identified impediments to organizing testing including difficulties establishing gestational age, late presentation for care, and a lack of standardized information and training. The availability of fetal anomaly testing is challenged by communication difficulties, including a focus on culturally specific biomedical concepts, and organizational barriers to arranging testing. Developing educational activities that address the technical aspects of screening and communication skills will assist in improving access. These activities must include AHPs. © 2015 Wiley Periodicals, Inc.

Systems for the management of respiratory disease in primary care--an international series: United Kingdom.

PubMed

Worth, Allison; Pinnock, Hilary; Fletcher, Monica; Hoskins, Gaylor; Levy, Mark L; Sheikh, Aziz

2011-03-01

The UK National Health Service (NHS) is essentially publicly funded through general taxation. Challenges facing the NHS include the rise in prevalence of long-term conditions and financial pressures. NATIONAL POLICY TRENDS: Political devolution within the UK has led to variations in the way services are organised and delivered between the four nations. PRIMARY CARE RESPIRATORY SERVICES IN THE UK: Primary care is the first point of contact with services. Most respiratory conditions are managed here, including prevention, diagnosis, treatment and palliative care. Respiratory disease accounts for more primary care consultations than any other type of illness, with 24 million consultations annually. Equitable access to care is an ongoing challenge: telehealthcare is being tried as a possible solution for monitoring of asthma and COPD. REFERRAL AND ACCESS TO SPECIALIST CARE: Referrals for specialist advice are usually to a secondary care respiratory physician, though respiratory General Practitioners with a Special Interest (GPwSIs) are an option in some localities. Prevalence of asthma and COPD is high. Asthma services are predominantly nurse-led. Self-management strategies are widely promoted but poorly implemented. COPD is high on the policy agenda with a shift in focus to preventive lung health and longterm condition management.

What does it means to be a critical scholar? A metalogue between science education doctoral students

NASA Astrophysics Data System (ADS)

Cian, Heidi; Dsouza, Nikeetha; Lyons, Renee; Alston, Daniel

2017-06-01

This manuscript is written in response to Lydia Burke and Jesse Bazzul's article Locating a space of criticality as new scholars in science education. As doctoral students finding our place in the culture of science education, we respond by discussing our journeys towards the development of a scholarly identity, with particular focus on whether or how we see ourselves as critical scholars. Since each of us authoring this paper has a different perspective, a metalogue format is utilized to ensure all of our voices and journeys are represented. We use the Burke and Bazzul article as a platform for conversations about challenges faced for emerging scholars in the field of science education and explore how we see our role in responding to these challenges. Specifically, we discuss the barriers to publication, dissemination of research to practitioners, and how to approach these problems from a grounding in critical theory. As a result of our conversations, we conclude that there is a need to reshape the field of science education to invite more unorthodox research perspectives, methodologies, and publication formats. To do so, the issues we explore require a continued conversation between emerging scholars, practicing researchers, and practicing educators.

Information from imagery: ISPRS scientific vision and research agenda

NASA Astrophysics Data System (ADS)

Chen, Jun; Dowman, Ian; Li, Songnian; Li, Zhilin; Madden, Marguerite; Mills, Jon; Paparoditis, Nicolas; Rottensteiner, Franz; Sester, Monika; Toth, Charles; Trinder, John; Heipke, Christian

2016-05-01

With the increased availability of very high-resolution satellite imagery, terrain based imaging and participatory sensing, inexpensive platforms, and advanced information and communication technologies, the application of imagery is now ubiquitous, playing an important role in many aspects of life and work today. As a leading organisation in this field, the International Society for Photogrammetry and Remote Sensing (ISPRS) has been devoted to effectively and efficiently obtaining and utilising information from imagery since its foundation in the year 1910. This paper examines the significant challenges currently facing ISPRS and its communities, such as providing high-quality information, enabling advanced geospatial computing, and supporting collaborative problem solving. The state-of-the-art in ISPRS related research and development is reviewed and the trends and topics for future work are identified. By providing an overarching scientific vision and research agenda, we hope to call on and mobilise all ISPRS scientists, practitioners and other stakeholders to continue improving our understanding and capacity on information from imagery and to deliver advanced geospatial knowledge that enables humankind to better deal with the challenges ahead, posed for example by global change, ubiquitous sensing, and a demand for real-time information generation.

Communication, Respect, and Leadership: Interprofessional Collaboration in Hospitals of Rural Ontario.

PubMed

Morris, Diane; Matthews, June

2014-12-01

Health care professionals are expected to work collaboratively across diverse settings. In rural hospitals, these professionals face different challenges from their urban colleagues; however, little is known about interprofessional practice in these settings. Eleven health care professionals from 2 rural interprofessional teams were interviewed about collaborative practice. The data were analyzed using a constant comparative method. Common themes included communication, respect, leadership, benefits of interprofessional teams, and the assets and challenges of working in small or rural hospitals. Differences between the cases were apparent in how the members conceptualized their teams, models of which were then compared with an "Ideal Interprofessional Team". These results suggest that many experienced health care professionals function well in interprofessional teams; yet, they did not likely receive much education about interprofessional practice in their training. Providing interprofessional education to new practitioners may help them to establish this approach early in their careers and build on it with additional experience. Finally, these findings can be applied to address concerns that have arisen from other reports by exploring innovative ways to attract health professionals to communities in rural, remote, and northern areas, as there is a constant need for dietitians and other health care professionals in these practice settings.

Scoping meta-review: introducing a new methodology.

PubMed

Sarrami-Foroushani, Pooria; Travaglia, Joanne; Debono, Deborah; Clay-Williams, Robyn; Braithwaite, Jeffrey

2015-02-01

For researchers, policymakers, and practitioners facing a new field, undertaking a systematic review can typically present a challenge due to the enormous number of relevant papers. A scoping review is a method suggested for addressing this dilemma; however, scoping reviews present their own challenges. This paper introduces the "scoping meta-review" (SMR) for expanding current methodologies and is based on our experiences in mapping the field of consumer engagement in healthcare. During this process, we developed the novel SMR method. An SMR combines aspects of a scoping review and a meta-review to establish an evidence-based map of a field. Similar to a scoping review, an SMR offers a practical and flexible methodology. However, unlike in a traditional scoping review, only systematic reviews are included. Stages of the SMR include: undertaking a preliminary nonsystematic review; building a search strategy; interrogating academic literature databases; classifying and excluding studies based on titles and abstracts; saving the refined database of references; revising the search strategy; selecting and reviewing the full text papers; and thematically analyzing the selected texts and writing the report. The main benefit of an SMR is to map a new field based on high-level evidence provided by systematic reviews. © 2014 Wiley Periodicals, Inc.

The effect of GP telephone triage on numbers seeking same-day appointments.

PubMed

Jiwa, Moyez; Mathers, Nigel; Campbell, Mike

2002-05-01

Telephone consultations with general practitioners (GPs) have not been shown to be an effective way to reduce the demandfor face-to face appointments during the surgery hours. This study aims to determine if GP telephone triage can effectively reduce the demandforface-to -face consultations for patients seeking same-day appointments in general practice. We report an interrupted time series, twoyears before and one year after introduction of GP-led telephone triage. Demand for face-to face appointments with a GPwas reduced by 39% (95% CI = 29 to 51%, P < 0.001). more than 92% of the telephone calls lasted less thanfive minutes. The telephone bill increased by 26%. For a substantial proportion of patients seeking same-day appointments telephone consultations were an acceptable alternative service.

Unsupervised Tensor Mining for Big Data Practitioners.

PubMed

Papalexakis, Evangelos E; Faloutsos, Christos

2016-09-01

Multiaspect data are ubiquitous in modern Big Data applications. For instance, different aspects of a social network are the different types of communication between people, the time stamp of each interaction, and the location associated to each individual. How can we jointly model all those aspects and leverage the additional information that they introduce to our analysis? Tensors, which are multidimensional extensions of matrices, are a principled and mathematically sound way of modeling such multiaspect data. In this article, our goal is to popularize tensors and tensor decompositions to Big Data practitioners by demonstrating their effectiveness, outlining challenges that pertain to their application in Big Data scenarios, and presenting our recent work that tackles those challenges. We view this work as a step toward a fully automated, unsupervised tensor mining tool that can be easily and broadly adopted by practitioners in academia and industry.

Application of Life Cycle Assessment on Electronic Waste Management: A Review.

PubMed

Xue, Mianqiang; Xu, Zhenming

2017-04-01

Electronic waste is a rich source of both valuable materials and toxic substances. Management of electronic waste is one of the biggest challenges of current worldwide concern. As an effective and prevailing environmental management tool, life cycle assessment can evaluate the environmental performance of electronic waste management activities. Quite a few scientific literatures reporting life cycle assessment of electronic waste management with significant outcomes have been recently published. This paper reviewed the trends, characteristics, research gaps, and challenges of these studies providing detailed information for practitioners involved in electronic waste management. The results showed that life cycle assessment studies were most carried out in Europe, followed by Asia and North America. The research subject of the studies mainly includes monitors, waste printed circuit boards, mobile phones, computers, printers, batteries, toys, dishwashers, and light-emitting diodes. CML was the most widely used life cycle impact assessment method in life cycle assessment studies on electronic waste management, followed by EI99. Furthermore, 40% of the reviewed studies combined with other environmental tools, including life cycle cost, material flow analysis, multi-criteria decision analysis, emergy analysis, and hazard assessment which came to more comprehensive conclusions from different aspects. The research gaps and challenges including uneven distribution of life cycle assessment studies, life cycle impact assessment methods selection, comparison of the results, and uncertainty of the life cycle assessment studies were examined. Although life cycle assessment of electronic waste management facing challenges, their results will play more and more important role in electronic waste management practices.

Application of Life Cycle Assessment on Electronic Waste Management: A Review

NASA Astrophysics Data System (ADS)

Xue, Mianqiang; Xu, Zhenming

2017-04-01

Electronic waste is a rich source of both valuable materials and toxic substances. Management of electronic waste is one of the biggest challenges of current worldwide concern. As an effective and prevailing environmental management tool, life cycle assessment can evaluate the environmental performance of electronic waste management activities. Quite a few scientific literatures reporting life cycle assessment of electronic waste management with significant outcomes have been recently published. This paper reviewed the trends, characteristics, research gaps, and challenges of these studies providing detailed information for practitioners involved in electronic waste management. The results showed that life cycle assessment studies were most carried out in Europe, followed by Asia and North America. The research subject of the studies mainly includes monitors, waste printed circuit boards, mobile phones, computers, printers, batteries, toys, dishwashers, and light-emitting diodes. CML was the most widely used life cycle impact assessment method in life cycle assessment studies on electronic waste management, followed by EI99. Furthermore, 40% of the reviewed studies combined with other environmental tools, including life cycle cost, material flow analysis, multi-criteria decision analysis, emergy analysis, and hazard assessment which came to more comprehensive conclusions from different aspects. The research gaps and challenges including uneven distribution of life cycle assessment studies, life cycle impact assessment methods selection, comparison of the results, and uncertainty of the life cycle assessment studies were examined. Although life cycle assessment of electronic waste management facing challenges, their results will play more and more important role in electronic waste management practices.

The challenges and opportunities in cumulative effects assessment

USGS Publications Warehouse

Foley, Melissa M.; Mease, Lindley A; Martone, Rebecca G; Prahler, Erin E; Morrison, Tiffany H; Clarke Murray, Cathryn; Wojcik, Deborah

2016-01-01

The cumulative effects of increasing human use of the ocean and coastal zone have contributed to a rapid decline in ocean and coastal resources. As a result, scientists are investigating how multiple, overlapping stressors accumulate in the environment and impact ecosystems. These investigations are the foundation for the development of new tools that account for and predict cumulative effects in order to more adequately prevent or mitigate negative effects. Despite scientific advances, legal requirements, and management guidance, those who conduct assessments—including resource managers, agency staff, and consultants—continue to struggle to thoroughly evaluate cumulative effects, particularly as part of the environmental assessment process. Even though 45 years have passed since the United States National Environmental Policy Act was enacted, which set a precedent for environmental assessment around the world, defining impacts, baseline, scale, and significance are still major challenges associated with assessing cumulative effects. In addition, we know little about how practitioners tackle these challenges or how assessment aligns with current scientific recommendations. To shed more light on these challenges and gaps, we undertook a comparative study on how cumulative effects assessment (CEA) is conducted by practitioners operating under some of the most well-developed environmental laws around the globe: California, USA; British Columbia, Canada; Queensland, Australia; and New Zealand. We found that practitioners used a broad and varied definition of impact for CEA, which led to differences in how baseline, scale, and significance were determined. We also found that practice and science are not closely aligned and, as such, we highlight opportunities for managers, policy makers, practitioners, and scientists to improve environmental assessment.

The challenges and opportunities in cumulative effects assessment

DOE Office of Scientific and Technical Information (OSTI.GOV)

Foley, Melissa M., E-mail: mfoley@usgs.gov; Center for Ocean Solutions, Stanford University, 99 Pacific St., Monterey, CA 93940; Mease, Lindley A., E-mail: lamease@stanford.edu

The cumulative effects of increasing human use of the ocean and coastal zone have contributed to a rapid decline in ocean and coastal resources. As a result, scientists are investigating how multiple, overlapping stressors accumulate in the environment and impact ecosystems. These investigations are the foundation for the development of new tools that account for and predict cumulative effects in order to more adequately prevent or mitigate negative effects. Despite scientific advances, legal requirements, and management guidance, those who conduct assessments—including resource managers, agency staff, and consultants—continue to struggle to thoroughly evaluate cumulative effects, particularly as part of the environmentalmore » assessment process. Even though 45 years have passed since the United States National Environmental Policy Act was enacted, which set a precedent for environmental assessment around the world, defining impacts, baseline, scale, and significance are still major challenges associated with assessing cumulative effects. In addition, we know little about how practitioners tackle these challenges or how assessment aligns with current scientific recommendations. To shed more light on these challenges and gaps, we undertook a comparative study on how cumulative effects assessment (CEA) is conducted by practitioners operating under some of the most well-developed environmental laws around the globe: California, USA; British Columbia, Canada; Queensland, Australia; and New Zealand. We found that practitioners used a broad and varied definition of impact for CEA, which led to differences in how baseline, scale, and significance were determined. We also found that practice and science are not closely aligned and, as such, we highlight opportunities for managers, policy makers, practitioners, and scientists to improve environmental assessment.« less

The waiting room: vector for health education? The general practitioner's point of view.

PubMed

Gignon, Maxine; Idris, Hadjila; Manaouil, Cecile; Ganry, Oliver

2012-09-18

General practitioners (GPs) play a central role in disseminating information and most health policies are tending to develop this pivotal role of GPs in dissemination of health-related information to the public. The objective of this study was to evaluate use of the waiting room by GPs as a vector for health promotion. A cross-sectional study was conducted on a representative sample of GPs using semi-structured, face-to-face interviews. A structured grid was used to describe the documents. Quantitative and qualitative analysis was performed. Sixty GPs participated in the study. They stated that a waiting room had to be pleasant, but agreed that it was a useful vector for providing health information. The GPs stated that they distributed documents designed to improve patient care by encouraging screening, providing health education information and addressing delicate subjects more easily. However, some physicians believed that this information can sometimes make patients more anxious. A large number of documents were often available, covering a variety of topics. General practitioners intentionally use their waiting rooms to disseminate a broad range of health-related information, but without developing a clearly defined strategy. It would be interesting to correlate the topics addressed by waiting room documents with prevention practices introduced during the visit.

Ethical psychiatry in an uncertain world: conversations and parallel truths.

PubMed

Carson, Alexander M; Lepping, Peter

2009-06-25

Psychiatric practice is often faced with complex situations that seem to pose serious moral dilemmas for practitioners. Methods for solving these dilemmas have included the development of more objective rules to guide the practitioner such as utilitarianism and deontology. A more modern variant on this objective model has been 'Principlism' where 4 mid level rules are used to help solve these complex problems. In opposition to this, there has recently been a focus on more subjective criteria for resolving complex moral dilemmas. In particular, virtue ethics has been posited as a more sensitive method for helping doctors to reason their way through difficult ethical issues. Here the focus is on the character traits of the practitioner. Bloch and Green advocated another way whereby more objective methods such as Principlism and virtue ethics are combined to produce what they considered sound moral reasoning in psychiatrists. This paper points out some difficulties with this approach and instead suggests that a better model of ethical judgment could be developed through the use of narratives or stories. This idea puts equal prima facie value on the patient's and the psychiatrist's version of the dilemma they are faced with. It has the potential to lead to a more genuine empathy and reflective decision-making.

Attendance for general practitioner asthma care by children with moderate to severe asthma in Auckland, New Zealand.

PubMed

Buetow, Stephen; Richards, Deborah; Mitchell, Ed; Gribben, Barry; Adair, Vivienne; Coster, Gregor; Hight, Makere

2004-11-01

Attendance for general practitioner (GP) care of childhood asthma varies widely in New Zealand (NZ). There is little current research to account for the variations, although groups such as Māori and Pacific peoples have traditionally faced barriers to accessing GP care. This paper aims to describe and account for attendance levels for GP asthma care among 6-9 year-olds with moderate to severe asthma in Auckland, NZ. During 2002, randomly selected schools identified all 6-9 year-olds with possible breathing problems. Completion of a questionnaire by each parent/guardian indicated which children had moderate to severe asthma, and what characteristics influenced their access to GP asthma care. A multilevel, negative binomial regression model (NBRM) was fitted to account for the number of reported GP visits for asthma, with adjustment for clustering within schools. Twenty-six schools (89.7 percent) identified 931 children with possible breathing problems. Useable questionnaires were returned to schools by 455 children (48.9 percent). Results indicated 209 children with moderate to severe asthma, almost one in every three reportedly making 5 or more GP visits for asthma in the previous year. Māori, Pacific and Asian children were disproportionately represented among these 'high attendees'. Low attendees (0-2 visits) were mainly NZ Europeans. The NBRM (n=155) showed that expected visits were increased by perceived need, ill-health, asthma severity and, in particular, Māori and Pacific child ethnicity. It may be that Māori and Pacific children no longer face significant barriers to accessing GP asthma care. However, more likely is that barriers apply only to accessing routine, preventative care, leading to poor asthma control, exacerbations requiring acute care, and paradoxically an increase in GP visits. That barriers may increase total numbers of visits challenges the assumption, for all health systems, that access can be defined in terms of barriers that must be overcome to obtain health care.

Healthcare providers’ knowledge, experience and challenges of reporting adverse events following immunisation: a qualitative study

PubMed Central

2013-01-01

Background Healthcare provider spontaneous reporting of suspected adverse events following immunisation (AEFI) is central to monitoring post-licensure vaccine safety, but little is known about how healthcare professionals recognise and report to surveillance systems. The aim of this study was explore the knowledge, experience and attitudes of medical and nursing professionals towards detecting and reporting AEFI. Methods We conducted a qualitative study, using semi-structured, face to face interviews with 13 Paediatric Emergency Department consultants from a tertiary paediatric hospital, 10 General Practitioners, 2 local council immunisation and 4 General Practice nurses, recruited using purposive sampling in Adelaide, South Australia, between December 2010 and September 2011. We identified emergent themes related to previous experience of an AEFI in practice, awareness and experience of AEFI reporting, factors that would facilitate or impede reporting and previous training in vaccine safety. Thematic analysis was used to analyse the data. Results AEFI reporting was infrequent across all groups, despite most participants having reviewed an AEFI. We found confusion about how to report an AEFI and variability, according to the provider group, as to the type of events that would constitute a reportable AEFI. Participants’ interpretation of a “serious” or “unexpected” AEFI varied across the three groups. Common barriers to reporting included time constraints and unsatisfactory reporting processes. Nurses were more likely to have received formal training in vaccine safety and reporting than medical practitioners. Conclusions This study provides an overview of experience and beliefs of three healthcare professional groups in relation to identifying and reporting AEFI. The qualitative assessment reveals differences in experience and awareness of AEFI reporting across the three professional groups. Most participants appreciated the importance of their role in AEFI surveillance and monitoring the ongoing safety of vaccines. Future initiatives to improve education, such as increased training to health care providers, particularly, medical professionals, are required and should be included in both undergraduate curricula and ongoing, professional development. PMID:23945045

The malpractice premium costs of obstetrics.

PubMed

Norton, S A

1997-01-01

This study examined, in 1992, the variation in the level of malpractice premiums, and the incremental malpractice premium costs associated with the practice of obstetrics for family practitioners and obstetricians. On average, in 1992 obstetricians and family practitioners providing obstetric services paid malpractice premiums of roughly $44,000 and $16,000, respectively. The incremental increase in malpractice premium costs represented roughly 70% of the premium the physicians would have paid had they not provided obstetric services. These results suggest that for both family practitioners and obstetricians, there is a considerable premium penalty associated with providing obstetric services which may have implications for women's access to obstetric services. Moreover, the results make it clear that physicians practicing in different states, and different specialists within a state, may face very different malpractice premium costs.

Impact Challenges in Community Science-with-Practice: Lessons from PROSPER on Transformative Practitioner-Scientist Partnerships and Prevention Infrastructure Development

PubMed Central

Greenberg, Mark

2011-01-01

At present, evidence-based programs (EBPs) to reduce youth violence are failing to translate into widespread community practice, despite their potential for impact on this pervasive public health problem. In this paper we address two types of challenges in the achievement of such impact, drawing upon lessons from the implementation of a partnership model called PROSPER. First, we address five key challenges in the achievement of community-level impact through effective community planning and action: readiness and mobilization of community teams; maintaining EBP implementation quality; sustaining community teams and EBPs; demonstrating community-level impact; and continuous, proactive technical assistance. Second, we consider grand challenges in the large-scale translation of EBPs: (1) building, linking and expanding existing infrastructures to support effective EBP delivery systems, and (2) organizing networks of practitioner-scientist partnerships—networks designed to integrate diffusion of EBPs with research that examines effective strategies to do so. The PROSPER partnership model is an evidence-based delivery system for community-based prevention and has evolved through two decades of NIH-funded research, assisted by land grant universities' Cooperative Extension Systems. Findings and lessons of relevance to each of the challenges are summarized. In this context, we outline how practitioner-scientist partnerships can serve to transform EBP delivery systems, particularly in conjunction with supportive federal policy. PMID:21222151

Impact challenges in community science-with-practice: lessons from PROSPER on transformative practitioner-scientist partnerships and prevention infrastructure development.

PubMed

Spoth, Richard; Greenberg, Mark

2011-09-01

At present, evidence-based programs (EBPs) to reduce youth violence are failing to translate into widespread community practice, despite their potential for impact on this pervasive public health problem. In this paper we address two types of challenges in the achievement of such impact, drawing upon lessons from the implementation of a partnership model called PROSPER. First, we address five key challenges in the achievement of community-level impact through effective community planning and action: readiness and mobilization of community teams; maintaining EBP implementation quality; sustaining community teams and EBPs; demonstrating community-level impact; and continuous, proactive technical assistance. Second, we consider grand challenges in the large-scale translation of EBPs: (1) building, linking and expanding existing infrastructures to support effective EBP delivery systems, and (2) organizing networks of practitioner-scientist partnerships-networks designed to integrate diffusion of EBPs with research that examines effective strategies to do so. The PROSPER partnership model is an evidence-based delivery system for community-based prevention and has evolved through two decades of NIH-funded research, assisted by land grant universities' Cooperative Extension Systems. Findings and lessons of relevance to each of the challenges are summarized. In this context, we outline how practitioner-scientist partnerships can serve to transform EBP delivery systems, particularly in conjunction with supportive federal policy.

Understanding the older food consumer. Present day behaviours and future expectations.

PubMed

Hunter, Wendy; Worsley, Tony

2009-02-01

The main aim of this study was to determine whether Baby boomers know how they would manage to maintain a healthy diet on lower incomes in retirement. A cross-sectional survey was conducted at two shopping centres in Melbourne, Australia with 352 respondents. Contingency table analyses (using chi-square tests) were used to examine differences in present and future cooking habits between gender, age and socio-economic groups as well as anticipated changes to food shopping if they had less money in the future. The findings suggest that the most common food preparation behaviours were making meals from scratch ingredients (approximately 80% of participants) or using a combination of fresh and convenience foods (approximately 55% of participants), with socio-economic and demographic factors significantly influencing specific behaviours. Nearly 50% responded that if they had reduced income they would make a change to their food shopping habits. The most common changes were to the types of food purchased and seeking out special offers or cheaper brands. The results suggest that when faced with a lower standard of living, people will make changes to their food consumption habits. The challenge facing health promotion practitioners, is to ensure that these changes are well informed, leading to healthy options.

Drought vulnerability assessment: The case of wheat farmers in Western Iran

NASA Astrophysics Data System (ADS)

Zarafshani, Kiumars; Sharafi, Lida; Azadi, Hossein; Hosseininia, Gholamhossein; De Maeyer, Philippe; Witlox, Frank

2012-12-01

Drought, as a natural and slow-onset phenomenon, creates numerous damages to agricultural communities. As a drought prone area in the Middle East, Iran has currently launched a crisis management approach to mitigate the harmful impacts of drought. However, thus far studies indicate that effective drought management strategies should be designed based upon vulnerability management which can increase farmers' ability to challenge the impacts. The purpose of this study was to assess drought vulnerability across three drought intensities (very high, extremely high, and critical) areas in Western Iran. Accordingly, a survey study was applied and 370 wheat farmers who all experienced drought during 2007-2009 were selected through a multi-stage stratified random sampling method. Face to face interviews were used to collect data on vulnerability indices from the farmers. Me-Bar and Valdez's vulnerability formula was applied to assess the vulnerability of wheat farmers during drought. Results revealed that the farmers' vulnerability is influenced mainly by economic, socio-cultural, psychological, technical, and infrastructural factors. The results also indicated that the farmers in Sarpole-Zahab township were most vulnerable compared to those in the Kermanshah township as the least vulnerable. Accordingly, some conclusions and recommendations are drawn for both policy-makers and practitioners who often must prioritize limited resources in the design vulnerability-reducing interventions.

Citizens advice in primary care: a qualitative study of the views and experiences of service users and staff.

PubMed

Burrows, J; Baxter, S; Baird, W; Hirst, J; Goyder, E

2011-10-01

To examine the views and experiences of staff and users of Citizens Advice Bureau (CAB) services located in general practice, and to identify key factors perceived as contributing to the intervention's effectiveness. A qualitative study in an urban and rural primary care setting in the UK. Semi-structured, face-to-face interviews (n = 22) with primary care and practice staff, CAB advisors and 12 service users. Key positive service features reported by all groups were: the confidential, non-stigmatizing and familiar environment of a general practitioner's (GP) surgery; the ability to make appointments and experienced advisor availability and continuity. Outcomes for service users were described as financial gain, managed debt, and beneficial social and mental health impacts. Perceived staff benefits were appropriate referral and better use of GP consultation time. Welfare advice in primary care has financial benefits and was perceived by participants to offer health and other benefits to patients and staff. However, while perceptions of gain from the intervention were evident, demonstration of measurable health improvement and well-being presents challenges. Further empirical work is needed in order to explore these complex cause-effect links and the cost-effectiveness of the intervention. Copyright © 2011 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Service user involvement in nurse education: a report on using online discussions with a service user to augment his digital story.

PubMed

Terry, Louise M

2012-02-01

Service user involvement is a key element within current pre- and post-registration nurse education in the U.K. but achieving this is challenging. Most service user involvement is through classroom visits. Digital stories, film and audio are alternatives but lack the interactivity and development of reflection that can be achieved through face-to-face contact. This report reviews the background to service user involvement in healthcare professional education then provides a reflective account of a novel initiative whereby a spinal-injured patient was involved in creating a digital story around some of his in-hospital experiences and then engaged in online discussions with post-registration nursing (degree) and practice educator (masters) students. These discussions provided a richer experience for the students enabling them to reflect more deeply on how nursing care is delivered and perceived by service users. The report concludes that digital stories can be used with repeated groups to inspire discussion and reflection. Augmenting such digital stories with online discussions with the service user whose story is told helps practitioners develop greater empathy, insight and understanding which are beneficial for improving service delivery and nursing care. Copyright © 2011 Elsevier Ltd. All rights reserved.

Social Justice Competencies and Career Development Practices

ERIC Educational Resources Information Center

Arthur, Nancy; Collins, Sandra; Marshall, Catherine; McMahon, Mary

2013-01-01

The recent focus on social justice issues in career development is primarily conceptual in nature and few resources account for the challenges or successes experienced by career development practitioners. The purpose of this article is to report the results of a research study of career practitioners in Canada regarding the competencies they use…

Fostering Transformative Practitioners for Critical EAP: Possibilities and Challenges

ERIC Educational Resources Information Center

Morgan, Brian

2009-01-01

In this article, I explore the often difficult transfer of theory to practice in respect to promoting the conceptual role of transformative intellectual/practitioner through a pre-service "social issues project" for future EAP and ESL teachers. Following an examination of more established role options in EAP (e.g. technician, reflective…

SARC Literacy Activities Handbook: Supporting Literacy for People with Intellectual/Developmental Challenges.

ERIC Educational Resources Information Center

Lockert, Richard

This document is intended as a handbook for literacy practitioners working with adults with intellectual and/or developmental disabilities. The handbook is the product of the following activities: extensive research of the literature; discussion and exchange with literacy experts, practitioners, and some learners; and solicitation of input from…

Dynamic Sustainability: Practitioners' Perspectives on Housing First Implementation Challenges and Model Fidelity Over Time

ERIC Educational Resources Information Center

Stergiopoulos, Vicky; Zerger, Suzanne; Jeyaratnam, Jeyagobi; Connelly, Jolynn; Kruk, Katherine; O'Campo, Patricia; Hwang, Stephen

2016-01-01

Objectives: Although Housing First (HF) is a popular evidence-based intervention for persons experiencing homelessness and mental illness, research exploring its sustainability over time is scant. This mixed methods study captures practitioners' perspectives on key shifts in implementation of Housing First in a large urban center, and factors…

Aligning Sales Curriculum Content and Pedagogy with Practitioners' Needs

ERIC Educational Resources Information Center

Newberry, Robert; Collins, Marianne K.

2015-01-01

Meeting the instructional needs of both students and sales practitioners is a common challenge for sales educators. The dynamic and ever evolving nature of the sales landscape, in conjunction with the need to align sales curriculum with relevant business practices is the focus of this article. Building on previous research, this study investigates…

Practitioner Research and Professional Development in Education

ERIC Educational Resources Information Center

Campbell, Anne; McNamara, Olwen; Gilroy, Peter

2004-01-01

This book aims to support and prepare practitioners to undertake small-scale inquiries and research investigations. The processes of research and inquiry-based learning help teachers come to terms with the complexities and challenges of teaching as their responsibilities widen to include the notion of the teacher as researcher. This major shift in…

Implications of Sport Retirement Research for the Practitioner.

ERIC Educational Resources Information Center

Greendorfer, Susan L.

This paper cites findings from a research study on 1,100 former intercollegiate athletes (427 males and 696 females) to demonstrate the relevance of sport retirement research to coaches and other practitioners. The data are used to challenge typical assumptions about the process of leaving sport (i.e., sport retirement is a termination of…

Preparing the Next Generation of Teacher Educators: The Role of Practitioner Inquiry

ERIC Educational Resources Information Center

Jacobs, Jennifer; Yendol-Hoppey, Diane; Dana, Nancy Fichtman

2015-01-01

Although the NCATE Blue Ribbon Panel Report challenges those responsible for teacher preparation to design clinically rich programs, there is little discussion about preparing teacher educators to actualize these innovations. This study explored how practitioner inquiry could serve as a mechanism to facilitate the development of the next…

The Future of Marketing Education: A Practitioner's Perspective

ERIC Educational Resources Information Center

Finch, David; Nadeau, John; O'Reilly, Norm

2013-01-01

Drawing on the marketing literature, as well as the views of both marketing educators and current marketers in Canada, a survey was conducted of marketing practitioners to determine their top priorities for improvement in marketing education, as well as the key challenges in need of attention. An importance-performance analysis was carried out on…

Educating Reflexive Practitioners: Casting Graduate Teaching Assistants as Mentors in First-Year Classrooms

ERIC Educational Resources Information Center

Henry, Jim; Bruland, Holly H.

2010-01-01

Reflective practice has become a mainstay in many inquiries into teaching and learning, presenting reflective practitioners with the challenge of accounting for their own institutional positions when interpreting student performance in the binary teacher-student configurations of most classrooms. This study analyzes the perspectives of TAs cast as…

Building a Bridge or Digging a Pipeline? Clinical Data Mining in Evidence-Informed Knowledge Building

ERIC Educational Resources Information Center

Epstein, Irwin

2015-01-01

Challenging the "bridge metaphor" theme of this conference, this article contends that current practice-research integration strategies are more like research-to-practice "pipelines." The purpose of this article is to demonstrate the potential of clinical data-mining studies conducted by practitioners, practitioner-oriented PhD…

Homeland Security. Management Challenges Facing Federal Leadership

DTIC Science & Technology

2002-12-01

Security Management Challenges Facing Federal Leadership 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT...including attention to management practices and key success factors. HOMELAND SECURITY Management Challenges Facing Federal Leadership www.gao.gov/cgi...significant management and coordination challenges if it is to provide this leadership and be successful in preventing and responding to any future

Development and psychometric testing of the Nurse Practitioner Primary Care Organizational Climate Questionnaire.

PubMed

Poghosyan, Lusine; Nannini, Angela; Finkelstein, Stacey R; Mason, Emanuel; Shaffer, Jonathan A

2013-01-01

Policy makers and healthcare organizations are calling for expansion of the nurse practitioner (NP) workforce in primary care settings to assure timely access and high-quality care for the American public. However, many barriers, including those at the organizational level, exist that may undermine NP workforce expansion and their optimal utilization in primary care. This study developed a new NP-specific survey instrument, Nurse Practitioner Primary Care Organizational Climate Questionnaire (NP-PCOCQ), to measure organizational climate in primary care settings and conducted its psychometric testing. Using instrument development design, the organizational climate domain pertinent for primary care NPs was identified. Items were generated from the evidence and qualitative data. Face and content validity were established through two expert meetings. Content validity index was computed. The 86-item pool was reduced to 55 items, which was pilot tested with 81 NPs using mailed surveys and then field-tested with 278 NPs in New York State. SPSS 18 and Mplus software were used for item analysis, reliability testing, and maximum likelihood exploratory factor analysis. Nurse Practitioner Primary Care Organizational Climate Questionnaire had face and content validity. The content validity index was .90. Twenty-nine items loaded on four subscale factors: professional visibility, NP-administration relations, NP-physician relations, and independent practice and support. The subscales had high internal consistency reliability. Cronbach's alphas ranged from.87 to .95. Having a strong instrument is important to promote future research. Also, administrators can use it to assess organizational climate in their clinics and propose interventions to improve it, thus promoting NP practice and the expansion of NP workforce.

Managing controversy through consultation: a qualitative study of communication and trust around MMR vaccination decisions

PubMed Central

McMurray, Robert; Cheater, Francine M; Weighall, Anna; Nelson, Carolyn; Schweiger, Martin; Mukherjee, Suzanne

2004-01-01

Background: Controversy over the measles, mumps, and rubella (MMR) vaccine has reduced uptake, raising concerns of a future disease epidemic. Aims: To explore parents' accounts of decision making relating to the MMR vaccine controversy, identifying uptake determinants and education needs. Design of study: Qualitative interviews analysed using the ‘framework’ approach. Setting: Five general practices in the Leeds area, 2002–2003. Method: Sixty-nine interviews conducted with parents of children aged between 4 and 5 years, and 12 interviews with primary care practitioners, managers and immunisation coordinators serving participating sites. Participants were interviewed one-to-one in a place of their choice. Results: The vaccination decision is primarily a function of parental assessments of the relative acceptability and likelihood of possible outcomes. For most parents the evidence of science and medicine plays little role in the decision. Although local general practitioners and health visitors are trusted information sources, the influence of primary care providers on the vaccination decision is limited by concerns over consultation legitimacy, discussion opportunity, and perceptions of financial and political partiality. Parents and practitioners identify a need for new approaches to support decisions and learning when faced with this and similar healthcare controversies. These include new collaborative approaches to information exchange designed to transform rather than supplant existing parent knowledge as part of an ongoing learning process. Conclusion: The study identified new ways in which parents and practitioners need to be supported in order to increase understanding of medical science and secure more informed decisions in the face of health controversy. PMID:15239914

Landowner and practitioner perspectives on private land conservation programs

USGS Publications Warehouse

Lute, Michelle L.; Gillespie, Caitlyn R.; Fontaine, Joseph J.; Martin, Dustin R.

2018-01-01

Efforts to reverse declines in native grasslands benefit from agricultural policies that encourage private land conservation. The U.S. Department of Agriculture’s Conservation Reserve Program (CRP) improved conservation across landscapes but enrollment has declined. We used sequential exploratory mixed methods to compare landowner and conservation practitioners’ perceptions, evaluate perceived benefits, and identify potential improvements to CRP. Focus groups of practitioners informed a quantitative survey of landowners who had properties >160 total acres in Nebraska. Results suggest potential misalignment in perceptions between practitioners and landowners. Practitioners were concerned that conservation, especially of wildlife, was secondary to profit. But the majority of landowners valued CRP-related ecosystem services, including native pollinators. Practitioners posited that younger landowners were primarily profit motivated, but CRP enrollment did not differ by demographics. Practitioners and landowners identified rule complexity as a major challenge and practitioner–landowner relationships as critical to success. Findings suggest that practitioners may underestimate non-economic motivations and illuminate opportunities to encourage private land conservation.

A simple device for teaching direct ophthalmoscopy to primary care practitioners.

PubMed

Chung, Kelly D; Watzke, Robert C

2004-09-01

Ophthalmoscopy, a valuable skill for primary care practitioners, can be challenging to learn. A simple and inexpensive device for teaching direct ophthalmoscopy to primary care practitioners is described. Device description. Cylindrical plastic canisters were altered to have an artificial pupil at one end and a replaceable fundus photograph at the other end to simulate the mechanics of performing direct ophthalmoscopy on a real eye. These were tested for ease of use by primary care students. The devices to aid in teaching ophthalmoscopy proved to be simple and inexpensive to construct. They allowed students to practice direct ophthalmoscopy technique and identification of funduscopic abnormalities. This simple device for teaching direct ophthalmoscopy to primary care practitioners is inexpensive to create and is a valuable aid for teaching direct ophthalmoscopy to primary care practitioners.

[Family practitioners in Switzerland by 2030: which roles for medical task delegation?].

PubMed

Jaccard Ruedin, Hélène; Seematter-Bagnoud, Laurence; Roth, Maik; Junod, Julien; Santos-Eggimann, Brigitte

2009-01-01

Due to population aging, by 2030 Switzerland may face a demand of 24 million family practitioner visits, a growth of 13 percent from the 2005 level. This result is based on the assumption that the per capita demand for doctor visits remains what was observed in 2005 by age groups and sex. During the same period, the total number of practitioners may decrease by 14 percent whereas the female proportion of such practitioners may double. These changes may cause a 33 percent decrease in the supply of physician visits to reach only 14 millions. The comparison of the demand and supply of family doctor visits reveals that by 2030, 10 million visits may be unmet which represents 40 percent of the demand. On the supply side, a full scale implementation of task delegation may partially reduce that gap (minus 2 millions). On the demand side, improved health status may bring in a larger decrease in the needs for visits (minus 4 million).

Psychological distress and subjective burden of caregivers of people with mental illness: the role of affiliate stigma and face concern.

PubMed

Mak, Winnie W S; Cheung, Rebecca Y M

2012-06-01

The present study tested the mediating role of affiliate stigma on the relationships between face concern with psychological distress and subjective burden among caregivers of people with severe mental illnesses. One hundred and eight Chinese caregivers in Hong Kong were surveyed. Based on Baron and Kenny's (J Pers Soc Psychol 51:1173-1182, 1986) approach, affiliate stigma was found to serve as a partial mediator between face concern and caregiver distress and a full mediator between face concern and subjective burden. Cultural linkage of stigma and caregiver outcomes was identified, suggesting that researchers and practitioners should use a culturally sensitive approach to understand caregivers' experience and alleviate their stigma.

E-Mentoring the Online Doctoral Student from the Dissertation Prospectus through Dissertation Completion

ERIC Educational Resources Information Center

Black, Ronald

2017-01-01

Faculty who mentor online doctoral candidates face many of the same challenges and opportunities as those mentoring doctoral candidates in traditional, face-to-face modalities. The main difference is that E-Mentoring is based on interacting in the online space rather than interacting face-to-face, which may present challenges for both the…

Tensions and Dilemmas in Community Development: New Discourses, New Trojans?

ERIC Educational Resources Information Center

Kenny, Sue

2002-01-01

Contradictory expectations facing community development practitioners include innovation versus bureaucratic accountability and professionalization versus grassroots activism. Four operating frameworks affect practice: charity, welfare state, activism, and market. In some instances, these frameworks and their related discourses are being fused,…

A simulation-based approach to evaluate safety impacts of increased traffic signal density.

DOT National Transportation Integrated Search

2002-01-01

One of the most controversial access management techniques practitioners face is also one of the most common: restricting signal density. Increased signal density can improve access for minor approaches to a corridor; however, it can also increase de...

Burning Mouth Syndrome.

PubMed

Klasser, Gary D; Grushka, Miriam; Su, Nan

2016-08-01

Burning mouth syndrome (BMS) is an enigmatic, misunderstood, and under-recognized painful condition. Symptoms associated with BMS can be varied, thereby providing a challenge for practitioners and having a negative impact on oral health-related quality of life for patients. Management also remains a challenge for practitioners because it is currently only targeted for symptom relief without a definitive cure. There is an urgent need for further investigations to determine the efficacy of different therapies because this is the only way viable therapeutic options can be established for patients with this chronic and painful syndrome. Copyright © 2016 Elsevier Inc. All rights reserved.

[Between individuality and "evidence-based medicine"--the role of the general practitioner within the scope of disease management programs].

PubMed

Szecsenyi, Joachim; Schneider, Antonius

2003-06-01

In Germany, the change from the "traditional", experience-based general practitioner (GP) to the evidence-based practising co-ordinator may be accelerated by the introduction of disease management programmes. Here, we will discuss some tools that can help to meet this challenge. Also, a set of requirements will be defined that the health care system will have to provide in support of GPs. Maintaining the relationship between doctor and patient and also allowing for individual care on the basis of evidence-based medicine will remain a challenge.

But I Don't Understand You: One Faculty's Observations of the Challenges Facing International Healthcare Students

ERIC Educational Resources Information Center

DuBose, Cheryl O.

2017-01-01

International students face many challenges when pursuing a degree in higher education. Communication and cultural differences are typically cited as the most challenging aspects of any study abroad program. Students attempting to complete a healthcare program face sometimes insurmountable issues, as communication, cultural differences, and…

The Sisters of Mercy in the Crimean War: Lessons for Catholic health care

PubMed Central

Paradis, Mary Raphael; Hart, Edith Mary; O’Brien, Mary Judith

2017-01-01

In 1856, an appeal went out to nurses in both England and Ireland, and especially to religious nurses, to care for the troops fighting in the Crimean War. The Sisters of Mercy, founded in 1831 by Venerable Catherine McAuley, answered that call. This article describes the enormous challenges the Sisters faced in that mission, which was a test of their nursing skills, flexibility, organizational ability, and their spirit of mercy. The challenges they faced professionally and as religious Sisters, the manner in which they faced those challenges, and their spiritual lives as religious women shaped their ability to give comprehensive care. Some applications are made to the challenges which religious communities and organizations working in health care face in our country at this time. Summary: This article describes the challenges faced by a group of Sisters of Mercy from England and Ireland who volunteered to serve as nurses in the Crimean War from 1856 to 1858. Applications are made to challenges which are faced by religious communities and organizations in the current secular healthcare environment. PMID:28392597

The Sisters of Mercy in the Crimean War: Lessons for Catholic health care.

PubMed

Paradis, Mary Raphael; Hart, Edith Mary; O'Brien, Mary Judith

2017-02-01

In 1856, an appeal went out to nurses in both England and Ireland, and especially to religious nurses, to care for the troops fighting in the Crimean War. The Sisters of Mercy, founded in 1831 by Venerable Catherine McAuley, answered that call. This article describes the enormous challenges the Sisters faced in that mission, which was a test of their nursing skills, flexibility, organizational ability, and their spirit of mercy. The challenges they faced professionally and as religious Sisters, the manner in which they faced those challenges, and their spiritual lives as religious women shaped their ability to give comprehensive care. Some applications are made to the challenges which religious communities and organizations working in health care face in our country at this time. Summary: This article describes the challenges faced by a group of Sisters of Mercy from England and Ireland who volunteered to serve as nurses in the Crimean War from 1856 to 1858. Applications are made to challenges which are faced by religious communities and organizations in the current secular healthcare environment.

Economic evaluation of nurse practitioner and clinical nurse specialist roles: A methodological review.

PubMed

Lopatina, Elena; Donald, Faith; DiCenso, Alba; Martin-Misener, Ruth; Kilpatrick, Kelley; Bryant-Lukosius, Denise; Carter, Nancy; Reid, Kim; Marshall, Deborah A

2017-07-01

Advanced practice nurses (e.g., nurse practitioners and clinical nurse specialists) have been introduced internationally to increase access to high quality care and to tackle increasing health care expenditures. While randomised controlled trials and systematic reviews have demonstrated the effectiveness of nurse practitioner and clinical nurse specialist roles, their cost-effectiveness has been challenged. The poor quality of economic evaluations of these roles to date raises the question of whether current economic evaluation guidelines are adequate when examining their cost-effectiveness. To examine whether current guidelines for economic evaluation are appropriate for economic evaluations of nurse practitioner and clinical nurse specialist roles. Our methodological review was informed by a qualitative synthesis of four sources of information: 1) narrative review of literature reviews and discussion papers on economic evaluation of advanced practice nursing roles; 2) quality assessment of economic evaluations of nurse practitioner and clinical nurse specialist roles alongside randomised controlled trials; 3) review of guidelines for economic evaluation; and, 4) input from an expert panel. The narrative literature review revealed several challenges in economic evaluations of advanced practice nursing roles (e.g., complexity of the roles, variability in models and practice settings where the roles are implemented, and impact on outcomes that are difficult to measure). The quality assessment of economic evaluations of nurse practitioner and clinical nurse specialist roles alongside randomised controlled trials identified methodological limitations of these studies. When we applied the Guidelines for the Economic Evaluation of Health Technologies: Canada to the identified challenges and limitations, discussed those with experts and qualitatively synthesized all findings, we concluded that standard guidelines for economic evaluation are appropriate for economic evaluations of nurse practitioner and clinical nurse specialist roles and should be routinely followed. However, seven out of 15 current guideline sections (describing a decision problem, choosing type of economic evaluation, selecting comparators, determining the study perspective, estimating effectiveness, measuring and valuing health, and assessing resource use and costs) may require additional role-specific considerations to capture costs and effects of these roles. Current guidelines for economic evaluation should form the foundation for economic evaluations of nurse practitioner and clinical nurse specialist roles. The proposed role-specific considerations, which clarify application of standard guidelines sections to economic evaluation of nurse practitioner and clinical nurse specialist roles, may strengthen the quality and comprehensiveness of future economic evaluations of these roles. Copyright © 2017 Elsevier Ltd. All rights reserved.

Improving the Curriculum with Ethics: Gaps between Perceived Ethical Challenges of Practitioners and Educators

ERIC Educational Resources Information Center

Dolezel, Diane M.; Morrison, Eileen E.

2017-01-01

Health information management (HIM) professionals must address ethical challenges in their role as guardians of patients' personal information and organizations' proprietary information. Because of this need, HIM educators strive prepare their students to address these challenges. Unfortunately, little evidence exists about specific areas of…

In search of evidence-based plastic surgery: the problems faced by the specialty.

PubMed

Offer, G J; Perks, A G

2000-07-01

Recently, there has been significant interest both from government and medical practitioners in the discipline of evidence-based medicine. In this article we discuss the problems faced by the plastic surgeon when trying to ensure that practice is evidence-based and highlight some of the reasons behind these difficulties. With the rapid growth of the Internet we also outline its use to access high quality information for the plastic surgeon. Copyright 2000 The British Association of Plastic Surgeons.

3D Face Generation Tool Candide for Better Face Matching in Surveillance Video

DTIC Science & Technology

2014-07-01

Safety and Security Program (CSSP) which is led by Defence Research and Development Canada’s Centre for Security Science, in partnership with Public ...by the Minister of National Defence, 2014 © Sa Majesté la Reine (en droit du Canada), telle que représentée par le ministre de la Défense nationale... public safety and security practitioners to achieve specific objectives; 4. Threats/Hazards F – Major trans-border criminal activity – e.g. smuggling

The effect of nurses’ preparedness and nurse practitioner status on triage call management in primary care: A secondary analysis of cross-sectional data from the ESTEEM trial

PubMed Central

Varley, Anna; Warren, Fiona C.; Richards, Suzanne H.; Calitri, Raff; Chaplin, Katherine; Fletcher, Emily; Holt, Tim A.; Lattimer, Valerie; Murdoch, Jamie; Richards, David A.; Campbell, John

2016-01-01

Background Nurse-led telephone triage is increasingly used to manage demand for general practitioner consultations in UK general practice. Previous studies are equivocal about the relationship between clinical experience and the call outcomes of nurse triage. Most research is limited to investigating nurse telephone triage in out-of-hours settings. Objective To investigate whether the professional characteristics of primary care nurses undertaking computer decision supported software telephone triage are related to call disposition. Design Questionnaire survey of nurses delivering the nurse intervention arm of the ESTEEM trial, to capture role type (practice nurse or nurse practitioner), prescriber status, number of years’ nursing experience, graduate status, previous experience of triage, and perceived preparedness for triage. Our main outcome was the proportion of triaged patients recommended for follow-up within the practice (call disposition), including all contact types (face-to-face, telephone or home visit), by a general practitioner or nurse. Settings 15 general practices and 7012 patients receiving the nurse triage intervention in four regions of the UK. Participants 45 nurse practitioners and practice nurse trained in the use of clinical decision support software. Methods We investigated the associations between nursing characteristics and triage call disposition for patient ‘same-day’ appointment requests in general practice using multivariable logistic regression modelling. Results Valid responses from 35 nurses (78%) from 14 practices: 31/35 (89%) had ≥10 years’ experience with 24/35 (69%) having ≥20 years. Most patient contacts (3842/4605; 86%) were recommended for follow-up within the practice. Nurse practitioners were less likely to recommend patients for follow-up odds ratio 0.19, 95% confidence interval 0.07; 0.49 than practice nurses. Nurses who reported that their previous experience had prepared them less well for triage were more likely to recommend patients for follow-up (OR 3.17, 95% CI 1.18–5.55). Conclusion Nurse characteristics were associated with disposition of triage calls to within practice follow-up. Nurse practitioners or those who reported feeling ‘more prepared’ for the role were more likely to manage the call definitively. Practices considering nurse triage should ensure that nurses transitioning into new roles feel adequately prepared. While standardised training is necessary, it may not be sufficient to ensure successful implementation. PMID:27087294

E-Assessment: Challenges to the Legitimacy of VET Practitioners and Auditors

ERIC Educational Resources Information Center

Callan, Victor J.; Johnston, Margaret A.; Clayton, Berwyn; Poulsen, Alison L.

2016-01-01

This research examines what practitioners in vocational education and training (VET) organisations and external auditors judge to be the key issues in the current and future use of e-assessment. Applying the framework of legitimacy theory, the study examined the tensions around the use and growth of e-assessment in training organisations, and…

Practitioner Action Research on Writing Center Tutor Training: Critical Discourse Analysis of Reflections on Video-Recorded Sessions

ERIC Educational Resources Information Center

Pigliacelli, Mary

2017-01-01

Training writing center tutors to work collaboratively with students on their writing is a complex and challenging process. This practitioner action research uses critical discourse analysis (Gee, 2014a) to interrogate tutors' understandings of their work, as expressed in their written reflections on video-recorded tutoring sessions, to facilitate…

Sharing a Room with Emile: Challenging the Role of the Educator in Experiential Learning Theory

ERIC Educational Resources Information Center

Ozar, Ryan

2015-01-01

Contemporary practitioners of experiential learning look to John Dewey and other progressives for the foundation on which to interpret, design, and facilitate learning through experience. Although Dewey's theory of learning through experience was greatly influenced by other educational theorists and practitioners of the 18th and 19th centuries, by…

Effective Consultation in Educational and Child Psychology Practice: Professional Training for Both Competence and Capability

ERIC Educational Resources Information Center

Kennedy, Emma Kate; Cameron, R. J.; Monsen, Jeremy

2009-01-01

How should applied psychology practitioners be prepared to meet an increasingly challenging and unpredictable working context? This article explores some of the key current issues for educational and child psychology practitioners and their professional trainers in the UK with regard to the topic of effective consultation. The article argues that…

Strategies for Data Collection in Social Skills Group Interventions: A Case Study

ERIC Educational Resources Information Center

Goforth, Anisa N.; Rennie, Brandon J.; Hammond, Julia; Schoffer Closson, Jennifer K.

2016-01-01

For many practitioners in schools and clinics, collecting data to show the effectiveness of an intervention is probably one of the most important yet challenging components of intervention implementation. This article provides practitioners with an example case study of how data can be organized and collected to determine the effectiveness of a…

Confronting Career Double Binds: Implications for Women, Organizations, and Career Practitioners

ERIC Educational Resources Information Center

Shapiro, Mary; Ingols, Cynthia; Blake-Beard, Stacy

2008-01-01

Over the past decade, practitioners and scholars have struggled to explain women's career choices. The current language, including "opting out," "on and off ramping," and "mommy track," is not only inadequate but assumes a deviation from an accepted norm. We challenge the relevance of the paradigm against which women are being judged, namely, the…

Identifying common practices and challenges for local urban tree monitoring programs across the United States

Treesearch

Lara A. Roman; E. Gregory McPherson; Bryant C. Scharenbroch; Julia Bartens

2013-01-01

Urban forest monitoring data are essential to assess the impacts of tree planting campaigns and management programs. Local practitioners have monitoring projects that have not been well documented in the urban forestry literature. To learn more about practitioner-driven monitoring efforts, the authors surveyed 32 local urban forestry organizations across the United...

Sustained Shared Thinking in an Early Childhood Setting: An Exploration of Practitioners' Perspectives

ERIC Educational Resources Information Center

Purdon, Anne

2016-01-01

Sustained shared thinking (SST) has been identified in the Teachers Standards (Early Years) (2013) as contributing to good progress and outcomes by children. In this paper, I define SST and discuss the outcomes of a study of practitioners' understandings of SST, its challenges and benefits. Writing frames, questionnaires and focus group interviews…

Community in Online Higher Education: Challenges and Opportunities

ERIC Educational Resources Information Center

Arasaratnam-Smith, Lily A.; Northcote, Maria

2017-01-01

Exploring the challenges and opportunities associated with the concepts of community and communication in online higher education, this paper reconsiders the intention to replicate face-to-face learning and teaching strategies in online learning environments. Rather than beginning with the assumption that face-to-face education is the prototype…

Query-oriented evidence extraction to support evidence-based medicine practice.

PubMed

Sarker, Abeed; Mollá, Diego; Paris, Cecile

2016-02-01

Evidence-based medicine practice requires medical practitioners to rely on the best available evidence, in addition to their expertise, when making clinical decisions. The medical domain boasts a large amount of published medical research data, indexed in various medical databases such as MEDLINE. As the size of this data grows, practitioners increasingly face the problem of information overload, and past research has established the time-associated obstacles faced by evidence-based medicine practitioners. In this paper, we focus on the problem of automatic text summarisation to help practitioners quickly find query-focused information from relevant documents. We utilise an annotated corpus that is specialised for the task of evidence-based summarisation of text. In contrast to past summarisation approaches, which mostly rely on surface level features to identify salient pieces of texts that form the summaries, our approach focuses on the use of corpus-based statistics, and domain-specific lexical knowledge for the identification of summary contents. We also apply a target-sentence-specific summarisation technique that reduces the problem of underfitting that persists in generic summarisation models. In automatic evaluations run over a large number of annotated summaries, our extractive summarisation technique statistically outperforms various baseline and benchmark summarisation models with a percentile rank of 96.8%. A manual evaluation shows that our extractive summarisation approach is capable of selecting content with high recall and precision, and may thus be used to generate bottom-line answers to practitioners' queries. Our research shows that the incorporation of specialised data and domain-specific knowledge can significantly improve text summarisation performance in the medical domain. Due to the vast amounts of medical text available, and the high growth of this form of data, we suspect that such summarisation techniques will address the time-related obstacles associated with evidence-based medicine. Copyright © 2015 Elsevier Inc. All rights reserved.

Can GPs working in secure environments in England re-license using the Royal College of General Practitioners revalidation proposals?

PubMed Central

2012-01-01

Background Revalidation for UK doctors is expected to be introduced from late 2012. For general practitioners (GPs), this entails collecting supporting information to be submitted and assessed in a revalidation portfolio every five years. The aim of this study was to explore the feasibility of GPs working in secure environments to collect supporting information for the Royal College of General Practitioners’ (RCGP) proposed revalidation portfolio. Methods We invited GPs working in secure environments in England to submit items of supporting information collected during the previous 12 months using criteria and standards required for the proposed RCGP revalidation portfolio and complete a GP issues log. Initial focus groups and initial and follow-up semi-structured face-to-face and telephone interviews were held to explore GPs’ views of this process. Quantitative and qualitative data were analysed using descriptive statistics and identifying themes respectively. Results Of the 50 GPs who consented to participate in the study, 20 submitted a portfolio. Thirty-eight GPs participated in an initial interview, nine took part in a follow-up interview and 17 completed a GP issues log. GPs reported difficulty in collecting supporting information for valid patient feedback, full-cycle clinical audits and evidence for their extended practice role(s) as sessional practitioners in the high population turnover custodial environment. Peripatetic practitioners experienced more difficulty than their institution based counterparts collating this evidence. Conclusions GPs working in secure environments may experience difficulties in collecting the newer types of supporting information for the proposed RCGP revalidation portfolio primarily due to their employment status within a non-medical environment and characteristics of the detainee population. Increased support from secure environment service commissioners and employers will be a prerequisite for these practitioners to enable them to re-license using the RCGP revalidation proposals. PMID:23253694

An intervention to improve program implementation: findings from a two-year cluster randomized trial of Assets-Getting To Outcomes

PubMed Central

2013-01-01

Background Studies have shown that communities have not always been able to implement evidence-based prevention programs with quality and achieve outcomes demonstrated by prevention science. Implementation support interventions are needed to bridge this gap between science and practice. The purpose of this article is to present two-year outcomes from an evaluation of the Assets Getting To Outcomes (AGTO) intervention in 12 Maine communities engaged in promoting Developmental Assets, a positive youth development approach to prevention. AGTO is an implementation support intervention that consists of: a manual of text and tools; face-to-face training, and onsite technical assistance, focused on activities shown to be associated with obtaining positive results across any prevention program. Methods This study uses a nested and cross-sectional, cluster randomized controlled design. Participants were coalition members and program staff from 12 communities in Maine. Each coalition nominated up to five prevention programs to participate. At random, six coalitions and their respective 30 programs received the two-year AGTO intervention and the other six maintained routine operations. The study assessed prevention practitioner capacity (efficacy and behaviors), practitioner exposure to and use of AGTO, practitioner perceptions of AGTO, and prevention program performance. Capacity of coalition members and performance of their programs were compared between the two groups across the baseline, one-, and two-year time points. Results We found no significant differences between AGTO and control group’s prevention capacity. However, within the AGTO group, significant differences were found between those with greater exposure to and use of AGTO. Programs that received the highest number of technical assistance hours showed the most program improvement. Conclusions This study is the first of its kind to show that use of an implementation support intervention-AGTO -yielded improvements in practitioner capacity and consequently in program performance on a large sample of practitioners and programs using a randomized controlled design. ClinicalTrials.gov identifier NCT00780338 PMID:23924279

Supporting mental health in South African HIV-affected communities: primary health care professionals’ understandings and responses

PubMed Central

Burgess, Rochelle Ann

2015-01-01

How do practitioners respond to the mental distress of HIV-affected women and communities? And do their understandings of patients’ distress matter? The World Health Organization (WHO) along with advocates from the Movement for Global Mental Health (MGMH) champion a primary mental health care model to address burgeoning mental health needs in resource-poor HIV-affected settings. Whilst a minority of studies have begun to explore interventions to target this group of women, there is a dearth of studies that explore the broader contexts that will likely shape service outcomes, such as health sector dynamics and competing definitions of mental ill-health. This study reports on an in-depth case study of primary mental health services in a rural HIV-affected community in Northern KwaZulu-Natal. Health professionals identified as the frontline staff working within the primary mental health care model (n = 14) were interviewed. Grounded thematic analysis of interview data highlighted that practitioners employed a critical and socially anchored framework for understanding their patients’ needs. Poverty, gender and family relationships were identified as intersecting factors driving HIV-affected patients’ mental distress. In a divergence from existing evidence, practitioner efforts to act on their understandings of patient needs prioritized social responses over biomedical ones. To achieve this whilst working within a primary mental health care model, practitioners employed a series of modifications to services to increase their ability to target the sociostructural realities facing HIV-affected women with mental health issues. This article suggests that beyond attention to the crucial issues of funding and human resources that face primary mental health care, attention must also be paid to promoting the development of policies that provide practitioners with increased and more consistent opportunities to address the complex social realities that frame the mental distress of HIV-affected women. PMID:25161270

Malpractice and the Communication Consultant: A Proactive Approach.

ERIC Educational Resources Information Center

Montgomery, Daniel J.; And Others

1995-01-01

Provides communication practitioners with an overview of legal and ethical issues facing individuals who market themselves as professional communication consultants. Discusses the tort of negligence. Outlines court-supported practices that professional consultants might use to help protect clients and themselves. Argues that an understanding of…

Patients' willingness to pay for electronic communication with their general practitioner.

PubMed

Bergmo, Trine Strand; Wangberg, Silje Camilla

2007-06-01

Despite the common use of electronic communication in other aspects of everyday life, its use between patients and health care providers has been slow to diffuse. Possible explanations are security issues and lack of payment mechanisms. This study investigated how patients value secure electronic access to their general practitioner (GP). One hundred and ninety-nine patients were asked an open-ended willingness-to-pay (WTP) question as part of a randomised controlled trial. We compared the WTP values between two groups of respondents; one group had had the opportunity to communicate electronically with their GP for a year and the other group had not. Fifty-two percent of the total sample was willing to pay for electronic GP contact. The group of patients with access revealed a significantly lower WTP than the group without such access. Possible explanations are that the system had fewer benefits than expected, a presence of hypothetical bias or simply a preference for face-to-face encounters.

Teaching differential diagnosis to nurse practitioner students in a distance program.

PubMed

Colella, Christine L; Beery, Theresa A

2014-08-01

An interactive case study (ICS) is a novel way to enhance the teaching of differential diagnosis to distance learning nurse practitioner students. Distance education renders the use of many teaching strategies commonly used with face-to-face students difficult, if not impossible. To meet this new pedagogical dilemma and to provide excellence in education, the ICS was developed. Kolb's theory of experiential learning supported efforts to follow the utilization of the ICS. This study sought to determine whether learning outcomes for the distance learning students were equivalent to those of on-campus students who engaged in a live-patient encounter. Accuracy of differential diagnosis lists generated by onsite and online students was compared. Equivalency testing assessed clinical, rather than only statistical, significance in data from 291 students. The ICS responses from the distance learning and onsite students differed by 4.9%, which was within the a priori equivalence estimate of 10%. Narrative data supported the findings. Copyright 2014, SLACK Incorporated.

Relevance of Whitnall's tubercle and auditory meatus in diagnosing exclusions during skull-photo superimposition.

PubMed

Jayaprakash, Paul T; Hashim, Natassha; Yusop, Ridzuan Abd Aziz Mohd

2015-08-01

Video vision mixer based skull-photo superimposition is a popular method for identifying skulls retrieved from unidentified human remains. A report on the reliability of the superimposition method suggested increased failure rates of 17.3 to 32% to exclude and 15 to 20% to include skulls while using related and unrelated face photographs. Such raise in failures prompted an analysis of the methods employed for the research. The protocols adopted for assessing the reliability are seen to vary from those suggested by the practitioners in the field. The former include overlaying the skull- and face-images on the basis of morphology by relying on anthropometric landmarks on the front plane of the face-images and evaluating the goodness of match depending on mix-mode images; the latter consist of orienting the skull considering landmarks on both the eye and ear planes of the face- and skull-images and evaluating the match utilizing images seen in wipe-mode in addition to those in mix-mode. Superimposition of a skull with face-images of five living individuals in two sets of experiments, one following the procedure described for the research on reliability and the other applying the methods suggested by the practitioners has shown that overlaying the images on the basis of morphology depending on the landmarks on the front plane alone and assessing the match in mix-mode fails to exclude the skull. However, orienting the skull relying on the relationship between the anatomical landmarks on the skull- and face-images such as Whitnall's tubercle and exocanthus in the front (eye) plane and the porion and tragus in the rear (ear) plane as well as assessing the match using wipe-mode images enables excluding that skull while superimposing with the same set of face-images. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Facilitating employment opportunities for adults with intellectual and developmental disability through parents and social networks.

PubMed

Petner-Arrey, Jami; Howell-Moneta, Angela; Lysaght, Rosemary

2015-07-01

People with intellectual and developmental disability (IDD) have historically had high unemployment and underemployment rates and continue to face significant barriers to attaining and sustaining employment. The purpose of this research, conducted in Ontario, Canada was to better understand the experiences of people with IDD gaining and keeping productivity roles. We used qualitative semi-structured interviews with 74 participants with IDD and their families or caregivers as proxies regarding the employment of a person with IDD. We selected a sample of persons from three different geographic regions in Ontario, Canada, and analyzed data through coding methods consistent with a grounded theory approach. Our results demonstrate the importance of parents and other members of social and family networks relative to connecting with work options and sustaining work over time, especially through continued advocacy and investment. Parents helped individuals with IDD negotiate the right job fit, though they often encountered challenges as a result of their efforts. Practitioners must understand how to support parents to be effective advocates for their adult children with IDD, assist them to develop and maintain their social networks and help them to avoid caregiver burnout. Implications for Rehabilitation People with intellectual and developmental disability (IDD) face numerous challenges in indentifying work options and overcoming barriers to employment. Parents and other non-paid support members of social networks can be instrumental in ensuring that persons with IDD not only secure initial job placements, but also sustain employment and employment alternatives. Professionals that support persons with IDD can direct their efforts to helping persons with IDD develop strong social connections, as well as helping parents to prevent burnout.

How international medical graduates view their learning needs for UK GP training.

PubMed

Warwick, Christopher

2014-03-01

International medical graduates (IMGs) form a vital group of general practitioners (GPs) in the NHS. They are known to face additional challenges above and beyond those faced by UK medical graduates in the course of their GP training. Whilst they are a heterogeneous group of professionals, their views on what they need to learn, and how they are supported, are often distant from those of the educators responsible for planning their education. This study was undertaken, through narrative-based focus groups, to explore the issues which matter to the IMGs, in an attempt to empower their voices about their experiences in GP training, and to see what lessons could be drawn from these views. The findings confirmed the central importance, and considerable challenge involved, in making an effective transition into the culture of the NHS and UK general practice. The IMGs felt that induction needed to be an on-going, iterative process of learning which continued throughout training, with a more effective individualised learning needs analysis at the start of GP training. Lack of sophisticated language skills was highlighted as a real concern. Recognition that their lack of knowledge about the NHS at the start of training should not be seen as an indicator of deficiency, but a clue to what they needed to learn were also key messages. IMGs also felt the earlier in their training they undertook a GP placement, the quicker they would start to understand the culture of general practice in the UK. Further work following on from this research should include how to manage change in the educational network for these barriers to be overcome.

Practitioner Views on the Impacts, Challenges, and Barriers in Supporting Older Survivors of Sexual Violence.

PubMed

Bows, Hannah

2018-07-01

Despite half a century of research on both sexual violence and elder abuse, the intersection between the two remains largely unexplored. Using theoretical lenses of feminist criminology and critical feminist gerontology, this article explores the intersection between age and sexual violence drawing on interviews with 23 practitioners supporting older survivors (aged 60 and over). They reported physical and emotional effects of sexual violence leading to limited lifestyles, disengagement from social networks, and reliance on pathogenic coping strategies. Provision of effective support was complicated by challenges associated with aging bodies and the social stigma associated with both sexual victimhood and older age. Additional challenges lay in supporting older male survivors and those living with dementia. The article ends by discussing implications for practice and an agenda for future research.

Caregiving of children with intellectual disabilities in China--an examination of affiliate stigma and the cultural thesis.

PubMed

Chiu, M Y L; Yang, X; Wong, F H T; Li, J H; Li, J

2013-12-01

While caregivers of children with intellectual disabilities are burdened in every part of the world, it is suspected that particular contexts may make the situation worse. There is little literature on caregivers in China, where familial and clan responsibility rather than individual effort is emphasised, and where communal support, while treasured, is often lacking. A total of 211 caregivers in two cities, one with and the other without randomised design, participated in a survey study that assessed affiliated stigma, loss of face, anxiety, mental health and empowerment. A proportion of 60.6% of participants were found to be conspicuous cases with mental disturbance of a level which required further professional attention. Participants with better resource appeared to have coped better, enjoying lower psychological distress, lower anxiety and a higher level of personal empowerment. Multiple regression analysis revealed that mental health is related to the affective dimension of affiliated stigma, loss of face and anxiety level. This was found to account for more than half the variance (55%). The subjective burden of care occurs not in isolation but in a cultural field. Chinese caregiving is characterised by a lack of formal support, and such cultural concerns as loss of face and strong affiliated stigma. This socio-political context makes caregiving all the more challenging. The situation has to be addressed by both practitioners and policy makers if family caregiving is to be valued and made sustainable. © 2012 The Authors. Journal of Intellectual Disability Research © 2012 John Wiley & Sons Ltd, MENCAP & IASSID.

The dilemma of diabetic patients living with hypoglycaemia.

PubMed

Wu, Fei-Ling; Juang, Jyuhn-Huarng; Yeh, Mei Chang

2011-08-01

To examine the impact of the threat of hypoglycaemic episodes on people with diabetes in Taiwan. Intensive diabetes treatment in people with diabetes helps them to achieve better glycaemic control. However, it also causes more frequent hypoglycaemic episodes and has an impact on their overall quality of life. Hypoglycaemia is accompanied by various distressing symptoms which may cause excessive fear, affecting decision making in hypoglycaemic management. Purposive sampling and in-depth, face-to-face interviews were used to collect data. Semi-structured interviews were conducted from July 2008-January 2009 with 17 individuals treated with insulin who had previous hypoglycaemic episodes. Data were analysed using qualitative content analysis. Four themes were generated from the analysis, 'inability to control fluctuations in health', 'challenges to interpersonal relationships', 'facing the disease alone' and 'finding a balance between competing symptoms'. Hypoglycaemia is a major health issue for many people with diabetes. Understanding individuals' experiences with hypoglycaemic episodes should help practitioners become more fully involved in promoting self-management. We identified key areas that health care providers should address, including concerns about patient education and professional support for people with diabetes experiencing hypoglycaemia, to enhance problem solving skills for them and their families. We recommend that health care providers make proper use of support groups for family caregivers or other important individuals in the lives of people with diabetes to provide education, clarification, support and guidance. In addition, health care providers also need to provide clients with hypoglycaemia-related emotional support, while enhancing diabetes self-management and problem-solving skills. © 2011 Blackwell Publishing Ltd.

Challenges of Virtual School Leadership

ERIC Educational Resources Information Center

Richardson, Jayson W.; LaFrance, Jason; Beck, Dennis

2015-01-01

The purpose of this case study was to examine challenges faced by virtual school leaders in the United States. Through semistructured interviews, the researchers explored challenges faced by eighteen leaders of fully online or blended online programs. Analysis revealed six main challenges: funding, staff, accountability, time, parents, and…

Using Behavior Over Time Graphs to Spur Systems Thinking Among Public Health Practitioners.

PubMed

Calancie, Larissa; Anderson, Seri; Branscomb, Jane; Apostolico, Alexsandra A; Lich, Kristen Hassmiller

2018-02-01

Public health practitioners can use Behavior Over Time (BOT) graphs to spur discussion and systems thinking around complex challenges. Multiple large systems, such as health care, the economy, and education, affect chronic disease rates in the United States. System thinking tools can build public health practitioners' capacity to understand these systems and collaborate within and across sectors to improve population health. BOT graphs show a variable, or variables (y axis) over time (x axis). Although analyzing trends is not new to public health, drawing BOT graphs, annotating the events and systemic forces that are likely to influence the depicted trends, and then discussing the graphs in a diverse group provides an opportunity for public health practitioners to hear each other's perspectives and creates a more holistic understanding of the key factors that contribute to a trend. We describe how BOT graphs are used in public health, how they can be used to generate group discussion, and how this process can advance systems-level thinking. Then we describe how BOT graphs were used with groups of maternal and child health (MCH) practitioners and partners (N = 101) during a training session to advance their thinking about MCH challenges. Eighty-six percent of the 84 participants who completed an evaluation agreed or strongly agreed that they would use this BOT graph process to engage stakeholders in their home states and jurisdictions. The BOT graph process we describe can be applied to a variety of public health issues and used by practitioners, stakeholders, and researchers.

The Impact of the Law on the Practice of Public Relations Discourse.

ERIC Educational Resources Information Center

Pohl, Gayle M.

A review of the literature useful for public relations researchers and students explored the primary legal concerns that public relations practitioners face, including first amendment rights, insider trading, regulations when working with foreign organizations, disclosure, privacy, copyright/trademark law, advertising, and defamation. Public…

Emotional Stamina--The Practitioners Dilemma

ERIC Educational Resources Information Center

Ball, Wilbert R.

1977-01-01

The major emphasis during counselor preparation is on the client's concerns. If this is so, the beginning counselor has not been adequately prepared to face the disparity between theory and reality. Many counselors realize the emotional demands are too great for the amount of return and leave the profession. (Author)

A Principal Calling: Professionalism and Health Care Services

ERIC Educational Resources Information Center

Cornett, Becky Sutherland

2006-01-01

As health care professionals, our ''product'' is clinical service. We demonstrate professionalism by attitudes, knowledge, and behaviors that reflect a multi-faceted approach to the standards, regulations, and principles underlying successful clinical practices. The issues facing practitioners who work in health care environments are complex,…

The Challenge of Being an Instructional Designer for New Media Development: A View from the Practitioners.

ERIC Educational Resources Information Center

Liu, Min; Gibby, Scott; Quiros, Ondrea; Demps, Elaine

The rapid changes in the field of technology are redefining the process of developing technology-enhanced educational materials as well as the roles of developers involved in the process.The purpose of this study was to learn from practitioners the roles and responsibilities of an instructional designer in developing new media enhanced…

Planning and Designing Academic Library Learning Spaces: Expert Perspectives of Architects, Librarians, and Library Consultants. Project Information Literacy Research Report. The Practitioner Series

ERIC Educational Resources Information Center

Head, Alison J.

2016-01-01

This paper identifies approaches, challenges, and best practices related to planning and designing today's academic library learning spaces. As part of the Project Information Literacy (PIL) Practitioner Series, qualitative data is presented from 49 interviews conducted with a sample of academic librarians, architects, and library consultants.…

Knowledge, Attitudes and Practice Relating to Hazardous Alcohol Use across the Continuum of Care in a Community Healthcare Centre

ERIC Educational Resources Information Center

Kishore, Vimal; Lynch, Sara; Pichon, Jamilia; Theall, Katherine; Johnson, Sandy; Roberson, Emily; Hinton, Susan

2011-01-01

Alcohol screening and intervention in community health settings places a great time demand on practitioners. Thus, implementation of practitioner-delivered intervention is challenging. Aims: The aim of this study was to assess the feasibility of incorporating a brief alcohol intervention into daily practices of a community health care centre by…

Front-line perspectives on 'joined-up' working relationships: a qualitative study of social prescribing in the west of Scotland.

PubMed

White, Jane M; Cornish, Flora; Kerr, Susan

2017-01-01

Cross-sector collaboration has been promoted by government policies in the United Kingdom and many western welfare states for decades. Literature on joint working has focused predominantly on the strategic level, neglecting the role of individual practitioners in putting 'joined-up working' into practice. This paper takes the case of 'social prescribing' in the west of Scotland as an instance of joined-up working, in which primary healthcare professionals are encouraged to refer patients to non-medical sources of support in the third sector. This study draws on social capital theory to analyse the quality of the relationships between primary healthcare professionals and third sector practitioners. Eighteen health professionals and 15 representatives of third sector organisations participated in a qualitative interview study. Significant barriers to collaborative working were evident. The two stakeholder groups expressed different understandings of health, with few primary healthcare professionals considering non-medical sources of support to be useful or relevant. Health professionals were mistrustful of unknown third sector organisations, and concerned about their accountability for referrals that were not successful or positive for the patient. Third sector practitioners sought to build trust through face-to-face interactions with health professionals. However, primary healthcare professionals and third sector practitioners were not connected in effective networks. We highlight the ongoing imbalance of power between primary healthcare professionals and third sector organisations. Strategic collaborations should be complemented by efforts to build shared understandings, trust and connections between the diverse front-line workers whose mutual co-operation is necessary to achieve effective joined-up working. © 2015 John Wiley & Sons Ltd.

Fix and forget or fix and report: a qualitative study of tensions at the front line of incident reporting.

PubMed

Hewitt, Tanya Anne; Chreim, Samia

2015-05-01

Practitioners frequently encounter safety problems that they themselves can resolve on the spot. We ask: when faced with such a problem, do practitioners fix it in the moment and forget about it, or do they fix it in the moment and report it? We consider factors underlying these two approaches. We used a qualitative case study design employing in-depth interviews with 40 healthcare practitioners in a tertiary care hospital in Ontario, Canada. We conducted a thematic analysis, and compared the findings with the literature. 'Fixing and forgetting' was the main choice that most practitioners made in situations where they faced problems that they themselves could resolve. These situations included (A) handling near misses, which were seen as unworthy of reporting since they did not result in actual harm to the patient, (B) prioritising solving individual patients' safety problems, which were viewed as unique or one-time events and (C) encountering re-occurring safety problems, which were framed as inevitable, routine events. In only a few instances was 'fixing and reporting' mentioned as a way that the providers dealt with problems that they could resolve. We found that generally healthcare providers do not prioritise reporting if a safety problem is fixed. We argue that fixing and forgetting patient safety problems encountered may not serve patient safety as well as fixing and reporting. The latter approach aligns with recent calls for patient safety to be more preventive. We consider implications for practice. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

A survey on the preference for continuing professional dental education amongst general dental practitioners who attended the 26th Asia Pacific Dental Congress.

PubMed

Chan, W C; Ng, C H; Yiu, B K; Liu, C Y; Ip, C M; Siu, H H; Chiu, G K C; Hägg, U; Jin, L J

2006-11-01

To identify the subjects of interest and to examine the modes as well as means of study for continuing professional dental education amongst general dental practitioners who attended the 26th Asia Pacific Dental Congress, 28 May-1 June 2004, Hong Kong. A total of 381 general dental practitioners as the registered conference delegates from Hong Kong, Mainland China and other Asia-Pacific regions were randomly selected for the present survey. The survey was conducted through face-to-face interviews by a group of practising dentists in Hong Kong. Overall, orthodontics and prosthodontics were the most popular subjects for clinical degree programmes, whilst oral implantology and cosmetic dentistry were the highly preferred subjects for continuing education courses. Concerning the preferred mode of study for degree programmes, the part-time study mode was chosen by 68.3% of the participating dentists. A didactic teaching approach was preferred by most of the participants (81.7%) for postgraduate study. The majority of the interviewees (76.5%) were interested in a proposed clinical degree programme to be offered jointly by The University of Hong Kong and a leading university in the Mainland. Overall, there was no marked difference in the preference for continuing dental education amongst the respondents from Hong Kong, Mainland China and other Asia-Pacific regions. The present survey shows the currently preferred specialty areas and subjects for continuing professional dental education amongst the general dental practitioners who attended the 26th Asia Pacific Dental Congress, with didactic teaching as the most preferred mode of study on a part-time basis.

Navigating manuscript assessment: The new practitioner's guide to primary literature peer review.

PubMed

Smith, Devlin V; Stokes, Laura B; Marx, Kayleigh; Aitken, Samuel L

2018-01-01

For pharmacists, the first years after graduation are spent developing their knowledge base, advancing as a practitioner, and honing their abilities as healthcare providers and drug information experts. New practitioners encounter many challenges during this time, which for many include publishing original research or reviewing manuscripts for colleagues and medical journals. Inexperience navigating the publication process, from submission to receipt of (and response to) peer review commentary, is often cited as a major barrier to timely publication of resident and new practitioner research. Serving as a peer reviewer in turn provides the new practitioner with insight on this process and can be an enlightening experience used to garner confidence in subsequently submitting their own formal manuscripts. A number of publications describing steps for peer review are available, however, many of these articles address more experienced reviewers or critique the peer review process itself. No definitive resource exists for new pharmacy practitioners interested in developing their peer review skills. The information presented in this summative guide should be used in conjunction with practice opportunities to help new practitioners develop proficiency at peer review.

Preventing Sexual Violence in Adolescence: Comparison of a Scientist-Practitioner Program and a Practitioner Program Using a Cluster-Randomized Design.

PubMed

Muck, Christoph; Schiller, Eva-Maria; Zimmermann, Maria; Kärtner, Joscha

2018-02-01

Numerous school-based prevention programs have been developed by scientists and practitioners to address sexual violence in adolescence. However, such programs struggle with two major challenges. First, the effectiveness of many well-established practitioner programs has not been rigorously evaluated. Second, effective scientific programs may be hard to implement into everyday school practice. Combining the knowledge of scientists and practitioners in a scientist-practitioner program could be a helpful compromise. The aim of the present study is to evaluate the effects of a scientist-practitioner program and a practitioner program using a cluster-randomized experimental design. Twenty-seven school classes were randomly assigned to either one of two programs or a control group. Outcome variables (knowledge, attitudes, behavior, and iatrogenic effects) were assessed at pretest, posttest, and a 6-month follow-up for 453 adolescents (55% female, Mage = 14.18). Short-term effects were found in both programs regarding general knowledge, knowledge of professional help, and victim-blaming attitudes. Long-term effects were found in both programs regarding general knowledge and knowledge of professional help and, in the practitioner program, in a reduction of victimization. No other effects were found on attitudes and behavior. No iatrogenic effects in the form of increased anxiety were found. Both the scientist-practitioner and the practitioner program show promise for the prevention of sexual violence in adolescence; in particular, the practitioner program may be a more cost-effective method.

From event analysis to global lessons: disaster forensics for building resilience

NASA Astrophysics Data System (ADS)

Keating, Adriana; Venkateswaran, Kanmani; Szoenyi, Michael; MacClune, Karen; Mechler, Reinhard

2016-04-01

With unprecedented growth in disaster risk, there is an urgent need for enhanced learning about and understanding disasters, particularly in relation to the trends in the drivers of increasing risk. Building on the disaster forensics field, we introduce the Post Event Review Capability (PERC) methodology for systematically and holistically analyzing disaster events, and identifying actionable recommendations. PERC responds to a need for learning about the successes and failures in disaster risk management and resilience, and uncovers the underlying drivers of increasing risk. We draw generalizable insights identified from seven applications of the methodology to date, where we find that across the globe policy makers and practitioners in disaster risk management face strikingly similar challenges despite variations in context, indicating encouraging potential for mutual learning. These lessons highlight the importance of integrated risk reduction strategies. We invite others to utilize the freely available PERC approach and contribute to building a repository of learnings on disaster risk management and resilience.

From event analysis to global lessons: disaster forensics for building resilience

NASA Astrophysics Data System (ADS)

Keating, Adriana; Venkateswaran, Kanmani; Szoenyi, Michael; MacClune, Karen; Mechler, Reinhard

2016-07-01

With unprecedented growth in disaster risk, there is an urgent need for enhanced learning and understanding of disasters, particularly in relation to the trends in drivers of increasing risk. Building on the disaster forensics field, we introduce the post-event review capability (PERC) methodology for systematically and holistically analysing disaster events, and identifying actionable recommendations. PERC responds to a need for learning about the successes and failures in disaster risk management and resilience, and uncovers the underlying drivers of increasing risk. We draw generalisable insights identified from seven applications of the methodology to date, where we find that across the globe policy makers and practitioners in disaster risk management face strikingly similar challenges despite variations in context, indicating encouraging potential for mutual learning. These lessons highlight the importance of integrated risk reduction strategies. We invite others to utilise the freely available PERC approach and contribute to building a repository of learning on disaster risk management and resilience.

Policy Making to Build Relationships: A Grounded Theory Analysis of Interviews and Documents Relating to H1N1, Ebola, and the U.S. Public Health Preparedness Network.

PubMed

Myers, Nathan

2016-01-01

In the last five years, the American public health emergency preparedness and response system has been tested by two significant threats, H1N1 and Ebola. While neither proved as dangerous as initially feared, these viruses highlighted on-going issues with collaborations in the field of public health and health care. Strengths were identified within the network, but also challenges that must be resolved before the U.S. faces a major pandemic. Employing interview data from public health emergency response practitioners and documentary evidence from the H1N1 and Ebola responses, this qualitative analysis uses the grounded theory approach to identify key areas for collaborative improvement. The grounded theory developed calls for a stronger policy framework at the federal level to facilitate more collaboration between U.S. agencies and facilitate more collaboration at the state and local level.

Generating unique IDs from patient identification data using security models.

PubMed

Mohammed, Emad A; Slack, Jonathan C; Naugler, Christopher T

2016-01-01

The use of electronic health records (EHRs) has continued to increase within healthcare systems in the developed and developing nations. EHRs allow for increased patient safety, grant patients easier access to their medical records, and offer a wealth of data to researchers. However, various bioethical, financial, logistical, and information security considerations must be addressed while transitioning to an EHR system. The need to encrypt private patient information for data sharing is one of the foremost challenges faced by health information technology. We describe the usage of the message digest-5 (MD5) and secure hashing algorithm (SHA) as methods for encrypting electronic medical data. In particular, we present an application of the MD5 and SHA-1 algorithms in encrypting a composite message from private patient information. The results show that the composite message can be used to create a unique one-way encrypted ID per patient record that can be used for data sharing. The described software tool can be used to share patient EMRs between practitioners without revealing patients identifiable data.

When Science is Not Enough: A Framework Towards More Customer-Focused Drug Development.

PubMed

Oraiopoulos, Nektarios; Dunlop, William C N

2017-07-01

The purpose of this study was to identify the key barriers to a customer-focused drug development process and develop a comprehensive framework to overcome them. The paper draws on existing literature, both academic and practitioner, across a range of disciplines (innovation management, marketing, organizational behavior, behavioral economics, health economics, industry reports). On the basis of this extensive review, a conceptual framework is developed that offers concrete suggestions on how organizations can overcome the barriers and enable a more customer-focused development process. The barriers to collaboration are organized into three distinct categories (economic, behavioral, organizational), and within each category, a one-to-one mapping between barriers and solutions is developed. The framework is specifically designed with the objective of offering actionable and practical advice to executives who face these challenges in their organizations. The paper provides a unique theoretical contribution by synthesizing findings from several academic disciplines with concrete examples from the pharmaceutical industry. Mundipharma International Limited.

Personalized medicine: reality and reality checks.

PubMed

Leeder, J Steven; Spielberg, Stephen P

2009-05-01

The evolving era of pharmacogenomics and personalized medicine is greeted with optimism by many, but this sentiment is not universally shared. The existence of diametrically opposed opinions concerning the potential benefits and obstacles facing the widespread implementation of genomic medicine should stimulate discussion and guide the design of studies to establish the value of interventions targeted at the level of individual patients. One of the more controversial aspects of personalized medicine is whether the anticipated benefits will be realized at an acceptable cost. Recently released analyses suggest that the returns on investment depend on the particular scenario and are different for different stakeholders. On the other hand, cost is only one of the challenges regarding implementation of personalized medicine. Among these are the development of universal standards for managing genomic information in electronic medical records, improvement in the collection and interpretation of clinical phenotype data, and new strategies to educate practitioners and patients/consumers. The reality is that personalized medicine is upon us; open discourse and periodic reality checks will be necessary as we confront it.

Innovations in information management and access for assessments

PubMed Central

Champion, Sarah M.; Kunkel, Kenneth E.; Tilmes, Curt

2017-01-01

The third National Climate Assessment (NCA3) included goals for becoming a more timely, inclusive, rigorous, and sustained process, and for serving a wider variety of decision makers. In order to accomplish these goals, it was necessary to deliberately design an information management strategy that could serve multiple stakeholders and manage different types of information - from highly mature government-supported climate science data, to isolated practitioner-generated case study information - and to do so in ways that are consistent and appropriate for a highly influential assessment. Meeting the information management challenge for NCA3 meant balancing relevance and authority, complexity and accessibility, inclusivity and rigor. Increasing traceability of data behind figures and graphics, designing a public-facing website, managing hundreds of technical inputs to the NCA, and producing guidance for over 300 participants on meeting the Information Quality Act were all aspects of a deliberate, multi-faceted, and strategic information management approach that nonetheless attempted to be practical and usable for a variety of participants and stakeholders. PMID:29081560

The identification of living persons on images: A literature review.

PubMed

Gibelli, D; Obertová, Z; Ritz-Timme, S; Gabriel, P; Arent, T; Ratnayake, M; De Angelis, D; Cattaneo, C

2016-03-01

Personal identification in the forensic context commonly concerns unknown decedents. However, recently there has been an increase in cases which require identification of living persons, especially from surveillance systems. These cases bring about a relatively new challenge for forensic anthropologists and pathologists concerning the selection of the most suitable methodological approaches with regard to the limitations of the photographic representation of a given person for individualization and identity. Facial features are instinctively the primary focus for identification approaches. However, other body parts (e.g. hands), and body height and gait (on videos) have been considered in cases of personal identification. This review aims at summarizing the state-of-the-art concerning the identification of the living on images and videos, including a critical evaluation of the advantages and limitations of different methods. Recommendations are given in order to aid forensic practitioners who face cases of identification of living persons. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

An analysis of 1361 aesthetic procedures from 2000 to 2005 in a large regional plastic surgery unit: implications for cosmetic surgery training.

PubMed

Whitaker, Iain S; Mason, Lyndon; Boyce, D E; Cooper, M A C S

2007-01-01

One of the challenges facing our profession is the adequate training of plastic surgeons in the subspeciality of aesthetic surgery, in addition to covering the rest of the large curriculum. The UK's Chief Medical Officer, Professor Sir Liam Donaldson, has recently called for better training for doctors, better information for patients, and a touger regulatory structure for private cosmetic surgery. In this study, we show that the training of cosmetic procedures in our unit has risen steadily over the 6 year period studied. As part of our committment to improving training, our unit has recently organised a 3 month block soely dedicated to aesthetic surgery, allowing increasing exposure to cosmetic clinics and theatre sessions. It is clear that as a group, we must continue to develop robust training schemes to produce plastic surgeons able to cope with the demands of 21st Century healthcare, and ensure that the public does not fall prey to practitioners in unregulated clinics.

View from the top: CEO perspectives on executive development and succession planning practices in healthcare organizations.

PubMed

Groves, Kevin S

2006-01-01

Many healthcare professionals question whether the industry's hospitals and multi-site systems are implementing the necessary executive development and succession planning systems to ensure that high potential managers are prepared and aptly selected to assume key executive roles. Survey data, case studies, and cross-industry comparisons suggest that healthcare organizations may face a leadership crisis as the current generation of chief executive officers (CEOs) nears retirement while traditional means of developing the leadership pipeline, including middle-management positions and graduate programs requiring formal residencies, continue to dissipate. Given the daunting challenges that accompany the healthcare industry's quest to identify, develop, and retain leadership talent, this article provides best practice findings from a qualitative study of 13 healthcare organizations with a record of exemplary executive development and succession planning practices. CEOs from six single-site hospitals, six healthcare systems, and one medical group were interviewed to identify industry best practices so that healthcare practitioners and educators may utilize the findings to enhance the industry's leadership capacity.

Summary Report for the Radiation Detection for Nuclear Security Summer School 2012

DOE Office of Scientific and Technical Information (OSTI.GOV)

Runkle, Robert C.; Baciak, James E.; Stave, Jean A.

The Pacific Northwest National Laboratory (PNNL) hosted students from across the United States at the inaugural Radiation Detection for Nuclear Security Summer School from June 11 – 22, 2012. The summer school provided students with a unique understanding of nuclear security challenges faced in the field and exposed them to the technical foundations, analyses, and insight that will be required by future leaders in technology development and implementation. The course heavily emphasized laboratory and field demonstrations including direct measurements of special nuclear material. The first week of the summer school focused on the foundational knowledge required by technology practitioners; themore » second week focused on contemporary applications. Student evaluations and feedback from student advisors indicates that the summer school achieved its objectives of 1) exposing students to the range of nuclear security applications for which radiation detection is necessary, 2) articulating the relevance of student research into the broader context, and 3) exciting students about the possibility of future careers in nuclear security.« less

Upper Face: Clinical Anatomy and Regional Approaches with Injectable Fillers.

PubMed

Sykes, Jonathan M; Cotofana, Sebastian; Trevidic, Patrick; Solish, Nowell; Carruthers, Jean; Carruthers, Alastair; Moradi, Amir; Swift, Arthur; Massry, Guy G; Lambros, Val; Remington, B Kent

2015-11-01

The use of facial fillers has been rapidly increased as the range of injectable products and indications continues to expand. Complications may arise from improper placement or technique. This article highlights the importance of anatomic knowledge when using injectable fillers in the face. A detailed review of the clinical anatomy of the upper face is performed. Regional approaches are described using the applied anatomy to efficiently and safely augment the different subunits of the upper face. Key aspects of safe and successful injection of fillers in the upper face include a thorough knowledge of the location of fat compartments and neurovascular structures. Awareness of these structures enables the practitioner to maximize injections, while avoiding damage to important nerves and vessels. A detailed knowledge of the anatomy and properties of the product is paramount to maximize the efficacy while minimizing the risk of complications.

Current Perspectives on Profiling and Enhancing Wheelchair Court Sport Performance.

PubMed

Paulson, Thomas; Goosey-Tolfrey, Victoria

2017-03-01

Despite the growing interest in Paralympic sport, the evidence base for supporting elite wheelchair sport performance remains in its infancy when compared with able-bodied (AB) sport. Subsequently, current practice is often based on theory adapted from AB guidelines, with a heavy reliance on anecdotal evidence and practitioner experience. Many principles in training prescription and performance monitoring with wheelchair athletes are directly transferable from AB practice, including the periodization and tapering of athlete loads around competition, yet considerations for the physiological consequences of an athlete's impairment and the interface between athlete and equipment are vital when targeting interventions to optimize in-competition performance. Researchers and practitioners are faced with the challenge of identifying and implementing reliable protocols that detect small but meaningful changes in impairment-specific physical capacities and on-court performance. Technologies to profile both linear and rotational on-court performance are an essential component of sport-science support to understand sport-specific movement profiles and prescribe training intensities. In addition, an individualized approach to the prescription of athlete training and optimization of the "wheelchair-user interface" is required, accounting for an athlete's anthropometrics, sports classification, and positional role on court. In addition to enhancing physical capacities, interventions must focus on the integration of the athlete and his or her equipment, as well as techniques for limiting environmental influence on performance. Taken together, the optimization of wheelchair sport performance requires a multidisciplinary approach based on the individual requirements of each athlete.

Medical Malpractice in Dermatology-Part II: What To Do Once You Have Been Served with a Lawsuit.

PubMed

Shah, Vidhi V; Kapp, Marshall B; Wolverton, Stephen E

2016-12-01

Facing a malpractice lawsuit can be a daunting and traumatic experience for healthcare practitioners, with most clinicians naïve to the legal landscape. It is crucial for physicians to know and understand the malpractice system and his or her role once challenged with litigation. We present part II of a two-part series addressing the most common medicolegal questions that cause a great deal of anxiety. Part I focused upon risk-management strategies and prevention of malpractice lawsuits, whereas part II provides helpful suggestions and guidance for the physician who has been served with a lawsuit complaint. Herein, we address the best approach concerning what to do and what not to do after receipt of a legal claim, during the deposition, and during the trial phases. We also discuss routine concerns that may arise during the development of the case, including the personal, financial, and career implications of a malpractice lawsuit and how these can be best managed. The defense strategies discussed in this paper are not a guide separate from legal representation to winning a lawsuit, but may help physicians prepare for and cope with a medical malpractice lawsuit. This article is written from a US perspective, and therefore not all of the statements made herein will be applicable in other countries. Within the USA, medical practitioners must be familiar with their own state and local laws and should consult with their own legal counsel to obtain advice about specific questions.

Exploiting Expertise and Knowledge Sharing Online for the Benefit of NASA's GN&C Community of Practice

NASA Technical Reports Server (NTRS)

Topousis, Daria E.; Lebsock, Kenneth L.; Dennehy, Cornelius J.

2010-01-01

In 2004, NASA faced major knowledge sharing challenges due to geographically isolated field centers that inhibited engineers from sharing their experiences, expertise, ideas, and lessons learned. The necessity to collaborate on complex development projects and the reality of constrained project resources together drove the need for ensuring that personnel at all NASA centers had comparable skill sets and that engineers could find resources in a timely fashion. Mission failures and new directions for the Agency also demanded better collaborative tools for NASA's engineering workforce. In response to these needs, the online NASA Engineering Network (NEN) was formed by the NASA Office of the Chief Engineer to provide a multi-faceted system for overcoming geographic and cultural barriers. NEN integrates communities of practice with a cross-repository search and the Lessons Learned Information System. This paper describes the features of the GN&C engineering discipline CoP site which went live on NEN in May of 2008 as an online means of gathering input and guidance from practitioners. It allows GN&C discipline expertise captured at one field center to be shared in a collaborative way with the larger discipline CoP spread across the entire Agency. The site enables GN&C engineers to find the information they need quickly, to find solutions to questions from experienced engineers, and to connect with other practitioners regardless of geographic location, thus increasing the probability of project success.

The accountability of clinical education: its definition and assessment.

PubMed

Murray, E; Gruppen, L; Catton, P; Hays, R; Woolliscroft, J O

2000-10-01

Medical education is not exempt from increasing societal expectations of accountability. Competition for financial resources requires medical educators to demonstrate cost-effective educational practice; health care practitioners, the products of medical education programmes, must meet increasing standards of professionalism; the culture of evidence-based medicine demands an evaluation of the effect educational programmes have on health care and service delivery. Educators cannot demonstrate that graduates possess the required attributes, or that their programmes have the desired impact on health care without appropriate assessment tools and measures of outcome. To determine to what extent currently available assessment approaches can measure potentially relevant medical education outcomes addressing practitioner performance, health care delivery and population health, in order to highlight areas in need of research and development. Illustrative publications about desirable professional behaviour were synthesized to obtain examples of required competencies and health outcomes. A MEDLINE search for available assessment tools and measures of health outcome was performed. There are extensive tools for assessing clinical skills and knowledge. Some work has been done on the use of professional judgement for assessing professional behaviours; scholarship; and multiprofessional team working; but much more is needed. Very little literature exists on assessing group attributes of professionals, such as clinical governance, evidence-based practice and workforce allocation, and even less on examining individual patient or population health indices. The challenge facing medical educators is to develop new tools, many of which will rely on professional judgement, for assessing these broader competencies and outcomes.

Women's cultural perceptions and attitudes towards breast cancer: Northern Ghana.

PubMed

Asobayire, Alice; Barley, Ruth

2015-09-01

This study investigates problems confronting breast cancer awareness in Ghana by ascertaining how societal perceptions and attitudes influence women's awareness of breast cancer in the Kassena-Nankana district. Data were gathered through focus group interviews and documentary analysis of current practices within the region. The data were then thematically analysed following an inductive analytical framework. The study concludes that women's perceptions of and attitudes towards breast cancer and its treatment are influenced by a myriad of economic and socio-cultural factors, which practitioners need to take into account when planning public health initiatives. There are a number of economic challenges facing breast cancer education and awareness programmes due to a lack of adequate numbers of specialized health personnel and breast cancer screening facilities in the district. Additionally, socio-cultural factors such as the absence of biomedical terminology in the local language, gender inequality and the prevailing influence of traditional health practitioners further compound the situation. Knowledge, awareness and attitudes of women towards breast cancer can also be improved if husbands of married women and respective community compound heads are targeted by public health educationists to get actively involved in education and awareness campaigns. The need to incorporate indigenous languages in public health educational materials for breast cancer in remote communities of deprived districts of Ghana is also recommended. © The Author (2014). Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

A Community-Responsive Adaptation to Reach and Engage Latino Families Affected by Maternal Depression.

PubMed

Valdez, Carmen R; Ramirez Stege, Alyssa; Martinez, Elizabeth; D'Costa, Stephanie; Chavez, Thomas

2017-07-23

As family researchers and practitioners seek to improve the quality and accessibility of mental health services for immigrant families, they have turned to culturally adapted interventions. Although many advancements have been made in adapting interventions for such families, we have yet to understand how the adaptation can ensure that the intervention is reaching families identified to be in greatest need within a local system of care and community. We argue that reaching, engaging, and understanding the needs of families entails a collaborative approach with multiple community partners to ensure that adaptations to intervention content and delivery are responsive to the sociocultural trajectory of families within a community. We describe a cultural adaptation framework that is responsive to the unique opportunities and challenges of identifying and recruiting vulnerable families through community partnerships, and of addressing the needs of families by incorporating multiple community perspectives. Specifically, we apply these principles to the cultural adaptation of an intervention originally developed for low-income African American and White families facing maternal depression. The new intervention, Fortalezas Familiares (Family Strengths), was targeted to Latino immigrant families whose mothers were in treatment for depression in mental health and primary care clinics. We conclude with key recommendations and directions for how family researchers and practitioners can design the cultural adaptation of interventions to be responsive to the practices, preferences, and needs of underserved communities, including families and service providers. © 2017 Family Process Institute.

Challenges Faced by Female-Students in Engineering-Education

ERIC Educational Resources Information Center

Madara, Diana Starovoytova; Cherotich, Sharon

2016-01-01

Gender-related challenges in learning technical courses are universal phenomenon. These challenges could restrain female students from achieving their fullest potential. The main focus of this study, therefore, is to examine self-recognized challenges faced by undergraduate female students in pursuing engineering at the School of Engineering…

Challenges to evaluating complex interventions: a content analysis of published papers

PubMed Central

2013-01-01

Background There is continuing interest among practitioners, policymakers and researchers in the evaluation of complex interventions stemming from the need to further develop the evidence base on the effectiveness of healthcare and public health interventions, and an awareness that evaluation becomes more challenging if interventions are complex. We undertook an analysis of published journal articles in order to identify aspects of complexity described by writers, the fields in which complex interventions are being evaluated and the challenges experienced in design, implementation and evaluation. This paper outlines the findings of this documentary analysis. Methods The PubMed electronic database was searched for the ten year period, January 2002 to December 2011, using the term “complex intervention*” in the title and/or abstract of a paper. We extracted text from papers to a table and carried out a thematic analysis to identify authors’ descriptions of challenges faced in developing, implementing and evaluating complex interventions. Results The search resulted in a sample of 221 papers of which full text of 216 was obtained and 207 were included in the analysis. The 207 papers broadly cover clinical, public health and methodological topics. Challenges described included the content and standardisation of interventions, the impact of the people involved (staff and patients), the organisational context of implementation, the development of outcome measures, and evaluation. Conclusions Our analysis of these papers suggests that more detailed reporting of information on outcomes, context and intervention is required for complex interventions. Future revisions to reporting guidelines for both primary and secondary research may need to take aspects of complexity into account to enhance their value to both researchers and users of research. PMID:23758638

Halal Supply Chain Management Streamlined Practices: Issues and Challenges

NASA Astrophysics Data System (ADS)

Hijrah Abd Kadir, Muhammad; Zuraidah Raja Mohd Rasi, Raja; Omar, Siti Sarah; Manap, Zariq Imran Abdul

2016-11-01

The quickly developing worldwide halal in business sector has given a remarkable window of chance, which empowers Malaysia to the renowned halal centre in worldwide (known as Halal-hubs). Malaysia also has proactively taken a lead in halal activities, which is presently considered as the benchmark for a halal framework worldwide. Malaysia also set up the Halal Industry Development Corporation (HDC) which driving a wide range of halal activities since the demand of halal food has increased significantly which is very crucial for a Muslim in ensuring its authenticity and integrity. Even in parallel to this developments, many studies has been conducted because there are many issues still occurs in the food industry. The issue of consumer awareness and understanding the halal principles, mixing of halal and non- halal products, halal certification and logo compliance with Shariah law and lack of regulation and enforcement need the serious attention by all parties along the supply chain. The challenges occur mainly in the halal food segregation and halal traceability of the products. The unit of analysis in this study different halal stakeholders group which are JAKIM, Halal Development Centre (HDC), Raw Material Manufacturers, Retailers and Government Agencies. This paper attempt discusses the issues and challenges occurs in the halal supply chain and faced by the practitioners as well as the relevant parties involved in the industry especially for food products manufacturers. The study would like to give a basic information about the issues and challenges in the contribution of Halal Supply Chain Management (HSCM) as well as for the future studies.

Continuing education for primary health care nurse practitioners in Ontario, Canada.

PubMed

Baxter, Pamela; DiCenso, Alba; Donald, Faith; Martin-Misener, Ruth; Opsteen, Joanne; Chambers, Tracey

2013-04-01

The Council of Ontario University Programs in Nursing offers a nine-university, consortium-based primary health care nurse practitioner education program and on-line continuing education courses for primary health care nurse practitioners. Our study sought to determine the continuing education needs of primary health care nurse practitioners across Ontario, how best to meet these needs, and the barriers they face in completing continuing education. Surveys were completed by 83 (40%) of 209 learners who had participated in continuing education offered by the Council of Ontario University Programs in Nursing between 2004 and 2007. While 83% (n=50) of nurse practitioners surveyed indicated that continuing education was extremely important to them, they also identified barriers to engaging in continuing education offerings including; time intensity of the courses, difficulty taking time off work, family obligations, finances and fatigue. The most common reason for withdrawal from a continuing education offering was the difficulty of balancing work and study demands. Continuing education opportunities are important to Ontario primary health care nurse practitioners, and on-line continuing education offerings have been well received, but in order to be taken up by their target audience they must be relevant, readily accessible, flexible, affordable and offered over brief, intense periods of time using technology that is easy to use and Internet sites that are easily navigated. Copyright © 2012 Elsevier Ltd. All rights reserved.

Geotourism and volcanoes: health hazards facing tourists at volcanic and geothermal destinations.

PubMed

Heggie, Travis W

2009-09-01

Volcano tourism and tourism to geothermal destinations is increasingly popular. If such endeavors are to be a sustainable sector of the tourism industry, tourists must be made aware of the potential health hazards facing them in volcanic environments. With the aim of creating awareness amongst the tourism industry and practitioners of travel medicine, this paper reviews the potential influences and effects of volcanic gases such as carbon dioxide (CO(2)), hydrogen sulfide (H(2)S), sulfur dioxide (SO(2)), and hydrogen chloride/hydrochloric acid (HCl). It also reviews the negative health impacts of tephra and ash, lava flows, landslides, and mudflows. Finally, future research striving to quantify the health risks facing volcano tourists is recommended.

Challenges Faced by Maine School Districts in Providing High Quality Public Education. Research Brief

ERIC Educational Resources Information Center

Silvernail, David L.; Linet, Sarah R.

2014-01-01

The goal of this study was to: (1) identify challenges faced by Maine school districts in providing high quality public education; (2) describe the magnitude of the challenges; and (3) identify areas where school districts were experiencing some success in meeting these challenges. The School Districts Challenge Survey was distributed online to…