Sample records for cleveland clinic experience

  1. Developing a leadership pipeline: the Cleveland Clinic experience.

    PubMed

    Hess, Caryl A; Barss, Christina; Stoller, James K

    2014-11-01

    The complexity of health care requires excellent leadership to address the challenges of access, quality, and cost of care. Because competencies to lead differ from clinical or research skills, there is a compelling need to develop leaders and create a talent pipeline, perhaps especially in physician-led organizations like Cleveland Clinic. In this context, we previously reported on a cohort-based physician leadership development course called Leading in Health Care and, in the current report, detail an expanded health care leadership development programme called the Cleveland Clinic Academy (CCA). CCA consists of a broad suite of offerings, including cohort-based learning and 'a la carte' half- or full-day courses addressing specific competencies to manage and to lead. Academy attendance is optional and is available to all physicians, nurses, and administrators with the requisite experience. Course selection is guided by competency matrices which map leadership competencies to specific courses. As of December 2012, a total of 285 course sessions have been offered to 6,050 attendees with uniformly high ratings of course quality and impact. During the past 10 years, Cleveland Clinic's leadership and management curriculum has successfully created a pipeline of health care leaders to fill executive positions, search committees, board openings, and various other organizational leadership positions. Health care leadership can be taught and learned.

  2. [A day in the busy obstetric unit from the anesthesiologist point of view, experience at the Cleveland clinic; Cleveland, Ohio].

    PubMed

    Ootaki, Chiyo; Barsoum, Sabri

    2009-10-01

    Cleveland Clinic Labor and Delivery Unit is a syntactical delivery facility and comprised of 16 delivery rooms, 3 operating rooms, 3 triage rooms, and 1 recovery room that has a capacity of 6 beds, 43 postpartum rooms, 2 nurseries, and 1 neonatal intensive care unit (NICU). Cleveland Clinic Labor and Delivery Unit (LDU) had 3,691 delivery cases in 2007. The ratio of neuraxial analgesia (NA) during labor is 84.2% (2,348/ 2,787), using epidural anesthesia or combined spinalepidural anesthesia (CSEA). This article introduces the obstetrical (OB) anesthesia practice at the Cleveland Clinic and our novel anesthetic regime as typical of one typical busy day.

  3. Physician leadership development at Cleveland Clinic: a brief review.

    PubMed

    Christensen, Terri; Stoller, James K

    2016-06-01

    We aim to describe the rationale for and spectrum of leadership development programs, highlighting experience at a large healthcare institution (Cleveland Clinic, Cleveland, Ohio, USA). Developing leaders is a universal priority to sustain organizational success. In health care, significant challenges of ensuring quality and access and making care affordable are widely shared internationally and demand effective physician leadership. Yet, leadership competencies differ from clinical and scientific competencies and features of selecting and training physicians-who have been called "heroic lone healers" -often conspire against physicians being effective leaders or followers. Thus, developing leadership competencies in physicians is critical.Leadership development programs have been signature features of successful organizations and various Australian organizations offer such training (e.g. The Australian Leadership Foundation and the University of South Australia), but relatively few health care organizations have adopted the practice of offering such training, both in Australia and elsewhere. As a United States example of one such integrated program, the Cleveland Clinic, a large, closed-staff physician-led group practice in Cleveland, Ohio has offered physician leadership training for over 15 years. This paper describes the rationale, structure, and some of the observed impacts associated with this program. © The Royal Australian and New Zealand College of Psychiatrists 2016.

  4. Contemporary art in medicine: the Cleveland Clinic art collection.

    PubMed

    Finkel, Jennifer

    2011-12-01

    Fine art is good medicine. It comforts, elevates the spirit, and affirms life and hope. Art in the healthcare setting, combined with outstanding care and service, creates an environment that encourages healing and supports the work of medical professionals. As one of the world's great medical centers, Cleveland Clinic has always included the arts in its healing environment. The four founders and subsequent leadership encouraged artistic and musical expression by employees. Distinguished artworks have long hung on the walls. In 1983, an Aesthetics Committee was officially formed at Cleveland Clinic to address issues of art and design in Cleveland Clinic facilities.

  5. Contemporary art in medicine: the Cleveland Clinic art collection

    PubMed Central

    2011-01-01

    Fine art is good medicine. It comforts, elevates the spirit, and affirms life and hope. Art in the healthcare setting, combined with outstanding care and service, creates an environment that encourages healing and supports the work of medical professionals. As one of the world’s great medical centers, Cleveland Clinic has always included the arts in its healing environment. The four founders and subsequent leadership encouraged artistic and musical expression by employees. Distinguished artworks have long hung on the walls. In 1983, an Aesthetics Committee was officially formed at Cleveland Clinic to address issues of art and design in Cleveland Clinic facilities. PMID:24282686

  6. Cleveland Clinic television series enhances branding in active market.

    PubMed

    Rees, T

    2001-01-01

    "Medical Miracles" premiered April 26. It is an information-packed series of programs showcasing The Cleveland Clinic's advanced medical practices. The Cleveland Clinic teamed with local NBC-affiliate, WKYC to develop half-hour shows on topics including neuro-sciences, orthopedics, eye, heart, pediatrics and cancer. As of this writing, three of the half-hour shows already have aired. They will resume in September, October and November, following a summer break. The collaboration is a healthy prospect all the way around. For Cleveland Clinic, it provides highly credible visibility in a competitive marketplace. And, according to WKYC president and general manager, Brooke Spectorsky, " Medical news and information is a high priority among our viewers."

  7. Library Architecture: The Cleveland Experience.

    ERIC Educational Resources Information Center

    Gaines, Ervin; And Others

    1982-01-01

    Discusses the importance of a well-designed library building as an important factor in creating social benefits and positive political responses in the community. The creation and implementation of design criteria for the Cleveland Public Library and the public response are described. (CHC)

  8. The State of Black Cleveland.

    ERIC Educational Resources Information Center

    Hemmons, Willa Mae, Ed.

    This book describes the Black Cleveland experience from the Afrocentric perspective of African American community leaders and researchers who have contributed 22 chapters. It is intended to serve the following functions: (1) establish a knowledge base about African Americans in the Greater Cleveland Area; (2) disseminate an Afrocentric perspective…

  9. Carboplatin plus paclitaxel in the treatment of gynecologic malignancies: the Cleveland Clinic experience.

    PubMed

    Markman, M; Kennedy, A; Webster, K; Kulp, B; Peterson, G; Belinson, J

    1997-10-01

    To examine the toxicity profile and antineoplastic activity of carboplatin (area under the concentration-time curve of 4 to 7.5) plus 3-hour infusional paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) (135 or 175 mg/m2) in women with advanced gynecologic malignancies, we retrospectively reviewed the experience of the Gynecologic Cancer Program at The Cleveland Clinic with this combination chemotherapy regimen. To date, 92 patients (median age, 67 years) have received a total of 460 courses (median number per patient, six) of this two-drug combination. The initial paclitaxel dose was 175 mg/m2 and the carboplatin area under the concentration-time curve was > or = 5 in 72% and 73% of patients, respectively. The major toxicity was neutropenia (grade 4 in 9% of patients), resulting in two febrile episodes and a single septic death. Grade 4 thrombocytopenia and grade 3 peripheral neuropathy were noted in one and two patients, respectively. Twelve patients (13%) experienced at least one episode of paclitaxel-associated hypersensitivity, but all were able to continue with the treatment program. Of the 62 patients with ovarian cancer or primary peritoneal carcinoma with carbohydrate antigen-125 levels > or = 60 U/mL before the initiation of chemotherapy, 74% exhibited a > or = 90% decline in the tumor marker following treatment. We conclude that the combination of carboplatin and 3-hour infusional paclitaxel can be administered in the outpatient setting with a highly acceptable toxicity profile and with major activity in patients with ovarian cancer and primary carcinoma of the peritoneum.

  10. Heart Pump Design for Cleveland Clinic Foundation

    NASA Technical Reports Server (NTRS)

    2005-01-01

    Through a Lewis CommTech Program project with the Cleveland Clinic Foundation, the NASA Lewis Research Center is playing a key role in the design and development of a permanently implantable, artificial heart pump assist device. Known as the Innovative Ventricular Assist System (IVAS), this device will take on the pumping role of the damaged left ventricle of the heart. The key part of the IVAS is a nonpulsatile (continuous flow) artificial heart pump with centrifugal impeller blades, driven by an electric motor. Lewis is part of an industry and academia team, led by the Ohio Aerospace Institute (OAI), that is working with the Cleveland Clinic Foundation to make IVAS a reality. This device has the potential to save tens of thousands of lives each year, since 80 percent of heart attack victims suffer irreversible damage to the left ventricle, the part of the heart that does most of the pumping. Impeller blade design codes and flow-modeling analytical codes will be used in the project. These codes were developed at Lewis for the aerospace industry but will be applicable to the IVAS design project. The analytical codes, which currently simulate the flow through the compressor and pump systems, will be used to simulate the flow within the blood pump in the artificial heart assist device. The Interdisciplinary Technology Office heads up Lewis' efforts in the IVAS project. With the aid of numerical modeling, the blood pump will address many design issues, including some fluid-dynamic design considerations that are unique to the properties of blood. Some of the issues that will be addressed in the design process include hemolysis, deposition, recirculation, pump efficiency, rotor thrust balance, and bearing lubrication. Optimum pumping system performance will be achieved by modeling all the interactions between the pump components. The interactions can be multidisciplinary and, therefore, are influenced not only by the fluid dynamics of adjacent components but also by

  11. Radio-frequency tracking of respiratory equipment: rationale and early experience at the Cleveland Clinic.

    PubMed

    Stoller, James K; Roberts, Vincent; Matt, David; Chom, Leslie; Sasidhar, Madhu; Chatburn, Robert L

    2013-12-01

    When respiratory therapists (RTs) seek respiratory care equipment, finding it quickly is desirable, both to expedite patient care and to avert RTs wasting time. To optimize RTs' ability to quickly locate ventilators, we developed and implemented a radio-frequency identification (RFID) tagging system called eTrak. The Clinical Engineering and Information Technology groups at Cleveland Clinic collaboratively developed a Wi-Fi-based RFID program that used active RFID tags. Altogether, 218 ventilators, 82 noninvasive ventilators, and various non-respiratory equipment were tagged, beginning in March 2010. We calculated the difference in time required to locate equipment before versus after implementation. The eTrak system had a mean 145 log-ons per week over the first year of use, and was associated with a decreased time required for RTs to locate ventilators: median 18 min (range 1-45 min) versus 3 min (range 1-6 min) (P < .001). Surveys of RTs regarding whether equipment was hard to find before versus after implementing eTrak showed a non-significant trend toward improvement. An RFID tracking system for respiratory equipment shortened the time to locate ventilators and non-significantly improved RT satisfaction with finding equipment. RFID tagging of equipment warrants further investigation.

  12. Developing leadership competencies among medical trainees: five-year experience at the Cleveland Clinic with a chief residents' training course.

    PubMed

    Farver, Carol F; Smalling, Susan; Stoller, James K

    2016-10-01

    Challenges in healthcare demand great leadership. In response, leadership training programs have been developed within academic medical centers, business schools, and healthcare organizations; however, we are unaware of any well-developed programs for physicians-in-training. To address this gap, we developed a two-day leadership development course for chief residents (CRs) at the Cleveland Clinic, framed around the concept of emotional intelligence. This paper describes our five-year experience with the CRs leadership program. Since inception, 105 CRs took the course; 81 (77%) completed before-and-after evaluations. Participants indicated that they had relatively little prior knowledge of the concepts that were presented and that the workshop greatly enhanced their familiarity with leadership competencies. Qualitative analysis of open-ended responses indicated that attendees valued the training, especially in conflict resolution and teamwork, and indicated specific action plans for applying these skills. Furthermore, the workshop spurred some participants to express plans to learn more about leadership competencies. This study extends prior experience in offering an emotional intelligence-based leadership workshop for CRs. Though the program is novel, further research is needed to more fully understand the impact of leadership training for CRs and for the institutions and patients they serve. © The Royal Australian and New Zealand College of Psychiatrists 2016.

  13. Reflective Writing in the Competency-Based Curriculum at the Cleveland Clinic Lerner College of Medicine

    PubMed Central

    Isaacson, J Harry; Salas, Renee; Koch, Carl; McKenzie, Margaret

    2008-01-01

    The Cleveland Clinic Lerner College of Medicine of Case Western Reserve University is a five-year medical school where the major emphasis is to train physician investigators. In this article we describe our experience with reflective writing in our competency-based medical school, which has reflective practice as one of the nine core competencies. We outline how we use reflective writing as a way to help students develop their reflective practice skills. Reflective writing opportunities, excerpts of student pieces, and faculty and student perspectives are included. We have experienced the value of reflective writing in medical school education and believe elements of our program can be adapted to other training environments. PMID:21364819

  14. 33 CFR 165.906 - Lakeside Yacht Club in Cleveland Harbor, Cleveland, OH-regulated navigation areas.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 33 Navigation and Navigable Waters 2 2011-07-01 2011-07-01 false Lakeside Yacht Club in Cleveland... Guard District § 165.906 Lakeside Yacht Club in Cleveland Harbor, Cleveland, OH—regulated navigation... portion of the vessel extending above the waterline. All of these areas are inside the “Lakeside Yacht...

  15. 33 CFR 165.906 - Lakeside Yacht Club in Cleveland Harbor, Cleveland, OH-regulated navigation areas.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 33 Navigation and Navigable Waters 2 2010-07-01 2010-07-01 false Lakeside Yacht Club in Cleveland... Guard District § 165.906 Lakeside Yacht Club in Cleveland Harbor, Cleveland, OH—regulated navigation... portion of the vessel extending above the waterline. All of these areas are inside the “Lakeside Yacht...

  16. Muffled by the Din: The Competitive Noneffects of the Cleveland Voucher Program.

    ERIC Educational Resources Information Center

    Hess, Frederick M.; McGuinn, Patrick J.

    2002-01-01

    Examines how the introduction of the Cleveland voucher experiment in 1995 affected the administration and leadership of Cleveland's public schools. As of summer 2001, the program has produced virtually no visible effects. Results suggest that choice-based reform may not spur improvement in urban school systems, at least in the short term or when…

  17. 77 FR 31067 - Cleveland Commercial Railroad Company, LLC-Continuance in Control Exemption-Cleveland Harbor Belt...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-24

    ... becoming a Class III rail carrier. CCR has established CHB as a limited liability company and has the... Commercial Railroad Company, LLC--Continuance in Control Exemption--Cleveland Harbor Belt Railroad Cleveland Commercial Railroad Company, LLC (CCR), a Class III rail carrier, has filed a verified notice of exemption...

  18. Cleveland Neighborhood Elderly Transportation Demonstration Project

    DOT National Transportation Integrated Search

    1977-04-01

    The document is a final evaluation report of the Cleveland Neighborhood Elderly Transportation (NET) System. The Cleveland NET Project was implemented in March 1975 with the purpose of providing personalized door-to-door transportation services for e...

  19. Segregation Levels in Cleveland Public Schools and the Cleveland Voucher Program. School Choice Issues in the State

    ERIC Educational Resources Information Center

    Forster, Greg

    2006-01-01

    Examining the widespread claims that private schools have high segregation levels and vouchers will lead to greater segregation, this study finds that both assertions are empirically unsupportable. Private schools participating in Cleveland's voucher program are much less segregated than Cleveland's public schools. This means that students using…

  20. From Hypothermia to Cephalosomatic Anastomoses: The Legacy of Robert White (1926-2010) at Case Western Reserve University of Cleveland.

    PubMed

    Manjila, Sunil; Alambyan, Vilakshan; Singh, Gagandeep; Satish, Priyanka; Geertman, Robert T

    2018-05-01

    Dr. Robert J. White (1926-2010) was an eminent neurosurgeon and bioethicist, renowned for his classic work in hypothermia and pioneering mammalian head transplant experiments. He founded the Division of Neurosurgery at the Cleveland Metropolitan General Hospital (currently MetroHealth Medical Center, a level 1 trauma county hospital) and became the youngest full professor at the Case Western Reserve University in Cleveland, Ohio. With over 500 research articles to his credit, he founded the Brain Research Laboratory at what was then the Cleveland Metropolitan General Hospital, which was also home to future leaders in neurosurgery, neurosciences, and allied specialties. He transferred a healthy monkey head onto a surgically beheaded monkey body under deep hypothermic conditions drawing both laurels and criticisms alike. Despite a largely controversial neurosurgical research career, his original contributions to deep hypothermia have found profound clinical applications in modern trauma and vascular neurosurgery. The new fusogens and myelorrhaphy methods being tried in Europe hold promise for a future of reanastomosing 2 homologous or heterologous tracts in the neuraxis. Copyright © 2018 Elsevier Inc. All rights reserved.

  1. 78 FR 42733 - Safety Zone; Cleveland Dragon Boat Festival and Head of the Cuyahoga, Cuyahoga River, Cleveland, OH

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-17

    ...-AA00 Safety Zone; Cleveland Dragon Boat Festival and Head of the Cuyahoga, Cuyahoga River, Cleveland... intended to restrict vessels from a portion of the Cuyahoga River during the Dragon Boat Festival and Head... over a decade and the Dragon Boat Festival for the last 7 years. In response to past years' events, the...

  2. The Cleveland City Normal School, 1874-1936.

    ERIC Educational Resources Information Center

    Kline, Melinda; Dye, Charles M.

    The Cleveland (Ohio) Board of Education opened the Cleveland City Normal School in the fall of 1874 to provide a teacher corps for the public schools that was prepared to meet the unique needs of the rapidly growing metropolitan area. Increased Ohio teacher certification requirements prompted the school board and Western Reserve University to…

  3. The portfolio approach to competency-based assessment at the Cleveland Clinic Lerner College of Medicine.

    PubMed

    Dannefer, Elaine F; Henson, Lindsey C

    2007-05-01

    Despite the rapid expansion of interest in competency-based assessment, few descriptions of assessment systems specifically designed for a competency-based curriculum have been reported. The purpose of this article is to describe the design of a portfolio approach to a comprehensive, competency-based assessment system that is fully integrated with the curriculum to foster an educational environment focused on learning. The educational design goal of the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University was to create an integrated educational program-curriculum and instructional methods, student assessment processes, and learning environment-to prepare medical students for success in careers as physician investigators. The first class in the five-year program matriculated in 2004. To graduate, a student must demonstrate mastery of nine competencies: research, medical knowledge, communication, professionalism, clinical skills, clinical reasoning, health care systems, personal development, and reflective practice. The portfolio provides a tool for collecting and managing multiple types of assessment evidence from multiple contexts and sources within the curriculum to document competence and promote reflective practice skills. This article describes how the portfolio was developed to provide both formative and summative assessment of student achievement in relation to the program's nine competencies.

  4. Human Fitting Studies of Cleveland Clinic Continuous-Flow Total Artificial Heart

    PubMed Central

    Karimov, Jamshid H.; Steffen, Robert J.; Byram, Nicole; Sunagawa, Gengo; Horvath, David; Cruz, Vincent; Golding, Leonard A.R.; Fukamachi, Kiyotaka; Moazami, Nader

    2015-01-01

    Implantation of mechanical circulatory support devices is challenging, especially in patients with a small chest cavity. We evaluated how well the Cleveland Clinic continuous-flow total artificial heart (CFTAH) fit the anatomy of patients about to receive a heart transplant. A mock pump model of the CFTAH was rapid-prototyped using biocompatible materials. The model was brought to the operative table, and the direction, length, and angulation of the inflow/outflow ports and outflow conduits were evaluated after the recipient's ventricles had been resected. Thoracic cavity measurements were based on preoperative computed tomographic data. The CFTAH fit well in all five patients (height, 170 ± 9 cm; weight, 75 ± 24 kg). Body surface area was 1.9 ± 0.3 m2 (range, 1.6-2.1 m2). The required inflow and outflow port orientation of both the left and right housings appeared consistent with the current version of the CFTAH implanted in calves. The left outflow conduit remained straight, but the right outflow direction necessitated a 73 ± 22 degree angulation to prevent potential kinking when crossing over the connected left outflow. These data support the fact that our design achieves the proper anatomical relationship of the CFTAH to a patient's native vessels. PMID:25806613

  5. Affirmative Action or Inaction? The Pursuit of Equal Employment Opportunity in Cleveland.

    ERIC Educational Resources Information Center

    Squires, Gregory D.

    This report documents the low economic status of minorities and women in Cleveland by examining inadequacies in the city's affirmative action plan, deficiencies in Cleveland's contract compliance program, and inconsistencies in the Federal government's civil rights enforcement effort. Four major problems with Cleveland's affirmative action plan…

  6. 2. COPY OF MAP DATED 121073, OF THE CLEVELAND DISTRICT ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    2. COPY OF MAP DATED 12-10-73, OF THE CLEVELAND DISTRICT STEEL PLANT, REPUBLIC STEEL CORPORATION. MAP COURTESY REPUBLIC STEEL. - Corrigan, McKinney Steel Company, 3100 East Forty-fifth Street, Cleveland, Cuyahoga County, OH

  7. The City Normal Schools of Cleveland and Akron, Ohio.

    ERIC Educational Resources Information Center

    Kline, Melinda J.

    The public school systems of 19th century Cleveland and Akron, Ohio, desiring a qualified and ready corps of teachers to staff their respective school systems, established normal schools to train their own staff. Increased Ohio certification requirements prompted Western Reserve University and the Cleveland school board as well as the Municipal…

  8. The Cleveland Clinic experience with adrenal cortical carcinoma.

    PubMed

    Bodie, B; Novick, A C; Pontes, J E; Straffon, R A; Montie, J E; Babiak, T; Sheeler, L; Schumacher, P

    1989-02-01

    Between 1936 and 1987, 82 patients with adrenal cortical carcinoma were seen at our clinic. Of these patients 49 (72 per cent) have been seen during the last 25 years. A total of 40 patients (48.8 per cent) presented with a hormonally functional tumor and 42 (51.2 per cent) had a nonfunctional tumor. Forty patients (48.8 per cent) presented with localized disease, 12 (14.6 per cent) with regional disease and 30 (36.6 per cent) with distant metastases. Complete surgical removal of all gross tumor was achieved in 49 patients. Over-all 3 and 5-year patient survival rates in this series were 37.5 and 25.1 per cent, respectively. Survival was significantly improved (43.9 per cent at 5 years, p equals 0.0001) in patients with localized disease that was completely removed surgically; postoperative adjuvant therapy with op'-DDD was of no benefit in these patients. Survival in patients with metastatic disease was poor and was not improved by treatment with op'-DDD, cytotoxic chemotherapy or radiation therapy.

  9. 75 FR 49912 - Foreign-Trade Zone 40-Cleveland, OH; Site Renumbering Notice

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-16

    ...)--Cleveland Business Park, Cleveland; Site 3 (450 acres)--Burke Lakefront Airport, 1501 North Marginal Road..., Glenwillow; Site 5 (17 acres)--within the Collinwood Industrial Park, South Waterloo (South Marginal) Road...

  10. Sculpted landscapes: art & place in Cleveland's Cultural Gardens, 1916-2006.

    PubMed

    Tebeau, Mark

    2010-01-01

    Perhaps the world's first peace garden, the Cleveland Cultural Gardens embody the history of twentieth-century America and reveal the complex interrelations between art and place. This essay uses the Cleveland Cultural Gardens as a lens through which to explore how art and place have intersected over time. It explores how communities have negotiated questions of national, ethnic, and American identity and embedded those identities into the vernacular landscape. It considers how the particulars of place were embedded into a public garden and asks whether it is possible for public art to transcend its place—both in terms of geography and history. In some sense, the Gardens have transcended their place, but in others respects, their fortunes were bound inextricably to that place, to the economic, demographic, and cultural contours that shaped and reshaped Northern Ohio. As works of art, the Cleveland Cultural Gardens both have reflected the history of Cleveland and American industrial cities during the 20th century and revealed something of the dynamics that underscored the changing character of public art and gardens in American cities.

  11. Surreptitious surgery on Long Island Sound: The oral cancer surgeries of President Grover Cleveland.

    PubMed

    Maloney, William

    2010-01-01

    Grover Cleveland rose from being the mayor of Buffalo to the governor of New York to the president of the United States. At the start of Cleveland's second term as president, the nation was involved in a severe financial crisis, the extent of which was not known by the general public. President Cleveland was to make a strong appeal to Congress in the coming months to repeal the Sherman Silver Purchase Act of 1890. He thought this would set the nation on the road to fiscal recovery. However, his vice president, Adlai Stevenson, strongly opposed repeal of the Sherman Act. Prior to scheduling his appearance before Congress, President Cleveland noticed a rough spot on his palate. A biopsy confirmed that it was cancer, and it was determined that surgery was needed. Cleveland and his advisors thought the nation would be thrown into a panic if the President's health did not remain a secret. A surgical team, which included a dentist, performed the surgery in secrecy while traveling aboard a yacht. A prosthetic obturator was fabricated by a New York prosthodontist to close the surgical defect. Cleveland recovered well, made a forceful speech before Congress, had the Sherman Act repealed and lived without a recurrence of his oral cancer for the rest of his life. The public remained unaware, for the most part, of the gravity of President Cleveland's health for decades.

  12. An Example of Effective Urban Outreach: Cleveland Metroparks' NatureTracks Program.

    ERIC Educational Resources Information Center

    Volbrecht, Vera E.; Hereford, Ray

    1996-01-01

    Describes a mobile interpretive unit of the Cleveland Metroparks that is involved with interpreting natural and cultural history to urban core audiences. The program focuses on plant and animal life in forest, pond, meadow, and urban environments with content targeted to urban youths who are often unable to visit Cleveland Metroparks and are…

  13. Cleveland Clinic's summer research program in reproductive medicine: an inside look at the class of 2014

    PubMed Central

    Durairajanayagam, Damayanthi; Kashou, Anthony H; Tatagari, Sindhuja; Vitale, Joseph; Cirenza, Caroline; Agarwal, Ashok

    2015-01-01

    Background The American Center for Reproductive Medicine's summer internship course in reproductive medicine and research at Cleveland Clinic is a rigorous, results-oriented annual program that began in 2008 to train both local and international students in the fundamentals of scientific research and writing. The foremost goal of the program is to encourage premedical and medical students to aspire toward a career as a physician–scientist. The internship provides participants with an opportunity to engage in original bench research and scientific writing while developing theoretical knowledge and soft skills. This study describes selected survey responses from interns who participated in the 2014 internship program. The objective of these surveys was to elicit the interns' perspective on the internship program, its strengths and weaknesses, and to obtain insight into potential areas for improvement. Methods Questionnaires were structured around the five fundamental aspects of the program: 1) theoretical knowledge, 2) bench research, 3) scientific writing, 4) mentorship, and 5) soft skills. In addition, an exit survey gathered information on factors that attracted the interns to the program, communication with mentors, and overall impression of the research program. Results The opportunity to experience hands-on bench research and scientific writing, personalized mentorship, and the reputation of the institution were appreciated and ranked highly among the interns. Nearly 90% of the interns responded that the program was beneficial and well worth the time and effort invested by both interns and faculty. Conclusion The outcomes portrayed in this study will be useful in the implementation of new programs or refinement of existing medical research training programs. PMID:26563960

  14. 75 FR 15739 - Lockheed Martin: Cleveland, OH; Notice of Termination of Investigation

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-30

    ... DEPARTMENT OF LABOR Employment and Training Administration [TA-W-73,284] Lockheed Martin: Cleveland, OH; Notice of Termination of Investigation Pursuant to Section 223 of the Trade Act of 1974, as... official on behalf of workers of Lockheed Martin, Cleveland, Ohio. The petitioner(s) has (have) requested...

  15. Practical guide for implementing hybrid PET/MR clinical service: lessons learned from our experience

    PubMed Central

    Parikh, Nainesh; Friedman, Kent P.; Shah, Shetal N.; Chandarana, Hersh

    2015-01-01

    Positron emission tomography (PET) and magnetic resonance imaging, until recently, have been performed on separate PET and MR systems with varying temporal delay between the two acquisitions. The interpretation of these two separately acquired studies requires cognitive fusion by radiologists/nuclear medicine physicians or dedicated and challenging post-processing. Recent advances in hardware and software with introduction of hybrid PET/MR systems have made it possible to acquire the PET and MR images simultaneously or near simultaneously. This review article serves as a road-map for clinical implementation of hybrid PET/MR systems and briefly discusses hardware systems, the personnel needs, safety and quality issues, and reimbursement topics based on experience at NYU Langone Medical Center and Cleveland Clinic. PMID:25985966

  16. Noise Assessment of the Greater Cleveland Regional Transit Authority Heavy Rail Transit Authority

    DOT National Transportation Integrated Search

    1978-10-01

    The report describes the noise climate on and near the Greater Cleveland Regional Transit Authority (RTA), formerly the Cleveland Transit System (CTS), Airport Line. The RTA urban rail transit line has approximately 19 miles of two-way revenue track ...

  17. RadNet Air Data From Cleveland, OH

    EPA Pesticide Factsheets

    This page presents radiation air monitoring and air filter analysis data for Cleveland, OH from EPA's RadNet system. RadNet is a nationwide network of monitoring stations that measure radiation in air, drinking water and precipitation.

  18. Brownfields City of Cleveland: Deconstruction Lessons Learned Report

    EPA Pesticide Factsheets

    This technical memorandum presents an overview of Cleveland’s current deconstruction initiative goals and lessons learned (in the Cleveland area) and potential strategies for addressing lessons learned.

  19. Five Years and Counting: A Closer Look at the Cleveland Voucher Program.

    ERIC Educational Resources Information Center

    Pathak, Arohi; Holmes, Dwight; Mincberg, Elliot; Neas, Ralph G.

    This report explores the Cleveland voucher program and its impact on Cleveland students, discussing the key questions that parents, the public, and policymakers are asking. It reviews how vouchers are funded, the actual cost of vouchers to taxpayers and the state, and what choices are really available to students whose families opt for vouchers.…

  20. Clinical exposures during internal medicine acting internship: profiling student and team experiences.

    PubMed

    Smith, Todd I; LoPresti, Charles M

    2014-07-01

    The clinical learning model in medical education is driven by knowledge acquisition through direct patient-care experiences. Despite the emphasis on experiential learning, the ability of educators to quantify the clinical exposures of learners is limited. To utilize Veterans Affairs (VA) electronic medical record information through a data warehouse to quantify clinical exposures during an inpatient internal medicine rotation. We queried the VA clinical data warehouse for the patients encountered by each learner completing an acting internship rotation at the Cleveland VA Medical Center from July 2008 to November 2011. We then used discharge summary information to identify team exposures-patients seen by the learner's inpatient team who were not primarily assigned to the learner. Based on the learner and team exposures, we complied lists of past medical problems, medications prescribed, laboratory tests that resulted, radiology evaluated, and primary discharge diagnoses. Primary learner and team-based clinical exposures were evaluated for a total of 128 acting internship students. The percentage of learners who had a primary exposure to a medication/lab value/imaging result/diagnosis was calculated. The percentage of learners with at least 1 primary or team-based exposure to an item was also calculated. The most common exposures in each category are presented. Analysis of the clinical exposures during an inpatient rotation can augment the ability of educators to understand learners' experiences. These types of analyses could provide information to improve learner experience, implement novel curricula, and address educational gaps in clinical rotations. © 2014 Society of Hospital Medicine.

  1. Cleveland Clinic intelligent mouthguard: a new technology to accurately measure head impact in athletes and soldiers

    NASA Astrophysics Data System (ADS)

    Bartsch, Adam; Samorezov, Sergey

    2013-05-01

    Nearly 2 million Traumatic Brain Injuries (TBI) occur in the U.S. each year, with societal costs approaching $60 billion. Including mild TBI and concussion, TBI's are prevalent in soldiers returning from Iraq and Afghanistan as well as in domestic athletes. Long-term risks of single and cumulative head impact dosage may present in the form of post traumatic stress disorder (PTSD), depression, suicide, Chronic Traumatic Encephalopathy (CTE), dementia, Alzheimer's and Parkinson's diseases. Quantifying head impact dosage and understanding associated risk factors for the development of long-term sequelae is critical toward developing guidelines for TBI exposure and post-exposure management. The current knowledge gap between head impact exposure and clinical outcomes limits the understanding of underlying TBI mechanisms, including effective treatment protocols and prevention methods for soldiers and athletes. In order to begin addressing this knowledge gap, Cleveland Clinic is developing the "Intelligent Mouthguard" head impact dosimeter. Current testing indicates the Intelligent Mouthguard can quantify linear acceleration with 3% error and angular acceleration with 17% error during impacts ranging from 10g to 174g and 850rad/s2 to 10000rad/s2, respectively. Correlation was high (R2 > 0.99, R2 = 0.98, respectively). Near-term development will be geared towards quantifying head impact dosages in vitro, longitudinally in athletes and to test new sensors for possible improved accuracy and reduced bias. Long-term, the IMG may be useful to soldiers to be paired with neurocognitive clinical data quantifying resultant TBI functional deficits.

  2. Cleveland Youths Leave Their Mark in the Park

    ERIC Educational Resources Information Center

    Riedel, Barb L.

    1975-01-01

    Forty young men between the ages of 13 and 17 worked on an innovative program that involved rebuilding a walking trail and preventing erosion of picnic area facilities at Euclid Creek Park in Cleveland, Ohio. (RC)

  3. Transit as transformation : the Euclid Corridor in Cleveland

    DOT National Transportation Integrated Search

    2012-06-30

    Public and private investments catalyzed a striking transformation along Euclid Avenue in Cleveland, generated in part by the construction of a new bus rapid transit (BRT) system known as the HealthLine. Euclid Avenues strategic location stretches...

  4. Service Learning in Community Development: Partnering with East Cleveland. Briefly Stated. Number 10-01

    ERIC Educational Resources Information Center

    Harris, David G.; Chupp, Mark G.

    2010-01-01

    Residents of East Cleveland are fighting to improve the quality of public education and access to vocational opportunities. "White flight" (Frey, 1979, p. 425), economic disinvestment, and ineffective political leadership have led to the disadvantages faced by East Cleveland (Kathi & Cooper, 2005). Nearly 1,200 vacant structures…

  5. Impact of donor age in liver transplantation from donation after circulatory death donors: A decade of experience at Cleveland Clinic.

    PubMed

    Firl, Daniel J; Hashimoto, Koji; O'Rourke, Colin; Diago-Uso, Teresa; Fujiki, Masato; Aucejo, Federico N; Quintini, Cristiano; Kelly, Dympna M; Miller, Charles M; Fung, John J; Eghtesad, Bijan

    2015-12-01

    The use of liver grafts from donation after circulatory death (DCD) donors remains controversial, particularly with donors of advanced age. This retrospective study investigated the impact of donor age in DCD liver transplantation. We examined 92 recipients who received DCD grafts and 92 matched recipients who received donation after brain death (DBD) grafts at Cleveland Clinic from January 2005 to June 2014. DCD grafts met stringent criteria to minimize risk factors in both donors and recipients. The 1-, 3-, and 5-year graft survival in DCD recipients was significantly inferior to that in DBD recipients (82%, 71%, 66% versus 92%, 87%, 85%, respectively; P = 0.03). Six DCD recipients (7%), but no DBD recipients, experienced ischemic-type biliary stricture (P = 0.01). However, the incidence of biliary stricture was not associated with donor age (P = 0.57). Interestingly, recipients receiving DCD grafts from donors who were <45 years of age (n = 55) showed similar graft survival rates compared to those receiving DCD grafts from donors who were ≥45 years of age (n = 37; 80%, 69%, 66% versus 83%, 72%, 66%, respectively; P = 0.67). Cox proportional hazards modeling in all study populations (n = 184) revealed advanced donor age (P = 0.05) and the use of a DCD graft (P = 0.03) as unfavorable factors for graft survival. Logistic regression analysis showed that the risk of DBD graft failure increased with increasing age, but the risk of DCD graft failure did not increase with increasing age (P = 0.13). In conclusion, these data suggest that stringent donor and recipient selection may ameliorate the negative impact of donor age in DCD liver transplantation. DCD grafts should not be discarded because of donor age, per se, and could help expand the donor pool for liver transplantation. © 2015 American Association for the Study of Liver Diseases.

  6. 76 FR 66250 - Television Broadcasting Services; Cleveland, OH

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-26

    ... FEDERAL COMMUNICATIONS COMMISSION 47 CFR Part 73 [MB Docket No. 11-159, RM-11644; DA 11-1690] Television Broadcasting Services; Cleveland, OH AGENCY: Federal Communications Commission. ACTION: Proposed... terminated analog service on June 12, 2009, and commenced post-transition digital service on its VHF channel...

  7. Cleveland's Multicultural Librarian: Eleanor (Edwards) Ledbetter, 1870-1954

    ERIC Educational Resources Information Center

    Jones, Plummer Alston, Jr.

    2013-01-01

    Eleanor (Edwards) Ledbetter, who served immigrant populations in Cleveland throughout most of the Progressive Era and the Great Depression, was one of the first librarians to advocate for multiculturalism (then called cultural pluralism) as opposed to Americanism. In providing multicultural and multilingual library services for immigrants,…

  8. Air quality aerometric data for the city of Cleveland from 1967 to 1970 for sulphur dioxide, suspended particulates, and nitrogen dioxide

    NASA Technical Reports Server (NTRS)

    Neustadter, H. E.; King, R. B.; Fordyce, J. S.; Burr, J. C., Jr.

    1972-01-01

    The NASA Lewis Research Center is assisting the City of Cleveland, Ohio, in its effort to monitor its air pollution. This report describes the Cleveland program of the past 4 years and the supportive Lewis program currently being developed. The data accumulated by Cleveland over the past 4 years are presented together with some preliminary statistical analyses indicating in a semiquantitive manner the degree of air pollution existing within the boundaries of Cleveland.

  9. 75 FR 4063 - Adequacy Status of the Cleveland/Akron, Ohio Submitted Annual Fine Particulate Matter Attainment...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-01-26

    ... Cleveland/Akron, Ohio Submitted Annual Fine Particulate Matter Attainment Demonstration for Transportation... (MVEBs) for fine particulate matter (PM 2.5 ) and oxides of nitrogen (NO X ) as a precursor to fine particulate matter in the Cleveland/Akron, Ohio area are adequate for use in transportation conformity...

  10. Tinea capitis in Cleveland: survey of elementary school students.

    PubMed

    Ghannoum, M; Isham, N; Hajjeh, R; Cano, M; Al-Hasawi, F; Yearick, D; Warner, J; Long, L; Jessup, C; Elewski, B

    2003-02-01

    Tinea capitis, a fungal infection of the scalp, is of increasing public health importance, and Trichophyton tonsurans has become the primary causative agent in North America. To determine the prevalence of dermatophyte-positive scalp cultures among elementary schoolchildren in Cleveland, Ohio, describe predisposing factors, and measure the antifungal susceptibility of isolates collected. A total of 937 children from 8 Cleveland elementary schools were cultured for the presence of dermatophytes; 122 children (13%), all of whom were African American, had dermatophyte-positive cultures of the scalp. Sixty percent of cases were asymptomatic, indicating a carrier state. Race, scaling, and the use of anti-dandruff shampoo were associated with increased likelihood of infection. T tonsurans was the only organism isolated (except 1 Microsporum canis isolate). All isolates were susceptible to fluconazole, griseofulvin, itraconazole, and terbinafine. T tonsurans was the predominant dermatophyte isolated. Further multicenter studies are needed to confirm the predominance of dermatophyte-positive scalp cultures among African American children and to determine modifiable and preventable risk factors.

  11. Aerodynamic size distribution of suspended particulate matter in the ambient air in the city of Cleveland, Ohio

    NASA Technical Reports Server (NTRS)

    Leibecki, H. F.; King, R. B.; Fordyce, J. S.

    1974-01-01

    The City of Cleveland Division of Air Pollution Control and NASA jointly investigated the chemical and physical characteristics of the suspended particulate matter in Cleveland, and as part of the program, measurements of the particle size distribution of ambient air samples at five urban locations during August and September 1972 were made using high-volume cascade impactions. The distributions were evaluated for lognormality, and the mass median diameters were compared between locations and as a function of resultant wind direction. Junge-type distributions were consistent with dirty continental aerosols. About two-thirds of the suspended particulate matter observed in Cleveland is less than 7 microns in diameter.

  12. 75 FR 9925 - Notice of Intent to Repatriate a Cultural Item: The Cleveland Museum of Natural History...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-04

    ... Cleveland Museum of Natural History, Cleveland, OH, that meets the definition of a ``sacred object'' under... Park Service is not responsible for the determinations in this notice. The sacred object is a wooden... when unwrapped. Thus, only part of the sacred object is currently in the collection. The pipe stem...

  13. Mitigating preventable chronic disease: Progress report of the Cleveland Clinic's Lifestyle 180 program

    PubMed Central

    2011-01-01

    Background Poor lifestyle choices are key in development and progression of preventable chronic diseases. The purpose of the study was to design and test a program to mitigate the physical and fiscal consequences of chronic diseases. Methods Here we report the outcomes for 429 participants with one or more chronic conditions, including obesity, hypertension, hyperlipidemia and diabetes mellitus, many of whom had failed traditional disease management programs, who enrolled into a comprehensive lifestyle intervention. The Lifestyle 180 program integrates nutrition, physical activity and stress management interventions and was conducted at the Wellness Institute of the Cleveland Clinic, United States. An intensive 6 week immersion course, with 8 hours of group instruction per week, was followed by 3 follow-up, 4 hour-long sessions over the course of 6 months. Results Changes in biometric (weight, height, waist circumference, resting heart rate and blood pressure) and laboratory variables (fasting lipid panel, blood glucose, insulin, hemoglobin A1c, ultra sensitive C-reactive protein) at 6 months were compared with baseline (pre-post analysis). At week 30, biometric and laboratory data were available for 244 (57%) and 299 (70%) participants, respectively. These had a mean ± SD reduction in weight (6.8 ± 6.9 kg, P < 0.001), waist circumference (6.1 ± 7.3 cm, P < 0.001), glucose (4.5 ± 29.6 mg/dL or 0.25 ± 1.64 mmol/L, P = 0.009), triglycerides (26.4 ± 58.5 mg/dL or 0.30 ± 0.66 mmol/L, P < 0.001), low-density lipoprotein cholesterol (LDL) (7.9 ± 25.1 mg/dL or 0.2 ± 0.65 mmol/L, P < 0.001), hemoglobin A1c (HgbA1c) (0.20 ± 0.64%, P = 0.001), insulin (3.8 ± 11 microU/ml or 26.6 ± 76.4 ρmol, P < 0.001) and ultra sensitive C-reactive protein (US - CRP) (0.9 ± 4.8 mg/dL or 7.3 ± 40.2 nmol/L, P = 0.012), an increase in mean high-density lipoprotein cholesterol (HDL) (3.7 ± 8.4 mg/dL or 0.1 ± 0.22, P < 0.001), and decreased use of medications. Conclusion

  14. Grover Cleveland School, Boston, Massachusetts. Refurbishment and Status Report.

    ERIC Educational Resources Information Center

    General Electric Co., Philadelphia, PA.

    The solar heating system is a retrofit installation on the roof of the Grover Cleveland Middle School in Boston. The system includes 4,600 square feet of flat plate collectors, a 2,000 gallon solar energy storage tank, plus the required structural steel, piping, insulation, pumps, heat exchangers, and controls to heat the air supplied by two…

  15. The Cleveland-Cuyahoga County Food Policy Coalition: "we have evolved".

    PubMed

    Walsh, Colleen C; Taggart, Morgan; Freedman, Darcy A; Trapl, Erika S; Borawski, Elaine A

    2015-06-04

    Several pieces of legislation passed in Cleveland, Ohio, from 2007 to 2011, focused on improving the city's food environment through urban agriculture initiatives. We used qualitative, case study methods, including interviews with 7 key informants, to examine the policy development process and investigate the role of the Cleveland-Cuyahoga County Food Policy Coalition in developing and implementing 4 pieces of legislation. In this article, we focus on 2 pieces of legislation: zoning designation of an urban garden and allowance of small farm animals and bees on residential property. Five key themes emerged: impetus for policy came from community needs; education and raising awareness helped mitigate barriers; a cultural shift took place among policy makers; social connections and individual champions were needed; and concerns over food access and health influenced policy decisions. Legislative actions are important tools to influence the nutrition environment, as long as they are based on local needs and context.

  16. Cleveland Clinic Rehabilitation Research Program

    DTIC Science & Technology

    2014-10-01

    risks have been identified that would require a new risk analysis. The study is now registered as a pilot clinical trial. Use of tDCS , TMS and structural...using behavioral recording and electroencephalographic ( EEG ) recording and results were published. Study 2: The motor cortex (M1) and the...four pilot projects. Study 1: Magnetic stimulation and epilepsy In this study, transcranial magnetic stimulation ( TMS ) will be tested for its

  17. Investigation of the General Electric I-40 Jet-Propulsion Engine in the Cleveland Altitude Wind Tunnel. 2 - Analysis of Compressor Performance Characteristics

    DTIC Science & Technology

    1946-11-18

    INVESTIGATION OF THE GENERAL ELECTRIC 1-40 JET -PROPULSION ENGINE IN THE CLEVELAND ALTITUDE WIND TUNNEL .; II - ANALYSIS OF COMPRESSOR PERFORMANCE...CHARACTERISTICS By Robert 0. Dietz, Jr. and Robert M. Gelsenheyner Aircraft Engine Research Laboratory 1 Cleveland, Ohio !f -NOT FM ED", P 0 W DESTROY...Command, Army Air Forces INVESTIGATION OF THE GENERAL ELECTRIC 1-40 JET -PROPULSION ENGINE IN THE CLEVELAND ALTITUDE WIND TUNNEL II - ANALYSIS OF

  18. 78 FR 14475 - Proposed Establishment of Class E Airspace; Cleveland, TN

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-06

    ...) Global Positioning System (GPS) Standard Instrument Approach Procedures at Cleveland Regional Jetport. This action would enhance the safety and airspace management of Instrument Flight Rules (IFR...; Airspace Docket No. 12-ASO-47) and be submitted in triplicate to the Docket Management System (see...

  19. 78 FR 27306 - Radio Broadcasting Services; Dermott, Arkansas, and Cleveland, Mississippi

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-10

    ... FEDERAL COMMUNICATIONS COMMISSION 47 CFR Part 73 [DA 13-905; MB Docket No. 12-53; RM-11658] Radio Broadcasting Services; Dermott, Arkansas, and Cleveland, Mississippi AGENCY: Federal Communications Commission.... Federal Communications Commission. Nazifa Sawez, Assistant Chief, Audio Division, Media Bureau. For the...

  20. Lockheed P-80 Shooting Star at the National Air Races in Cleveland, Ohio

    NASA Image and Video Library

    1946-08-21

    A Lockheed P-80 Shooting Star jet aircraft on the tarmac at the National Advisory Committee for Aeronautics (NACA) NACA Lewis Flight Propulsion Laboratory in Cleveland, Ohio. The Air Force aircraft was participating in the 1946 National Air Races over Labor Day weekend. The air races were held at the Cleveland Municipal Airport seven times between 1929 and 1939. The events included long distance, sprint, and circuit competitions, as well as aeronautical displays, demonstrations, and celebrities. The air races were suspended indefinitely in 1940 for a variety of reasons, including the start of World War II in Europe. The nature of the National Air Races changed dramatically when the event resumed in 1946. The introduction of jet aircraft, primarily the Lockheed P-80 seen here, required an entire separate division for each event. Since military pilots were the only ones with any jet aircraft experience, only they could participate in those divisions. In addition, the performance and quantity of commercially manufactured piston aircraft had increased dramatically during the war. By 1946, the custom-built racing aircraft that made the pre-war races so interesting were no longer present. The P-80 was the first US-designed and US-manufactured jet aircraft. Early models were tested during the war in NACA Lewis’ Altitude Wind Tunnel. A modified P-80 set the world’s speed record at the 1947 air races by achieving 620 miles per hour.

  1. Grassroots Journalism in the City: Cleveland's Neighborhood Newspapers. Monograph No. 6.

    ERIC Educational Resources Information Center

    Jeffres, Leo W.; And Others

    The first section of this monograph on community newspapers describes the patterns and trends of "grassroots journalism" in the Cleveland, Ohio, area. Based on interviews with 37 newspaper editors, the following topics are covered: origins and history, goals, organization and structure, method of production, advertising, content,…

  2. West Virginians in Their Own State and in Cleveland, Ohio. Summary and Conclusions of a Comparative Social Study. West Virginia University, Appalachian Center Information Report 3.

    ERIC Educational Resources Information Center

    Photiadis, John D.

    Nonmigrants, returned migrants, migrants living in Cleveland ghettos, and migrants living in Cleveland suburbs were studied in order to: (1) examine social and sociopsychological characteristics of West Virginians living in their own state and in Cleveland and (2) test the hypothesis that in order to satisfy societal expectations in terms of…

  3. Grover Cleveland High School Project CAUSA, 1985-1986. OEA Evaluation Report.

    ERIC Educational Resources Information Center

    New York City Board of Education, Brooklyn. Office of Educational Assessment.

    In 1985-86, Project CAUSA completed a three-year funding cycle at Grover Cleveland High School in Queens, New York. The project provided 132 newly arrived students from Italy and several Spanish-speaking countries with instruction in English as a second language (ESL), native language arts, and content areas. Basic goals were to help students…

  4. 33 CFR 165.T09-0073 - Safety and Security Zones; Tall Ships Challenge 2010; Great Lakes; Cleveland, OH; Bay City, MI...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 33 Navigation and Navigable Waters 2 2010-07-01 2010-07-01 false Safety and Security Zones; Tall Ships Challenge 2010; Great Lakes; Cleveland, OH; Bay City, MI; Duluth, MN; Green Bay, WI; Sturgeon Bay...; Cleveland, OH; Bay City, MI; Duluth, MN; Green Bay, WI; Sturgeon Bay, WI; Chicago, IL; Erie, PA. (a...

  5. From Slovenian to American: Immigrants in Cleveland's Public and Parochial Schools

    ERIC Educational Resources Information Center

    Gombach, Marlene

    2006-01-01

    In a Cleveland that was one of the most foreign of the country's cities, the Slovenian community struggled with the problem of maintaining its cultural ties while still adopting enough American customs to enable it to take advantage of the opportunities in a democratic, industrialized city. This article attempts to clarify some of the problems of…

  6. Environmental impact statement for National Aeronautics and Space Administration Lewis Research Center, Cleveland, Ohio

    NASA Technical Reports Server (NTRS)

    1971-01-01

    The probable environmental impact and adverse effects of the Lewis Research Center are assessed. The Cleveland and Plum Brook facilities are briefly described. It is felt that the absence of harmful environmental impact from the Cleveland site is apparent, and the monitoring at the Plum Brook reactor facility shows the effectiveness of effluent controls. The probable adverse effects are considered for air, water, and noise pollution, and radioactive and hazardous waste storage and disposal; it is concluded that all emissions are maintained below Federal, and local standards. There are no appropriate alternatives to the operation of the Center, and no improvement in environmental quality would result from relocation. The relationship between local short-term productivity is briefly discussed. No adverse comment has been received from public agencies or private organizations or individuals.

  7. Western dwarf mistletoe infects understory Jeffrey pine seedlings on Cleveland National Forest, California

    Treesearch

    Robert F. Scharpf; Detlev Vogler

    1986-01-01

    Many young, understory Jeffrey pines (Pinus jeffreyi Grev. & Balf.) were found to be infected by western dwarf mistletoe (Arceuthobium campylopodum Engelm.) on Laguna Mountain, Cleveland National Forest, in southern California. Under heavily infected overstory, about three-fourths of the young pines (about 15 years old on the...

  8. Characteristics of Effective Clinical Teachers in Simulated Clinical Experiences Compared to Traditional Clinical Experiences

    ERIC Educational Resources Information Center

    Sieh-Bliss, Selina

    2014-01-01

    While there is evidence in the literature measuring effective clinical teacher characteristics in traditional experiences, little is known of effective characteristics expected from clinical teachers during simulated clinical experiences. This study examined which clinical teaching behaviors and characteristics are perceived by nursing students'…

  9. Baseball caps of the Atlanta Braves and Cleveland Indians in the flight deck

    NASA Image and Video Library

    1995-10-25

    STS073-E-5135 (26 Oct. 1995) --- Baseball caps from the two 1995 World Series representative franchises float near the cabin windows of the Earth-orbiting space shuttle Columbia, with the Earth in the background. The American League champion Cleveland Indians and their National League counterpart Atlanta Braves were engaged in a scheduled best-of-seven World Series throughout the first portion of the scheduled 16-day mission in space. Off-duty crewmembers came out of a rest period to set up the scene in tribute to the October classic. The crew will continue working in shifts around the clock on a diverse assortment of United States Microgravity Laboratory (USML-2) experiments located in the science module. Fields of study include fluid physics, materials science, biotechnology, combustion science and commercial space processing technologies. The frame was exposed with an Electronic Still Camera (ESC).

  10. Advantageous GOES IR results for ash mapping at high latitudes: Cleveland eruptions 2001

    USGS Publications Warehouse

    Gu, Yingxin; Rose, William I.; Schneider, D.J.; Bluth, G.J.S.; Watson, I.M.

    2005-01-01

    The February 2001 eruption of Cleveland Volcano, Alaska allowed for comparisons of volcanic ash detection using two-band thermal infrared (10-12 ??m) remote sensing from MODIS, AVHRR, and GOES 10. Results show that high latitude GOES volcanic cloud sensing the range of about 50 to 65??N is significantly enhanced. For the Cleveland volcanic clouds the MODIS and AVHRR data have zenith angles 6-65 degrees and the GOES has zenith angles that are around 70 degrees. The enhancements are explained by distortion in the satellite view of the cloud's lateral extent because the satellite zenith angles result in a "side-looking" aspect and longer path lengths through the volcanic cloud. The shape of the cloud with respect to the GOES look angle also influences the results. The MODIS and AVHRR data give consistent retrievals of the ash cloud evolution over time and are good corrections for the GOES data. Copyright 2005 by the American Geophysical Union.

  11. Chemical Composition and Source Apportionment of Size Fractionated Particulate Matter in Cleveland, Ohio, USA

    EPA Science Inventory

    The Cleveland airshed comprises a complex mixture of industrial source emissions that contribute to periods of non-attainment for fine particulate matter (PM 2.5 ) and are associated with increased adverse health outcomes in the exposed population. Specific PM sources responsible...

  12. Proposed Plan for Magnet Schools--Cleveland Public Schools. Section II, Health Careers Center.

    ERIC Educational Resources Information Center

    Fleming, Margaret, Ed.; And Others

    A plan for a magnet school health careers program for 11th and 12th graders, intended to promote desegregation and provide improved educational opportunities for Cleveland students, is described in this proposal. Detailed descriptions cover staff requirements and qualifications, staff development plans, curriculum, and support activities. Included…

  13. 75 FR 47632 - Thomson Reuters Legal, Legal Editorial Operations, Cleveland Office, Including Workers Whose...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-06

    ..., Legal Editorial Operations, Cleveland Office, Including Workers Whose Unemployment Insurance (UI) Wages... Office had their wages reported under a separated unemployment insurance (UI) tax account under the name... unemployment insurance (UI) wages are paid through West Services, Inc., Independence, Ohio, who became totally...

  14. Proposed Plan for Magnet Schools--Cleveland Public Schools. Section I: Overview of Magnet Program.

    ERIC Educational Resources Information Center

    Fleming, Margaret, Ed.; And Others

    This report presents an overview of Cleveland's proposed magnet program for facilitating school desegregation and improving educational opportunities for students from diverse ethnic/racial backgrounds. Included are discussions of individual student needs, strategies for improved instruction, possible community impact, the United States Office of…

  15. Students' Performance in M. Ed. Programs at the Cleveland State University, 1968-1975.

    ERIC Educational Resources Information Center

    Gans, Thomas G.

    The College of Education of the Cleveland State University opened its first graduate program in 1968. The purpose of the study reported here is to provide information for reflection about the college's past performance and for planning new directions in its graduate programs. The study uses information from college and university records,…

  16. Green Residential Demolitions: Case Study of Vacant Land Reuse in Storm Water Management in Cleveland

    EPA Science Inventory

    The demolition process impacts how vacant land might be reused for storm water management. For five residential demolition sites (Cleveland, Ohio), an enhanced green demolition process was observed in 2012, and soil physical and hydrologic characteristics were measured predemolit...

  17. Preliminary report on near-surface lignite occurrences, Cleveland County, Arkansas

    USGS Publications Warehouse

    Heermann, Stephen E.

    1983-01-01

    Four cross sections were constructed from lithologic descriptions of 43 drill holes in Cleveland County, Ark., in order to illustrate the occurrence of lignite and to relate the lignite beds to the regional stratigraphic framework. Of 43 holes drilled, 8 contained beds of lignite, but only two had beds greater than 30 in. thick. These beds are apparently lenticular and are restricted to the upper 60 ft. of the Cockfield Formation of the Claiborne Group of Middle Eocene age. The Cockfield Formation is at or near the surface west of the Saline River.

  18. Statistical summary of air quality data for metropolitian Cleveland, Ohio, 1967 - 1972: Total suspended particulates, nitrogen dioxide, and sulfur dioxide

    NASA Technical Reports Server (NTRS)

    King, R. B.; Neustadter, H. E.; Fordyce, J. S.; Burr, J. C., Jr.; Cornett, C. L.

    1974-01-01

    Air-quality data for metropolitan Cleveland, Ohio, from 1967 through 1972 were collated and statistically analyzed. Total suspended particulates (TSP) departed from lognormal distribution in 1972. Nitrogen dioxide and sulfur dioxide, departed significantly from lognormal distributions in 1972. In Cleveland the Ohio standards were not met. However, the data indicate a general improvement in air quality. Unusually high precipitation (43% above the average in 1972) may be responsible in lowering these values from the 1971 levels. The mean values of TSP, NO2, and SO2 are 104, 191, and 83 microgram/cu m respectively.

  19. Modeling Code Is Helping Cleveland Develop New Products

    NASA Technical Reports Server (NTRS)

    1998-01-01

    Master Builders, Inc., is a 350-person company in Cleveland, Ohio, that develops and markets specialty chemicals for the construction industry. Developing new products involves creating many potential samples and running numerous tests to characterize the samples' performance. Company engineers enlisted NASA's help to replace cumbersome physical testing with computer modeling of the samples' behavior. Since the NASA Lewis Research Center's Structures Division develops mathematical models and associated computation tools to analyze the deformation and failure of composite materials, its researchers began a two-phase effort to modify Lewis' Integrated Composite Analyzer (ICAN) software for Master Builders' use. Phase I has been completed, and Master Builders is pleased with the results. The company is now working to begin implementation of Phase II.

  20. Grover Cleveland High School. Basic Bilingual Program. O.E.E. Evaluation Report, 1981-1982.

    ERIC Educational Resources Information Center

    Di Martino, Vincent James; And Others

    This paper evaluates the bilingual educational program at Grover Cleveland High School, Queens, New York City. The program offered instruction in English as a second language (ESL) and native language skills in Italian and Spanish as well as courses in science, mathematics, and social studies to 142 students with limited English proficiency. The…

  1. A tale of two rain gardens: Barriers and bridges to adaptive management of urban stormwater in Cleveland, Ohio.

    PubMed

    Chaffin, Brian C; Shuster, William D; Garmestani, Ahjond S; Furio, Brooke; Albro, Sandra L; Gardiner, Mary; Spring, MaLisa; Green, Olivia Odom

    2016-12-01

    Green infrastructure installations such as rain gardens and bioswales are increasingly regarded as viable tools to mitigate stormwater runoff at the parcel level. The use of adaptive management to implement and monitor green infrastructure projects as experimental attempts to manage stormwater has not been adequately explored as a way to optimize green infrastructure performance or increase social and political acceptance. Efforts to improve stormwater management through green infrastructure suffer from the complexity of overlapping jurisdictional boundaries, as well as interacting social and political forces that dictate the flow, consumption, conservation and disposal of urban wastewater flows. Within this urban milieu, adaptive management-rigorous experimentation applied as policy-can inform new wastewater management techniques such as the implementation of green infrastructure projects. In this article, we present a narrative of scientists and practitioners working together to apply an adaptive management approach to green infrastructure implementation for stormwater management in Cleveland, Ohio. In Cleveland, contextual legal requirements and environmental factors created an opportunity for government researchers, stormwater managers and community organizers to engage in the development of two distinct sets of rain gardens, each borne of unique social, economic and environmental processes. In this article we analyze social and political barriers to applying adaptive management as a framework for implementing green infrastructure experiments as policy. We conclude with a series of lessons learned and a reflection on the prospects for adaptive management to facilitate green infrastructure implementation for improved stormwater management. Copyright © 2016 Elsevier Ltd. All rights reserved.

  2. Passive Sampling to Capture the Spatial Variability of Coarse Particles by Composition in Cleveland, OH

    EPA Science Inventory

    Passive samplers deployed at 25 sites for three week-long intervals were used to characterize spatial variability in the mass and composition of coarse particulate matter (PM10-2.5) in Cleveland, OH in summer 2008. The size and composition of individual particles deter...

  3. 76 FR 5840 - The Basic Aluminum Castings Co., Cleveland, OH; Notice of Revised Determination on Reconsideration

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-02

    ... DEPARTMENT OF LABOR Employment and Training Administration [TA-W-73,091] The Basic Aluminum Castings Co., Cleveland, OH; Notice of Revised Determination on Reconsideration By application dated December 3, 2010, The International Union, United Automobile, Aerospace and Agricultural Implement Workers...

  4. 77 FR 3500 - Hugo Boss Cleveland, Inc., Including Workers Whose Unemployment Insurance (UI) Wages Are Paid...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-01-24

    ...., Including Workers Whose Unemployment Insurance (UI) Wages Are Paid Through Tjfc Distribution Brooklyn, OH... separate unemployment insurance (UI) tax account under the name TJFC Distribution. Accordingly, the... Hugo Boss Cleveland, Inc., including workers whose unemployment insurance (UI) wages are paid through...

  5. Compounds in airborne particulates - Salts and hydrocarbons. [at Cleveland, OH

    NASA Technical Reports Server (NTRS)

    King, R. B.; Antoine, A. C.; Fordyce, J. S.; Neustadter, H. E.; Leibecki, H. F.

    1977-01-01

    Concentrations of 10 polycyclic aromatic hydrocarbons (PAH), the aliphatics as a group, sulfate, nitrate, fluoride, acidity, and carbon in the airborne particulate matter were measured at 16 sites in Cleveland, OH over a 1-year period during 1971 and 1972. Analytical methods used included gas chromatography, colorimetry, and combustion techniques. Uncertainties in the concentrations associated with the sampling procedures, and the analytical methods are evaluated. The data are discussed relative to other studies and source origins. High concentrations downwind of coke ovens for 3,4 benzopyrene are discussed. Hydrocarbon correlation studies indicated no significant relations among compounds studied.

  6. Elemental composition and size distribution of particulates in Cleveland, Ohio

    NASA Technical Reports Server (NTRS)

    King, R. B.; Fordyce, J. S.; Neustadter, H. E.; Leibecki, H. F.

    1975-01-01

    Measurements were made of the elemental particle size distribution at five contrasting urban environments with different source-type distributions in Cleveland, Ohio. Air quality conditions ranged from normal to air pollution alert levels. A parallel network of high-volume cascade impactors (5-state) were used for simultaneous sampling on glass fiber surfaces for mass determinations and on Whatman-41 surfaces for elemental analysis by neutron activation for 25 elements. The elemental data are assessed in terms of distribution functions and interrelationships and are compared between locations as a function of resultant wind direction in an attempt to relate the findings to sources.

  7. Elemental composition and size distribution of particulates in Cleveland, Ohio

    NASA Technical Reports Server (NTRS)

    Leibecki, H. F.; King, R. B.; Fordyce, J. S.; Neustadter, H. E.

    1975-01-01

    Measurements have been made of the elemental particle size distribution at five contrasting urban environments with different source-type distributions in Cleveland, Ohio. Air quality conditions ranged from normal to air pollution alert levels. A parallel network of high-volume cascade impactors (5-stage) were used for simultaneous sampling on glass fiber surfaces for mass determinations and on Whatman-41 surfaces for elemental analysis by neutron activation for 25 elements. The elemental data are assessed in terms of distribution functions and interrelationships and are compared between locations as a function of resultant wind direction in an attempt to relate the findings to sources.

  8. Development of a pharmacy resident rotation to expand decentralized clinical pharmacy services.

    PubMed

    Hill, John D; Williams, Jonathan P; Barnes, Julie F; Greenlee, Katie M; Cardiology, Bcps-Aq; Leonard, Mandy C

    2017-07-15

    The development of a pharmacy resident rotation to expand decentralized clinical pharmacy services is described. In an effort to align with the initiatives proposed within the ASHP Practice Advancement Initiative, the department of pharmacy at Cleveland Clinic, a 1,400-bed academic, tertiary acute care medical center in Cleveland, Ohio, established a goal to provide decentralized clinical pharmacy services for 100% of patient care units within the hospital. Patient care units that previously had no decentralized pharmacy services were evaluated to identify opportunities for expansion. Metrics analyzed included number of medication orders verified per hour, number of pharmacy dosing consultations, and number of patient discharge counseling sessions. A pilot study was conducted to assess the feasibility of this service and potential resident learning opportunities. A learning experience description was drafted, and feedback was solicited regarding the development of educational components utilized throughout the rotation. Pharmacists who were providing services to similar patient populations were identified to serve as preceptors. Staff pharmacists were deployed to previously uncovered patient care units, with pharmacy residents providing decentralized services on previously covered areas. A rotating preceptor schedule was developed based on geographic proximity and clinical expertise. An initial postimplementation assessment of this resident-driven service revealed that pharmacy residents provided a comparable level of pharmacy services to that of staff pharmacists. Feedback collected from nurses, physicians, and pharmacy staff also supported residents' ability to operate sufficiently in this role to optimize patient care. A learning experience developed for pharmacy residents in a large medical center enabled the expansion of decentralized clinical services without requiring additional pharmacist full-time equivalents. Copyright © 2017 by the American Society of

  9. Prospective Clinical Study of Precision Oncology in Solid Tumors.

    PubMed

    Sohal, Davendra P S; Rini, Brian I; Khorana, Alok A; Dreicer, Robert; Abraham, Jame; Procop, Gary W; Saunthararajah, Yogen; Pennell, Nathan A; Stevenson, James P; Pelley, Robert; Estfan, Bassam; Shepard, Dale; Funchain, Pauline; Elson, Paul; Adelstein, David J; Bolwell, Brian J

    2015-11-09

    Systematic studies evaluating clinical benefit of tumor genomic profiling are lacking. We conducted a prospective study in 250 patients with select solid tumors at the Cleveland Clinic. Eligibility required histopathologic diagnosis, age of 18 years or older, Eastern Cooperative Oncology Group performance status 0-2, and written informed consent. Tumors were sequenced using FoundationOne (Cambridge, MA). Results were reviewed at the Cleveland Clinic Genomics Tumor Board. Outcomes included feasibility and clinical impact. Colorectal (25%), breast (18%), lung (13%), and pancreatobiliary (13%) cancers were the most common diagnoses. Median time from consent to result was 25 days (range = 3-140). Of 223 evaluable samples, 49% (n = 109) of patients were recommended a specific therapy, but only 11% (n = 24) received such therapy: 12 on clinical trials, nine off-label, three on-label. Lack of clinical trial access (n = 49) and clinical deterioration (n = 29) were the most common reasons for nonrecommendation/nonreceipt of genomics-driven therapy. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  10. Building a Network of Services: 1963-1971. Final Report: Greater Cleveland Mental Retardation Development Project.

    ERIC Educational Resources Information Center

    Buckman, Rilma Oxley

    The final report documents the Greater Cleveland Mental Retardation Development Project, a 5-year demonstration project concerned with solving such problems as how a community can provide all the services and programs needed by the retarded and their families, ensure successful and appropriate employment, and staff and finance such programs.…

  11. Content Knowledge of the Internet Among Public Reference Librarians at the Cleveland Heights Public Library.

    ERIC Educational Resources Information Center

    Augustine, Matthew J.

    The Internet is becoming an increasingly important medium of electronic information dissemination, and thus an increasingly important library reference tool. This study examines the Internet skills of a sample group of 15 public reference librarians in the Adult Services Department at the Cleveland Heights Public Library. The Internet skills that…

  12. Calculating the Weather: Deductive Reasoning and Disciplinary "Telos" in Cleveland Abbe's Rhetorical Transformation of Meteorology

    ERIC Educational Resources Information Center

    Majdik, Zoltan P.; Platt, Carrie Anne; Meister, Mark

    2011-01-01

    This paper explores the rhetorical basis of a major paradigm change in meteorology, from a focus on inductive observation to deductive, mathematical reasoning. Analysis of Cleveland Abbe's "The Physical Basis of Long-Range Weather Forecasts" demonstrates how in his advocacy for a new paradigm, Abbe navigates the tension between piety to tradition…

  13. Cleveland Harbor, Cuyahoga County, Ohio Confined Disposal Facility Project (Site 10B-15 Year)

    DTIC Science & Technology

    1994-01-01

    industries in the Cleveland area include: primary metals, fabricated metal products , machinery, transportation equipment industries , and building products ... industry ; and employment and income. Minor to moderate long-term beneficial impacts would be anticipated for: sediment quality; vegetation; public...community and regional growth; business and industry ; and employment and income. AREAS OF CONTROVERSY Siting of a CDF for discharge of dredged

  14. Cleveland Clinic experience with interstitial laser coagulation of the prostate

    NASA Astrophysics Data System (ADS)

    Ulchaker, James C.; Ng, Christopher S.; Palone, David; Angie, Michelle; Kursh, Elroy D.

    2000-05-01

    Transurethral resection of the prostate (TURP) has long been considered the gold standard therapy for benign prostatic hyperplasia (BPH). The problems associated with the TURP, which have been extensively described, include significant bleeding, TUR syndrome, incontinence, stricture, bladder neck contracture, and sexual dysfunction. The desire for simpler, less morbid alternative therapies to TURP has led to an eruption of research and development in the last decade. This is fueled by the continued research for more economical alternatives in our current high cost health care system.

  15. 78 FR 16826 - Approval and Promulgation of Air Quality Implementation Plans; Ohio; Cleveland-Akron-Lorain and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-19

    ...-9790-1] Approval and Promulgation of Air Quality Implementation Plans; Ohio; Cleveland-Akron-Lorain and Columbus 1997 8-Hour Ozone Maintenance Plan Revisions to Approved Motor Vehicle Emissions Budgets AGENCY... quality State Implementation Plans (SIPs) under the Clean Air Act to replace the previously approved motor...

  16. 75 FR 14459 - Notice of Intent to Repatriate Cultural Items: Western Reserve Historical Society, Cleveland, OH

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-25

    ... Reserve Historical Society, Cleveland, OH, that meet the definitions of ``sacred objects'' and ``objects... consultation that the objects are considered to be both sacred and objects of cultural patrimony. Officials of... American religious leaders for the practice of traditional Native American religions by their present-day...

  17. Investigating the impact of local urban sources on total atmospheric mercury wet deposition in Cleveland, Ohio, USA

    EPA Science Inventory

    Event-based precipitation samples were collected at a downtown industrial and a predominantly upwind rural location in the Cleveland, Ohio metropolitan area from July 2009 through December 2010 to investigate the potential local total mercury (Hg) wet deposition enhancement in a ...

  18. A Celebration of Life: Memories of an Arab-American in Cleveland. ADC Issues, Issue #7.

    ERIC Educational Resources Information Center

    Macron, Mary

    This document discusses the life celebrations of Arab American immigrants to Cleveland from the late 1870s. Assembled from what is largely an oral tradition of family history, the booklet describes the home life, weddings, and final partings when elderly relatives returned to the homeland or died in the United States. The economic situation and…

  19. Changing patterns of inpatient respiratory care services over a decade at the Cleveland Clinic: challenges posed and proposed responses.

    PubMed

    Orens, Douglas K; Kester, Lucy; Konrad, Dale J; Stoller, James K

    2005-08-01

    Changing characteristics of hospitalized patients over the last decade have created challenges for all health-care providers in delivering optimal care. In the specific case of respiratory care, trends that hospitalized patients have generally become sicker over time and that average lengths of stay have generally become shorter have posed the challenge of meeting demands for more services delivered with greater immediacy. We undertook the current analysis to assess how the delivery of respiratory care services at a tertiary-care academic medical center, the Cleveland Clinic Foundation Hospital, has evolved over the decade 1991 to 2001. In this observational study, we examined concurrent departmental trends and speculated that the capability to increase clinical activity with maintained or improved clinical outcomes, preserved costs, and a lower turnover rate among respiratory therapists reflects features of the professional environment within our Section of Respiratory Therapy. This analysis compares patterns of respiratory care service delivery in two 5-year intervals: from 1991 to 1996 and from 1996 to 2001. Data were collected using a respiratory care information-management system and an inpatient hospital information system, which track the volume and actual cost of services provided. These analyses accounted for the actual time-based cost of the services, including labor (with benefits), necessary equipment and supplies, medications, and equipment maintenance and depreciation. Hospital case-mix index values were determined according to guidelines from the Centers for Medicare and Medicaid Services, as the weighted average of resource allocation scores assigned to diagnosis-related-group categories of hospitalized patients. From 1991 to 2001, there were important expansions in the scope of respiratory care practice by our Section of Respiratory Care, while the volume of respiratory care services delivered per year increased 1.96-fold (from 339,600 to 665

  20. THE NATIONAL COASTAL ASSESSMENT: PARTNERSHIP FOR SUCCESS COASTAL ZONE SYMPOSIUM, CLEVELAND, OH JULY 15-19, 2001

    EPA Science Inventory

    Partnering for Success (Abstract). Presented at Coastal Zone 01: Hands Across the Water - Linking Land, Lake, and Sea, 15-19 July 2001, Cleveland, OH. 1 p. (ERL,GB R843).

    The National Coastal Assessment (Coastal 2000) is a coastal monitoring survey that responds to the ne...

  1. Preliminary analysis of an extensive one year survey of trace elements and compounds in the suspended particulate matter in Cleveland, Ohio

    NASA Technical Reports Server (NTRS)

    King, R. B.; Fordyce, J. S.; Antoine, A. C.; Leibecki, H. F.; Neustadter, H. E.; Sidik, S. M.; Burr, J. C.; Craig, G. T.; Cornett, C. L.

    1974-01-01

    Beginning in 1971 a cooperative program has been carried on by the City of Cleveland Division of Air Pollution Control and NASA Lewis Research Center to study the trace element and compound concentrations in the ambient suspended particulate matter in Cleveland Ohio as a function of source, monitoring location and meteorological conditions. The major objectives were to determine the ambient concentration levels at representative urban sites and to develop a technique using trace element and compound data in conjunction with meteorological conditions to identify specific pollution sources which could be developed into a practical system that could be readily utilized by an enforcement agency.

  2. Barriers to supplemental calcium use among women in suburban family practice: a report from the Cleveland Clinic Ambulatory Research Network (CleAR-eN).

    PubMed

    Tyler, Carl V; Werner, James J; Panaite, Vanessa; Snyder, Sandra M; Ford, Donald B; Conway, Jessica L; Young, Christopher W; Powell, Brenda L; Smolak, Michael J; Zyzanski, Stephen J

    2008-01-01

    The majority of adult women in the United States fail to meet daily calcium intake recommendations. This study was undertaken to (1) identify predictors of calcium supplement use versus non-use, (2) understand barriers to calcium supplementation, and (3) determine the potential impact of physician recommendation on calcium supplement use. Surveys were self-administered by 185 women, ages 20 to 64, presenting consecutively for care at 6 suburban community-based family medicine practices within the Cleveland Clinic Ambulatory Research Network (CleAR-eN). We compared demographic characteristics, health beliefs, and health behaviors of those women who reported never using calcium supplements with those who presently took calcium supplements. Women who never took calcium were also queried about reasons for non-use and whether physician recommendation would influence their adoption of calcium supplementation. Multivitamin use, self-perceived risk of osteoporosis, and age were independent predictors of calcium supplement use. Leading barriers for never-users were lack of knowledge about the need/importance of increasing calcium intake, lack of motivation to start supplements, and the belief that their dietary calcium intake alone was sufficient. Ninety-six percent of never-users reported that they would consider taking a calcium supplement if recommended by their physician. Many patient-identified barriers to calcium supplementation seem amenable to focused and brief office-based interventions that could increase the number of women meeting calcium intake guidelines.

  3. Cycle Training Using Implanted Neural Prostheses: Team Cleveland

    PubMed Central

    McDaniel, John; Lombardo, Lisa M.; Foglyano, Kevin M.; Marasco, Paul D.; J.Triolo, Ronald

    2017-01-01

    Recently our laboratory team focused on training five individuals with complete spinal cord injuries for an overground FES bike race in the 2016 Cybathlon held in Zurich Switzerland. A unique advantage team Cleveland had over other teams was the use of implanted pulse generators that provide more selective activation of muscles compared to standard surface stimulation. The advancements in muscle strength and endurance and ultimately cycling power our pilots made during this training period helped propel our competing pilot to win gold at the Cybathlon and allowed our pilots to ride their bikes outside within their communities. Such positive outcomes has encouraged us to further explore more widespread use of FES overground cycling as a rehabilitative tool for those with spinal cord injuries. This review will describes our approach to this race including information on the pilots, stimulation strategy, bike details and training program. PMID:29299221

  4. Cycle Training Using Implanted Neural Prostheses: Team Cleveland.

    PubMed

    McDaniel, John; Lombardo, Lisa M; Foglyano, Kevin M; Marasco, Paul D; J Triolo, Ronald

    2017-12-05

    Recently our laboratory team focused on training five individuals with complete spinal cord injuries for an overground FES bike race in the 2016 Cybathlon held in Zurich Switzerland. A unique advantage team Cleveland had over other teams was the use of implanted pulse generators that provide more selective activation of muscles compared to standard surface stimulation. The advancements in muscle strength and endurance and ultimately cycling power our pilots made during this training period helped propel our competing pilot to win gold at the Cybathlon and allowed our pilots to ride their bikes outside within their communities. Such positive outcomes has encouraged us to further explore more widespread use of FES overground cycling as a rehabilitative tool for those with spinal cord injuries. This review will describes our approach to this race including information on the pilots, stimulation strategy, bike details and training program.

  5. Clinical Characteristics and Associated Systemic Diseases in Patients With Esophageal "Absent Contractility"-A Clinical Algorithm.

    PubMed

    Laique, Sobia; Singh, Tavankit; Dornblaser, David; Gadre, Abhishek; Rangan, Vikram; Fass, Ronnie; Kirby, Donald; Chatterjee, Soumya; Gabbard, Scott

    2018-01-19

    This study was carried out to assess the clinical characteristics and associated systemic diseases seen in patients diagnosed with absent contractility as per the Chicago Classification version 3.0, allowing us to propose a diagnostic algorithm for their etiologic testing. The Chicago Classification version 3.0 has redefined major and minor esophageal motility disorders using high-resolution esophageal manometry. There is a dearth of publications based on research on absent contractility, which historically has been associated with myopathic processes such as systemic sclerosis (SSc). We conducted a retrospective, multicenter study. Data of patients diagnosed with absent contractility were pooled from Cleveland Clinic, Cleveland, OH (January 2006 to July 2016) and Metrohealth Medical Center, Cleveland, OH (July 2014 to July 2016) and included: age, gender, associated medical conditions, surgical history, medications, and specific antibody testing. A total of 207 patients, including 57 male individuals and 150 female individuals, with mean age of 56.1 and 60.0 years, respectively, were included. Disease distribution was as follows: SSc (diffuse or limited cutaneous) 132, overlap syndromes 7, systemic lupus erythematosus17, Sjögren syndrome 4, polymyositis 3, and dermatomyositis 3. Various other etiologies including gastroesophageal reflux disease, postradiation esophagitis, neuromuscular disorders, and surgical complications were seen in the remaining cohort. Most practitioners use the term "absent contractility" interchangeably with "scleroderma esophagus"; however, only 63% of patients with absent contractility had SSc. Overall, 20% had another systemic autoimmune rheumatologic disease and 16% had a nonrheumatologic etiology for absent contractility. Therefore, alternate diagnosis must be sought in these patients. We propose an algorithm for their etiologic evaluation.

  6. BIOLOGICAL INDICATOR OF SUMMATIONAL EXPOSURES TO LEAD. TOOTH LEAD IN CHILDREN LIVING IN CLEVELAND AND ITS SUBURBS

    EPA Science Inventory

    An epidemiologic study of the distribution of lead absorption in the Cleveland Metropolitan Area was carried out by analyzing the lead content of shed or extracted deciduous teeth of 11,241 children. Mean amounts of lead in teeth of children living in some suburbs were as high as...

  7. Marching toward Justice: Lessons Learned from the Shaw High School Mighty Cardinals Marching Band in East Cleveland

    ERIC Educational Resources Information Center

    Luminais, Misty; Williams, Rhonda Y.

    2016-01-01

    The Shaw High School marching band has emerged as a collective site of individual and group pride and empowerment in the stories gathered through the community-based "Voicing & Action Project", which the Social Justice Institute debuted in East Cleveland. At first glance, a high school marching band might not have much in common with…

  8. From IDs to Ice Cream to "I, Claudius": Security Is in the Cards at Cleveland Hill Union Free School District.

    ERIC Educational Resources Information Center

    Passmore, Cheryl

    2002-01-01

    Describes the use of plastic identity badges with photographs and barcodes issued to all administrators, teachers, staff members, and students in grades 6-12 at the Cleveland Hill Union Free School District in Cheektowaga, New York. (PKP)

  9. Detecting hidden volcanic explosions from Mt. Cleveland Volcano, Alaska with infrasound and ground-couples airwaves

    USGS Publications Warehouse

    De Angelis, Slivio; Fee, David; Haney, Matthew; Schneider, David

    2012-01-01

    In Alaska, where many active volcanoes exist without ground-based instrumentation, the use of techniques suitable for distant monitoring is pivotal. In this study we report regional-scale seismic and infrasound observations of volcanic activity at Mt. Cleveland between December 2011 and August 2012. During this period, twenty explosions were detected by infrasound sensors as far away as 1827 km from the active vent, and ground-coupled acoustic waves were recorded at seismic stations across the Aleutian Arc. Several events resulting from the explosive disruption of small lava domes within the summit crater were confirmed by analysis of satellite remote sensing data. However, many explosions eluded initial, automated, analyses of satellite data due to poor weather conditions. Infrasound and seismic monitoring provided effective means for detecting these hidden events. We present results from the implementation of automatic infrasound and seismo-acoustic eruption detection algorithms, and review the challenges of real-time volcano monitoring operations in remote regions. We also model acoustic propagation in the Northern Pacific, showing how tropospheric ducting effects allow infrasound to travel long distances across the Aleutian Arc. The successful results of our investigation provide motivation for expanded efforts in infrasound monitoring across the Aleutians and contributes to our knowledge of the number and style of vulcanian eruptions at Mt. Cleveland.

  10. 78 FR 52424 - Amendment of Class E Airspace; Dayton, TN, Establishment of Class E Airspace; Cleveland, TN, and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-23

    ... AGENCY: Federal Aviation Administration (FAA), DOT. ACTION: Final rule. SUMMARY: This action amends Class... in this document will be published subsequently in the Order. The Rule This amendment to Title 14... within a 7.4 mile radius at Cleveland Regional Jetport, with a segment extending from the 7.4-mile radius...

  11. State Fiscal Year 1997-2000 State Transportation Improvement Program (STIP) Cleveland/Akron/Lorain Moderate Ozone Nonattainment Area Air Quality Conformity Documentation

    DOT National Transportation Integrated Search

    1996-06-01

    This document, which is a portion of the Ohio 1997-2000 State Transportation Improvement Program (STIP), describes the conformity determination for the former eight county Cleveland/Akron/Lorain (CAL) Moderate Ozone Nonattainment Area, which includes...

  12. Big Creek Flood Control Project, Cleveland, Ohio. Phase II. General Design Memorandum. Appendix B. Alternative Studies.

    DTIC Science & Technology

    1978-11-01

    120, Engineering and Design Additional Guidance for Riprap Channel Protection. Good qual- ity stone is available in the Cleveland area; therefore, it...design life. The galvanizing is subject to abrasion and deterioration. As the gabions would be filled with stone that would have the same quality of...riprap, the PVC coated gabions would provide protection in excess of 50 years without anticipated maintenance. As the stone size for all gabions is

  13. Assessing student clinical learning experiences.

    PubMed

    Nehyba, Katrine; Miller, Susan; Connaughton, Joanne; Singer, Barbara

    2017-08-01

    This article describes the use of an activity worksheet and questionnaire to investigate the learning experience of students on clinical placement. The worksheet measures the amount of time students spend in different learning activities, and the questionnaire explores student satisfaction and preferred learning activities. An activity worksheet and questionnaire … investigate[d] the learning experiences of students on clinical placement METHODS: The activity worksheet and questionnaire were used in a cohort pilot study of physiotherapy students on clinical placement. The activity worksheet provides details of the amount of time students engage in a range of clinical and non-clinical tasks while on placement, such as time spent treating patients, working individually, working with their peers and engaging in reflective practice. In combination with the questionnaire results, it allows clinicians to gain an understanding of the clinical learning environment experienced by their students. The data collected using these tools provide a description of the students' activities while undertaking the clinical placement. This information may guide the refinement of the clinical experience, and offers an opportunity to individualise learning activities to match students' needs and preferences. © 2016 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

  14. Outpatient Palliative Cardiology Service Embedded Within a Heart Failure Clinic: Experiences With an Emerging Model of Care.

    PubMed

    Gandesbery, Benjamin; Dobbie, Krista; Gorodeski, Eiran Z

    2018-04-01

    The role of palliative care consultation in the outpatient treatment of patients with symptomatic heart failure (HF) is poorly studied. In August 2015, we created an outpatient palliative care service embedded within the HF clinic at Cleveland Clinic main campus. To characterize patients cared for by our novel outpatient palliative cardiology service, including their degree of HF, symptoms, comorbidities, topics addressed in clinic, palliative treatments prescribed, advanced directives status, and mortality. We conducted a retrospective chart review of all patients evaluated by this outpatient service. Eighty patients were seen in 229 outpatient encounters. The most commonly reported symptoms were tiredness (74%), pain (64%), dyspnea (57%), drowsiness (45%), anxiety (45%), and depression (43%). The most frequently addressed issues were pain management (55%) and advanced care planning (54%). The most common palliative medications prescribed in palliative care clinic were opiates (48%), laxatives (22%), antineuropathics (22%), and antidepressants (16%). The 1-year survival rate was 70% (CI 65-75%). Embedding palliative medicine services in an HF outpatient clinic is feasible. Patients seen in this setting had an array of quality-of-life limiting symptoms and were medically managed with several interventions familiar to palliative medicine specialists. Outpatients with chronic HF have a significant symptom burden and may benefit from outpatient specialist palliative care.

  15. Comparison of linear cephalometric dimensions in Americans of European descent (Ann Arbor, Cleveland, Philadelphia) and Americans of African descent (Nashville).

    PubMed

    Dibbets, Jos M H; Nolte, Kai

    2002-08-01

    Eleven dimensions, extracted from four commercially available cephalometric atlases were compared. Three populations were American of European descent and one was American of African descent. The source data were carefully corrected for linear enlargement. The confounding effect of linear radiographic enlargement is exemplified by depicting the often-used distance, sella-nasion, before and after correction. Total face height was smallest in the Cleveland population and largest in the Nashville population. The difference was fully accounted for by differences in lower face height and that was the most variable of all dimensions studied. Upper face height was almost identical in all four populations. Posterior face height was largest in the Nashville population. The mandible in the Nashville population had an average ramus height, but a longer corpus. Mandibular dimensions were equal in the three other populations. The maxilla was clearly shortest in the Cleveland population and almost of equal length in the three others.

  16. EnviroAtlas - Cleveland, OH - Ecosystem Services by Block Group

    EPA Pesticide Factsheets

    This EnviroAtlas dataset presents environmental benefits of the urban forest in 1,442 block groups in Cleveland, Ohio. Carbon attributes, temperature reduction, pollution removal and value, and runoff effects are calculated for each block group using i-Tree models (www.itreetools.org), local weather data, pollution data, EPA provided city boundary and land cover data, and U.S. Census derived block group boundary data. This dataset was produced by the US Forest Service to support research and online mapping activities related to EnviroAtlas. EnviroAtlas (https://www.epa.gov/enviroatlas ) allows the user to interact with a web-based, easy-to-use, mapping application to view and analyze multiple ecosystem services for the contiguous United States. The dataset is available as downloadable data (https://edg.epa.gov/data/Public/ORD/EnviroAtlas) or as an EnviroAtlas map service. Additional descriptive information about each attribute in this dataset can be found in its associated EnviroAtlas Fact Sheet (https://www.epa.gov/enviroatlas/enviroatlas-fact-sheets).

  17. Bell palsy: Clinical examination and management.

    PubMed

    Patel, Donika K; Levin, Kerry H

    2015-07-01

    Bell palsy is a common neurologic disorder characterized by acute facial mononeuropathy of unclear cause presenting with unilateral facial weakness. Careful examination and a detailed history are important in making an accurate diagnosis. Early recognition is essential, as treatment with corticosteroids within 72 hours of onset has been shown to hasten recovery. Fortunately, most patients recover spontaneously within 3 weeks, even if untreated. Copyright © 2015 Cleveland Clinic.

  18. Additions to the Flora of Cleveland County, Arkansas: Collections From Moro Bottoms Natural Area, A State-Protected Old-Growth Bottomland Hardwood Forest

    Treesearch

    Danny Skojac; Margaret S. Devall; Bernard R. Parresol

    2003-01-01

    An annotated list of 38 additions to the vascular flora of Cleveland County, Arkansas is presented. The additions presented were collected from Moro Bottoms Natural Area, a state-protected old-growth bottomland hardwood forest located in the northwest region of the county.

  19. Satellite-based PM concentrations and their application to COPD in Cleveland, OH

    PubMed Central

    Kumar, Naresh; Liang, Dong; Comellas, Alejandro; Chu, Allen D.; Abrams, Thad

    2014-01-01

    A hybrid approach is proposed to estimate exposure to fine particulate matter (PM2.5) at a given location and time. This approach builds on satellite-based aerosol optical depth (AOD), air pollution data from sparsely distributed Environmental Protection Agency (EPA) sites and local time–space Kriging, an optimal interpolation technique. Given the daily global coverage of AOD data, we can develop daily estimate of air quality at any given location and time. This can assure unprecedented spatial coverage, needed for air quality surveillance and management and epidemiological studies. In this paper, we developed an empirical relationship between the 2 km AOD and PM2.5 data from EPA sites. Extrapolating this relationship to the study domain resulted in 2.3 million predictions of PM2.5 between 2000 and 2009 in Cleveland Metropolitan Statistical Area (MSA). We have developed local time–space Kriging to compute exposure at a given location and time using the predicted PM2.5. Daily estimates of PM2.5 were developed for Cleveland MSA between 2000 and 2009 at 2.5 km spatial resolution; 1.7 million (~79.8%) of 2.13 million predictions required for multiyear and geographic domain were robust. In the epidemiological application of the hybrid approach, admissions for an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) was examined with respect to time–space lagged PM2.5 exposure. Our analysis suggests that the risk of AECOPD increases 2.3% with a unit increase in PM2.5 exposure within 9 days and 0.05° (~5 km) distance lags. In the aggregated analysis, the exposed groups (who experienced exposure to PM2.5 >15.4 μg/m3) were 54% more likely to be admitted for AECOPD than the reference group. The hybrid approach offers greater spatiotemporal coverage and reliable characterization of ambient concentration than conventional in situ monitoring-based approaches. Thus, this approach can potentially reduce exposure misclassification errors in the conventional

  20. Post-Occupancy Evaluation (POE) Methodologies for School Facilities: A Case Study of the V. Sue Cleveland High School Post Occupancy Evaluation

    ERIC Educational Resources Information Center

    Harmon, Marcel; Larroque, Andre; Maniktala, Nate

    2012-01-01

    The New Mexico Public School Facilities Authority (NMPSFA) is the agency responsible for administering state-funded capital projects for schools statewide. Post occupancy evaluation (POE) is the tool selected by NMPSFA for measuring project outcomes. The basic POE process for V. Sue Cleveland High School (VSCHS) consisted of a series of field…

  1. Desegregation Activities: Administration of Education Grant Funds at the Cleveland School District. Report to the Honorable Louis Stokes, House of Representatives.

    ERIC Educational Resources Information Center

    General Accounting Office, Washington, DC. Div. of Human Resources.

    An examination was made of the U.S. Department of Education grants awarded to the Cleveland School District for desegregation activities, including how Department of Education funds were used by the school district and how the department administered and monitored Magnet School grants awarded to the school district for fiscal years 1986 and 1987.…

  2. Understanding Antegrade Colonic Enema (ACE) Surgery

    MedlinePlus

    ... recognized leader in digestive diagnosis, treatments and surgical innovations. Cleveland Clinic is a non-profit academic medical ... Safety Office of Diversity & Inclusion Patient Experience Research & Innovations Government & Community Relations Careers For Employees Resources for ...

  3. CENTRALIZED TREATMENT OF METAL FINISHING WASTES AT A CLEVELAND RESOURCE RECOVERY PARK: PART 1. DESIGN AND COSTS. PART 2. FINANCING. PART 3. SITE INVESTIGATION

    EPA Science Inventory

    The report, in three parts, describes the characteristics of the Cleveland (OH) area electroplating industry and an approach and design for a centralized facility to treat cyanide and heavy metal wastes generated by this industry. The facility is termed the Resource Recovery Park...

  4. The business of palliative medicine--part 6: clinical operations in a comprehensive integrated program.

    PubMed

    Lagman, Ruth L; Walsh, Declan; LeGrand, Susan B; Davis, Mellar P

    2011-03-01

    The medical care of individuals with advanced disease is complex and has historically been fragmented and suboptimal. Palliative medicine attempts to address these needs. The Harry R. Horvitz Center for Palliative Medicine at the Cleveland Clinic is an established comprehensive integrated program. Structured and seamless clinical operations are important to ensure the best delivery of high-quality medical care and continuity for those affected by life-limiting illness.

  5. Stage 2 Report for Reformulation Phase I General Design Memorandum, Cleveland Harbor, Ohio. Volume I. Main Report. Revision.

    DTIC Science & Technology

    1983-02-01

    Geographic Extent and Profile 59 9 Cereal Food Processors, Inc. Facility 78 10 Conrail Bridge No. 14 83 11 Jefferson Avenue Bridge Abutments 83 12...Cleveland Harbor would probably be similar to Table 7 (White et al., 1975). Goldfish, pumpkinseed sunfish, largemouth bass , and yel1-w perch were...perch . 153 1.42 Brook Silverside . 3 0.03 White Bass : 223 : 2.07 White Crappie 80 0.74 Black Crappie . 11 0.10 Northern Rock Bass 5 0.05 Northern

  6. Designing a Curriculum for Clinical Experiences

    ERIC Educational Resources Information Center

    Henning, John E.; Erb, Dorothy J.; Randles, Halle Schoener; Fults, Nanette; Webb, Kathy

    2016-01-01

    The purpose of this article is to describe a collaborative effort among five teacher preparation programs to create a conceptual tool designed to put clinical experiences at the center of our programs. The authors refer to the resulting product as a clinical curriculum. The clinical curriculum describes a developmental sequence of clinical…

  7. Cleveland Clinic Rehabilitation Research Program

    DTIC Science & Technology

    2015-12-01

    Study 1: The penicillin-induced seizure animal model has been generated by acute focal intracortical injection of penicillin in the motor cortex of rats ... motor cortex of rats . The effects of transcranial magnetic stimulation (TMS) on penicillin-induced seizure have been investigated using behavioral...electroencephalographic (EEG) recording. Study 2: The motor cortex (M1) and the corticospinal tracts (CST) will be directly modulated using brain stimulation

  8. Preliminary analysis of an extensive one year survey of trace elements and compounds in the suspended particulate matter in Cleveland, Ohio

    NASA Technical Reports Server (NTRS)

    King, R. B.; Fordyce, J. S.; Antoine, A. C.; Leibecki, H. F.; Neustadter, H. E.; Sidik, S. M.; Burr, J. C.; Craig, G. T.; Cornett, C. L.

    1974-01-01

    Preliminary review of a study of trace elements and compound concentrations in the ambient suspended particulate matter in Cleveland, Ohio, measured from August 1971 through June 1973, as a function of source, monitoring location, and meteorological conditions. The study is aimed at the development of techniques for identifying specific pollution sources which could be integrated into a practical system readily usable by an enforcement agency.

  9. Willingness to Participate in a National Precision Medicine Cohort: Attitudes of Chronic Kidney Disease Patients at a Cleveland Public Hospital.

    PubMed

    Cooke Bailey, Jessica N; Crawford, Dana C; Goldenberg, Aaron; Slaven, Anne; Pencak, Julie; Schachere, Marleen; Bush, William S; Sedor, John R; O'Toole, John F

    2018-06-26

    Multiple ongoing, government-funded national efforts longitudinally collect health data and biospecimens for precision medicine research with ascertainment strategies increasingly emphasizing underrepresented groups in biomedical research. We surveyed chronic kidney disease patients from an academic, public integrated tertiary care system in Cleveland, Ohio, to examine local attitudes toward participation in large-scale government-funded studies. Responses ( n = 103) indicate the majority (71%) would participate in a hypothetical national precision medicine cohort and were willing to send biospecimens to a national repository and share de-identified data, but <50% of respondents were willing to install a phone app to track personal data. The majority of participants (62%) indicated that return of research results was very important, and the majority (54%) also wanted all of their research-collected health and genetic data returned. Response patterns did not differ by race/ethnicity. Overall, we found high willingness to participate among this Cleveland patient population already participating in a local genetic study. These data suggest that despite common perceptions, subjects from communities traditionally underrepresented in genetic research will participate and agree to store samples and health data in repositories. Furthermore, most participants want return of research results, which will require a plan to provide these data in a secure, accessible, and understandable manner.

  10. Elemental composition of airborne particulates and source identification - An extensive one year survey. [in Cleveland, OH

    NASA Technical Reports Server (NTRS)

    King, R. B.; Fordyce, J. S.; Antoine, A. C.; Leibecki, H. F.; Neustadter, H. E.; Sidik, S. M.

    1976-01-01

    Concentrations of 60 chemical elements in the airborne particulate matter were measured at 16 sites in Cleveland, OH over a 1 year period during 1971 and 1972 (45 to 50 sampling days). Analytical methods used included instrumental neutron activation, emission spectroscopy, and combustion techniques. Uncertainties in the concentrations associated with the sampling procedures, the analytical methods, the use of several analytical facilities, and samples with concentrations below the detection limits are evaluated in detail. The data are discussed in relation to other studies and source origins. The trace constituent concentrations as a function of wind direction are used to suggest a practical method for air pollution source identification.

  11. Chemical composition and source apportionment of size fractionated particulate matter in Cleveland, Ohio, USA.

    PubMed

    Kim, Yong Ho; Krantz, Q Todd; McGee, John; Kovalcik, Kasey D; Duvall, Rachelle M; Willis, Robert D; Kamal, Ali S; Landis, Matthew S; Norris, Gary A; Gilmour, M Ian

    2016-11-01

    The Cleveland airshed comprises a complex mixture of industrial source emissions that contribute to periods of non-attainment for fine particulate matter (PM 2.5 ) and are associated with increased adverse health outcomes in the exposed population. Specific PM sources responsible for health effects however are not fully understood. Size-fractionated PM (coarse, fine, and ultrafine) samples were collected using a ChemVol sampler at an urban site (G.T. Craig (GTC)) and rural site (Chippewa Lake (CLM)) from July 2009 to June 2010, and then chemically analyzed. The resulting speciated PM data were apportioned by EPA positive matrix factorization to identify emission sources for each size fraction and location. For comparisons with the ChemVol results, PM samples were also collected with sequential dichotomous and passive samplers, and evaluated for source contributions to each sampling site. The ChemVol results showed that annual average concentrations of PM, elemental carbon, and inorganic elements in the coarse fraction at GTC were ∼2, ∼7, and ∼3 times higher than those at CLM, respectively, while the smaller size fractions at both sites showed similar annual average concentrations. Seasonal variations of secondary aerosols (e.g., high NO 3 - level in winter and high SO 4 2- level in summer) were observed at both sites. Source apportionment results demonstrated that the PM samples at GTC and CLM were enriched with local industrial sources (e.g., steel plant and coal-fired power plant) but their contributions were influenced by meteorological conditions and the emission source's operation conditions. Taken together the year-long PM collection and data analysis provides valuable insights into the characteristics and sources of PM impacting the Cleveland airshed in both the urban center and the rural upwind background locations. These data will be used to classify the PM samples for toxicology studies to determine which PM sources, species, and size fractions are

  12. Students' clinical experience on outreach placements.

    PubMed

    Smith, M; Lennon, M A; Robinson, P G

    2010-02-01

    Primary care outreach placements increasingly feature in UK undergraduate dental curricula. The profile of clinical work undertaken on placement may differ from traditional hospital-based programmes and between outreach settings. An appreciation of any differences could inform curriculum development. To compare the profiles of clinical work experienced on a traditional hospital-based programme and outreach placements in different settings. One dental hospital and eight existing primary care block placements in England. Subjects were four cohorts of senior dental students in one UK dental school. Departmental records provided data on students' clinical experience in different settings and their achievement of placement learning objectives. Descriptive statistics for groups were compared. (1) Counts of patients encountered and of clinical procedures completed in the following categories: simple plastic restorations, endodontics, cast restorations, dentures, extractions and children's dentistry. (2) Student perceptions of placement learning reported via Likert scales. Outreach students encountered twice as many patients and typically completed about three times as much clinical work as students in the hospital, e.g. 44 cf 16 simple plastic restorations, seven cf two endodontic procedures. There were variations in profiles by setting. For example, amalgam being more likely to be used on outreach especially in the General Dental Service; more children's dentistry in community services and more extractions in Dental Access Centres. Students reported learning outcomes generally being achieved (average 94%) although with some variation by setting. Dental outreach training greatly increases the quantity of students' clinical experience in everyday dentistry compared to a hospital-based programme. Placements also increase awareness of service delivery and develop clinical skills. There are appreciable variations between outreach settings possibly reflecting their purposes

  13. Perspectives on the use of green infrastructure for stormwater management in Cleveland and Milwaukee.

    PubMed

    Keeley, Melissa; Koburger, Althea; Dolowitz, David P; Medearis, Dale; Nickel, Darla; Shuster, William

    2013-06-01

    Green infrastructure is a general term referring to the management of landscapes in ways that generate human and ecosystem benefits. Many municipalities have begun to utilize green infrastructure in efforts to meet stormwater management goals. This study examines challenges to integrating gray and green infrastructure for stormwater management, informed by interviews with practitioners in Cleveland, OH and Milwaukee WI. Green infrastructure in these cities is utilized under conditions of extreme fiscal austerity and its use presents opportunities to connect stormwater management with urban revitalization and economic recovery while planning for the effects of negative- or zero-population growth. In this context, specific challenges in capturing the multiple benefits of green infrastructure exist because the projects required to meet federally mandated stormwater management targets and the needs of urban redevelopment frequently differ in scale and location.

  14. Perspectives on the Use of Green Infrastructure for Stormwater Management in Cleveland and Milwaukee

    NASA Astrophysics Data System (ADS)

    Keeley, Melissa; Koburger, Althea; Dolowitz, David P.; Medearis, Dale; Nickel, Darla; Shuster, William

    2013-06-01

    Green infrastructure is a general term referring to the management of landscapes in ways that generate human and ecosystem benefits. Many municipalities have begun to utilize green infrastructure in efforts to meet stormwater management goals. This study examines challenges to integrating gray and green infrastructure for stormwater management, informed by interviews with practitioners in Cleveland, OH and Milwaukee WI. Green infrastructure in these cities is utilized under conditions of extreme fiscal austerity and its use presents opportunities to connect stormwater management with urban revitalization and economic recovery while planning for the effects of negative- or zero-population growth. In this context, specific challenges in capturing the multiple benefits of green infrastructure exist because the projects required to meet federally mandated stormwater management targets and the needs of urban redevelopment frequently differ in scale and location.

  15. Proceedings of the Special Demonstration Workshop for Integrating Blind Children with Sighted Children into Ongoing Physical Education and Recreation Programs (Cleveland, Ohio, October 9-10, 1969).

    ERIC Educational Resources Information Center

    Boninger, Walter B., Ed.

    A special education workshop (Cleveland, Ohio, October 9-10, 1969) for integrating blind children with sighted children into ongoing physical education and recreation programs is described. Physical education and blind children from the viewpoint of opthalmology, social and psychological aspects of blindness as they relate to participation in…

  16. Clinical Experiences in Athletic Training.

    ERIC Educational Resources Information Center

    Knight, Kenneth L.

    This book offers a systematic approach to teaching athletic training. Modules are separated into 10 content areas: direct clinical experience; policies and procedures; emergency procedures; modality operation; advanced modality operation; taping, wrapping, bracing, and padding; management of specific injuries; examination; supervision; and…

  17. Opportunity to discuss ethical issues during clinical learning experience.

    PubMed

    Palese, Alvisa; Gonella, Silvia; Destrebecq, Anne; Mansutti, Irene; Terzoni, Stefano; Morsanutto, Michela; Altini, Pietro; Bevilacqua, Anita; Brugnolli, Anna; Canzan, Federica; Ponte, Adriana Dal; De Biasio, Laura; Fascì, Adriana; Grosso, Silvia; Mantovan, Franco; Marognolli, Oliva; Nicotera, Raffaela; Randon, Giulia; Tollini, Morena; Saiani, Luisa; Grassetti, Luca; Dimonte, Valerio

    2018-01-01

    Undergraduate nursing students have been documented to experience ethical distress during their clinical training and felt poorly supported in discussing the ethical issues they encountered. Research aims: This study was aimed at exploring nursing students' perceived opportunity to discuss ethical issues that emerged during their clinical learning experience and associated factors. An Italian national cross-sectional study design was performed in 2015-2016. Participants were invited to answer a questionnaire composed of four sections regarding: (1) socio-demographic data, (2) previous clinical learning experiences, (3) current clinical learning experience quality and outcomes, and (4) the opportunity to discuss ethical issues with nurses in the last clinical learning experience (from 0 - 'never' to 3 - 'very much'). Participants and research context: Participants were 9607 undergraduate nursing students who were attending 95 different three-year Italian baccalaureate nursing programmes, located at 27 universities in 15 Italian regions. Ethical considerations: This study was conducted in accordance with the Human Subject Research Ethics Committee guidelines after the research protocol was approved by an ethics committee. Overall, 4707 (49%) perceived to have discussed ethical issues 'much' or 'very much'; among the remaining, 3683 (38.3%) and 1217 (12.7%) students reported the perception of having discussed, respectively, 'enough' or 'never' ethical issues emerged in the clinical practice. At the multivariate logistic regression analysis explaining 38.1% of the overall variance, the factors promoting ethical discussion were mainly set at the clinical learning environment levels (i.e. increased learning opportunities, self-directed learning, safety and nursing care quality, quality of the tutorial strategies, competences learned and supervision by a clinical nurse). In contrast, being male was associated with a perception of less opportunity to discuss ethical issues

  18. Clinical learning experiences of nursing students using an innovative clinical partnership model: A non-randomized controlled trial.

    PubMed

    Chan, Aileen W K; Tang, Fiona W K; Choi, Kai Chow; Liu, Ting; Taylor-Piliae, Ruth E

    2018-06-05

    Clinical practicum is a major learning component for pre-registration nursing students. Various clinical practicum models have been used to facilitate students' clinical learning experiences, employing both university-based and hospital-based clinical teachers. Considering the strengths and limitations of these clinical practicum models, along with nursing workforce shortages, we developed and tested an innovative clinical partnership model (CPM) in Hong Kong. To evaluate an innovative CPM among nursing students actual and preferred clinical learning environment, compared with a conventional facilitation model (CFM). A non-randomized controlled trial examining students' clinical experiences, comparing the CPM (supervised by hospital clinical teacher) with the CFM (supervised by university clinical teacher). One university in Hong Kong. Pre-registration nursing students (N = 331), including bachelor of nursing (n = 246 year three-BN) and masters-entry nursing (n = 85 year one-MNSP). Students were assigned to either the CPM (n = 48 BN plus n = 85 MNSP students) or the CFM (n = 198 BN students) for their clinical practice experiences in an acute medical-surgical ward. Clinical teachers supervised between 6 and 8 students at a time, during these clinical practicums (duration = 4-6 weeks). At the end of the clinical practicum, students were invited to complete the Clinical Learning Environment Inventory (CLEI). Analysis of covariance was used to compare groups; adjusted for age, gender and prior work experience. A total of 259 students (mean age = 22 years, 76% female, 81% prior work experience) completed the CLEI (78% response rate). Students had higher scores on preferred versus actual experiences, in all domains of the CLEI. CPM student experiences indicated a higher preferred task orientation (p = 0.004), while CFM student experiences indicated a higher actual (p < 0.001) and preferred individualization (p = 0

  19. Learning community health nursing concepts from clinical experience.

    PubMed

    Lasater, Kathie; Luce, Linda; Volpin, Miriam; Terwilliger, Allison; Wild, Jackson

    2007-01-01

    Clinical faculty often struggle to design competency demonstrations that promote quality learning experiences. A nursing program in Oregon combined mental health and community health nursing practica and required well-planned, integrated competency demonstrations. This requirement became the impetus for students to promote the health of clients and learn clinical concepts that are difficult to experience in a typical term. Faculty coached students to make a significant contribution that would last beyond their clinical practica. A case study in competency demonstration design is described, and implications for curriculum development are presented.

  20. [Ethic review on clinical experiments of medical devices in medical institutions].

    PubMed

    Shuai, Wanjun; Chao, Yong; Wang, Ning; Xu, Shining

    2011-07-01

    Clinical experiments are always used to evaluate the safety and validity of medical devices. The experiments have two types of clinical trying and testing. Ethic review must be done by the ethics committee of the medical department with the qualification of clinical research, and the approval must be made before the experiments. In order to ensure the safety and validity of clinical experiments of medical devices in medical institutions, the contents, process and approval criterions of the ethic review were analyzed and discussed.

  1. Emotional Intelligence in Intensive Clinical Experiences for Nursing Students

    ERIC Educational Resources Information Center

    Zoromski, Lorraine M.

    2017-01-01

    This study looked for associations between measures of emotional intelligence in an intensive clinical experience for nursing students in their final semester of an associate's degree program. The theory of emotional labor was used to make connections between nursing clinical experience and emotional intelligence. Twenty nursing students from a…

  2. Benefits and challenges of caring for international patients.

    PubMed

    Cawcutt, Kelly A; Wilson, John W

    2016-11-01

    Increasing numbers of international patients are receiving care at US medical centers, entailing various challenges and benefits to all involved. Despite the potential challenges, the collective experiences can transform healthcare providers and their institutions into better physicians, better medical centers, and overall better members of a global society with increased awareness of the global human experience. Copyright © 2016 Cleveland Clinic.

  3. Magmatic degassing, lava dome extrusion, and explosions from Mount Cleveland volcano, Alaska, 2011-2015: Insight into the continuous nature of volcanic activity over multi-year timescales

    NASA Astrophysics Data System (ADS)

    Werner, Cynthia; Kern, Christoph; Coppola, Diego; Lyons, John J.; Kelly, Peter J.; Wallace, Kristi L.; Schneider, David J.; Wessels, Rick L.

    2017-05-01

    Mount Cleveland volcano (1730 m) is one of the most active volcanoes in the Aleutian arc, Alaska, but heightened activity is rarely accompanied by geophysical signals, which makes interpretation of the activity difficult. In this study, we combine volcanic gas emissions measured for the first time in August 2015 with longer-term measurements of thermal output and lava extrusion rates between 2011 and 2015 calculated from MODIS satellite data with the aim to develop a better understanding of the nature of volcanic activity at Mount Cleveland. Degassing measurements were made in the month following two explosive events (21 July and 7 August 2015) and during a period of new dome growth in the summit crater. SO2 emission rates ranged from 400 to 860 t d- 1 and CO2/SO2 ratios were < 3, consistent with the presence of shallow magma in the conduit and the observed growth of a new lava dome. Thermal anomalies derived from MODIS data from 2011 to 2015 had an average repose time of only 4 days, pointing to the continuous nature of volcanic activity at this volcano. Rapid increases in the cumulative thermal output were often coincident with visual confirmation of dome growth or accumulations of tephra in the crater. The average rate of lava extrusion calculated for 9 periods of rapid increase in thermal output was 0.28 m3 s- 1, and the total volume extruded from 2011 to 2015 was 1.9-5.8 Mm3. The thermal output from the lava extrusion events only accounts for roughly half of the thermal budget, suggesting a continued presence of shallow magma in the upper conduit, likely driven by convection. Axisymmetric dome morphology and occasional drain back of lava into the conduit suggests low-viscosity magmas drive volcanism at Mount Cleveland. It follows also that only small overpressures can be maintained given the small domes and fluid magmas, which is consistent with the low explosivity of most of Mount Cleveland's eruptions. Changes between phases of dome growth and explosive

  4. Results From a Microbial Source-Tracking Study at Villa Angela Beach, Cleveland, Ohio, 2007

    USGS Publications Warehouse

    Bushon, Rebecca N.; Stelzer, Erin A.; Stoeckel, Donald M.

    2009-01-01

    During the 2007 recreational season at Villa Angela Beach in Cleveland, Ohio, scientists with the U.S. Geological Survey (USGS) and the Northeast Ohio Regional Sewer District (NEORSD) found high Escherichia coli (E. coli) concentrations that were not easily explained by results obtained to date in ongoing investigations of recreational water quality at the beach. To help understand the sources behind these elevated E. coli concentrations, the USGS and NEORSD sampled beach-area water for Bacteroides DNA markers. Bacteroides are a group of enteric bacteria that are being used in microbial source tracking, in hope that host-associated DNA markers could be used to indicate potential sources of E. coli in the Villa Angela environment. The USGS Ohio Water Microbiology Laboratory analyzed a total of 13 source samples (sewage and waterfowl feces) and 33 beach-area water and sand samples for three Bacteroides DNA markers. This report lists the results of those analyses, along with environmental conditions at Villa Angela on the dates that samples were collected.

  5. A unique, innovative, and clinically oriented approach to anatomy education.

    PubMed

    Drake, Richard L

    2007-05-01

    The establishment of The Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, whose first class entered in 2004, provided a unique opportunity to design an anatomy program that, from all indications, is effective, time efficient, and clinically relevant in the context of a nonlecture, problem-based, organ-systems-oriented curriculum. Through consultation with surgery colleagues, the case-directed anatomy program was developed. This approach, meeting one day a week for 1 hour 50 minutes for 30 weeks, uses clinical cases to introduce anatomical information that is reinforced using prosected cadavers and imaging. The format of the approach involves three steps: (1) students preview a clinical case with clinical questions and learning objectives, (2) students acquire basic knowledge using textbooks and self-directed learning modules, and (3) students reinforce their basic knowledge in weekly case-directed anatomy sessions, which involve an interactive discussion of the clinical case followed by a laboratory. In the laboratory, students rotate around stations viewing prosected cadavers and imaging. Learning anatomy does not stop after the first year, because the program is longitudinal. During the second year, students review anatomy in each organ-system course using the first-year format. Also, second-year students can assist the fellows or residents prepare the prosections for first-year students and for their review of anatomy in the second year. This provides students with a dissection experience. During third-year clinical rotations, anatomy knowledge is reinforced, and several surgery anatomy electives are available during the final year. In this way, anatomy is learned and reinforced throughout the medical school curriculum.

  6. Solar Heating Experiment on the Grover Cleveland School, Boston, Massachusetts. Final Report.

    ERIC Educational Resources Information Center

    General Electric Co., Philadelphia, PA. Space Div.

    General Electric Company was one of four contractors who received a contract in early January 1974 to design, build, and install a solar heating experiment in a public school. The overall objective of this program was to obtain data that would assist in evaluating the applicability of solar heating systems in large metropolitan areas. This data…

  7. Dome growth at Mount Cleveland, Aleutian Arc, quantified by time-series TerraSAR-X imagery

    USGS Publications Warehouse

    Wang, Teng; Poland, Michael; Lu, Zhong

    2016-01-01

    Synthetic aperture radar imagery is widely used to study surface deformation induced by volcanic activity; however, it is rarely applied to quantify the evolution of lava domes, which is important for understanding hazards and magmatic system characteristics. We studied dome formation associated with eruptive activity at Mount Cleveland, Aleutian Volcanic Arc, in 2011–2012 using TerraSAR-X imagery. Interferometry and offset tracking show no consistent deformation and only motion of the crater rim, suggesting that ascending magma may pass through a preexisting conduit system without causing appreciable surface deformation. Amplitude imagery has proven useful for quantifying rates of vertical and areal growth of the lava dome within the crater from formation to removal by explosive activity to rebirth. We expect that this approach can be applied at other volcanoes that host growing lava domes and where hazards are highly dependent on dome geometry and growth rates.

  8. Education at the Dittrick Museum of Medical History, Case Western Reserve University, Cleveland, Ohio, USA.

    PubMed

    Edmonson, James M

    2009-01-01

    The Dittrick Museum of Medical History pursues an educational mission as being part of a major research university. While the Dittrick dates to 1899 as a historical committee of the Cleveland Medical Library Association, it first affiliated with Case Western Reserve University in 1966, and became a department of the College of Arts and Sciences of CWRU in 1998. The Dittrick maintains a museum exhibition gallery that is open to the public free of charge, and museum staff provide guided tours on appointment. Much of the teaching and instruction at the Dittrick is conducted by university professors; their classes meet in the museum and use museum resources in the form of artifacts, images, archives, and rare books. Class projects using Dittrick collections may take the form of research papers, exhibitions, and online presentations. Dittrick staff assist in these classes and are available to help researchers use museum resources.

  9. Clinical Needs Finding: Developing the Virtual Experience, A Case Study

    PubMed Central

    Mittal, Vaishali; Thompson, Megan; Altman, Stuart M; Taylor, Peter; Summers, Alexander; Goodwin, Kelsey; Louie, Angelique Y

    2013-01-01

    We describe an innovative program at the University of California, Davis for students to engage in clinical needs finding. Using a team-based approach, students participated in clinical rotations to observe firsthand the needs of clinicians at the university affiliated medical center. The teams were asked to develop documentary-style videos to capture key experiences that would allow future viewers to use the videos as “virtual” clinical rotations. This was conceived as a strategy to allow students in prohibitively large classes, or students in programs at institutions without associated medical or veterinary school programs, to experience clinical rotations and perform needs assessments. The students' perspectives on the experience as well as instructor analysis of best practices for this type of activity are presented and discussed. We found that the internship experience was valuable to the students participating, by not only introducing the practice of needs finding but for increasing the students' confidence in the practice of engineering design and their ability to work independently. The videos produced were of such high quality that instructors from other institutions have requested copies for instructional use. Virtual clinical rotations through video experiences may provide a reasonable substitute for students who do not have the ability to participate in rotations in person. PMID:23483373

  10. Clinical Environment as a Learning Environment: Student Nurses' Perceptions Concerning Clinical Learning Experiences.

    ERIC Educational Resources Information Center

    Papp, Inkeri; Markkanen, Marjatta; von Bonsdorff, Mikaela

    2003-01-01

    Finnish student nurses (n=16) described their clinical learning experiences. Several themes were identified: feeling appreciated and supported, the quality of mentoring and patient care, and self-directedness. School and clinical staff cooperation helped create a good learning environment in which theory and practice complemented each other.…

  11. The Importance of Early Experiences: Clinical, Research, and Policy Perspectives

    ERIC Educational Resources Information Center

    Zeanah, Charles H.

    2009-01-01

    The degree to which early adverse experiences exert long term effects on development and how much early adversity may be overcome through subsequent experiences are important mental health questions. The clinical, research and policy perspectives on these questions lead to different answers. From a clinical perspective, change is always possible,…

  12. Engaging doctors in the health care revolution.

    PubMed

    Lee, Thomas H; Cosgrove, Toby

    2014-06-01

    A health care revolution is under way, and doctors must be part of it. But many are deeply anxious and angry about the transformation, fearing loss of autonomy, respect, and income. Given their resistance, how can health system Leaders engage them in redesigning care? In this article, Dr. Thomas H. Lee, Press Ganey's chief medical officer, and Dr. Toby Cosgrove, the CEO of the Cleveland Clinic, describe a framework they've developed for encouraging buy-in. Adapting Max Weber's "typology of motives," and applying behavioral economics and other motivational principles, they describe four tactics leadership must apply in concert: engaging doctors in a noble shared purpose; addressing their economic self-interest; leveraging their desire for respect; and appealing to their sense of tradition. Drawing from experiences at the Mayo Clinic, Geisinger Health System, Partners HealthCare, the Cleveland Clinic, Ascension Health, and others, the authors show how the four motivational levers work together to bring this critical group of stakeholders on board.

  13. Impact of digital radiography on clinical workflow.

    PubMed

    May, G A; Deer, D D; Dackiewicz, D

    2000-05-01

    It is commonly accepted that digital radiography (DR) improves workflow and patient throughput compared with traditional film radiography or computed radiography (CR). DR eliminates the film development step and the time to acquire the image from a CR reader. In addition, the wide dynamic range of DR is such that the technologist can perform the quality-control (QC) step directly at the modality in a few seconds, rather than having to transport the newly acquired image to a centralized QC station for review. Furthermore, additional workflow efficiencies can be achieved with DR by employing tight radiology information system (RIS) integration. In the DR imaging environment, this provides for patient demographic information to be automatically downloaded from the RIS to populate the DR Digital Imaging and Communications in Medicine (DICOM) image header. To learn more about this workflow efficiency improvement, we performed a comparative study of workflow steps under three different conditions: traditional film/screen x-ray, DR without RIS integration (ie, manual entry of patient demographics), and DR with RIS integration. This study was performed at the Cleveland Clinic Foundation (Cleveland, OH) using a newly acquired amorphous silicon flat-panel DR system from Canon Medical Systems (Irvine, CA). Our data show that DR without RIS results in substantial workflow savings over traditional film/screen practice. There is an additional 30% reduction in total examination time using DR with RIS integration.

  14. Client Accounts of Corrective Experiences in Psychotherapy: Implications for Clinical Practice.

    PubMed

    Angus, Lynne; Constantino, Michael J

    2017-02-01

    The Patient Perceptions of Corrective Experiences in Individual Therapy (PPCEIT; Constantino, Angus, Friedlander, Messer, & Moertl, 2011) posttreatment interview guide was developed to provide clinical researchers with an effective mode of inquiry to identify and further explore clients' firsthand accounts of corrective and transformative therapy experiences and their determinants. Not only do findings from the analysis of client corrective experience (CE) accounts help identify what and how CEs happen in or as a result of psychotherapy, but the measure itself may also provide therapists with an effective tool to further enhance clients' awareness, understanding, and integration of transformative change experiences. Accordingly, we discuss in this afterword to the series the implications for clinical practice arising from (a) the thematic analysis of client CE accounts, drawn from a range of clinical samples and international research programs and (b) the clinical effect of completing the PPCEIT posttreatment interview inquiry. We also identify directions for future clinical training and research. © 2016 Wiley Periodicals, Inc.

  15. Physiotherapy clinical educators' perceptions and experiences of clinical prediction rules.

    PubMed

    Knox, Grahame M; Snodgrass, Suzanne J; Rivett, Darren A

    2015-12-01

    Clinical prediction rules (CPRs) are widely used in medicine, but their application to physiotherapy practice is more recent and less widespread, and their implementation in physiotherapy clinical education has not been investigated. This study aimed to determine the experiences and perceptions of physiotherapy clinical educators regarding CPRs, and whether they are teaching CPRs to students on clinical placement. Cross-sectional observational survey using a modified Dillman method. Clinical educators (n=211, response rate 81%) supervising physiotherapy students from 10 universities across 5 states and territories in Australia. Half (48%) of respondents had never heard of CPRs, and a further 25% had never used CPRs. Only 27% reported using CPRs, and of these half (51%) were rarely if ever teaching CPRs to students in the clinical setting. However most respondents (81%) believed CPRs assisted in the development of clinical reasoning skills and few (9%) were opposed to teaching CPRs to students. Users of CPRs were more likely to be male (p<0.001), have post-professional qualifications (p=0.020), work in private practice (p<0.001), and work in the area of musculoskeletal physiotherapy (p<0.001) compared with non-users. The CPRs most commonly known, used and taught were the Ottawa Ankle Rule, the Ottawa Knee Rule, and Wells' Rule for Deep Vein Thrombosis. Students are unlikely to be learning about CPRs on clinical placement, as few clinical educators use them. Clinical educators will require training in CPRs and assistance in teaching them if students are to better learn about implementing CPRs in physiotherapy clinical practice. Copyright © 2015 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

  16. Preparing for practice: Nursing intern and faculty perceptions on clinical experiences.

    PubMed

    AlThiga, Hanan; Mohidin, Sharifah; Park, Yoon Soo; Tekian, Ara

    2017-04-01

    Clinical experience and exposure to real patients are required elements of nursing education. Trainees in nursing are expected to be prepared adequately for the hard-working environment, increasing patient complexity, and higher-level competencies. This study investigates differences between nursing interns and clinical faculty on actual and perceived importance of educational preparation and development of clinical competencies, focusing on the nursing curriculum and transition to practice. A convenient sampling technique with a mixed-methods design was used to collect quantitative and qualitative data, by surveying and interviewing nursing interns and faculty members from King Abdul-Aziz University in Saudi Arabia; data collection occurred in December 2015. The survey (23 items) and focused interviews measured perceptions of clinical instruction and experience. Descriptive statistics and t-tests were used to analyze differences in mean ratings between actual and perceived importance. Themes collected from narrative interview data were summarized. Significant differences were found between nursing interns (n = 46) and faculty (n = 29) perceptions of actual clinical teaching and experiences and its importance including the clinical teaching and the development of clinical competence, p < .01. Moreover, nursing interns rated actual experiences of knowledge base and skills significantly lower than faculty perceptions, p = .001. Narrative data provided in-depth information on factors contributing and hindering the learning and teaching environment. Findings from this study call for clinical instruction and experiences to take a step further to meet current practice standards and to improve patient safety in the health professions education of nurses.

  17. Dental Students' Clinical Expectations and Experiences Treating Persons with Disabilities.

    PubMed

    Perusini, Darsi J; Llacuachaqui, Marcia; Sigal, Michael J; Dempster, Laura J

    2016-03-01

    Persons with disabilities (PWDs) have a disproportionate level of dental disease relative to the general population. Access to care is a cause along with dentists' willingness to treat PWDs. The aim of this study was to investigate the expectations and experiences of dental students in providing treatment to these patients in a hospital-based dental clinic for PWDs. Senior dental students at the Faculty of Dentistry, University of Toronto (n=92) were surveyed prior to (Phase I) and at the end of (Phase II) mandatory clinical rotations at the Mount Sinai Hospital's Dentistry Clinic for Persons with Special Needs. Response rates were 88% for Phase I and 58% for Phase II. Before the rotations, 70% of the respondents reported little or no experience with PWDs, and 46% said they did not feel comfortable providing basic dental treatment to PWDs. However, in Phase II, significantly more students reported being comfortable than in Phase I (p=0.001). Overall, the majority of respondents (Phase I 95%; Phase II 98%) indicated they would at least attempt to provide basic dental care to PWDs after graduation. The majority also identified the opportunity to provide care and interact with PWDs as the most enjoyable aspect of their experience at the clinic. They reported that the experience helped reduce their concerns about treating PWDs including being more realistic about the time required and ideal quality of the treatment they could provide. These results suggest that their experience in the clinic significantly increased students' comfort in treating PWDs. The respondents expressed a willingness to treat PWDs once graduated and generally identified their experience as being more positive than their expectations.

  18. Preceptor-guided clinical practica and the learning experiences of nursing students.

    PubMed

    Jiang, Ru-Shang; Chou, Chuan-Chiang; Tsai, Pi-Lan

    2012-06-01

    In Taiwan, nearly one third of newly graduated nurses quit their first nursing job within 3 months and many never return to nursing. Because traditional clinical practice designs do not offer adequate opportunities for students to work independently, many senior nursing students lack self-confidence in their nursing skills and are not familiar with the day-to-day realities of nursing even after completing all their required clinical practica. A model for a preceptor-guided clinical practicum was designed to address this concern. The aim of this study was to explore the learning experiences of senior nursing students who worked with preceptors during their clinical practica. Thirteen female nursing students were interviewed to discover their perceptions of their preceptor-guided clinical practicum. All interviews were tape recorded and transcribed. Descriptions were analyzed using Colaizzi's phenomenological methodology. Four themes emerged from the data that described the preceptorship experience in the clinical practicum: (1) information and new experience overload, (2) feelings of loneliness and stress, (3) questioning whether strict preceptors achieve the best results, and (4) beginning to feel like a nurse. Findings suggest that it is important for nurse educators to be clear and precise about the expectations of the preceptorship experience. Orientation for both preceptors and students is essential. Support and encouragement throughout the entire practicum experience for preceptors and students is necessary to ensure program success.

  19. Influence of Clinical Experience and Productivity on Emergency Medicine Faculty Teaching Scores

    PubMed Central

    Clyne, Brian; Smith, Jessica L.; Napoli, Anthony M.

    2012-01-01

    Background Commonly cited barriers to effective teaching in emergency medicine include lack of time, competing demands for patient care, and a lack of formal teaching experience. Teaching may be negatively affected by demands for increased clinical productivity, or positively influenced by clinical experience. Objective To examine the association between faculty teaching scores and clinical productivity, years of clinical experience, and amount of clinical contact with resident physicians. Methods We conducted a retrospective, observational study with existing data on full-time faculty at a high-volume, urban emergency medicine residency training program for academic year 2008–2009. Residents rated faculty on 9 domains of teaching, including willingness to teach, enthusiasm for teaching, medical knowledge, preparation, and communication. Clinical productivity data for relative value units per hour and number of patients per hour, years of clinical experience, and annual clinical hours were obtained from existing databases. Results For the 25 core faculty members included in the study, there was no relationship between faculty teaching scores and clinical productivity measures (relative value units per hour: r2  =  0.01, P  =  .96, patients per hour: r2  =  0.00, P  =  .76), or between teaching scores and total clinical hours with residents (r2  =  0.07, P  =  .19). There was a significant negative relationship between years of experience and teaching scores (r2  =  0.27, P < .01). Conclusions Our study demonstrated that teaching scores for core emergency medicine faculty did not correlate with clinical productivity or amount of clinical contact with residents. Teaching scores were inversely related to number of years of clinical experience, with more experienced faculty earning the lowest teaching scores. Further study is necessary to determine if there are clinical measures that identify good educators

  20. Using business intelligence to improve performance.

    PubMed

    Wadsworth, Tom; Graves, Brian; Glass, Steve; Harrison, A Marc; Donovan, Chris; Proctor, Andrew

    2009-10-01

    Cleveland Clinic's enterprise performance management program offers proof that comparisons of actual performance against strategic objectives can enable healthcare organization to achieve rapid organizational change. Here are four lessons Cleveland Clinic learned from this initiative: Align performance metrics with strategic initiatives. Structure dashboards for the CEO. Link performance to annual reviews. Customize dashboard views to the specific user.

  1. Magmatic degassing, lava dome extrusion, and explosions from Mount Cleveland volcano, Alaska, 2011–2015: Insight into the continuous nature of volcanic activity over multi-year timescales

    USGS Publications Warehouse

    Werner, Cynthia; Kern, Christoph; Coppola, Diego; Lyons, John; Kelly, Peter; Wallace, Kristi; Schneider, David; Wessels, Rick

    2017-01-01

    Mount Cleveland volcano (1730 m) is one of the most active volcanoes in the Aleutian arc, Alaska, but heightened activity is rarely accompanied by geophysical signals, which makes interpretation of the activity difficult. In this study, we combine volcanic gas emissions measured for the first time in August 2015 with longer-term measurements of thermal output and lava extrusion rates between 2011 and 2015 calculated from MODIS satellite data with the aim to develop a better understanding of the nature of volcanic activity at Mount Cleveland. Degassing measurements were made in the month following two explosive events (21 July and 7 August 2015) and during a period of new dome growth in the summit crater. SO2 emission rates ranged from 400 to 860 t d− 1 and CO2/SO2 ratios were < 3, consistent with the presence of shallow magma in the conduit and the observed growth of a new lava dome. Thermal anomalies derived from MODIS data from 2011 to 2015 had an average repose time of only 4 days, pointing to the continuous nature of volcanic activity at this volcano. Rapid increases in the cumulative thermal output were often coincident with visual confirmation of dome growth or accumulations of tephra in the crater. The average rate of lava extrusion calculated for 9 periods of rapid increase in thermal output was 0.28 m3 s− 1, and the total volume extruded from 2011 to 2015 was 1.9–5.8 Mm3. The thermal output from the lava extrusion events only accounts for roughly half of the thermal budget, suggesting a continued presence of shallow magma in the upper conduit, likely driven by convection. Axisymmetric dome morphology and occasional drain back of lava into the conduit suggests low-viscosity magmas drive volcanism at Mount Cleveland. It follows also that only small overpressures can be maintained given the small domes and fluid magmas, which is consistent with the low explosivity of most of Mount Cleveland's eruptions. Changes between phases of dome growth

  2. Planning a study abroad clinical experience.

    PubMed

    Wright, Dolores J

    2010-05-01

    Not only is globalization expanding areas of human activity, it is also influencing the variety of educational offerings in universities. Therefore, globalization must be considered by nurse educators as they reevaluate ways of preparing nursing students to meet the health care needs of populations they currently serve and will care for in the future. Study abroad programs have been encouraged to be part of the college experience in the United States for more than 30 years; however, these programs have been relatively lacking in nursing education. Most of the study abroad programs described in the nursing literature are research-based or first-person accounts of an experience and provide little information about planning a study abroad program. This article describes a study abroad learning experience for senior nursing students and discusses the issues such as student selection, student safety, and available clinical experiences that need to be considered before undertaking such an endeavor.

  3. Interprofessional student experiences on the HAVEN free clinic leadership board.

    PubMed

    Scott, Elizabeth Anne; Swartz, Martha K

    2015-01-01

    In this study, we examined the experiences of students serving on the leadership board of HAVEN - the student-run free clinic of the Yale University health professional schools. Open-ended responses were collected from 18 of the 28 members of the 2011-2012 leadership board through an online survey. Students reported an overall positive experience participating on the board and valued the opportunity to be part of a committed community creating change. The majority of students reported that their time as a board member had improved their attitude towards interprofessional collaboration (78%) and had also fostered their leadership skills (67%). Around two thirds (67%) reported that their experience had positively impacted their future career plans, either reinforcing their desire to work with underserved populations or encouraging them to pursue leadership roles. Based on these data, it is suggested that the HAVEN Free Clinic offers a useful opportunity for students to experience the demands of clinical care leadership while working together in an interprofessional context.

  4. Dental Students' Clinical Experience Across Three Successive Curricula at One U.S. Dental School.

    PubMed

    White, Joel M; Jenson, Larry E; Gansky, Stuart A; Walsh, Cameron J; Accurso, Brent T; Vaderhobli, Ram M; Kalenderian, Elsbeth; Walji, Muhammad F; Cheng, Jing

    2017-04-01

    As dental schools continue to seek the most effective ways to provide clinical education for students, it is important to track the effects innovations have on students' clinical experience to allow for quantitative comparisons of various curricula. The aim of this study was to compare the impact of three successive clinical curricula on students' experience at one U.S. dental school. The three were a discipline-based curriculum (DBC), a comprehensive care curriculum (CCC), and a procedural requirement curriculum plus externships (PRCE). Students' clinic experience data from 1992 to 2013 were analyzed for total experience and in five discipline areas. Clinic experience metrics analyzed were patient visits (PVs), relative value units (RVUs), and equivalent amounts (EQAs). A minimum experience threshold (MET) and a high experience threshold (HET) were set at one standard deviation above and below the mean for the DBC years. Students below the MET were designated as low achievers; students above the HET were designated as high achievers. The results showed significant differences among the three curricula in almost all areas of comparison: total PVs, total EQAs, total RVUs, RVUs by discipline, and number of high and low achievers in total clinical experience and by discipline. The comprehensive care approach to clinical education did not negatively impact students' clinical experience and in many cases enhanced it. The addition of externships also enhanced student total clinical experience although more study is needed to determine their effectiveness. The insights provided by this study suggest that the methodology used including the metrics of PVs, EQAs, and RVUs may be helpful for other dental schools in assessing students' clinical experience.

  5. The Meta-Analysis of Clinical Judgment Project: Effects of Experience on Judgment Accuracy

    ERIC Educational Resources Information Center

    Spengler, Paul M.; White, Michael J.; Aegisdottir, Stefania; Maugherman, Alan S.; Anderson, Linda A.; Cook, Robert S.; Nichols, Cassandra N.; Lampropoulos, Georgios K.; Walker, Blain S.; Cohen, Genna R.; Rush, Jeffrey D.

    2009-01-01

    Clinical and educational experience is one of the most commonly studied variables in clinical judgment research. Contrary to clinicians' perceptions, clinical judgment researchers have generally concluded that accuracy does not improve with increased education, training, or clinical experience. In this meta-analysis, the authors synthesized…

  6. A Medical Student-Run Child and Adolescent Psychiatry Clinic: One Institution's Experience.

    PubMed

    Murzl, Cassandra A; Durns, Tyler A; Mowrey, Lorin T; Tubbs, Andrew S; Boeve, Sally A

    2017-10-01

    This report examines the experience of one institution's development of the first student-run psychiatry clinic that serves both adult and pediatric populations. The clinic is held weekly with pre-clinical and clinical medical student volunteers under the supervision of board-certified adult and child psychiatrists. The development and evolution of the clinic over time are evaluated with particular attention to obstacles overcome. Medical student volunteers were surveyed retrospectively to evaluate their experience with patients with psychiatric illness, skill development, and interest in psychiatry. Since January 2016, the clinic has scheduled 90 patients, 32% of which were pediatric patients. Ninety-six medical students have volunteered, with roughly equal parts from all four medical school classes. Respondents to the experience survey showed marked improvement in their comfort working with patients with mental illness. Additionally, 40% "strongly agreed" or "agreed" that their experience influenced their interest in pursuing psychiatry as a career. This report describes a student-run psychiatry clinic with a dual mission of education and service, and the challenges associated with these sometimes competing goals. This clinic serves a vital need within our community and may be an example of the role that student-run clinics can have in fostering interdisciplinary care, psychiatric recruitment, and training for medical students.

  7. ACTS Satellite Telemammography Network Experiments

    NASA Technical Reports Server (NTRS)

    Kachmar, Brian A.; Kerczewski, Robert J.

    2000-01-01

    The Satellite Networks and Architectures Branch of NASA's Glenn Research Center has developed and demonstrated several advanced satellite communications technologies through the Advanced Communications Technology Satellite (ACTS) program. One of these technologies is the implementation of a Satellite Telemammography Network (STN) encompassing NASA Glenn, the Cleveland Clinic Foundation. the University of Virginia, and the Ashtabula County Medical Center. This paper will present a look at the STN from its beginnings to the impact it may have on future telemedicine applications. Results obtained using the experimental ACTS satellite demonstrate the feasibility of Satellite Telemammography. These results have improved teleradiology processes and mammography image manipulation, and enabled advances in remote screening methodologies. Future implementation of satellite telemammography using next generation commercial satellite networks will be explored. In addition, the technical aspects of the project will be discussed, in particular how the project has evolved from using NASA developed hardware and software to commercial off the shelf (COTS) products. Development of asymmetrical link technologies was an outcome of this work. Improvements in the display of digital mammographic images, better understanding of end-to-end system requirements, and advances in radiological image compression were achieved as a result of the research. Finally, rigorous clinical medical studies are required for new technologies such as digital satellite telemammography to gain acceptance in the medical establishment. These experiments produced data that were useful in two key medical studies that addressed the diagnostic accuracy of compressed satellite transmitted digital mammography images. The results of these studies will also be discussed.

  8. Starting a Health Professions Education Graduate Program

    ERIC Educational Resources Information Center

    Hansman, Catherine A.

    2018-01-01

    This chapter is a case story of the evolution of the Master of Education in Health Professions Education (MEHPE), a collaborative graduate program developed by the Adult Learning and Development program at Cleveland State University and the Cleveland Clinic.

  9. The Lived-Experience of Novice Nurse's Actualizing Clinical Reasoning in Academic Simulation

    ERIC Educational Resources Information Center

    Brinker, Mary Catherine

    2016-01-01

    The purpose of this existential-phenomenological study was to address the first-person perspective of what it is like to experience clinical reasoning during a simulation. It was not known how a novice nurse would describe the experience of actualizing clinical reasoning during the academic simulation experience. In order to maintain the…

  10. Development of an International Clinical Education Extracurricular Experience Through a Collaborative Partnership.

    PubMed

    Mandich, MaryBeth; Erickson, Mia; Nardella, Beth

    2017-01-01

    Participating in global health care through international clinical education may enhance the development of cultural competence and professionalism. Many logistical issues need to be resolved in the development of international clinical education experiences that meet program requirements. The purpose of this case report is to describe how a university developed such an experience for students by partnering with Amizade Global Service-Learning (Amizade), an organization that facilitates global learning experiences. Medical, nursing, and pharmacy students were already participating in a 4-week international health-related service learning rotation through Amizade. The preexisting relationship and contractual agreement with the university provided the necessary legal framework. Amizade staff assisted in finding a physical therapist qualified and willing to host a student. The academic coordinator for clinical education at the university and Amizade liaisons determined living arrangements, schedule, clinical settings, and patient population. The selected student had expressed interest and had met all clinical education placement requirements. The academic coordinator for clinical education had ongoing electronic communications with all parties. The student demonstrated predicted attributes of cultural competence and professionalism; through the partnership with Amizade, the student was exposed to several unique interprofessional experiences. The steps used by the university faculty in developing this interprofessional, international clinical education experience through a collaborative partnership may provide guidance for other institutions. © 2017 American Physical Therapy Association

  11. Cultural sensitivity or professional acculturation in early clinical experience?

    PubMed

    Whitford, David L; Hubail, Amal Redha

    2014-11-01

    This study aimed to explore the early clinical experience of medical students following the adaptation of an Early Patient Contact curriculum from a European culture in Ireland to an Arab culture in Bahrain. Medical students in Bahrain took part in an Early Patient Contact module modelled on a similar module from a partner medical school in Ireland. We used a qualitative approach employing thematic analysis of 54 student reflective logbooks. Particular attention was placed on reflections of cultural influences of experience in the course. Medical students undergoing this module received reported documented benefits of early clinical experience. However, students in Bahrain were exposed to cultural norms of the local Arab society including gender values, visiting the homes of strangers, language barriers and generous hospitality that led to additional challenges and learning for the medical students in acculturating to norms of the medical profession. Modules intended for curriculum adaptation between two cultures would be best served by a group of "core" learning outcomes with "secondary" outcomes culturally appropriate to each site. Within the context of the Arab culture, early clinical experience has the added benefit of allowing students to learn about both local and professional cultural norms, thereby facilitating integration of these two cultures.

  12. New Research Methods Developed for Studying Diabetic Foot Ulceration

    NASA Technical Reports Server (NTRS)

    1998-01-01

    Dr. Brian Davis, one of the Cleveland Clinic Foundation's researchers, has been investigating the risk factors related to diabetic foot ulceration, a problem that accounts for 20 percent of all hospital admissions for diabetic patients. He had developed a sensor pad to measure the friction and pressure forces under a person's foot when walking. As part of NASA Lewis Research Center's Space Act Agreement with the Cleveland Clinic Foundation, Dr. Davis requested Lewis' assistance in visualizing the data from the sensor pad. As a result, Lewis' Interactive Data Display System (IDDS) was installed at the Cleveland Clinic. This computer graphics program is normally used to visualize the flow of air through aircraft turbine engines, producing color two- and three-dimensional images.

  13. Undergraduate nursing students' experience related to their clinical learning environment and factors affecting to their clinical learning process.

    PubMed

    Arkan, Burcu; Ordin, Yaprak; Yılmaz, Dilek

    2018-03-01

    Clinical education is an essential part of nursing education. The purpose of this study was to explore nurse students' experiences related to cinical learning environments, factors effecting to clinical learning process. Descriptive qualitative design was used in this study, and data were collected from 2nd class nursing student (n = 14). The study took the form of in-depth interviews between August-October 2015. The qualitative interviews were analyzed by using simple content analysis. Data were analyzed manually. Experiences nurse students are described five themes. The themes of the study are (1) effecting persons to clinical learning, (2) educational atmosphere, (3) students' personal charactering, (4) the impact of education in school, and (5) students' perceptions related to clinical learning. Participants stated that they experienced many difficulties during clinical learning process. All students importantly stated that nurse teacher is very effecting to clinical learning. This study contributes to the literature by providing data on beginner nursing student' experiences about clinical learning process. The data of this present study show to Turkish nursing student is affecting mostly from persons in clinical learning. The data of this present study will guide nurse teacher when they plan to interventions to be performed to support student during clinical learning process. Copyright © 2017 Elsevier Ltd. All rights reserved.

  14. Nurses’ experiences of humour in clinical settings

    PubMed Central

    Ghaffari, Fatemeh; Dehghan-Nayeri, Nahid; Shali, Mahboubeh

    2015-01-01

    Background: Providing holistic nursing care when there is a shortage of personnel and equipment exposes nurses to stress and a higher risk of occupational burnout. Humour can promote nurses’ health and influence nursing care. The aim of this study was to describe nurses’ experiences of humour in clinical settings and factors affecting it. Methods: This qualitative study investigated nurses’ experiences of humour. Five hospitals affiliated to Tehran University of Medical Sciences provided the setting for this study. The participants comprised of 17 nurses with master’s and Baccalaureate degrees (BSN) in nursing. These nurses worked at educational hospitals affiliated to Tehran University of Medical Sciences and had minimum work experience of 12 months in various clinical wards. Nurses from all wards were invited to participate in this study. The data were collected through semi structure interviews using guides comprising probing questions. Telephonic interviews were used to further supplement the data. The data were analysed using conventional content analysis. Results: The data were classified into five themes including the dynamics of humour, condition enforcement, Risk making probability, Instrumental use and Change: opportunities and threats. Conclusion: Understanding nurses’ perceptions and experiences of humour helps identify its contributing factors and provides valuable guidelines for enhancing nurses and patients’ mental, emotional and physical health. Spreading a culture of humour through teaching methods can improve workplace cheerfulness and highlights the importance of humour in patient care in nurses and nursing students. PMID:26034735

  15. Statistical summary and trend evaluation of air quality data for Cleveland, Ohio in 1967 to 1971: Total suspended particulate, nitrogen dioxide, and sulfur dioxide

    NASA Technical Reports Server (NTRS)

    Neustadter, H. E.; Sidik, S. M.; Burr, J. C., Jr.

    1972-01-01

    Air quality data for Cleveland, Ohio, for the period of 1967 to 1971 were collated and subjected to statistical analysis. The total suspended particulate component is lognormally distributed; while sulfur dioxide and nitrogen dioxide are reasonably approximated by lognormal distributions. Only sulfur dioxide, in some residential neighborhoods, meets Ohio air quality standards. Air quality has definitely improved in the industrial valley, while in the rest of the city, only sulfur dioxide has shown consistent improvement. A pollution index is introduced which displays directly the degree to which the environmental air conforms to mandated standards.

  16. Management Control Systems and Clinical Experience of Managers in Public Hospitals

    PubMed Central

    Naranjo-Gil, David

    2018-01-01

    Healthcare authorities are encouraging managers in hospitals to acquire clinical experience and knowledge in order to better carry out and coordinate healthcare service delivery. The main objective of this paper is to analyse how the clinical experience of hospital managers is related to public health institutions’ performance. It is proposed that the effect of the clinical experience on operative and financial organizational performance is indirect through the mediating variables of perceived utility of management information and horizontal management control system. This paper analyses how these variables impact hospital performance through the data from a survey sent to 364 hospital managers in Brazil. The results show that managers’ clinical experience is related to higher perceived utility of historical, financial, short-term, and internal information, but not with horizontal control adoption in hospitals. Furthermore, our results show that, in hospitals, perceived utility of forecasted, non-financial, long-term, and external managerial information positively affects hospitals’ financial performance, while adoption of horizontal control management positively affects operational performance. Through showing evidence that clinical background could explain the differences not only in hospital service management but also in information capabilities and management control processes, this study offer meaningful implications for healthcare authorities and hospital managers involved in the development and implementation of strategies in the health sector. PMID:29673192

  17. Application of lean methods improves surgical clinic experience.

    PubMed

    Waldhausen, John H T; Avansino, Jeffrey R; Libby, Arlene; Sawin, Robert S

    2010-07-01

    A quality visit in high volume surgery clinics is challenging. There is variability in numbers of patients seen and care provider behavior. Documentation, regulatory and compliance issues and computerization of patient care systems may decrease clinic efficiency and throughput. We tried to reduce variability and improve patient experience. Baseline data included: patients seen, time in exam rooms, and spent with providers, and patient satisfaction surveys. Two Rapid Process Improvement Workshops (RPIWs) were conducted to apply lean methods. 5S techniques helped standardize exam rooms. Similar data were collected at 30 days, 60 days, and 1 year. Satisfaction surveys were followed at 6 months and 1 year. Median pre-RPIW room time was 49 minutes. Post-RPIW times were 33 minutes at 30 days, 41 minutes at 60 days, and 42 minutes at 1 year. Face to face provider-patient time increased 30% to 61% at 30 days, 58% at 60 days, and 59% at 1 year. The median number of patients in a 4-hour clinic increased from 10 to 12. Satisfaction survey Problem Scores improved and were sustained. Lean methodology may be used to improve clinic efficiency as well as patient and staff's experience. Copyright 2010. Published by Elsevier Inc.

  18. Extensive 1-year survey of trace elements and compounds in the airborne suspended particulate matter in Cleveland, Ohio

    NASA Technical Reports Server (NTRS)

    King, R. B.; Fordyce, J. S.; Antoine, A. C.; Leibecki, H. F.; Neustadter, H. E.; Sidik, S. M.

    1976-01-01

    Concentrations of 75 chemical constituents in the airborne particulate matter were measured in Cleveland, Ohio, during 1971 and 1972. Values covering a 1-year period (45 to 50 sampling days) at each of 16 sites are presented for 60 elements. A lesser number of values is given for sulfate, nitrate, fluoride, acidity, 10 polynuclear aromatic hydrocarbon compounds, and the aliphatic hydrocarbon compounds as a group. Methods used included instrumental neutron activation, emission spectroscopy, gas chromatography, combustion techniques, and colorimetry. Uncertainties in the concentrations associated with the sampling procedures, the analysis methods, the use of several analytical facilities, and samples with concentrations below the detection limits are evaluated in detail. The data is discussed in relation to other studies and source origins. The trace constituent concentrations as a function of wind direction are used to suggest a practical method for air pollution source identification.

  19. Enhancing an introductory Pharmacy Practice Experience at free medical clinics.

    PubMed

    Morello, Candis M; Singh, Renu F; Chen, Karen J; Best, Brookie M

    2010-02-01

    The aim of the study was to assess and improve first-year student pharmacists' satisfaction and learning experience in a Student-Run Free Medical Clinic Project (SFMCP) providing medical care to an underserved population. Two consecutive classes of first-year student pharmacists at the University of California San Diego (UCSD) Skaggs School of Pharmacy and Pharmaceutical Sciences participated in an Introductory Pharmacy Practice Experience (IPPE) at the UCSD SFMCP. This IPPE involved two inter-professional evening free clinics which provide medical care to an underserved population and opportunities for healthcare professional training and service. Year 1 students completed a self-assessment survey instrument and year 2 students completed the survey instrument plus a new competency checklist tool. Average scores from the self-assessment survey instrument were compared between years 1 and 2. Initial survey results showed that students felt the SFMCP was worthwhile; however, they did not experience enough involvement in the patient assistance programme or non-pharmacy-related clinic activities. After the competency checklist tool implementation, overall student pharmacist satisfaction of the SFMCP IPPE remained high (88%), participation in identified weak areas improved and students agreed that the tool helped focus their clinic experience. Areas of improvement were identified with the survey instrument and the competency checklist tool increased achievement of learning objectives. Overall, student pharmacists felt the SFMCP IPPE was a good learning experience. Practising pharmacists can employ these or similar tools in specific practice settings, to evaluate and help ensure that student pharmacists or interns are achieving applicable learning objectives.

  20. An Exploration of Dental Students' Assumptions About Community-Based Clinical Experiences.

    PubMed

    Major, Nicole; McQuistan, Michelle R

    2016-03-01

    The aim of this study was to ascertain which assumptions dental students recalled feeling prior to beginning community-based clinical experiences and whether those assumptions were fulfilled or challenged. All fourth-year students at the University of Iowa College of Dentistry & Dental Clinics participate in community-based clinical experiences. At the completion of their rotations, they write a guided reflection paper detailing the assumptions they had prior to beginning their rotations and assessing the accuracy of their assumptions. For this qualitative descriptive study, the 218 papers from three classes (2011-13) were analyzed for common themes. The results showed that the students had a variety of assumptions about their rotations. They were apprehensive about working with challenging patients, performing procedures for which they had minimal experience, and working too slowly. In contrast, they looked forward to improving their clinical and patient management skills and knowledge. Other assumptions involved the site (e.g., the equipment/facility would be outdated; protocols/procedures would be similar to the dental school's). Upon reflection, students reported experiences that both fulfilled and challenged their assumptions. Some continued to feel apprehensive about treating certain patient populations, while others found it easier than anticipated. Students were able to treat multiple patients per day, which led to increased speed and patient management skills. However, some reported challenges with time management. Similarly, students were surprised to discover some clinics were new/updated although some had limited instruments and materials. Based on this study's findings about students' recalled assumptions and reflective experiences, educators should consider assessing and addressing their students' assumptions prior to beginning community-based dental education experiences.

  1. Physiotherapy students' perceptions and experiences of clinical prediction rules.

    PubMed

    Knox, Grahame M; Snodgrass, Suzanne J; Stanton, Tasha R; Kelly, David H; Vicenzino, Bill; Wand, Benedict M; Rivett, Darren A

    2017-09-01

    Clinical reasoning can be difficult to teach to pre-professional physiotherapy students due to their lack of clinical experience. It may be that tools such as clinical prediction rules (CPRs) could aid the process, but there has been little investigation into their use in physiotherapy clinical education. This study aimed to determine the perceptions and experiences of physiotherapy students regarding CPRs, and whether they are learning about CPRs on clinical placement. Cross-sectional survey using a paper-based questionnaire. Final year pre-professional physiotherapy students (n=371, response rate 77%) from five universities across five states of Australia. Sixty percent of respondents had not heard of CPRs, and a further 19% had not clinically used CPRs. Only 21% reported using CPRs, and of these nearly three-quarters were rarely, if ever, learning about CPRs in the clinical setting. However most of those who used CPRs (78%) believed CPRs assisted in the development of clinical reasoning skills and none (0%) was opposed to the teaching of CPRs to students. The CPRs most commonly recognised and used by students were those for determining the need for an X-ray following injuries to the ankle and foot (67%), and for identifying deep venous thrombosis (63%). The large majority of students in this sample knew little, if anything, about CPRs and few had learned about, experienced or practiced them on clinical placement. However, students who were aware of CPRs found them helpful for their clinical reasoning and were in favour of learning more about them. Copyright © 2016 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

  2. The Relationship Between Levels of Fidelity in Simulation, Traditional Clinical Experiences and Objectives.

    PubMed

    Gore, Teresa

    2017-06-15

    The purpose of this study was to explore the relationship of baccalaureate nursing students' (BSN) perceived learning effectiveness using the Clinical Learning Environments Comparison Survey of different levels of fidelity simulation and traditional clinical experiences. A convenience sample of 103 first semester BSN enrolled in a fundamental/assessment clinical course and 155 fifth semester BSN enrolled in a leadership clinical course participated in this study. A descriptive correlational design was used for this cross-sectional study to evaluate students' perceptions after a simulation experience and the completion of the traditional clinical experiences. The subscales measured were communication, nursing leadership, and teaching-learning dyad. No statistical differences were noted based on the learning objectives. The communication subscale showed a tendency toward preference for traditional clinical experiences in meeting students perceived learning for communication. For student perceived learning effectiveness, faculty should determine the appropriate level of fidelity in simulation based on the learning objectives.

  3. Early experiences of accredited clinical informatics fellowships.

    PubMed

    Longhurst, Christopher A; Pageler, Natalie M; Palma, Jonathan P; Finnell, John T; Levy, Bruce P; Yackel, Thomas R; Mohan, Vishnu; Hersh, William R

    2016-07-01

    Since the launch of the clinical informatics subspecialty for physicians in 2013, over 1100 physicians have used the practice and education pathways to become board-certified in clinical informatics. Starting in 2018, only physicians who have completed a 2-year clinical informatics fellowship program accredited by the Accreditation Council on Graduate Medical Education will be eligible to take the board exam. The purpose of this viewpoint piece is to describe the collective experience of the first four programs accredited by the Accreditation Council on Graduate Medical Education and to share lessons learned in developing new fellowship programs in this novel medical subspecialty. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  4. Practice-based learning experience to develop residents as clinical faculty members.

    PubMed

    Slazak, Erin M; Zurick, Gina M

    2009-07-01

    A practice-based learning experience designed to expose postgraduate year 1 (PGY1) and 2 (PGY2) residents to and prepare them for a career as clinical faculty is described. A practice-based learning experience was designed to give PGY1 and PGY2 residents exposure to the responsibilities of a clinical faculty member, integrating clinical practice, preceptor duties, and other academia-related responsibilities. The learning experience is a four-week, elective rotation for PGY1 and PGY2 residents. The rotation is designed to correspond to a four-week advanced pharmacy practice experience (APPE) rotation, allowing the resident to work continuously with the same one or two APPE students for the entire rotation. The resident is required to design and implement a rotation for the students and provide clinical services while integrating students into daily tasks, facilitating topic and patient discussions, evaluating assignments, providing constructive feedback, and assigning a final rotation grade. The resident also attends all academic and committee meetings and teaching obligations with his or her residency director, if applicable. The resident is mentored by the residency director throughout all phases of the rotation and is evaluated using goals and objectives tailored to this experience. The development of a formal, structured rotation to give postgraduate residents experience as a preceptor provided an opportunity for residents to further explore their interests in academia and allowed them to serve as a primary preceptor while being guided and evaluated by a mentor.

  5. Management Control Systems and Clinical Experience of Managers in Public Hospitals.

    PubMed

    Lunkes, Rogério Joao; Naranjo-Gil, David; Lopez-Valeiras, Ernesto

    2018-04-17

    Healthcare authorities are encouraging managers in hospitals to acquire clinical experience and knowledge in order to better carry out and coordinate healthcare service delivery. The main objective of this paper is to analyse how the clinical experience of hospital managers is related to public health institutions’ performance. It is proposed that the effect of the clinical experience on operative and financial organizational performance is indirect through the mediating variables of perceived utility of management information and horizontal management control system. This paper analyses how these variables impact hospital performance through the data from a survey sent to 364 hospital managers in Brazil. The results show that managers’ clinical experience is related to higher perceived utility of historical, financial, short-term, and internal information, but not with horizontal control adoption in hospitals. Furthermore, our results show that, in hospitals, perceived utility of forecasted, non-financial, long-term, and external managerial information positively affects hospitals’ financial performance, while adoption of horizontal control management positively affects operational performance. Through showing evidence that clinical background could explain the differences not only in hospital service management but also in information capabilities and management control processes, this study offer meaningful implications for healthcare authorities and hospital managers involved in the development and implementation of strategies in the health sector.

  6. [Application of portfolio in teaching dermatology clinic: an experience in teaching of medicine].

    PubMed

    de Cabalier, M E; Chalub, D M

    2009-01-01

    We present a learning experience conducted in the Chair of Dermatology Clinic of the Faculty of Medical Sciences, National University of Cordoba in the context of curriculum change. For comprehension,present a theoretical framework and practical from the conceptualization of the "portfolio" teaching and its role teaching and learning paradigms sustained constructivist medical education. The portfolio Teach-ing is not a collection of papers, but a coherent set of experiences led thoughtful learning between teachers and students. This resource allows to account for the "qualitative achievements" of students from their work produced, sorted and evaluated in a carefully planned sequence of experiences and case Dermatology Clinic. To introduce the teaching portfolio, the planned new student grouping shapes and a sequence of learning experiences for the construction of this resource, namely: "The development of theoretical material iconographic resources and working guidelines for students. "The clinical reasoning on a case or laboratory experience-Clinical case Discussion and bibliography. -The development of records to from observation of patients. "The study of clinical cases: diagnosis and evolution of clinical cases. Interconsultations-Registration and referrals. "The magazine room and sharing experiences. In each of these, production, tutorial feedback Team teaching and assessment tasks allowed assessment approach to learning and improving he achievements of the students to the approval of the subject.

  7. South Asian patients' views and experiences of clinical trial participation.

    PubMed

    Hussain-Gambles, Mah

    2004-12-01

    This paper explores South Asian patients' views and experiences of clinical trial participation, as part of a larger study which sought to assess British South Asian under-representation in clinical trials. The study was based on semi-structured interviews with South Asian trial participants in primary care and specialist treatment centres in the north of England. Fifteen South Asian patients who had participated in one of six different clinical trials to test pharmaceutical products comprised the study cohort. South Asian motivations to participate in clinical trials are similar to those of the majority 'White' population. Clear and concise trial information (provided by caring and understanding trial staff) was considered an important aspect of the respondents' experiences. Appealing to South Asian peoples' altruistic nature by making them aware of South Asian under-representation (especially in clinical trials that investigate illnesses prevalent in their community) was also identified as a strong motivational factor. Potential barriers to their participation included: trial burden (which bears heavily on the poor), language, and discriminatory practices in the NHS, which can lead to mistrust of health professionals. In addition, female modesty and preference for female trial staff was recognized as a 'cultural' barrier to participation. There are more similarities than differences between the experiences of British South Asians and 'White' trial participants. Present findings suggest that ethnicity operates at different levels. In addition to South Asian trial participants' culture, social class and gender are also as likely to affect their participation in clinical trials. To improve South Asian accrual rates, strategies should be designed to take into consideration linguistic differences and improving overall trust in the clinical trial team.

  8. Physiotherapy students' experiences of bullying on clinical internships: a qualitative study.

    PubMed

    Whiteside, Diana; Stubbs, Brendon; Soundy, Andy

    2014-03-01

    To consider the experiences of final-year physiotherapy students who have experienced workplace bullying on a clinical internship. Qualitative methodology using individual semi-structured interviews. A university in the Midlands region of the UK. Eight undergraduate physiotherapy students who had experienced one incident of bullying on a clinical internship. Thematic analysis of semi-structured interviews. Four main themes were identified: (1) external and situational influences of bullying; (2) students' reactions to the experience of bullying; (3) inability to reveal the experience; and (4) overcoming problems. Bullying had a range of adverse effects on the students, with many expressing self-doubt in their competence and viewing their supervisor as unapproachable and unsupportive. Five students were not initially able to recognise the experience as bullying. In addition, students did not feel able to report the experience and use the support mechanisms in place. This may have been a result of having concerns that the problem would escalate if they reported the experience and, as a consequence, have a negative effect on their grade. Students were keen to offer a range of strategies for clinical practice in order to prevent bullying for future generations of students. Students' health, security and confidence in their ability as a physiotherapist can be at great risk from bullying. Steps are needed to ensure that students are better protected from bullying, and feel more able to address bullying behaviour during clinical internships. Copyright © 2013 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

  9. Our clinical experience in low-energy laser medical treatments

    NASA Astrophysics Data System (ADS)

    Antipa, Ciprian; Bruckner, Ion I.; Crangulescu, Nicolae; Moldovan, Corneliu I.; Podoleanu, Adrian G.; Stanciulescu, Viorica; Ionescu, Elena

    1996-05-01

    In clinical research the efficiency of low-energy laser (LEL) therapy remains controversial. We present here some of the most important results of our clinical experience in this field. We summarize our opinions about the LEL effects in rheumatic diseases, in chronic pelvic inflammatory disorders, in the treatment of some dermatological disorders, and in the recovery of the distal forearm nerve from traumatic lesion after surgical suture. We conclude that these results may be important evidence for the real clinical efficiency of the LEL.

  10. Experiences of clinical teaching for dental core trainees working in hospital.

    PubMed

    Mannion, C J; Brotherton, P

    2014-07-11

    There is recognition that the provision of excellence in education and training results in a skilled and competent workforce. However, the educational experiences of dental core trainees (DCT's) working in the hospital oral and maxillofacial surgery (OMFS) setting have not been previously investigated. In this paper, we examine DCT's learning experiences both 'formal' and 'non-formal' within the hospital setting of ward and clinic-based teaching. Are hospital dental core trainees receiving a meaningful educational experience? To conclude this paper, the authors recommend methods, based upon sound educational principles, to maximise the value of clinical sessions for teaching.

  11. Post-explant visualization of thrombi in outflow grafts and their junction to a continuous-flow total artificial heart using a high-definition miniaturized camera.

    PubMed

    Karimov, Jamshid H; Horvath, David; Sunagawa, Gengo; Byram, Nicole; Moazami, Nader; Golding, Leonard A R; Fukamachi, Kiyotaka

    2015-12-01

    Post-explant evaluation of the continuous-flow total artificial heart in preclinical studies can be extremely challenging because of the device's unique architecture. Determining the exact location of tissue regeneration, neointima formation, and thrombus is particularly important. In this report, we describe our first successful experience with visualizing the Cleveland Clinic continuous-flow total artificial heart using a custom-made high-definition miniature camera.

  12. Experience with Fingolimod in Clinical Practice

    PubMed Central

    Hersh, Carrie M.; Hara-Cleaver, Claire; Rudick, Richard A.; Cohen, Jeffrey A.; Bermel, Robert A.; Ontaneda, Daniel

    2015-01-01

    Aim To report experience with fingolimod in clinical practice. Design/Methods Patients in an academic medical center who were prescribed fingolimod from October 2010 to August 2011 were identified through the electronic medical record and followed for 12 months after fingolimod initiation. Adverse effects, clinical measures, MRI data, and quality of life measures were assessed. Results Three hundred seventeen patients started fingolimod. Eleven patients were treatment naïve (3.5%) and 76 (24.0%) had remote disease modifying therapy use prior to fingolimod. One hundred fifty-one (47.6%) switched because of patient preference and 79 (24.9%) switched because of breakthrough disease. About 11.6% transitioned from natalizumab. Follow-up data were available for 306 patients (96.5%) with mean follow-up time 332 days. Fingolimod was discontinued in 76 of 306 patients (24.8%) at mean 248 days after fingolimod start. Discontinuation most often was due to adverse effects (n=40) or breakthrough disease (n=22). Among patients who started fingolimod with available 12 month follow-up data, 267 (87.3%) remained relapse free and 256 (83.7%) had no relapses or gadolinium enhancement. Time to first relapse occurred at mean 282 days after fingolimod initiation. Quality of life measures remained stable at follow-up. Conclusions Fingolimod was discontinued at a higher rate in clinical practice than in clinical trials. Discontinuation was primarily due to adverse effects or breakthrough disease. Disease activity was adequately controlled in most patients who started fingolimod. This clinical practice cohort is consistent with efficacy data from phase 3 trials and describes the most common tolerability issues in clinical practice. PMID:25271798

  13. Fostering new relational experience: clinical process in couple psychotherapy.

    PubMed

    Marmarosh, Cheri L

    2014-03-01

    One of the most critical goals for couple psychotherapy is to foster a new relational experience in the session where the couple feels safe enough to reveal more vulnerable emotions and to explore their defensive withdrawal, aggressive attacking, or blaming. The lived intimate experience in the session offers the couple an opportunity to gain integrative insight into their feelings, expectations, and behaviors that ultimately hinder intimacy. The clinical processes that are necessary include empathizing with the couple and facilitating safety within the session, looking for opportunities to explore emotions, ruptures, and unconscious motivations that maintain distance in the relationship, and creating a new relational experience in the session that has the potential to engender integrative insight. These clinical processes will be presented with empirical support. Experts from a session will be used to highlight how these processes influence the couple and promote increased intimacy. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

  14. Implementation of an intraoperative clinical experience for senior level baccalaureate nursing students.

    PubMed

    Mott, Jason

    2012-04-01

    Perioperative nursing is a specialty that has been eliminated from many nursing education programs. With the loss of perioperative clinical experiences, the number of students pursuing a career in perioperative nursing after graduation has declined. A faculty member at one Midwestern school of nursing developed and implemented a perioperative clinical experience for senior-level baccalaureate nursing students in a critical care nursing course. This program, developed with the assistance of four local hospitals and the college of nursing, included an eight-hour OR orientation and 56 clinical hours. Students were placed in the OR under preceptor guidance and supervision. Feedback from evaluations was positive and provided recommendations for improving the program, in particular, to allow more clinical hours and more hands-on experience for the students. Copyright © 2012 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  15. Coordination of Scheduling Clinical Externship or Clinical Practice Experiences for Students in Physical Therapy Educational Programs.

    ERIC Educational Resources Information Center

    Patterson, Robert K.; Kass, Susan H.

    A project to coordinate the scheduling of allied health occupations students for clinical practice or externship experiences in Southeast Florida is described. A model clinical facility utilization and time schedule matrix was developed for four programs: the physical therapy programs at Florida International University (FIU) and the University of…

  16. Clinical reasoning of Filipino physical therapists: Experiences in a developing nation.

    PubMed

    Rotor, Esmerita R; Capio, Catherine M

    2018-03-01

    Clinical reasoning is essential for physical therapists to engage in the process of client care, and has been known to contribute to professional development. The literature on clinical reasoning and experiences have been based on studies from Western and developed nations, from which multiple influencing factors have been found. A developing nation, the Philippines, has distinct social, economic, political, and cultural circumstances. Using a phenomenological approach, this study explored experiences of Filipino physical therapists on clinical reasoning. Ten therapists working in three settings: 1) hospital; 2) outpatient clinic; and 3) home health were interviewed. Major findings were: a prescription-based referral system limited clinical reasoning; procedural reasoning was a commonly experienced strategy while diagnostic and predictive reasoning were limited; factors that influenced clinical reasoning included practice setting and the professional relationship with the referring physician. Physical therapists' responses suggested a lack of autonomy in practice that appeared to stifle clinical reasoning. Based on our findings, we recommend that the current regulations governing PT practice in the Philippines may be updated, and encourage educators to strengthen teaching approaches and strategies that support clinical reasoning. These recommendations are consistent with the global trend toward autonomous practice.

  17. Patients first! Engaging the hearts and minds of nurses with a patient-centered practice model.

    PubMed

    Small, Deborah C; Small, Robert M

    2011-05-31

    Like every healthcare system today, the Cleveland Clinic health system is a combination of medical hospitals, institutes, and services in which the implementation of uniform care methodologies faces significant barriers. The guiding principle of the Cleveland Clinic, 'Patients First,' focuses on the principle of patient- and family-centered care (PFCC) but deliberately lacks details due to the wide scope of care delivered by the organization. The Stanley Shalom Zielony Institute of Nursing Excellence (the Nursing Institute) at the Cleveland Clinic was charged with standardizing nursing practice across a system with 11,000 registered nurses and 800 advanced practice nurses. The challenge involved providing firm direction on delivering PFCC that was appropriate for all clinical disciplines and could be implemented quickly across existing practices and technologies. Successful implementation required full engagement in the concept of PFCC by what the Institute for Healthcare Improvement has termed the 'hearts and minds' of nurses. To achieve these ends, development of a systemwide nursing practice model was initiated. In this article the authors identify the essence of PFCC, consider barriers to PFCC, review their process of developing PFCC, and describe how the Cleveland Clinic health system has implemented a PFCC nursing practice model. In doing so the authors explore how the concept of 'Passion for Nursing' was used to stimulate nurse engagement in PFCC.

  18. Feedback in clinical practice: Enhancing the students' experience through action research.

    PubMed

    Adamson, Elizabeth; King, Linda; Foy, Lynn; McLeod, Margo; Traynor, Jennifer; Watson, Wendy; Gray, Morag

    2018-05-01

    Feedback within clinical practice is known to be central to the learning and development of student nurses and midwives. A study that focused on student experience of assessment identified that a high proportion of students reported that they had received insufficient feedback whilst on clinical placement. In response to this academics and members of the clinical education team set out to explore this with a view to improving the student experience using action research. Key findings indicated that responsibility for feedback on clinical placement lies with both students and mentors, distinct factors can enable effective feedback and that positive outcomes for mentors and students resulted through engaging with the project. The process, outcomes and actions taken to improve practice are the focus of this paper. Copyright © 2018 Elsevier Ltd. All rights reserved.

  19. Volcanic gas emissions during active dome growth at Mount Cleveland, Alaska, August 2015

    NASA Astrophysics Data System (ADS)

    Werner, Cynthia; Kern, Christoph; Lyons, John; Kelly, Peter; Schneider, David; Wallace, Kristi; Wessels, Rick

    2016-04-01

    Volcanic gas emissions and chemistry data were measured for the first time at Mount Cleveland (1730 m) in the Central Aleutian arc, Alaska, on August 14-15, 2015 as part of the NSF-GeoPRISMS initiative, and co-funded by the Deep Carbon Observatory (DCO) and the USGS Alaska Volcano Observatory. The measurements were made in the month following two explosive events (July 21 and August 7, 2015) that destroyed a small dome (˜50x85 m), which had experienced episodic growth in the crater since November, 2014. These explosions resulted in the elevation of the aviation color code and alert level from Yellow/Advisory to Orange/Watch on July 21, 2015. Between the November, 2014 and July, 2015 dome-destroying explosions, the volcano experienced: (1) frequent periods of elevated surface temperatures in the summit region (based on Mid-IR satellite observations), (2) limited volcano-seismic tremor, (3) visible degassing as recorded in webcam images with occasionally robust plumes, and (4) at least one aseismic volcanic event that deposited small amounts of ash on the upper flanks of the volcano (detected by infrasound, observed visually and in Landsat 8 images). Intermittent plumes were also sometimes detectable up to 60 km downwind in Mid-IR satellite images, but this was not typical. Lava extrusion resumed following the explosion as indicated in satellite data by highly elevated Mid-IR surface temperatures, but was not identifiable in seismic data. By early-mid August, 2015, a new dome growing in the summit crater had reached 80 m across with temperatures of 550-600 C as measured on August 4 with a helicopter-borne thermal IR camera. A semitransparent plume extended several kilometers downwind of the volcano during the field campaign. A helicopter instrumented with an upward-looking UV spectrometer (mini DOAS) and a Multi-GAS was used to measure SO2 emission rates and in situ mixing ratios of H2O, CO2, SO2, and H2S in the plume. On August 14 and 15, 2015, a total of 14

  20. Hydraulic fracture treatment design and postfracture analysis: Maxus Exploration Company, Ellis Ranch Field, Ochiltree County, Texas. Carl Ellis E/3 Cleveland Sand. Topical report, October 1992

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

    Not Available

    A discussion of a hydraulic fracture treatment and post-fracture tests on a tight gas sands well is presented. The treatment design was based on the results of an analysis of the stimulation of another well in the same field and a minifracture analysis of the Carl Ellis E-3. The quality and consistency of the interpretation and evaluation of the Carl Ellis E-3 and H.T. Glasgow No. 2 suggest that a consistent reservoir model has been developed that allows for further improvement of the stimulation technique in the Cleveland Formation.

  1. Evaluation of the Clinical Learning Experience of Nursing Students: a Cross-Sectional Descriptive Study.

    PubMed

    Gurková, Elena; Žiaková, Katarína

    2018-05-18

    The purpose of the cross-sectional descriptive study was to explore and compare the students' experiences of the clinical environment and supervision in Slovakia. Students' clinical learning experience were measured by the valid and reliable clinical learning instrument. A higher frequency of successful supervisory experience was found in the universities which provided accredited mentor preparation programmes or courses and individualised supervisory approaches. Frequency of supervision meetings, the occupational title of a supervisor and mainly the supervision model have an association with students 'perceptions of different domains of clinical learning environment. The duration of the placement was not related to students' experience and perceptions of the learning environment. Slovak students reported higher score regarding the quality of nursing care or ward culture than in the supervisory relationships between students, clinical and school staff. Further studies in this field, extended to different Eastern European countries and clinical settings, may help us to understand factors affecting workplace training.

  2. Predicting medical school and internship success: does the quality of the research and clinical experience matter?

    PubMed

    Paolino, Nathalie D; Artino, Anthony R; Saguil, Aaron; Dong, Ting; Durning, Steven J; DeZee, Kent J

    2015-04-01

    This article explores specific aspects of self-reported clinical and research experience and their relationship to performance in medical training. This is a retrospective cohort study conducted at the Uniformed Services University. The American Medical College Application Service application was used to discern students' self-reported clinical and research experience. Two authors applied a classification scheme for clinical and research experience to the self-reported experiences. Study outcomes included medical school grade point average (GPA), U.S. Medical Licensing Examination (USMLE) scores, and intern expertise and professionalism scores. A linear regression analysis was conducted for each outcome while controlling for prematriculation GPA. Data were retrieved on 1,020 matriculants. There were several statistically significant but small differences across outcomes when comparing the various categories of clinical experience with no clinical experience. The technician-level experience group had a decrease of 0.1 in cumulative GPA in comparison to students without self-reported clinical experience (p = 0.004). This group also performed 5 points lower on the USMLE Step 2 than students who did not report clinical experience (p = 0.013). The various levels of self-reported research experience were unrelated to success in medical school and graduate medical education. These findings indicate that self-reported technician-level clinical experience is related to a small reduction in typically reported outcomes in medical school. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.

  3. A marketing matrix for health care organizations.

    PubMed

    Weaver, F J; Gombeski, W R; Fay, G W; Eversman, J J; Cowan-Gascoigne, C

    1986-06-01

    Irrespective of the formal marketing structure successful marketing for health care organizations requires the input on many people. Detailed here is the Marketing Matrix used at the Cleveland Clinic Foundation in Cleveland, Ohio. This Matrix is both a philosophy and a tool for clarifying and focusing the organization's marketing activities.

  4. Clinical experience does not correlate with the perceived need for cardiopulmonary resuscitation training.

    PubMed

    Lunz, Dirk; Brandl, Anita; Lang, Klaus; Weiss, Berthold; Haneya, Assad; Pühler, Thomas; Graf, Bernhard M; Zausig, York A

    2013-02-01

    The efficiency of cardiopulmonary resuscitation (CPR) training is dependent upon different influencing factors, such as the presented concepts, the participants' willingness to learn, and the interval between training sessions. However, the optimal interval for refreshing CPR training is less clear. We evaluated the perceived need of simulator-based CPR training for nurses and correlated it with their clinical experience. The 60 invited nurses were trained in simulator-based CPR. Knowledge about adult advanced life support was evaluated using a questionnaire after training, and participants rated their desired individual frequency of simulator-based training as well as the value of the presented training using a six-point Likert scale. The same questions were asked again after 1 year. All participants agreed about the usefulness of this type of simulator-based training. The average number of correct answers about typical facts in adult advanced life support showed an almost bell-shaped distribution, with the highest point at 6-15 years of clinical experience and the lowest points at≤5 and≥21 years. The desired training-frequency need was inversely correlated with clinical experience. There is a high interest in CPR training among nursing staff. Self-assessment about the training-frequency need was inversely correlated with clinical experience. However, the average number of correct answers on resuscitation questions decreased with clinical experience. Therefore, the training effectiveness seems to be extremely dependent on clinical experience, and therefore, training experienced senior nurses might be more challenging than training novice nurses. Copyright © 2013 Elsevier Inc. All rights reserved.

  5. Clinicians' experiences with the fragile X clinical and research consortium.

    PubMed

    Liu, Jessica A; Hagerman, Randi J; Miller, Robert M; Craft, Lisa T; Finucane, Brenda; Tartaglia, Nicole; Berry-Kravis, Elizabeth M; Sherman, Stephanie L; Kidd, Sharon A; Cohen, Jeffrey

    2016-12-01

    The objectives of the study were to assess the attitudes and experiences of clinicians involved in a consortium of clinics serving people with fragile X-associated disorders to gauge satisfaction with the consortium and its efforts to improve quality of life for patients and the community. An internet survey was sent to 26 fragile X (FX) clinic directors participating in the Fragile X Clinical and Research Consortium (FXCRC). Respondents were asked to complete 19 questions on consortium performance and outcomes relevant for their own clinic. The response rate was 84% (22/26), with two surveys providing incomplete data. Assistance with clinic establishment, opportunities for research collaborations, and access to colleagues and information were highly valued. Approximately 76% of clinicians reported improvements in patient care and 60% reported an increase in patient services. There was a 57% increase in participation in a FX-related clinical trial among clinics since joining the FXCRC (24% vs. 81%). Overall, respondents reported primarily positive experiences from participation in the FXCRC. Common suggestions for improvement included additional financial support and increased utilization of collected patient data for research purposes. Additionally, a Clinic Services Checklist was administered annually to examine changes in services offered over time. There were several important changes regarding the provision of services by clinics, often with multiple clinics changing with respect to a service. In conclusion, the FXCRC has led to the establishment and sustainment of fragile X clinics in the U.S., fostered cooperation among fragile X clinicians, and provided clinics with a platform to share recommendations and best practices to maximize quality of life for their patients and the overall fragile X community. The results from the survey and checklist also provide suggestions to strengthen the FXCRC and enhance future collaborations among FXCRC members. © 2016

  6. Practicum and clinical experiences: postpracticum students' views.

    PubMed

    Ralph, Edwin; Walker, Keith; Wimmer, Randolph

    2009-08-01

    The clinical or practicum component of preservice undergraduate education across all disciplines typically is rated by prebaccalaureate students as the most important phase of their entire professional preparation. This study collected e-mail survey responses from 63 post-practicum nursing students who had just completed their culminating fourth-year clinical course. Students identified the most positive and the most negative aspects of that final practicum experience. These responses were compared with those reported by postpracticum students from the disciplines of engineering and teacher education. The cross-disciplinary similarity of these data related to postpracticum students' perceptions of this experiential learning phase of their preservice professional training was noted. The student voice provides a critical dimension to the program-enhancement process for all professional disciplines, and practicum organizers across the disciplines should value such student input and collaborate to improve the clinical phase of preservice education for all professions. Copyright 2009, SLACK Incorporated.

  7. Learning Clinical Procedures Through Internet Digital Objects: Experience of Undergraduate Students Across Clinical Faculties.

    PubMed

    Li, Tse Yan; Gao, Xiaoli; Wong, Kin; Tse, Christine Shuk Kwan; Chan, Ying Yee

    2015-04-14

    Various digital learning objects (DLOs) are available via the World Wide Web, showing the flow of clinical procedures. It is unclear to what extent these freely accessible Internet DLOs facilitate or hamper students' acquisition of clinical competence. This study aimed to understand the experience of undergraduate students across clinical disciplines-medicine, dentistry, and nursing-in using openly accessible Internet DLOs, and to investigate the role of Internet DLOs in facilitating their clinical learning. Mid-year and final-year groups were selected from each undergraduate clinical degree program of the University of Hong Kong-Bachelor of Medicine and Bachelor of Surgery (MBBS), Bachelor of Dental Surgery (BDS), and Bachelor of Nursing (BNurs). All students were invited to complete a questionnaire on their personal and educational backgrounds, and their experiences and views on using Internet DLOs in learning clinical procedures. The questionnaire design was informed by the findings of six focus groups. Among 439 respondents, 97.5% (428/439) learned a variety of clinical procedures through Internet DLOs. Most nursing students (107/122, 87.7%) learned preventive measures through Internet DLOs, with a lower percentage of medical students (99/215, 46.0%) and dental students (43/96, 45%) having learned them this way (both P<.001). Three-quarters (341/439, 77.7%) of students accessed DLOs through public search engines, whereas 93.2% (409/439) accessed them by watching YouTube videos. Students often shared DLOs with classmates (277/435, 63.7%), but rarely discussed them with teachers (54/436, 12.4%). The accuracy, usefulness, and importance of Internet DLOs were rated as 6.85 (SD 1.48), 7.27 (SD 1.53), and 7.13 (SD 1.72), respectively, out of a high score of 10. Self-exploration of DLOs in the unrestricted Internet environment is extremely common among current e-generation learners and was regarded by students across clinical faculties as an important supplement to

  8. Teachers' Clinical Experiences and Attitudes toward Technology Inclusion

    ERIC Educational Resources Information Center

    Paganelli, Andrea Lynch

    2010-01-01

    The purpose of this qualitative multisite case study is to examine participants' attitudes toward technology, types of technology available for participant use, and the extent to which technology is used by preservice and mentor teachers during clinical experiences. Research supports the benefit of improved attitudes toward technology integration…

  9. Korean speech-language pathologists' attitudes toward stuttering according to clinical experiences.

    PubMed

    Lee, Kyungjae

    2014-11-01

    Negative attitudes toward stuttering and people who stutter (PWS) are found in various groups of people in many regions. However the results of previous studies examining the influence of fluency coursework and clinical certification on the attitudes of speech-language pathologists (SLPs) toward PWS are equivocal. Furthermore, there have been few empirical studies on the attitudes of Korean SLPs toward stuttering. To determine whether the attitudes of Korean SLPs and speech-language pathology students toward stuttering would be different according to the status of clinical certification, stuttering coursework completion and clinical practicum in stuttering. Survey data from 37 certified Korean SLPs and 70 undergraduate students majoring in speech-language pathology were analysed. All the participants completed the modified Clinician Attitudes Toward Stuttering (CATS) Inventory. Results showed that the diagnosogenic view was still accepted by many participants. Significant differences were found in seven out of 46 CATS Inventory items according to the certification status. In addition significant differences were also found in three items and one item according to stuttering coursework completion and clinical practicum experience in stuttering, respectively. Clinical and educational experience appears to have mixed influences on SLPs' and students' attitudes toward stuttering. While SLPs and students may demonstrate more appropriate understanding and knowledge in certain areas of stuttering, they may feel difficulty in their clinical experience, possibly resulting in low self-efficacy. © 2014 Royal College of Speech and Language Therapists.

  10. Medical students' clerkship experiences and self-perceived competence in clinical skills.

    PubMed

    Katowa-Mukwato, P; Andrews, B; Maimbolwa, M; Lakhi, S; Michelo, C; Mulla, Y; Banda, S S

    2014-01-01

    In a traditional curriculum, medical students are expected to acquire clinical competence through the apprenticeship model using the Halstedian "see one, do one, and teach one, approach". The University of Zambia School of Medicine used a traditional curriculum model from 1966 until 2011 when a competence-based curriculum was implemented. To explore medical students' clerkships experiences and self-perceived competence in clinical skills. A cross-sectional survey was conducted on 5th, 6 th , and 7 th year medical students of the University of Zambia, School of Medicine two months prior to final examinations. Students were asked to rate their clerkship experiences with respect to specific skills on a scale of 1 to 4 and their level of self-perceived competence on a scale of 1 to 3. Skills evaluated were in four main domains: history taking and communication, physical examination, procedural, and professionalism, team work and medical decision making. Using Statistical Package for Social Scientist (SPSS), correlations were performed between experiences and self-perceived competence on specific skills, within domains and overall. Out of 197 clinical students 138 (70%) participated in the survey. The results showed significant increase in the proportion of students performing different skills and reporting feeling very competent with each additional clinical year. Overall correlations between experience and self-perceived competence were moderate (0.55). On individual skills, the highest correlation between experience and self-perceived competence were observed on mainly medical and surgical related procedural skills with the highest at 0.82 for nasal gastric tube insertion and 0.76 for endotracheal intubation. Despite the general improvement in skills experiences and self-perceived competence, some deficiencies were noted as significant numbers of final year students had never attempted common important procedures especially those performed in emergency situations

  11. Hyperinsulinemic Normoglycemia during Cardiac Surgery Reduces a Composite of 30-day Mortality and Serious In-hospital Complications: A Randomized Clinical Trial.

    PubMed

    Duncan, Andra E; Sessler, Daniel I; Sato, Hiroaki; Sato, Tamaki; Nakazawa, Keisuke; Carvalho, George; Hatzakorzian, Roupen; Codere-Maruyama, Takumi; Abd-Elsayed, Alaa; Bose, Somnath; Said, Tamer; Mendoza-Cuartas, Maria; Chowdary, Hyndhavi; Mascha, Edward J; Yang, Dongsheng; Gillinov, A Marc; Schricker, Thomas

    2018-06-01

    Hyperinsulinemic normoglycemia augments myocardial glucose uptake and utilization. We tested the hypothesis that hyperinsulinemic normoglycemia reduces 30-day mortality and morbidity after cardiac surgery. This dual-center, parallel-group, superiority trial randomized cardiac surgical patients between August 2007 and March 2015 at the Cleveland Clinic, Cleveland, Ohio, and Royal Victoria Hospital, Montreal, Canada, to intraoperative glycemic management with (1) hyperinsulinemic normoglycemia, a fixed high-dose insulin and concomitant variable glucose infusion titrated to glucose concentrations of 80 to 110 mg · dl; or (2) standard glycemic management, low-dose insulin infusion targeting glucose greater than 150 mg · dl. The primary outcome was a composite of 30-day mortality, mechanical circulatory support, infection, renal or neurologic morbidity. Interim analyses were planned at each 12.5% enrollment of a maximum 2,790 patients. At the third interim analysis (n = 1,439; hyperinsulinemic normoglycemia, 709, standard glycemic management, 730; 52% of planned maximum), the efficacy boundary was crossed and study stopped per protocol. Time-weighted average glucose concentration (means ± SDs) with hyperinsulinemic normoglycemia was 108 ± 20 versus 150 ± 33 mg · dl with standard glycemic management, P < 0.001. At least one component of the composite outcome occurred in 49 (6.9%) patients receiving hyperinsulinemic normoglycemia versus 82 (11.2%) receiving standard glucose management (P < efficacy boundary 0.0085); estimated relative risk (95% interim-adjusted CI) 0.62 (0.39 to 0.97), P = 0.0043. There was a treatment-by-site interaction (P = 0.063); relative risk for the composite outcome was 0.49 (0.26 to 0.91, P = 0.0007, n = 921) at Royal Victoria Hospital, but 0.96 (0.41 to 2.24, P = 0.89, n = 518) at the Cleveland Clinic. Severe hypoglycemia (less than 40 mg · dl) occurred in 6 (0.9%) patients. Intraoperative hyperinsulinemic normoglycemia

  12. Effect of experience on clinical decision making by cardiorespiratory physiotherapists in acute care settings.

    PubMed

    Smith, Megan; Higgs, Joy; Ellis, Elizabeth

    2010-02-01

    This article investigates clinical decision making in acute care hospitals by cardiorespiratory physiotherapists with differing degrees of clinical experience. Participants were observed as they engaged in their everyday practice and were interviewed about their decision making. Texts of the data were interpreted by using a hermeneutic approach that involved repeated reading and analysis of fieldnotes and interview transcripts to develop an understanding of the effect of experience on clinical decision making. Participants were classified into categories of cardiorespiratory physiotherapy experience: less experienced (<2 years), intermediate experience (2.5-4 years), and more experienced (>7 years). Four dimensions characteristic of increasing experience in cardiorespiratory physiotherapy clinical decision making were identified: 1) an individual practice model, 2) refined approaches to clinical decision making, 3) working in context, and 4) social and emotional capability. Underpinning these dimensions was evidence of reflection on practice, motivation to achieve best practice, critique of new knowledge, increasing confidence, and relationships with knowledgeable colleagues. These findings reflect characteristics of physiotherapy expertise that have been described in the literature. This study adds knowledge about the field of cardiorespiratory physiotherapy to the existing body of research on clinical decision making and broadens the existing understanding of characteristics of physiotherapy expertise.

  13. Concept-Based Learning in Clinical Experiences: Bringing Theory to Clinical Education for Deep Learning.

    PubMed

    Nielsen, Ann

    2016-07-01

    Concept-based learning is used increasingly in nursing education to support the organization, transfer, and retention of knowledge. Concept-based learning activities (CBLAs) have been used in clinical education to explore key aspects of the patient situation and principles of nursing care, without responsibility for total patient care. The nature of best practices in teaching and the resultant learning are not well understood. The purpose of this multiple-case study research was to explore and describe concept-based learning in the context of clinical education in inpatient settings. Four clinical groups (each a case) were observed while they used CBLAs in the clinical setting. Major findings include that concept-based learning fosters deep learning, connection of theory with practice, and clinical judgment. Strategies used to support learning, major teaching-learning foci, and preconditions for concept-based teaching and learning will be described. Concept-based learning is promising to support integration of theory with practice and clinical judgment through application experiences with patients. [J Nurs Educ. 2016;55(7):365-371.]. Copyright 2016, SLACK Incorporated.

  14. Pediatricians' Experience with Clinical Ethics Consultation: A National Survey.

    PubMed

    Morrison, Wynne; Womer, James; Nathanson, Pamela; Kersun, Leslie; Hester, D Micah; Walsh, Corbett; Feudtner, Chris

    2015-10-01

    To conduct a national survey of pediatricians' access to and experience with clinical ethics consultation. We surveyed a randomly selected sample of 3687 physician members of the American Academy of Pediatrics. We asked about their experiences with ethics consultation, the helpfulness of and barriers to consultation, and ethics education. Using a discrete choice experiment with maximum difference scaling, we evaluated which traits of ethics consultants were most valuable. Of the total sample of 3687 physicians, 659 (18%) responded to the survey. One-third of the respondents had no experience with clinical ethics consultation, and 16% reported no access to consultation. General pediatricians were less likely to have access. The vast majority (90%) who had experience with consultation had found it helpful. Those with fewer years in practice were more likely to have training in ethics. The most frequently reported issues leading to consultation concerned end-of-life care and conflicts with patients/families or among the team. Intensive care unit physicians were more likely to have requested consultation. Mediation skills and ethics knowledge were the most highly valued consultant characteristics, and representing the official position of the hospital was the least-valued characteristic. There is variability in pediatricians' access to ethics consultation. Most respondents reported that consultation had been helpful in the past. Determining ethically appropriate end-of-life care and mediation of disagreements are common reasons that pediatricians request consultation. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. Experiences from an interprofessional student-assisted chronic disease clinic.

    PubMed

    Frakes, Kerrie-Anne; Brownie, Sharon; Davies, Lauren; Thomas, Janelle; Miller, Mary-Ellen; Tyack, Zephanie

    2014-11-01

    Faced with significant health and workforce challenges in the region, the Central Queensland Health Service District (CQHSD) commenced a student-assisted clinical service. The Capricornia Allied Health Partnership (CAHP) is an interprofessional clinical placement program in which pre-entry students from exercise physiology, nutrition and dietetics, occupational therapy, pharmacy, podiatry and social work are embedded in a collaborative chronic disease service delivery model. The model coordinates multiple student clinical placements to: address service delivery gaps for previously underserved people with chronic disease in need of early intervention and management; provide an attractive clinical placement opportunity for students that will potentially lead to future recruitment success, and demonstrate leadership in developing future health workforce trainees to attain appropriate levels of interprofessional capacity. The CAHP clinic commenced student placements and client services in February 2010. This report provides early evaluative information regarding student experiences included self-reported changes in practice.

  16. Swedish nursing students' experience of stress during clinical practice in relation to clinical setting characteristics and the organisation of the clinical education.

    PubMed

    Blomberg, Karin; Bisholt, Birgitta; Kullén Engström, Agneta; Ohlsson, Ulla; Sundler Johansson, Annelie; Gustafsson, Margareta

    2014-08-01

    To describe nursing students' experience of stress during clinical practice and evaluate the risk of stress in relation to the clinical setting characteristics and the organisation of the clinical education. Stress during clinical practice is well documented, but there is a lack of knowledge concerning whether the clinical setting characteristics and the organisation of the education make a difference. A cross-sectional study with evaluative design. Data were collected by means of a numerical rating scale for the assessment of stress and questions about the clinical setting characteristics and the organisation of the education. One hundred and eighty-four students who had completed their final year on the nursing programme at three universities in Sweden were included. Nearly half of the students (43%) experienced high level of stress during clinical practice. Measured by decision in the tree analysis, the absolute risk of stress was 57% in students with placements in hospital departments, as compared to 13% in students with placements in other clinical settings. The risk of stress increased to 71% if the students with placement in a hospital took the national clinical final examination. Performance of practice in a hospital department overcrowded with patients was also associated with increased risk of stress. The organisation of supervision and number of students at the clinical placement had an effect on the experience of stress, but did not prove to be risk factors in the analysis. The risk of stress in nursing students during their clinical practice differs depending on clinical setting characteristics. The taking of the national clinical final examination could be a source of stress, but this requires further investigation. It is important that supervisors are aware that students in hospital departments overcrowded with patients are at risk of stress and may have increased need of support. © 2014 John Wiley & Sons Ltd.

  17. Learning Clinical Procedures Through Internet Digital Objects: Experience of Undergraduate Students Across Clinical Faculties

    PubMed Central

    Li, Tse Yan; Wong, Kin; Tse, Christine Shuk Kwan; Chan, Ying Yee

    2015-01-01

    Background Various digital learning objects (DLOs) are available via the World Wide Web, showing the flow of clinical procedures. It is unclear to what extent these freely accessible Internet DLOs facilitate or hamper students’ acquisition of clinical competence. Objective This study aimed to understand the experience of undergraduate students across clinical disciplines—medicine, dentistry, and nursing—in using openly accessible Internet DLOs, and to investigate the role of Internet DLOs in facilitating their clinical learning. Methods Mid-year and final-year groups were selected from each undergraduate clinical degree program of the University of Hong Kong—Bachelor of Medicine and Bachelor of Surgery (MBBS), Bachelor of Dental Surgery (BDS), and Bachelor of Nursing (BNurs). All students were invited to complete a questionnaire on their personal and educational backgrounds, and their experiences and views on using Internet DLOs in learning clinical procedures. The questionnaire design was informed by the findings of six focus groups. Results Among 439 respondents, 97.5% (428/439) learned a variety of clinical procedures through Internet DLOs. Most nursing students (107/122, 87.7%) learned preventive measures through Internet DLOs, with a lower percentage of medical students (99/215, 46.0%) and dental students (43/96, 45%) having learned them this way (both P<.001). Three-quarters (341/439, 77.7%) of students accessed DLOs through public search engines, whereas 93.2% (409/439) accessed them by watching YouTube videos. Students often shared DLOs with classmates (277/435, 63.7%), but rarely discussed them with teachers (54/436, 12.4%). The accuracy, usefulness, and importance of Internet DLOs were rated as 6.85 (SD 1.48), 7.27 (SD 1.53), and 7.13 (SD 1.72), respectively, out of a high score of 10. Conclusions Self-exploration of DLOs in the unrestricted Internet environment is extremely common among current e-generation learners and was regarded by students

  18. Clinical Experience and Learning Style of Flight Nurse and Aeromedical Evacuation Technician Students.

    PubMed

    De Jong, Marla J; Dukes, Susan F; Dufour, Karey M; Mortimer, Darcy L

    2017-01-01

    The clinical experience and preferred learning style of U.S. Air Force flight nurses and aeromedical evacuation technicians are unknown. Using a cross-sectional survey design, we gathered data regarding the clinical experience, level of comfort providing clinical care, and preferred learning style of 77 active duty (AD), Air Force Reserve (AFR), and Air National Guard (ANG) nurses enrolled in the U.S. Air Force School of Aerospace Medicine Flight Nurse course, and 121 AD, AFR, and ANG medical technicians enrolled in the Aeromedical Evacuation Technician course. Nurses and medical technicians reported 7.6 ± 5.5 and 3.9 ± 4.5 yr of experience, respectively. AD, AFR, and ANG nurses had comparable years of experience: 5.8 ± 3.2, 8.3 ± 6.6, and 7.9 ± 4.2 yr, respectively; however, AD medical technicians had more years of experience (5.6 ± 4.4 yr) than AFR (3.1 ± 4.8 yr) and ANG (1.9 ± 2.8 yr) medical technicians. Both nurses and medical technicians reported infrequently caring for patients with various disease processes and managing equipment or devices that they will routinely encounter when transporting patients as an aeromedical evacuation clinician. Nurses and medical technicians preferred a kinesthetic learning style or a multimodal learning style that included kinesthetic learning. Nearly all (99%) nurses and 97% of medical technicians identified simulation as their preferred teaching method. These findings confirm faculty concerns regarding the clinical experience of flight nurse and aerospace evacuation technician students.De Jong MJ, Dukes SF, Dufour KM, Mortimer DL. Clinical experience and learning style of flight nurse and aeromedical evacuation technician students. Aerosp Med Hum Perform. 2017; 88(1):23-29.

  19. How do general practice registrars learn from their clinical experience? A critical incident study.

    PubMed

    Holmwood, C

    1997-01-01

    This preliminary study of RACGP registrars in the period of subsequent general practice experience examines the types of clinical experiences from which registrars learn, what they learn from the experiences and the process of learning from such experiences. A critical incident method was used on a semi structured interview process. Registrars were asked to recall clinical incidents where they had learnt something of importance. Data were sorted and categorised manually. Nine registrars were interviewed before new categories of data ceased to develop. Registrars learnt from the opportunity to follow up patients. An emotional response to the interaction was an important part of the learning process. Learning from such experiences is haphazard and unstructured. Registrars accessed human resources in response to their clinical difficulties rather than text or electronic based information sources. Registrars should be aware of their emotional responses to interactions with patients; these emotional responses often indicate important learning opportunities. Clinical interactions and resultant learning could be made less haphazard by structuring consultations with patients with specific problems. These learning opportunities should be augmented by the promotion of follow up of patients.

  20. New data towards the development of a comprehensive taphonomic framework for the Late Jurassic Cleveland-Lloyd Dinosaur Quarry, Central Utah

    PubMed Central

    Warnock, Jonathan P.; Eberhart, Shawn L.; Clawson, Steven R.; Noto, Christopher R.

    2017-01-01

    The Cleveland-Lloyd Dinosaur Quarry (CLDQ) is the densest deposit of Jurassic theropod dinosaurs discovered to date. Unlike typical Jurassic bone deposits, it is dominated by the presence of Allosaurus fragilis. Since excavation began in the 1920s, numerous hypotheses have been put forward to explain the taphonomy of CLDQ, including a predator trap, a drought assemblage, and a poison spring. In an effort to reconcile the various interpretations of the quarry and reach a consensus on the depositional history of CLDQ, new data is required to develop a robust taphonomic framework congruent with all available data. Here we present two new data sets that aid in the development of such a robust taphonomic framework for CLDQ. First, x-ray fluorescence of CLDQ sediments indicate elevated barite and sulfide minerals relative to other sediments from the Morrison Formation in the region, suggesting an ephemeral environment dominated by periods of hypereutrophic conditions during bone accumulation. Second, the degree of abrasion and hydraulic equivalency of small bone fragments dispersed throughout the matrix were analyzed from CLDQ. Results of these analyses suggest that bone fragments are autochthonous or parautochthonous and are derived from bones deposited in the assemblage rather than transported. The variability in abrasion exhibited by the fragments is most parsimoniously explained by local periodic re-working and re-deposition during seasonal fluctuations throughout the duration of the quarry assemblage. Collectively, these data support previous interpretations that the CLDQ represents an attritional assemblage in a poorly-drained overbank deposit where vertebrate remains were introduced post-mortem to an ephemeral pond during flood conditions. Furthermore, while the elevated heavy metals detected at the Cleveland-Lloyd Dinosaur Quarry are not likely the primary driver for the accumulation of carcasses, they are likely the result of multiple sources; some metals may be

  1. Authenticity in Learning--Nursing Students' Experiences at a Clinical Education Ward

    ERIC Educational Resources Information Center

    Manninen, Katri; Henriksson, Elisabet Welin; Scheja, Max; Silen, Charlotte

    2013-01-01

    Purpose: This study aims to explore and understand first year nursing students' experiences of learning at a clinical education ward. Design/methodology/approach: The setting is a clinical education ward for nursing students at a department of infectious diseases. A qualitative study was carried out exploring students' encounters with patients,…

  2. Evidence That a Psychopathology Interactome Has Diagnostic Value, Predicting Clinical Needs: An Experience Sampling Study

    PubMed Central

    van Os, Jim; Lataster, Tineke; Delespaul, Philippe; Wichers, Marieke; Myin-Germeys, Inez

    2014-01-01

    Background For the purpose of diagnosis, psychopathology can be represented as categories of mental disorder, symptom dimensions or symptom networks. Also, psychopathology can be assessed at different levels of temporal resolution (monthly episodes, daily fluctuating symptoms, momentary fluctuating mental states). We tested the diagnostic value, in terms of prediction of treatment needs, of the combination of symptom networks and momentary assessment level. Method Fifty-seven patients with a psychotic disorder participated in an ESM study, capturing psychotic experiences, emotions and circumstances at 10 semi-random moments in the flow of daily life over a period of 6 days. Symptoms were assessed by interview with the Positive and Negative Syndrome Scale (PANSS); treatment needs were assessed using the Camberwell Assessment of Need (CAN). Results Psychotic symptoms assessed with the PANSS (Clinical Psychotic Symptoms) were strongly associated with psychotic experiences assessed with ESM (Momentary Psychotic Experiences). However, the degree to which Momentary Psychotic Experiences manifested as Clinical Psychotic Symptoms was determined by level of momentary negative affect (higher levels increasing probability of Momentary Psychotic Experiences manifesting as Clinical Psychotic Symptoms), momentary positive affect (higher levels decreasing probability of Clinical Psychotic Symptoms), greater persistence of Momentary Psychotic Experiences (persistence predicting increased probability of Clinical Psychotic Symptoms) and momentary environmental stress associated with events and activities (higher levels increasing probability of Clinical Psychotic Symptoms). Similarly, the degree to which momentary visual or auditory hallucinations manifested as Clinical Psychotic Symptoms was strongly contingent on the level of accompanying momentary paranoid delusional ideation. Momentary Psychotic Experiences were associated with CAN unmet treatment needs, over and above PANSS

  3. An Enzymatic Clinical Chemistry Laboratory Experiment Incorporating an Introduction to Mathematical Method Comparison Techniques

    ERIC Educational Resources Information Center

    Duxbury, Mark

    2004-01-01

    An enzymatic laboratory experiment based on the analysis of serum is described that is suitable for students of clinical chemistry. The experiment incorporates an introduction to mathematical method-comparison techniques in which three different clinical glucose analysis methods are compared using linear regression and Bland-Altman difference…

  4. [Clinical experience with 53 consecutive heart transplants].

    PubMed

    Villavicencio, Mauricio; Rossel, Víctor; Larrea, Ricardo; Peralta, Juan Pablo; Larraín, Ernesto; Sung Lim, Jong; Rojo, Pamela; Gajardo, Francesca; Donoso, Erika; Hurtado, Margarita

    2013-12-01

    Heart transplantation is the therapy of choice for advance heart failure. Our group developed two transplant programs at Instituto Nacional del Tórax and Clínica Dávila. We report our clinical experience based on distinctive clinical policies. Fifty-three consecutive patients were transplanted between November 2008 and April 2013, representing 51% of all Chilean cases. Distinctive clinical policies include intensive donor management, generic immunosuppression and VAD (ventricular assist devices) insertion. Ischemic or dilated cardiomyopathy were the main indications (23 (43%) each), age 48 ± 13 years and 48 (91%) were male. Transplant listing Status: IA 14 (26%) (VAD or 2 inotropes), IB 14 (26%) (1 inotrope) and II25 (47%) (no inotrope). Mean waiting time 70 ± 83 days. Twelve (24%) were transplanted during VAD support (median support: 36 days). orthotopic bicaval transplant with ischemia time: 175 ± 54 min. Operative mortality: 3 (6%), all due to right ventricular failure. Re-exploration for bleeding 2 (4%), stroke 3 (6%), mediastinitis 0 (0%), pneumonia 4 (8%), and transient dialysis 6 (11%). Mean follow-up was 21 ± 14 months. Three-year survival was 86 ± 6%. One patient died of Pneumocystis jirovecii pneumonia and the other died suddenly (non-compliance). Freedom from rejection requiring specific therapy was 80 ± 7% at 3 years of follow-up. Four hundred eighty four endomyocardial biopsies were done: 11 (2.3%) had 2R rejection. All survivors are in NYHA (New York Heart Association) functional class I and all but one have normal biventricular function. Mid-term results are similar to those reported by the registry of the International Society for Heart and Lung Transplantation. This experience has a higher proportion of VAD support than previous national series. Rejection rates are low in spite of generic immunosuppression.

  5. Clinical nursing leaders', team members' and service managers' experiences of implementing evidence at a local level.

    PubMed

    Kitson, Alison; Silverston, Heidi; Wiechula, Rick; Zeitz, Kathryn; Marcoionni, Danni; Page, Tammy

    2011-05-01

    To describe the experiences of 14 clinical nursing leaders introducing a knowledge translation (KT) project into one metropolitan acute care hospital in South Australia. The study also explored team members' and service managers' experiences. KT strategies assume that local (nursing) clinical leaders have the capacity and capability to champion innovation combining positional leadership roles (ward leader) with a project lead role. There is limited evidence to support these assumptions. Semi-structured interviews of clinical nursing leaders and managers were undertaken at month 4 and 12 of the project. Data were also collected from the interdisciplinary team members (n = 28). Clinical nursing leaders identified risks and anxieties associated with taking on an additional leadership role, whereas managers acknowledged the multiple pressures on the system and the need for local level innovation. Team members generally reported positive experiences. With support, clinical nursing leaders can effectively embrace KT project leadership roles that complement their positional leadership roles. Clinical nursing leaders' experiences differed from nursing and medical managers' experiences.   Managers need to be more attuned to the personal risks local leaders experience, providing support for leaders to experiment and innovate. Managers need to integrate local priorities with broader system wide agendas. © 2011 The Authors. Journal compilation © 2011 Blackwell Publishing Ltd.

  6. [Leadership Experience of Clinical Nurses: Applying Focus Group Interviews].

    PubMed

    Lee, Byoung Sook; Eo, Yong Sook; Lee, Mi Aie

    2015-10-01

    The purpose of this study was to understand and describe the leadership experience of clinical nurses. During 2014, data were collected using focus group interviews. Three focus group interviews were held with a total of 20 clinical nurses participating. All interviews were recorded as they were spoken and transcribed and data were analyzed using qualitative content analysis. Fifteen categories emerged from the five main themes. 1) Thoughts on the leadership category: to lead others, to cope with problem situations adequately and to serve as a shield against difficulties. 2) Situations requiring leadership: situation that requires correct judgement, coping and situations that need coordination and cooperation. 3-1) Leadership behaviors: other-oriented approach and self-oriented approach. 3-2) Leadership behavior consequences: relevant compensation and unfair termination. 4-1) Facilitators of leadership: confidence and passion for nursing and external support and resources. 4-2) Barriers to leadership: non-supportive organization culture and deficiency in own leadership competencies. 5) Strategies of leadership development: strengthen leadership through self-development and organizational leadership development. In conclusion, the results indicate that it is necessary to enhance clinical nurses' leadership role in healthcare. Enhancement can be achieved through leadership programs focused on enlarging leadership experience, constant self-development, leadership training, and development of leadership competencies suited to the nursing environment.

  7. AWBAT: early clinical experience.

    PubMed

    Vandenberg, Victoria B

    2010-03-15

    The purpose of this article is to describe the early clinical experience with AWBAT. Burn patients requiring (1) donor sites or (2) treatment of a superficial burn wound injury were treated. A total of 45 patients with 69 distinct wounds were included. AWBAT-D was evaluated in donor sites and AWBAT-S was evaluated in superficial partial-thickness burns. Days to healing, pain, hematoma/seroma formation, and infection were noted. Ease of application, adherence, transparency, and physical adaptability details were collected. Average period to healing of donor sites treated with AWBAT-D (n=22 patients with n=26 wounds) was 11.2 days, sigma =1.95, with a range of 8-15 days and a median of 11 days. Pain rating at 24 hours was 1.2, sigma =0.43 (n=18) and at 48 hours mean was 1.2, sigma =0.46 (n=15). Average period to healing of superficial burns treated with AWBAT-S (n=15 patients with n=18 wounds) was 8.1 days, sigma =2.48, with a range of 5-13 days and a median of 7 days. Pain rating at 24 hours was 1.5, sigma =0.85 (n=10) and at 48 hours mean was 1.75, sigma =0.89 (n=8). There was zero incidence of hematoma/seroma. No infections were seen. Results indicate that AWBAT was easily applied with good initial adherence. It was noted to be transparent, conformant, and pliable. Early experience demonstrates that AWBAT performs well on donor sites and superficial partial-thickness burns and delivers the desired attributes of a temporary skin substitute including good adherence, infection control, transparency, adapatability, and pain control.

  8. Nursing Faculty Experiences of Virtual Learning Environments for Teaching Clinical Reasoning

    ERIC Educational Resources Information Center

    Zacharzuk-Marciano, Tara

    2017-01-01

    Nurses need sharp, clinical reasoning skills to respond to critical situations and to be successful at work in a complex and challenging healthcare system. While past research has focused on using virtual learning environments to teach clinical reasoning, there has been limited research on the experiences of nursing faculty and there is a need for…

  9. Diagnostic games: from adequate formalization of clinical experience to structure discovery.

    PubMed

    Shifrin, Michael A; Kasparova, Eva I

    2008-01-01

    A method of obtaining well-founded and reproducible results in clinical decision making is presented. It is based on "diagnostic games", a procedure of elicitation and formalization of experts' knowledge and experience. The use of this procedure allows formulating decision rules in the terms of an adequate language, that are both unambiguous and clinically clear.

  10. Association Between Medicare Summary Star Ratings for Patient Experience and Clinical Outcomes in US Hospitals.

    PubMed

    Trzeciak, Stephen; Gaughan, John P; Bosire, Joshua; Mazzarelli, Anthony J

    2016-03-01

    In 2015, the Centers for Medicare and Medicaid Services (CMS) released new summary star ratings for US hospitals based on patient experience. We aimed to test the association between CMS patient experience star ratings and clinical outcomes. We analyzed risk-adjusted data for more than 3000 US hospitals from CMS Hospital Compare using linear regression. We found that better patient experience was associated with favorable clinical outcomes. Specifically, a higher number of stars for patient experience had a statistically significant association with lower rates of many in-hospital complications. A higher patient experience star rating also had a statistically significant association with lower rates of unplanned readmissions to the hospital within 30 days. Better patient experience according to the CMS star ratings is associated with favorable clinical outcomes. These results support the inclusion of patient experience data in the framework of how hospitals are paid for services.

  11. Miniaturized, Portable Sensors Monitor Metabolic Health

    NASA Technical Reports Server (NTRS)

    2014-01-01

    In order to measure astronauts' metabolic rates in space, Glenn Research Center partnered with Case Western University and the Cleveland Clinic to develop the Portable Unit for Metabolic Analysis (PUMA). Cleveland-based Orbital Research licensed and then modified PUMA to help the US Navy assess pilot oxygen problems and is now designing a device that can be used in hospitals.

  12. Expertise in Clinical Psychology. The Effects of University Training and Practical Experience on Expertise in Clinical Psychology

    PubMed Central

    Vollmer, Sabine; Spada, Hans; Caspar, Franz; Burri, Salome

    2013-01-01

    How do university training and subsequent practical experience affect expertise in clinical psychology? To answer this question we developed methods to assess psychological knowledge and the competence to diagnose, construct case conceptualizations, and plan psychotherapeutic treatment: a knowledge test and short case studies in a first study, and a complex, dynamically evolving case study in the second study. In our cross-sectional studies, psychology students, trainees in a certified postgraduate psychotherapist curriculum, and behavior therapists with more than 10 years of experience were tested (100 in total: 20 each of novice, intermediate, and advanced university students, postgraduate trainees, and therapists). Clinical knowledge and competence increased up to the level of trainees but unexpectedly decreased at the level of experienced therapists. We discuss the results against the background of expertise research and the training of clinical psychologists (in Germany). Important factors for the continuing professional development of psychotherapists are proposed. PMID:23543213

  13. The Group Objective Structured Clinical Experience: building communication skills in the clinical reasoning context.

    PubMed

    Konopasek, Lyuba; Kelly, Kevin V; Bylund, Carma L; Wenderoth, Suzanne; Storey-Johnson, Carol

    2014-07-01

    Students are rarely taught communication skills in the context of clinical reasoning training. The purpose of this project was to combine the teaching of communication skills using SPs with clinical reasoning exercises in a Group Objective Structured Clinical Experience (GOSCE) to study feasibility of the approach, the effect on learners' self-efficacy and attitude toward learning communication skills, and the effect of providing multiple sources of immediate, collaborative feedback. GOSCE sessions were piloted in Pediatrics and Medicine clerkships with students assessing their own performance and receiving formative feedback on communication skills from peers, standardized patients (SPs), and faculty. The sessions were evaluated using a retrospective pre/post-training questionnaire rating changes in self-efficacy and attitudes, and the value of the feedback. Results indicate a positive impact on attitudes toward learning communication skills and self-efficacy regarding communication in the clinical setting. Also, learners considered feedback by peers, SPs, and faculty valuable in each GOSCE. The GOSCE is an efficient and learner-centered method to attend to multiple goals of teaching communication skills, clinical reasoning, self-assessment, and giving feedback in a formative setting. The GOSCE is a low-resource, feasible strategy for experiential learning in communication skills and clinical reasoning. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  14. A memory of an aesthetic experience transferred to clinical practice.

    PubMed

    Wikström, Britt-Maj

    2003-03-01

    To examine the usefulness of writing about a memory of an aesthetic experience, and then transfer the aesthetic experience to a health care situation. The study was accomplished at two university colleges of health sciences in Sweden. It started with student nurses (N=291) writing about a memory of an aesthetic experience. Then they transferred the aesthetic experience to a purposeful clinical practice. The results showed that each student could report on a positive memory of an aesthetic experience. Embedded in each story was an aesthetic experience that was meaningful to the student. Domains of memory most frequently reported were music, work of art and nature. Themes derived from the aesthetic memory were happiness and awareness. The awareness theme comprized the value of aesthetic experiences for the patients, and for student nurses. The process of writing about a memory of an aesthetic experience provided an alternative model for nursing education that could improve patient care.

  15. Experience of Adjunct Novice Clinical Nursing Faculty: An Interpretive Case Study

    ERIC Educational Resources Information Center

    Mann, Carol

    2013-01-01

    The purpose of this qualitative interpretive case study was to describe the experience of adjunct novice clinical nursing faculty who has less than three years teaching experience or feels novice in this setting. The nursing shortage in the United States is well documented and is forecasted to have significant impacts on the health care delivery…

  16. Supreme Court of the United States Syllabus: Cleveland Board of Education Et Al. v. LaFleur Et Al. Certiorari to the United States Court of Appeals for the Sixth Circuit. No. 72-77, Argued October 15, 1973 -- Decided January 21, 1974.

    ERIC Educational Resources Information Center

    Supreme Court of the U. S., Washington, DC.

    School board rules for the Cleveland, Ohio, and the Chesterfield County, Virginia, districts required pregnant teachers to take unpaid maternity leave five months and four months respectively before expected childbirth. A date for eligibility for return to work was also arbitrarily set. This pamphlet contains the entire official text of the…

  17. Nursing students' reflections on the learning experience of a unique mental health clinical placement.

    PubMed

    Patterson, Christopher; Moxham, Lorna; Brighton, Renee; Taylor, Ellie; Sumskis, Susan; Perlman, Dana; Heffernan, Tim; Hadfield, Louise

    2016-11-01

    There exists a need for innovative thinking to identify new clinical placement opportunities for nursing students. Recovery-based clinical placements for mental health nurse students remain unique and require investigation. To examine the learning experience of Bachelor of Nursing students who undertook an innovative mental health clinical placement known as Recovery Camp. This study incorporated qualitative analysis of written reflections. Using Braun and Clarke's (2006) six phases of thematic analysis the corpus of student reflections were reviewed by three members of the research team independent to each other. Four themes emerged. The theme of Pre-placement Expectations incorporates participant foci on pre-conceptions of Recovery Camp. The theme of Student Learning incorporates the ways in which participants recognised the experience of Recovery Camp influenced learning. Reflections themed under the title Placement Setting include discussion of the Recovery Camp as a clinical placement. The theme of Future Practice incorporates students' reflections on how they plan to practice as nurses as a result the learning experiences of Recovery Camp. An immersive clinical placement such as Recovery Camp can influence students' perceptions of people with mental illness, have a positive impact on student learning and influence students' decisions about future practice. The learning experience of nursing students whom attend unique, recovery-orientated clinical placements can be both positive and educative. Copyright © 2016 Elsevier Ltd. All rights reserved.

  18. Students' description of factors contributing to a meaningful clinical experience in entry-level physical therapist professional education.

    PubMed

    Rindflesch, Aaron; Hoversten, Kelsey; Patterson, Britta; Thomas, Laura; Dunfee, Heidi

    2013-01-01

    The objective of this study was to identify student, clinical instructor (CI), and environmental characteristics and behaviors that make for positive clinical experiences as perceived by physical therapy students. Nine third-year physical therapist students from entry-level physial therapist education programs around the United States participated in this study. In this phenomenologic study, participants were interviewed using open-ended questions designed to facilitate rich description. Interviews were recorded, transcribed, validated, and analyzed. Themes were identified through collaborative analysis using constant comparative coding. Students described student, CI, and environmental factors and behaviors that contribute to a quality clinical experience, including: the students' demonstration of initiative to prepare for the clinical experience and preparation after clinic hours; the importance of the CI's insight, allowing CIs to ascertain how much guidance to give in order to foster independence in the student; and the clinical environment's ability to welcome a student and provide the student with novel learning experiences. The student descriptions, including positive and negative examples shared by the interviewees, demonstrate essential characteristics that contribute to a positive clinical experience. Many of the factors identified by students can be influenced by student and CI training and preparation prior to the clinical experience.

  19. A systematic review of evidence on the links between patient experience and clinical safety and effectiveness

    PubMed Central

    Doyle, Cathal; Lennox, Laura; Bell, Derek

    2013-01-01

    Objective To explore evidence on the links between patient experience and clinical safety and effectiveness outcomes. Design Systematic review. Setting A wide range of settings within primary and secondary care including hospitals and primary care centres. Participants A wide range of demographic groups and age groups. Primary and secondary outcome measures A broad range of patient safety and clinical effectiveness outcomes including mortality, physical symptoms, length of stay and adherence to treatment. Results This study, summarising evidence from 55 studies, indicates consistent positive associations between patient experience, patient safety and clinical effectiveness for a wide range of disease areas, settings, outcome measures and study designs. It demonstrates positive associations between patient experience and self-rated and objectively measured health outcomes; adherence to recommended clinical practice and medication; preventive care (such as health-promoting behaviour, use of screening services and immunisation); and resource use (such as hospitalisation, length of stay and primary-care visits). There is some evidence of positive associations between patient experience and measures of the technical quality of care and adverse events. Overall, it was more common to find positive associations between patient experience and patient safety and clinical effectiveness than no associations. Conclusions The data presented display that patient experience is positively associated with clinical effectiveness and patient safety, and support the case for the inclusion of patient experience as one of the central pillars of quality in healthcare. It supports the argument that the three dimensions of quality should be looked at as a group and not in isolation. Clinicians should resist sidelining patient experience as too subjective or mood-oriented, divorced from the ‘real’ clinical work of measuring safety and effectiveness. PMID:23293244

  20. A Thematic Inquiry into the Burnout Experience of Australian Solo-Practicing Clinical Psychologists.

    PubMed

    Hammond, Trent E; Crowther, Andrew; Drummond, Sally

    2017-01-01

    Objective: Burnout is conceptualized as a syndrome that consists of emotional exhaustion, depersonalization, and decreased personal accomplishment. Despite the increased frequency and severity of burnout in the Western world, there is limited published research regarding the experiences of clinical psychologists who have had burnout. The present study examines clinical psychologists' different experiences of burnout in Australia. Design and Methods: In the year 2015, six privately practicing and solo-employed clinical psychologists provided rich qualitative data by participating in semi-structured interviews. Thematic analysis was the method used to analyze clinical psychologists' natural accounts of their burnout experiences. Using NVivo, emerging themes were identified through coding 'first order constructs' and then axial code 'second order constructs.' Findings: Clinical psychologists indicated that their roles are demanding and a diverse range of symptoms, including the enduring effects of burnout, mental stress, fatigue, decreased personal accomplishment, negative affect, depersonalization, reduced productivity and motivation, and insomnia. They identified precursors of burnout, including excessive workload and hours of work, life stresses, mismanaged workload, and transference. Clinical psychologists suggested that protective factors of burnout include knowledge and years worked in direct care, and trusting and long-term relationships. They indicated that the barriers to overcoming burnout include the fallacy that their clients' expectations and needs are more important than their own, the financial cost of working in private practice, contemporary knowledge and inadequate education regarding self-care, and time constraints. Discussion and Conclusion: The findings presented in this study provide psychologists and other health professionals with an insight about the burnout experience and inform professionals of the mental shortcomings of working as a solo

  1. A Thematic Inquiry into the Burnout Experience of Australian Solo-Practicing Clinical Psychologists

    PubMed Central

    Hammond, Trent E.; Crowther, Andrew; Drummond, Sally

    2018-01-01

    Objective: Burnout is conceptualized as a syndrome that consists of emotional exhaustion, depersonalization, and decreased personal accomplishment. Despite the increased frequency and severity of burnout in the Western world, there is limited published research regarding the experiences of clinical psychologists who have had burnout. The present study examines clinical psychologists’ different experiences of burnout in Australia. Design and Methods: In the year 2015, six privately practicing and solo-employed clinical psychologists provided rich qualitative data by participating in semi-structured interviews. Thematic analysis was the method used to analyze clinical psychologists’ natural accounts of their burnout experiences. Using NVivo, emerging themes were identified through coding ‘first order constructs’ and then axial code ‘second order constructs.’ Findings: Clinical psychologists indicated that their roles are demanding and a diverse range of symptoms, including the enduring effects of burnout, mental stress, fatigue, decreased personal accomplishment, negative affect, depersonalization, reduced productivity and motivation, and insomnia. They identified precursors of burnout, including excessive workload and hours of work, life stresses, mismanaged workload, and transference. Clinical psychologists suggested that protective factors of burnout include knowledge and years worked in direct care, and trusting and long-term relationships. They indicated that the barriers to overcoming burnout include the fallacy that their clients’ expectations and needs are more important than their own, the financial cost of working in private practice, contemporary knowledge and inadequate education regarding self-care, and time constraints. Discussion and Conclusion: The findings presented in this study provide psychologists and other health professionals with an insight about the burnout experience and inform professionals of the mental shortcomings of

  2. Building workplace social capital: A longitudinal study of student nurses' clinical placement experiences.

    PubMed

    Materne, Michelle; Henderson, Amanda; Eaton, Emma

    2017-09-01

    Quality clinical placement experiences have been associated with nurses' workplace social capital. Social capital is broadly understood as the social organisation of trust, norms and networks that benefit society. Building social capital in the workplace may benefit experiences of staff and students. The aim of this study was to assess the impact of building workplace social capital on student nurse perceptions of clinical learning experiences. A quality improvement process was measured through repeated student surveys. First, second, third year students (n = 1176) from three universities completed a validated Student Clinical Learning Culture Survey (SCLCS) following their placement, at the commencement of quality improvement initiatives and five years later. The SCLCS measured students' perceptions of social affiliation, their motivation, satisfaction and dissatisfaction with clinical contexts. The first year of systematic changes focused on increasing student numbers along with improving communication, trust and knowledge sharing, antecedents to workplace social capital. No change was evident after the first year. Six years after commencement of building workplace social capital differences across all subscales, except dissatisfaction, were significant (p < 0.001). Leadership that promotes open communication and connections across staff and students to achieve common goals can build workplace social capital that enhances student placement experiences. Copyright © 2017 Elsevier Ltd. All rights reserved.

  3. Learning on clinical placement: the experience of six Australian student nurses.

    PubMed

    Nolan, C A

    1998-11-01

    Concerns about the adequacy of clinical education in nursing courses in Australia have escalated since the transfer of pre-registration nursing education into the tertiary sector. This descriptive, interpretative study, informed by the tradition of critical social science, sought to understand the clinical learning experiences of undergraduate nursing students. At the same time, it fostered an active participation of students in their own learning. Daily post-clinical conferences with the students were taped and transcribed verbatim to provide data for the study. Additional data was collected from informal discussions and observations of the students during the placement. Analysis revealed three main categories, which reflected the students' experiences. These included: (1) I don't belong; (2) doing and practising: progress at last; and (3) transitions in thinking. Feeling part of the team was closely linked to the opportunity to learn, emphasizing the important role not only of educators but also clinicians in undergraduate learning on clinical placement. Though the findings reflect age-long problems associated with student learning in the clinical field, it serves to remind all nurses of the importance they play in the learning process. This study reflects the importance of effective communication between the health and education sectors and the need to concentrate on strategies which will strengthen this bond.

  4. Challenging clinical learning environments: experiences of undergraduate nursing students.

    PubMed

    O'Mara, Linda; McDonald, Jane; Gillespie, Mary; Brown, Helen; Miles, Lynn

    2014-03-01

    Clinical learning is an essential component of becoming a nurse. However at times, students report experiencing challenging clinical learning environments (CCLE), raising questions regarding the nature of a challenging clinical learning environment, its impact on students' learning and how students might respond within a CCLE. Using an Interpretive Descriptive study design, researchers held focus groups with 54 students from two Canadian sites, who self-identified as having experienced a CCLE. Students defined a CCLE as affected by relationships in the clinical area and by the context of their learning experiences. CCLE decreased students' learning opportunities and impacted on them as persons. As students determined which relationships were challenging, they tapped other resources and they used strategies to rebuilt, reframe, redirect and/or retreat relative to the specific challenge. Relationships also acted as buffers to unsupportive practice cultures. Implications for practice and research are addressed. Copyright © 2013 Elsevier Ltd. All rights reserved.

  5. Sacubitril/Valsartan: From Clinical Trials to Real-world Experience.

    PubMed

    Joly, Joanna M; Desai, Akshay S

    2018-04-23

    Compared to enalapril, use of angiotensin-receptor blocker and neprilysin inhibitor sacubitril/valsartan to treat patients with heart failure and reduced ejection fraction (HFrEF) is associated with substantial reductions in both cardiovascular mortality and heart failure progression. The purpose of this review is to discuss the real-world experience of sacubitril/valsartan. In the years following the publication of the landmark PARADIGM-HF trial in 2014 and its subsequent FDA approval, a growing evidence base supports the safety and efficacy of sacubitril/valsartan in a broad spectrum of patients with HFrEF. Updated clinical practice guidelines have embraced the use of sacubitril/valsartan in preference to ACE inhibitors or ARBs in selected patients. In this review, we highlight the clinical trials that led to these key updates to clinical guidelines, offer practical strategies for patient selection and utilization in clinical practice, and identify important areas of uncertainty that require future research.

  6. AWBATTM: Early Clinical Experience

    PubMed Central

    Vandenberg, Victoria B.

    2010-01-01

    Objective: The purpose of this article is to describe the early clinical experience with AWBAT. Methods: Burn patients requiring (1) donor sites or (2) treatment of a superficial burn wound injury were treated. A total of 45 patients with 69 distinct wounds were included. AWBATTM-D was evaluated in donor sites and AWBATTM-S was evaluated in superficial partial-thickness burns. Days to healing, pain, hematoma/seroma formation, and infection were noted. Ease of application, adherence, transparency, and physical adaptability details were collected. Results: Average period to healing of donor sites treated with AWBAT-D (n=22 patients with n=26 wounds) was 11.2 days, σ =1.95, with a range of 8–15 days and a median of 11 days. Pain rating at 24 hours was 1.2, σ =0.43 (n=18) and at 48 hours mean was 1.2, σ =0.46 (n=15). Average period to healing of superficial burns treated with AWBAT-S (n=15 patients with n=18 wounds) was 8.1 days, σ =2.48, with a range of 5–13 days and a median of 7 days. Pain rating at 24 hours was 1.5, σ =0.85 (n=10) and at 48 hours mean was 1.75, σ =0.89 (n=8). There was zero incidence of hematoma/seroma. No infections were seen. Results indicate that AWBAT was easily applied with good initial adherence. It was noted to be transparent, conformant, and pliable. Discussion: Early experience demonstrates that AWBAT performs well on donor sites and superficial partial-thickness burns and delivers the desired attributes of a temporary skin substitute including good adherence, infection control, transparency, adapatability, and pain control. PMID:20361005

  7. Predoctoral Dental Students' Perceptions of Dental Implant Training: Effect of Preclinical Simulation and Clinical Experience.

    PubMed

    Prasad, Soni; Bansal, Naveen

    2017-04-01

    The aims of this study were to assess 1) differences in perceptions of dental implant training between dental students who received didactic training alone (control group) and those who received didactic plus simulation training (test group); 2) differences in response between students with and without clinical experience in implant dentistry; and 3) the interaction effect of simulation training and clinical experience on students' satisfaction. A survey was distributed to the control group in 2014 and to the test group in 2015; both groups were at the same U.S. dental school. Data were collected on confidence levels with various implant restorative procedures along with overall satisfaction and number of implant restorations performed by each student. The response rate was 78.7% in the control group and 81.3% in the test group. In the control group, 85.7% of students reported being satisfied with implant training compared to 90.8% of students in the test group. The interaction effect of simulation training and clinical experience on overall student satisfaction was OR=1.5 at 95% CI: 0.8, 3.0. The students who had clinical experience with implant restorative procedures had significantly greater satisfaction than those who did not (OR=4.8, 95% CI: 2.1, 11.1, p<0.01). This study found that both the simulation and clinical experience affected these students' confidence and satisfaction levels with implant education: they were almost five times more satisfied with implant training when clinical experience in implant restorative procedures was a part of their implant education.

  8. Facilitative and obstructive factors in the clinical learning environment: Experiences of pupil enrolled nurses.

    PubMed

    Lekalakala-Mokgele, Eucebious; Caka, Ernestine M

    2015-03-31

    The clinical learning environment is a complex social entity that influences student learning outcomes in the clinical setting. Students can experience the clinical learning environment as being both facilitative and obstructive to their learning. The clinical environment may be a source of stress, creating feelings of fear and anxiety which in turn affect the students' responses to learning. Equally, the environment can enhance learning if experienced positively. This study described pupil enrolled nurses' experiences of facilitative and obstructive factors in military and public health clinical learning settings. Using a qualitative, contextual, exploratory descriptive design, three focus group interviews were conducted until data saturation was reached amongst pupil enrolled nurses in a military School of Nursing. Data analysed provided evidence that acceptance by clinical staff and affordance of self-directed learning facilitated learning. Students felt safe to practise when they were supported by the clinical staff. They felt a sense of belonging when the staff showed an interest in and welcomed them. Learning was obstructed when students were met with condescending comments. Wearing of a military uniform in the public hospital and horizontal violence obstructed learning in the clinical learning environment. Students cannot have effective clinical preparation if the environment is not conducive to and supportive of clinical learning, The study shows that military nursing students experience unique challenges as they are trained in two professions that are hierarchical in nature. The students experienced both facilitating and obstructing factors to their learning during their clinical practice. Clinical staff should be made aware of factors which can impact on students' learning. Policies need to be developed for supporting students in the clinical learning environment.

  9. The Impact of Clinical Experiences from Athletic Training Student and Preceptor Perspectives

    ERIC Educational Resources Information Center

    Benes, Sarah S.; Mazerolle, Stephanie M.; Bowman, Thomas G.

    2014-01-01

    Context: Clinical education is an integral part of athletic training programs. This is where students should develop their professional identities and become socialized into the profession. Understanding the student and preceptor perspectives of the impact that clinical experiences have on students can provide valuable insight into this aspect of…

  10. The effect of alternative clinical teaching experience on preservice science teachers' self-efficacy

    NASA Astrophysics Data System (ADS)

    Klett, Mitchell Dean

    The purpose of this study was to compare different methods of alternative clinical experience; family science nights and Saturday science (authentic teaching) against micro-teaching (peer teaching) in terms of self-efficacy in science teaching and teaching self-efficacy. The independent variable, or cause, is teaching experiences (clinical vs. peer teaching); the dependent variable, or effect, is two levels of self-efficacy. This study was conducted at the University of Idaho's main campus in Moscow and extension campus in Coeur d'Alene. Four sections of science methods were exposed to the same science methods curriculum and will have opportunities to teach. However, each of the four sections were exposed to different levels or types of clinical experience. One section of preservice teachers worked with students in a Saturday science program. Another section worked with students during family science nights. The third worked with children at both the Saturday science program and family science nights. The last section did not have a clinical experience with children, instead they taught in their peer groups and acted as a control group. A pre-test was given at the beginning of the semester to measure their content knowledge, teaching self-efficacy and self-efficacy in science teaching. A post-test was given at the end of the semester to see if there was any change in self-efficacy or science teaching self-efficacy. Throughout the semester participants kept journals about their experiences and were interviewed after their alternative clinical teaching experiences. These responses were categorized into three groups; gains in efficacy, no change in efficacy, and drop in efficacy. There was a rise in teaching efficacy for all groups. The mean scores for personal teaching efficacy dropped for the Monday-Wednesday and Tuesday-Thursday group while the both Coeur D'Alene groups remained nearly unchanged. There was no significant change in the overall means for science

  11. Time Keeps on Ticking: The Experience of Clinical Judgment

    ERIC Educational Resources Information Center

    Spengler, Paul M.; White, Michael J.; Aegisdottir, Stefania; Maugherman, Alan S.

    2009-01-01

    The reactions by Ridley and Shaw-Ridley (EJ832451) and Lichtenberg (EJ832452) to the authors' meta-analysis on the effects of experience on judgment accuracy add positively to what is hoped will become an ever more focused discourse on this most basic question: How can mental health clinical decision making be improved? In this rejoinder, the…

  12. BRIEF REPORT: Beyond Clinical Experience: Features of Data Collection and Interpretation That Contribute to Diagnostic Accuracy

    PubMed Central

    Nendaz, Mathieu R; Gut, Anne M; Perrier, Arnaud; Louis-Simonet, Martine; Blondon-Choa, Katherine; Herrmann, François R; Junod, Alain F; Vu, Nu V

    2006-01-01

    BACKGROUND Clinical experience, features of data collection process, or both, affect diagnostic accuracy, but their respective role is unclear. OBJECTIVE, DESIGN Prospective, observational study, to determine the respective contribution of clinical experience and data collection features to diagnostic accuracy. METHODS Six Internists, 6 second year internal medicine residents, and 6 senior medical students worked up the same 7 cases with a standardized patient. Each encounter was audiotaped and immediately assessed by the subjects who indicated the reasons underlying their data collection. We analyzed the encounters according to diagnostic accuracy, information collected, organ systems explored, diagnoses evaluated, and final decisions made, and we determined predictors of diagnostic accuracy by logistic regression models. RESULTS Several features significantly predicted diagnostic accuracy after correction for clinical experience: early exploration of correct diagnosis (odds ratio [OR] 24.35) or of relevant diagnostic hypotheses (OR 2.22) to frame clinical data collection, larger number of diagnostic hypotheses evaluated (OR 1.08), and collection of relevant clinical data (OR 1.19). CONCLUSION Some features of data collection and interpretation are related to diagnostic accuracy beyond clinical experience and should be explicitly included in clinical training and modeled by clinical teachers. Thoroughness in data collection should not be considered a privileged way to diagnostic success. PMID:17105525

  13. Use of the experience sampling method in the context of clinical trials

    PubMed Central

    Verhagen, Simone J W; Hasmi, Laila; Drukker, Marjan; van Os, J; Delespaul, Philippe A E G

    2016-01-01

    Objective The experience sampling method (ESM) is a structured diary technique to appraise subjective experiences in daily life. It is applied in psychiatric patients, as well as in patients with somatic illness. Despite the potential of ESM assessment, the improved logistics and its increased administration in research, its use in clinical trials remains limited. This paper introduces ESM for clinical trials in psychiatry and beyond. Methods ESM is an ecologically valid method that yields a comprehensive view of an individual's daily life. It allows the assessment of various constructs (eg, quality of life, psychopathology) and psychological mechanisms (eg, stress-sensitivity, coping). These constructs are difficult to assess using cross-sectional questionnaires. ESM can be applied in treatment monitoring, as an ecological momentary intervention, in clinical trials, or in single case clinical trials. Technological advances (eg, smartphone applications) make its implementation easier. Results Advantages of ESM are highlighted and disadvantages are discussed. Furthermore, the ecological nature of ESM data and its consequences are explored, including the potential pitfalls of ambiguously formulated research questions and the specificities of ESM in statistical analyses. The last section focuses on ESM in relation to clinical trials and discusses its future use in optimising clinical decision-making. Conclusions ESM can be a valuable asset in clinical trial research and should be used more often to study the benefits of treatment in psychiatry and somatic health. PMID:27443678

  14. Experience inheritance from famous specialists based on real-world clinical research paradigm of traditional Chinese medicine.

    PubMed

    Song, Guanli; Wang, Yinghui; Zhang, Runshun; Liu, Baoyan; Zhou, Xuezhong; Zhou, Xiaji; Zhang, Hong; Guo, Yufeng; Xue, Yanxing; Xu, Lili

    2014-09-01

    The current modes of experience inheritance from famous specialists in traditional Chinese medicine (TCM) include master and disciple, literature review, clinical-epidemiology-based clinical research observation, and analysis and data mining via computer and database technologies. Each mode has its advantages and disadvantages. However, a scientific and instructive experience inheritance mode has not been developed. The advent of the big data era as well as the formation and practice accumulation of the TCM clinical research paradigm in the real world have provided new perspectives, techniques, and methods for inheriting experience from famous TCM specialists. Through continuous exploration and practice, the research group proposes the innovation research mode based on the real-world TCM clinical research paradigm, which involves the inheritance and innovation of the existing modes. This mode is formulated in line with its own development regularity of TCM and is expected to become the main mode of experience inheritance in the clinical field.

  15. Real-Time, Interactive Echocardiography Over High-Speed Networks: Feasibility and Functional Requirements

    NASA Technical Reports Server (NTRS)

    Bobinsky, Eric A.

    1998-01-01

    Real-time, Interactive Echocardiography Over High Speed Networks: Feasibility and Functional Requirements is an experiment in advanced telemedicine being conducted jointly by the NASA Lewis Research Center, the NASA Ames Research Center, and the Cleveland Clinic Foundation. In this project, a patient undergoes an echocardiographic examination in Cleveland while being diagnosed remotely by a cardiologist in California viewing a real-time display of echocardiographic video images transmitted over the broadband NASA Research and Education Network (NREN). The remote cardiologist interactively guides the sonographer administering the procedure through a two-way voice link between the two sites. Echocardiography is a noninvasive medical technique that applies ultrasound imaging to the heart, providing a "motion picture" of the heart in action. Normally, echocardiographic examinations are performed by a sonographer and cardiologist who are located in the same medical facility as the patient. The goal of telemedicine is to allow medical specialists to examine patients located elsewhere, typically in remote or medically underserved geographic areas. For example, a small, rural clinic might have access to an echocardiograph machine but not a cardiologist. By connecting this clinic to a major metropolitan medical facility through a communications network, a minimally trained technician would be able to carry out the procedure under the supervision and guidance of a qualified cardiologist.

  16. Characterizing Clinical Genetic Counselors' Countertransference Experiences: an Exploratory Study.

    PubMed

    Reeder, Rebecca; Veach, Patricia McCarthy; MacFarlane, Ian M; LeRoy, Bonnie S

    2017-10-01

    Countertransference (CT) refers to conscious and unconscious emotions, fantasies, behaviors, perceptions, and psychological defenses genetic counselors experience in response to any aspect of genetic counseling situations (Weil 2010). Some authors theorize about the importance of recognizing and managing CT, but no studies solely aim to explore genetic counselors' experiences of the phenomenon. This study examined the extent to which clinical genetic counselors' perceive themselves as inclined to experience CT, gathered examples of CT encountered in clinical situations, and assessed their CT management strategies. An anonymous online survey, sent to NSGC members, yielded 127 usable responses. Participants completed Likert-type items rating their CT propensities; 57 of these individuals also provided examples of CT they experienced in their practice. Factor analysis of CT propensities tentatively suggested four factors: Control, Conflict Avoidance, Directiveness, and Self-Regulation, accounting for 38.5% of response variance. Thematic analysis of CT examples yielded five common triggers: general similarity to patient, medical/genetic similarity, angry patients, patient behaves differently from counselor expectations, and disclosing bad news; six common manifestations: being self-focused, projecting feelings onto the patient, intense emotional reaction to patient, being overly invested, disengagement, and physical reaction; five CT effects: disruption in rapport building, repaired empathy, over-identification, conversation does not reach fullest potential, and counselor is drained emotionally; and three management strategies: recognizing CT as it occurs, self-reflection, and consultation. Results suggest CT is a common experience, occurring in both "routine" and emotionally complex cases. Training programs, continuing education, and peer supervision might include discussion of CT, informed by examples from the present study, to increase genetic counselor awareness

  17. Experience from mental health clinics held during medical service camps in Fiji.

    PubMed

    Sivakumaran, Hemalatha; George, Kuruvilla; Naker, Gunu; Nadanachandran, Kathir

    2015-12-01

    We aim to describe the experience and findings of mental health clinics held during medical service camps in the rural settings of Fiji. Descriptive data collated at the end of the medical camps across 2011-2014 are used to highlight the main findings. The exposure to mental health assessments and brief interventions at these camps was a validating experience for both individuals and medical students attending the clinics. The most common presentations can be categorised under symptoms of depression, anxiety and relationship problems. The accessibility of mental health support services is a challenge in Fiji. Medical service camps can form an important pathway in promoting mental health awareness, especially amongst the rural communities of Fiji, and a useful platform for medical students to acquire some clinical exposure. © The Royal Australian and New Zealand College of Psychiatrists 2015.

  18. [Introduction of a Clinical Research Experience Program in Hospital Practical Training for Pharmacy Students and Its Evaluation].

    PubMed

    Takahashi, Katsuyuki; Suda, Yasuki; Kawaguchi, Hiroshi; Nakamura, Yasutaka; Kawabata, Shiho; Kawakami, Noriko; Nishikawa, Takeshi; Nagayama, Katsuya

    2015-01-01

    Long-term clinical training based on a model core curriculum was conducted to nurture highly competent pharmacists in the clinical field. Pharmacists' responsibilities are expanding, and a system has been developed to help pharmacists gain accreditation, identify specialties, and improve their training. However, this system requires research competency. Therefore clinical research should be considered a part of clinical training to encourage high competency among pharmacists. Because the model core curriculum does not include a section on clinical research. Osaka City University Hospital introduced a hands-on clinical research experience program and evaluated its usefulness. A significant improvement in the level of knowledge and awareness of clinical research was seen among students who underwent the clinical research experience program. In addition, the level of student satisfaction was higher. These findings suggest that a clinical research experience program may be useful to nurture a greater awareness of clinical research and knowledge acquisition among pharmacists.

  19. Work Experience Program at a Metropolitan Paediatric Hospital: Assisting Rural and Metropolitan Allied Health Professionals Exchange Clinical Skills.

    ERIC Educational Resources Information Center

    Parkin, Ann E.; McMahon, Sandra; Upfield, Nancy; Copley, Jodie; Hollands, Karen

    2001-01-01

    A clinical experience program provided 29 rural Australian allied health professionals with experience in pediatric clinical areas and opportunities to share clinical knowledge and develop networks with metropolitan peers. Questionnaires and focus groups indicated that networking, clinical skills, knowledge, confidence, and awareness of rural…

  20. A short version of the revised 'experience of close relationships questionnaire': investigating non-clinical and clinical samples.

    PubMed

    Wongpakaran, Tinakon; Wongpakaran, Nahathai

    2012-01-01

    This study seeks to investigate the psychometric properties of the short version of the revised 'Experience of Close Relationships' questionnaire, comparing non-clinical and clinical samples. In total 702 subjects participated in this study, of whom 531 were non-clinical participants and 171 were psychiatric patients. They completed the short version of the revised 'Experience of Close Relationships' questionnaire (ECR-R-18), the Perceived Stress Scale-10(PSS-10), the Rosenberg Self-Esteem Scale (RSES) and the UCLA Loneliness scale. A retest of the ECR-R-18 was then performed at four-week intervals. Then, confirmatory factor analyses were performed to test the validity of the new scale. The ECR-R-18 showed a fair to good internal consistency (α 0.77 to 0.87) for both samples, and the test-retest reliability was found to be satisfactory (ICC = 0.75). The anxiety sub-scale demonstrated concurrent validity with PSS-10 and RSES, while the avoidance sub-scale showed concurrent validity with the UCLA Loneliness Scale. Confirmatory factor analysis using method factors yielded two factors with an acceptable model fit for both groups. An invariance test revealed that the ECR-R-18 when used on the clinical group differed from when used with the non-clinical group. The ECR-R-18 questionnaire revealed an overall better level of fit than the original 36 item questionnaire, indicating its suitability for use with a broader group of samples, including clinical samples. The reliability of the ECR-R- 18 might be increased if a modified scoring system is used and if our suggestions with regard to future studies are followed up.

  1. Clinical evaluation of music perception, appraisal and experience in cochlear implant users.

    PubMed

    Drennan, Ward R; Oleson, Jacob J; Gfeller, Kate; Crosson, Jillian; Driscoll, Virginia D; Won, Jong Ho; Anderson, Elizabeth S; Rubinstein, Jay T

    2015-02-01

    The objectives were to evaluate the relationships among music perception, appraisal, and experience in cochlear implant users in multiple clinical settings and to examine the viability of two assessments designed for clinical use. Background questionnaires (IMBQ) were administered by audiologists in 14 clinics in the United States and Canada. The CAMP included tests of pitch-direction discrimination, and melody and timbre recognition. The IMBQ queried users on prior musical involvement, music listening habits pre and post implant, and music appraisals. One-hundred forty-five users of Advanced Bionics and Cochlear Ltd cochlear implants. Performance on pitch direction discrimination, melody recognition, and timbre recognition tests were consistent with previous studies with smaller cohorts, as well as with more extensive protocols conducted in other centers. Relationships between perceptual accuracy and music enjoyment were weak, suggesting that perception and appraisal are relatively independent for CI users. Perceptual abilities as measured by the CAMP had little to no relationship with music appraisals and little relationship with musical experience. The CAMP and IMBQ are feasible for routine clinical use, providing results consistent with previous thorough laboratory-based investigations.

  2. A Mandala: A Diagram of the Clinical Education Experience in Athletic Training

    ERIC Educational Resources Information Center

    Cernohous, Steve; West, Sharon

    2007-01-01

    Objective: The objective of this paper is to present the practical use of a Mandala that: 1) provides opportunities for athletic training students to explore, reflect on and appreciate their clinical experiences; 2) provides educators with a model to understand and value athletic training student experiences; 3) organizes and captures factors and…

  3. Student agreement regarding adequacy of didactic content and practical experiences of vaccination clinic business operations.

    PubMed

    George, David L; Johnson, Eric J; O'Neal, Katherine S; Smith, Michael J

    2018-04-01

    To report student perceived adequacy regarding didactic content and practical experiences of vaccination clinic business operations. Didactic content, a case study, and practical experiences regarding vaccination clinic business operations were implemented in related lectures of a Pharmacy Business and Entrepreneurship (PBE) elective and the college of pharmacy sponsored vaccination clinics. An online survey was used to evaluate student perceived adequacy of didactic content and practical experiences of vaccination clinic business operations. Mean scaled agreement was compared between students in the PBE elective versus those not in the elective. Student confidence in performing business operations was also assessed. Students in the PBE had higher mean confidence than non-elective students regarding staff management (3.23 vs. 2.73, p = 0.04). Success of the interventions may be attributed to students in the PBE elective that reported a higher mean perceived adequacy of content and practical experiences and confidence in performing nearly all business operations. Still, further evaluation of interventions is being considered to assess effectiveness of learning. Published by Elsevier Inc.

  4. Understanding Clinical Expertise: Nurse Education, Experience, and the Hospital Context

    PubMed Central

    McHugh, Matthew D.; Lake, Eileen T.

    2010-01-01

    Clinical nursing expertise is central to quality patient care. Research on factors that contribute to expertise has focused largely on individual nurse characteristics to the exclusion of contextual factors. To address this, we examined effects of hospital contextual factors and individual nurse education and experience on clinical nursing expertise in a cross-sectional analysis of data from 8,611 registered nurses. In a generalized ordered logistic regression analysis, the composition of the hospital staff, particularly the proportion of nurses with at least a bachelor of science in nursing degree, was associated with significantly greater odds of a nurse reporting a more advanced expertise level. Our findings suggest that, controlling for individual characteristics, the hospital context significantly influences clinical nursing expertise. PMID:20645420

  5. An investigation of nurse educator's perceptions and experiences of undertaking clinical practice.

    PubMed

    Williams, Angela; Taylor, Cathy

    2008-11-01

    Educational policy (DOH, 1999. Making a difference: strengthening the nursing, midwifery and health visiting contribution to health and healthcare. Department of Health, London; UKCC, 1999. Fitness for Practice. United Kingdom Central Council for Nursing, Midwifery and Health Visiting, London; Nursing and Midwifery Council, 2006. Standards to support learning and assessment in practice. Nursing and Midwifery Council, London) and current nursing literature (Griscti, O., Jacono, B., Jacono, J., 2005. The nurse educator's clinical role. Journal of Advanced Nursing 50 (1), 84-92; Owen, S., Ferguson, K., Baguley, I., 2005. The clinical activity of mental health nurse lecturers. Journal of Psychiatric and Mental Health Nursing 12, 310-316), place increasing emphasis on nurse educators undertaking clinical practice to facilitate their clinical confidence and competence. This study investigated nurse educators' perceptions and experiences of undertaking clinical practice. A qualitative design and descriptive, exploratory approach were used. A purposive sample of 11 nurse educators in one nursing department, took part in two focus group interviews, one with 5 and the other with 6 respondents, to identify and discuss their perceptions and experiences of undertaking clinical practice. A process of thematic content analysis revealed three broad themes relating to the meaning and importance of clinical practice, perceived benefits and barriers which are examined and discussed. The paper concludes that despite policy recommendations, barriers highlighted in this study such as insufficient time, heavy workload and a lack of valuing of the clinical role have been raised over the past few decades. The effect of undertaking clinical practice, particularly on the quality of teaching is argued to be valuable armoury in the battle to secure sufficient resources to support engagement in clinical practice. Financial and organisational commitment; valuing of clinical practice and research

  6. A discussion of nursing students' experiences of culture shock during an international clinical placement and the clinical facilitators' role.

    PubMed

    Maginnis, Cathy; Anderson, Judith

    2017-06-01

    This paper examines the meaning and experience of culture shock for nursing students undertaking an international clinical placement (ICP) and the role of the clinical facilitator. Oberg's four stages of adapting to culture shock were aligned to anecdotal conversations with nursing students on an ICP. All four stages were identified in anecdotal conversations with the students. Support by the accompanying clinical facilitator is pivotalin overcoming culture shock and maximising the learning experience. It is essential that students are prepared for the change in cultural norms and are supported by the academic staff to work through the processes required to adapt to culture shock. Planning and preparation prior to departure is essential to assist with managing culture shock with an emphasis on the inclusion of cultural norms and beliefs. The role of the facilitator is crucial to guide and support the students through the culture shock process.

  7. Exploring nursing students’ experience of peer learning in clinical practice

    PubMed Central

    Ravanipour, Maryam; Bahreini, Masoud; Ravanipour, Masoumeh

    2015-01-01

    Background: Peer learning is an educational process wherein someone of the same age or level of experience level interacts with other students interested in the same topic. There is limited evidence specifically focusing on the practical use of peer learning in Iran. The aim of this study was to explore nursing students’ experiences of peer learning in clinical practice. Materials and Methods: A qualitative content analysis was conducted. Focus groups were used to find the students’ experiences about peerlearning. Twenty-eight baccalaureate nursing students at Bushehr University of Medical Sciences were selected purposively, and were arranged in four groups of seven students each. The focus group interviews were conducted using a semi-structured interview schedule. All interviews were tape-recorded, transcribed verbatim, and analyzed using conventional content analysis method. Results: The analysis identified four themes: Paradoxical dualism, peer exploitation, first learning efficacy, and socialization practice. Gained advantages and perceived disadvantages created paradoxical dualism, and peer exploitation resulted from peer selection and peer training. Conclusion: Nursing students reported general satisfaction concerning peer learning due to much more in-depth learning with little stress than conventional learning methods. Peer learning is a useful method for nursing students for practicing educational leadership and learning the clinical skills before they get a job. PMID:26097860

  8. Role of Clinical Education Experiences on Athletic Training Students' Development of Professional Commitment

    ERIC Educational Resources Information Center

    Mazerolle, Stephanie M.; Dodge, Thomas

    2015-01-01

    Context: Limited evidence exists on the role clinical education can play in the development of athletic training student commitment for the profession. Objective: Investigating the role clinical education experiences play on the development of passion for athletic training. Design: Exploratory qualitative study. Setting: Athletic training…

  9. Geriatric Medicine Fellows' Experiences and Attitudes toward an Objective Structured Clinical Examination (OSCE)

    ERIC Educational Resources Information Center

    Bagri, Anita S.; Zaw, Khin M.; Milanez, Marcos N.; Palacios, Juan J.; Qadri, Syeda S.; Bliss, Linda A.; Roos, Bernard A.; Ruiz, Jorge G.

    2009-01-01

    A total of 8 geriatric medicine fellows participated in an objective structured clinical examination (OSCE) assessing communication skills and clinical reasoning in common geriatric syndromes. To determine their perceptions about the experience, we conducted surveys and semistructured interviews. We analyzed the survey data using descriptive…

  10. FEANICS: A Multi-User Facility For Conducting Solid Fuel Combustion Experiments On ISS

    NASA Technical Reports Server (NTRS)

    Frate, David T.; Tofil, Todd A.

    2001-01-01

    The Destiny Module on the International Space Station (ISS) will soon be home for the Fluids and Combustion Facility's (FCF) Combustion Integrated Rack (CIR), which is being developed at the NASA Glenn Research Center in Cleveland, Ohio. The CIR will be the platform for future microgravity combustion experiments. A multi-user mini-facility called FEANICS (Flow Enclosure Accommodating Novel Investigations in Combustion of Solids) will also be built at NASA Glenn. This mini-facility will be the primary means for conducting solid fuel combustion experiments in the CIR on ISS. The main focus of many of these solid combustion experiments will be to conduct basic and applied scientific investigations in fire-safety to support NASA's Bioastronautics Initiative. The FEANICS project team will work in conjunction with the CIR project team to develop upgradeable and reusable hardware to meet the science requirements of current and future investigators. Currently, there are six experiments that are candidates to use the FEANICS mini-facility. This paper will describe the capabilities of this mini-facility and the type of solid combustion testing and diagnostics that can be performed.

  11. Interdisciplinary integration for quality improvement: the Cleveland Veterans Affairs Medical Center Firm System.

    PubMed

    Aucott, J N; Pelecanos, E; Bailey, A J; Shupe, T C; Romeo, J H; Ravdin, J I; Aron, D C

    1995-04-01

    Many of the characteristics of Firm Systems lend themselves to the application of principles of continuous quality improvement (CQI). A Firm System is defined as two or more parallel practices organized on the principle of continuity of relationships between patients and an interdisciplinary group of health care professionals and trainees. Firm Systems are organized around the care of the patient or customer and emphasize access, continuity, and quality of care. The Firm System was implemented at the Cleveland Veterans Affairs Medical Center (VAMC) not as a CQI initiative per se, but as an effort to coordinate the processes involved in the delivery of patient care. The primary goals of this implementation were to improve the quality of patient care, medical education, and health care research. The main strategy to deal with problems caused by uncoordinated care were to move from a departmental approach to an integrated interdisciplinary approach. This approach represented a paradigm shift within the organization that extended to planning, documentation, and the general work environment. Most important, the institution had leaders who were committed to the Firm System and willing to authorize resources to ensure its success. VA hospitals are ideal settings for Firm Systems because they provide longitudinal, comprehensive care with a centralized, prepaid payment mechanism, and they have well-developed information systems that allow the random assignment of patients to Firms. Recommendations to others interested in implementing Firm Systems include creation of a written plan that can gain general support; identification of resources needed for successful implementation; remembering that the patient is the most important customer, as well as that complex systems have many customers; monitoring of performance; and the importance of randomizing patients and providers.

  12. The Student Trainer Clinical Experience at Lock Haven State College.

    ERIC Educational Resources Information Center

    Tomasi, David

    An integral part of the clinical experience for athletic trainers at Lock Haven State College (Pennsylvania) is training in first aid and learning to evaluate not only sport-related injuries but all injuries. Thorough knowledge is expected of athletic trainers in the areas of cardiopulmonary resuscitation, first aid, and treatment of…

  13. The Mini Alcohol Craving Experience Questionnaire: Development and Clinical Application.

    PubMed

    Coates, Jason M; Gullo, Matthew J; Feeney, Gerald F X; Kavanagh, David J; Young, Ross McD; Dingle, Genevieve A; May, Jon; Andrade, Jackie; Statham, Dixie J; Connor, Jason P

    2017-01-01

    Standardized alcohol craving scales are rarely used outside of research environments despite recognized clinical utility. Scale length is a key barrier to more widespread application. A brief measure of alcohol craving is needed to improve research and treatment of alcohol use disorders (AUDs). Grounded in the Elaborated Intrusion Theory of Desire, the Alcohol Craving Experience (ACE) Questionnaire comprises two 11-item self-report scales that assess past-week frequency and maximum strength of alcohol craving. This study aimed to create a brief version of the ACE while maintaining psychometric integrity and clinical utility. Patients attending a university hospital alcohol and drug outpatient service for the treatment of AUD completed the ACE as part of a questionnaire battery. Three patient samples were utilized: 519 patients with pretreatment and outcome data, 228 patients with pretreatment data, and 66 patients who completed the ACE at treatment sessions 1 and 2. The Frequency scale of the ACE possessed greater clinical utility and predictive validity than the Strength scale. Revision of the Frequency measure produced a 5-item "Mini Alcohol Craving Experience" (MACE) Questionnaire. Satisfactory validity (construct, predictive, concurrent, convergent, and incremental) and reliability (internal and test-retest) were maintained. A 1 standard deviation increase in pretreatment MACE score was associated with a 54 percentage increase in the odds of patient lapse or dropout. The MACE provides a brief, theoretically, and psychometrically robust measure of alcohol craving suitable for use with AUD populations in time-limited clinical and research settings. Copyright © 2016 by the Research Society on Alcoholism.

  14. Culturally and linguistically diverse healthcare students' experiences of learning in a clinical environment: A systematic review of qualitative studies.

    PubMed

    Mikkonen, Kristina; Elo, Satu; Kuivila, Heli-Maria; Tuomikoski, Anna-Maria; Kääriäinen, Maria

    2016-02-01

    Learning in the clinical environment of healthcare students plays a significant part in higher education. The greatest challenges for culturally and linguistically diverse healthcare students were found in clinical placements, where differences in language and culture have been shown to cause learning obstacles for students. There has been no systematic review conducted to examine culturally and linguistically diverse healthcare students' experiences of their learning in the clinical environment. This systematic review aims to identify culturally and linguistically diverse healthcare students' experiences of learning in a clinical environment. The search strategy followed the guidelines of the Centre of Reviews and Dissemination. The original studies were identified from seven databases (CINAHL, Medline Ovid, Scopus, Web of Science, Academic Search Premiere, Eric and Cochrane Library) for the period 2000-2014. Two researchers selected studies based on titles, abstracts and full texts using inclusion criteria and assessed the quality of studies independently. Twelve original studies were chosen for the review. The culturally and linguistically diverse healthcare students' learning experiences were divided into three influential aspects of learning in a clinical environment: experiences with implementation processes and provision; experiences with peers and mentors; and experiences with university support and instructions. The main findings indicate that culturally and linguistically diverse healthcare students embarking on clinical placements initially find integration stressful. Implementing the process of learning in a clinical environment requires additional time, well prepared pedagogical orientation, prior cultural and language education, and support for students and clinical staff. Barriers to learning by culturally and linguistically diverse healthcare students were not being recognized and individuals were not considered motivated; learners experienced the

  15. Retention in HIV care depends on patients' perceptions of the clinic experience.

    PubMed

    Wessinger, Matthew H; Hennink, Monique M; Kaiser, Bonnie N; Mangal, Jed P; Gokhale, Runa H; Ruchin, Lauren; Moanna, Abeer; Rimland, David; Farber, Eugene W; Marconi, Vincent C

    2017-10-01

    Institutional barriers in HIV primary care settings can contribute substantially to disparities in retention in HIV treatment and HIV-related outcomes. This qualitative study compared the perceptions of clinic experiences of persons living with HIV (PLWH) in a Veterans Affairs HIV primary care clinic setting who were retained in care with the experiences of those who were not retained in care. Qualitative data from 25 in-depth interviews were analyzed to identify facilitators and barriers to retention in HIV care. Results showed that participants not retained in care experienced barriers to retention involving dissatisfaction with clinic wait times, low confidence in clinicians, and customer service concerns. For participants retained in care, patience with procedural issues, confidence in clinicians, and interpersonal connections were factors that enhanced retention despite the fact that these participants recognized the same barriers as those who were not retained in care. These findings can inform interventions aimed at improving retention in HIV care.

  16. Self-perception but not peer reputation of bullying victimization is associated with non-clinical psychotic experiences in adolescents.

    PubMed

    Gromann, P M; Goossens, F A; Olthof, T; Pronk, J; Krabbendam, L

    2013-04-01

    Bullying victimization may be linked to psychosis but only self-report measures of victimization have been used so far. This study aimed (a) to investigate the differential associations of peer-nominated versus self-reported victim status with non-clinical psychotic experiences in a sample of young adolescents, and (b) to examine whether different types of self-reported victimization predict non-clinical psychotic experiences in these adolescents. Method A combination of standard self-report and peer nomination procedures was used to assess victimization. The sample (n = 724) was divided into four groups (exclusively self-reported victims, self- and peer-reported victims, exclusively peer-reported victims, and non-victims) to test for a group effect on non-clinical psychotic experiences. The relationship between types of victimization and non-clinical psychotic experiences was examined by a regression analysis. Self-reported victims, along with self- and peer-reported victims, scored higher than peer-reported victims and non-victims on non-clinical psychotic experiences. Self-reports of direct relational, indirect relational and physical victimization significantly improved the prediction of non-clinical psychotic experiences whereas verbal and possession-directed victimization had no significant predictive value. The relationship between victimization and non-clinical psychotic experiences is only present for self-reported victimization, possibly indicative of an interpretation bias. The observed discrepancy between self-report and peer-report highlights the importance of implementing a combination of both measures for future research.

  17. [Professor WANG Fuchun's experience in the acupoint selection of clinical treatment with acupuncture and moxibustion].

    PubMed

    Jiang, Hailin; Liu, Chengyu; Ha, Lijuan; Li, Tie

    2017-11-12

    Professor WANG Fuchun 's experience in the acupoint selection of clinical treatment with acupuncture and moxibustion was summarized. The main acupoints are selected by focusing on the chief symptoms of disease, the supplementary points are selected by differentiating the disorders. The acupoints are modified in terms of the changes of sickness. The effective acupoints are selected flexibly in accordance with the specific effects of points. The summary on the acupoint selection reflects professor WANG Fuchun 's academic thoughts and clinical experience and effectively instructs the clinical practice of acupuncture and moxibustion.

  18. Encountering aged care: a mixed methods investigation of medical students' clinical placement experiences.

    PubMed

    Annear, Michael J; Lea, Emma; Lo, Amanda; Tierney, Laura; Robinson, Andrew

    2016-02-04

    Residential aged care is an increasingly important health setting due to population ageing and the increase in age-related conditions, such as dementia. However, medical education has limited engagement with this fast-growing sector and undergraduate training remains primarily focussed on acute presentations in hospital settings. Additionally, concerns have been raised about the adequacy of dementia-related content in undergraduate medical curricula, while research has found mixed attitudes among students towards the care of older people. This study explores how medical students engage with the learning experiences accessible in clinical placements in residential aged care facilities (RACFs), particularly exposure to multiple comorbidity, cognitive impairment, and palliative care. Fifth-year medical students (N = 61) completed five-day clinical placements at two Australian aged care facilities in 2013 and 2014. The placements were supported by an iterative yet structured program and academic teaching staff to ensure appropriate educational experiences and oversight. Mixed methods data were collected before and after the clinical placement. Quantitative data included surveys of dementia knowledge and questions about attitudes to the aged care sector and working with older adults. Qualitative data were collected from focus group discussions concerning medical student expectations, learning opportunities, and challenges to engagement. Pre-placement surveys identified good dementia knowledge, but poor attitudes towards aged care and older adults. Negative placement experiences were associated with a struggle to discern case complexity and a perception of an aged care placement as an opportunity cost associated with reduced hospital training time. Irrespective of negative sentiment, post-placement survey data showed significant improvements in attitudes to working with older people and dementia knowledge. Positive student experiences were explained by in

  19. [Facing, accepting, growing and expecting: the practical experience of nursing students during their first clinical practice].

    PubMed

    Sun, Jia-Jing; Sun, Hui-Lin

    2011-04-01

    Clinical practice experiences, while important, can be highly stressful for nursing students and have a deep effect on their subsequent professional development. This study explored nursing student experiences during their first clinical practice. The study used exploratory and descriptive research methodologies, and researchers selected a phenomenological approach to analysis. Nine nursing students described experiences centered on their first clinical practices using daily dairies and assignments. Transcripts were analyzed using interpretative phenomenological analysis. Four major themes emerged from the data, including: (1) Joining an exciting and intimidating journey in which participants anticipated a precious learning opportunity while fearing failure; (2) Identifying professional role models in which participants learned about nursing content from nursing staff and through step by step instruction from teachers; (3) Growing into caring relationships in which participants increasingly realized the importance of communication, gave empathy and caring to patients, and discovered that patients are the best teachers; and (4) Insight into self-professional capacity and the expectation of their future learning in which participants learned from actual experience, evaluated self-performance and encouraged themselves. Such facilitated self-improvement and instilled the learning necessary to advance to the next stage. Nursing student clinical practice experiences may be used to both advance academic studies and enhance understanding of student feelings, difficulties and experiences. Such can assist nursing students to gain greater positive experiences in their profession.

  20. Clinical evaluation of music perception, appraisal and experience in cochlear implant users

    PubMed Central

    Drennan, Ward. R.; Oleson, Jacob J.; Gfeller, Kate; Crosson, Jillian; Driscoll, Virginia D.; Won, Jong Ho; Anderson, Elizabeth S.; Rubinstein, Jay T.

    2014-01-01

    Objectives The objectives were to evaluate the relationships among music perception, appraisal, and experience in cochlear implant users in multiple clinical settings and to examine the viability of two assessments designed for clinical use. Design Background questionnaires (IMBQ) were administered by audiologists in 14 clinics in the United States and Canada. The CAMP included tests of pitch-direction discrimination, and melody and timbre recognition. The IMBQ queried users on prior musical involvement, music listening habits pre and post implant, and music appraisals. Study sample One-hundred forty-five users of Advanced Bionics and Cochlear Ltd cochlear implants. Results Performance on pitch direction discrimination, melody recognition, and timbre recognition tests were consistent with previous studies with smaller cohorts, as well as with more extensive protocols conducted in other centers. Relationships between perceptual accuracy and music enjoyment were weak, suggesting that perception and appraisal are relatively independent for CI users. Conclusions Perceptual abilities as measured by the CAMP had little to no relationship with music appraisals and little relationship with musical experience. The CAMP and IMBQ are feasible for routine clinical use, providing results consistent with previous thorough laboratory-based investigations. PMID:25177899

  1. Women's Management of Recurrent Bacterial Vaginosis and Experiences of Clinical Care: A Qualitative Study.

    PubMed

    Bilardi, Jade; Walker, Sandra; McNair, Ruth; Mooney-Somers, Julie; Temple-Smith, Meredith; Bellhouse, Clare; Fairley, Christopher; Chen, Marcus; Bradshaw, Catriona

    2016-01-01

    Few data are available on how women manage recurring bacterial vaginosis (BV) and their experiences of the clinical care of this condition. This study aimed to explore women's recurrent BV management approaches and clinical care experiences, with a view to informing and improving the clinical management of BV. A descriptive, social constructionist approach was chosen as the framework for the study. Thirty-five women of varying sexual orientation who had experienced recurrent BV in the past 5 years took part in semi-structured interviews. The majority of women reported frustration and dissatisfaction with current treatment regimens and low levels of satisfaction with the clinical management of BV. Overall, women disliked taking antibiotics regularly, commonly experienced adverse side effects from treatment and felt frustrated at having symptoms recur quite quickly after treatment. Issues in clinical care included inconsistency in advice, misdiagnosis and inappropriate diagnostic approaches and insensitive or dismissive attitudes. Women were more inclined to report positive clinical experiences with sexual health physicians than primary care providers. Women's frustrations led most to try their own self-help remedies and lifestyle modifications in an attempt to treat symptoms and prevent recurrences, including well-known risk practices such as douching. In the face of considerable uncertainty about the cause of BV, high rates of recurrence, unacceptable treatment options and often insensitive and inconsistent clinical management, women are trying their own self-help remedies and lifestyle modifications to prevent recurrences, often with little effect. Clinical management of BV could be improved through the use of standardised diagnostic approaches, increased sensitivity and understanding of the impact of BV, and the provision of evidence based advice about known BV related risk factors.

  2. Application of optimal design methodologies in clinical pharmacology experiments.

    PubMed

    Ogungbenro, Kayode; Dokoumetzidis, Aristides; Aarons, Leon

    2009-01-01

    Pharmacokinetics and pharmacodynamics data are often analysed by mixed-effects modelling techniques (also known as population analysis), which has become a standard tool in the pharmaceutical industries for drug development. The last 10 years has witnessed considerable interest in the application of experimental design theories to population pharmacokinetic and pharmacodynamic experiments. Design of population pharmacokinetic experiments involves selection and a careful balance of a number of design factors. Optimal design theory uses prior information about the model and parameter estimates to optimize a function of the Fisher information matrix to obtain the best combination of the design factors. This paper provides a review of the different approaches that have been described in the literature for optimal design of population pharmacokinetic and pharmacodynamic experiments. It describes options that are available and highlights some of the issues that could be of concern as regards practical application. It also discusses areas of application of optimal design theories in clinical pharmacology experiments. It is expected that as the awareness about the benefits of this approach increases, more people will embrace it and ultimately will lead to more efficient population pharmacokinetic and pharmacodynamic experiments and can also help to reduce both cost and time during drug development. Copyright (c) 2008 John Wiley & Sons, Ltd.

  3. Associations Between Physician Empathy, Physician Characteristics, and Standardized Measures of Patient Experience.

    PubMed

    Chaitoff, Alexander; Sun, Bob; Windover, Amy; Bokar, Daniel; Featherall, Joseph; Rothberg, Michael B; Misra-Hebert, Anita D

    2017-10-01

    To identify correlates of physician empathy and determine whether physician empathy is related to standardized measures of patient experience. Demographic, professional, and empathy data were collected during 2013-2015 from Cleveland Clinic Health System physicians prior to participation in mandatory communication skills training. Empathy was assessed using the Jefferson Scale of Empathy. Data were also collected for seven measures (six provider communication items and overall provider rating) from the visit-specific and 12-month Consumer Assessment of Healthcare Providers and Systems Clinician and Group (CG-CAHPS) surveys. Associations between empathy and provider characteristics were assessed by linear regression, ANOVA, or a nonparametric equivalent. Significant predictors were included in a multivariable linear regression model. Correlations between empathy and CG-CAHPS scores were assessed using Spearman rank correlation coefficients. In bivariable analysis (n = 847 physicians), female sex (P < .001), specialty (P < .01), outpatient practice setting (P < .05), and DO degree (P < .05) were associated with higher empathy scores. In multivariable analysis, female sex (P < .001) and four specialties (obstetrics-gynecology, pediatrics, psychiatry, and thoracic surgery; all P < .05) were significantly associated with higher empathy scores. Of the seven CG-CAHPS measures, scores on five for the 583 physicians with visit-specific data and on three for the 277 physicians with 12-month data were positively correlated with empathy. Specialty and sex were independently associated with physician empathy. Empathy was correlated with higher scores on multiple CG-CAHPS items, suggesting improving physician empathy might play a role in improving patient experience.

  4. Students' Experiences of Clinic-Based Learning during a Final Year Veterinary Internship Programme

    ERIC Educational Resources Information Center

    Matthew, Susan M.; Taylor, Rosanne M.; Ellis, Robert A.

    2010-01-01

    This study investigated veterinary students' experiences of clinic-based learning (CBL) during a comprehensive final year internship programme. Open-ended surveys (n = 93) were used to gather qualitative data about students' conceptions of what is learned during CBL and their approaches to learning in clinics. Phenomenography was used for detailed…

  5. Neuroimaging of Brain Injuries and Disorders at Cleveland Clinic

    DTIC Science & Technology

    2013-12-01

    LFBFs) in the human brain during a state of alert rest. These spontaneous fluctuations are correlated in brain regions with a high degree of connectivity...behavioral performance on the finger tapping fMRI scan. One subject was excluded due to significantly different anatomy from the group (large ventricles...FSL 4.0 image processing software package (http://www.fmrib.ox.ac.uk/fsl/tbss/index.html) to create a mean white matter skeleton . Specifically, all

  6. An exploration of the clinical learning experience of nursing students in nine European countries.

    PubMed

    Warne, Tony; Johansson, Unn-Britt; Papastavrou, Evridiki; Tichelaar, Erna; Tomietto, Marco; Van den Bossche, Koen; Moreno, Maria Flores Vizcaya; Saarikoski, Mikko

    2010-11-01

    The overall aim of the study was to develop a composite and comparative view of what factors enhance the learning experiences of student nurses whilst they are in clinical practice. The study involved students undertaking general nurse training programmes in nine Western European countries. The study focused on: (1) student nurse experiences of clinical learning environments, (2) the supervision provided by qualified nurses in clinical placements, and (3) the level of interaction between student and nurse teachers. The study utilised a validated theoretical model: the Clinical Learning Environment, Supervision and Nurse Teacher (CLES+T) evaluation scale. The evaluation scale has a number of sub-dimensions: Pedagogical atmosphere on the ward; Supervisory Relationships; the Leadership Style of Ward Managers; Premises of Nursing; and the Role of the Nurse Teacher. Data (N=1903) was collected from Cyprus, Belgium, England, Finland, Ireland, Italy, Netherlands, Spain and Sweden using web-based questionnaire 2007-2008. The findings revealed that respondents were generally satisfied with their clinical placements. There was clear support for the mentorship approach; 57% of respondents had a successful mentorship experience although some 18% of respondents experienced unsuccessful supervision. The most satisfied students studied at a university college, and had at least a seven week clinical placement supported by individualised mentorship relationships. Learning to become a nurse is a multidimensional process that requires both significant time being spent working with patients and a supportive supervisory relationship. Copyright © 2010 Elsevier Ltd. All rights reserved.

  7. Health care provider experiences in primary care memory clinics: a phenomenological study.

    PubMed

    Sheiban, Linda; Stolee, Paul; McAiney, Carrie; Boscart, Veronique

    2018-05-19

    There is a growing need for community-based services for persons with Alzheimer's disease and related dementias (ADRD). Memory clinic (MC) teams in primary care settings have been established to provide care to people with ADRD. To consider wider adoption of these MC teams, insight is needed into the experiences of practitioners working in these models. The purpose of the current study is to explore the experiences of health care providers (HCPs) who work in primary care Memory Clinic (MC) teams to provide care to persons with Alzheimer's disease and related dementias (ADRD). This study utilized a phenomenological methodology to explore experiences of 12 HCPs in two primary care MCs. Semi-structured interviews were completed with each HCP. Interviews were recorded and transcribed verbatim. Colaizzi's steps for analyzing phenomenological data was utilized by the authors. Three themes emerged from the analysis to describe HCP experiences: supporting patients and family members during ADRD diagnosis and treatment, working in a team setting, and personal and professional rewards of caring for people with ADRD and their family members. Findings provide insight into current practices in primary care MCs and on the motivation of HCPs working with persons with ADRD.

  8. [Clinical Work Experience of Korean Immigrant Nurses in U.S. Hospitals].

    PubMed

    Seo, Kumsook; Kim, Miyoung

    2016-04-01

    The purpose of this qualitative study was to explore the meaning of the experience of Korean immigrant nurses working in US hospitals. Purposive sampling yielded 15 Korean immigrant nurses who had more than one year of clinical experience in US hospitals. Data were collected from March to August 2012 through in-depth interviews and thematic analysis was conducted using van Manen's hermeneutic phenomenological approach. The findings were classified into eight themes: 'struggling from staff at workplace being territorial to outsiders', 'feeling oppressed due to language barrier', 'accepting rational and horizontal relationships at work', 'staying alert in the environment where lawsuits are rife', 'feeling a sense of stability from the social system that values human dignity', 'maintaining self-confidence from prominent nursing practices and senior Korean nurses' professional reputation', 'performing essential comprehensive nursing care', 'promoting self-development to be equipped with professionalism.' The findings indicate that the Korean immigrant nurses were able to excel in their workplace when their clinical experience at US hospitals was combined with the lived space in US politics and environment, lived time of patience, lived body to be alert, and lived others with multi cultural characteristics.

  9. The patient as experience broker in clinical learning.

    PubMed

    Stockhausen, Lynette J

    2009-05-01

    A review of the literature reveals deficit information on patient's involvement in student's learning. The study presented in this paper investigates how the educationally unprepared patient engages with students and experienced clinicians to become involved in learning and teaching encounters. As a qualitative study 14 adult patients were interviewed to determine how they perceived experienced clinicians and students engage in learning and teaching moments and how the patient contributes to students learning to care. Revealed is a new and exciting dimension in learning and teaching in the clinical environment. Patients as experience brokers are positioned in a unique learning triad as they mediate and observe teaching and learning to care between students and experienced clinicians whilst also becoming participants in teaching to care. Further investigation is warranted to determine the multi-dimensional aspects of patients' involvement in student learning in various clinical environments. Future studies have the potential to represent a new educational perspective (andragogy).

  10. The clinical nurse leader in the perioperative setting: a preceptor experience.

    PubMed

    Wesolowski, Michael S; Casey, Gwendolyn L; Berry, Shirley J; Gannon, Jane

    2014-07-01

    The U.S. Veterans Administration (VA) has implemented the clinical nurse leader (CNL) role nationwide. Nursing leaders at the Malcolm Randall VA Medical Center in Gainesville, Florida, implemented the development of the CNL role in the perioperative setting during the summer of 2012. The perioperative department developed the position in partnership with the University of Florida College of Nursing, Gainesville, Florida. The team developed a description of the roles and experiences of the preceptors, the clinical nurse leader resident, and the University of Florida faculty member. The clinical nurse leader resident's successes and the positive outcomes, such as improved patient outcomes, experienced by the perioperative department demonstrated the importance of the CNL role. Published by Elsevier Inc.

  11. Undergraduate student nurses' lived experiences of anxiety during their first clinical practicum: A phenomenological study.

    PubMed

    Sun, Fan-Ko; Long, Ann; Tseng, Yun Shan; Huang, Hui-Man; You, Jia-Hui; Chiang, Chun-Ying

    2016-02-01

    The Fundamental Nursing clinical practicum is an essential module for nursing students. Some feel stress or anxiety about attending this first placement; however, evidence demonstrates that it is rare to explore the feelings of anxiety felt by the nursing students concerning their first clinical practicum. This study was designed to explore student nurses' experiences of anxiety felt regarding their initial clinical practicum while studying for their University degree. A phenomenological approach was used. A university in Southern Taiwan. A purposive sampling of fifteen student nurses with anxiety reactions who had completed their first clinical practicum. Data were collected using a semi-structured guide and deep interview. Data were analyzed using Colaizzi's seven-step phenomenological method. Three themes surfaced in the findings. The first theme was anxiety around their first clinical practicum, which stirred up anxiety about: self-doubt, worry and fear; difficulty coping with the learning process; worry hampered establishing therapeutic relationships with patients; the progress of the patients' illness could not be predicted; and anxiety felt about lecturer-student interactions. The second theme was three phases of anxiety reactions, which included increasing anxiety before clinical practicum; exacerbated anxiety during clinical practicum, and relief of anxiety after clinical practicum. The third theme was coping behaviors. This comprised: self-reflection in preparation for clinical practicum; finding ways to release emotions; distractions from the anxiety; and, also facing their difficulties head-on. The findings could help raise the awareness of lecturers and students by understanding student nurses' anxiety experiences and facilitating a healthy preparation for their initial clinical practicum, consequently proactively helping reduce potential anxiety experiences. Copyright © 2015 Elsevier Ltd. All rights reserved.

  12. The Lived Experience and Training Needs of Librarians Serving at the Clinical Point-of-Care

    PubMed Central

    Kuntz, Gretchen M.; Edwards, Mary E.; Butson, Linda C.; Auten, Beth

    2016-01-01

    This study examines the emotional experiences and perceptions of librarians embedded into clinical care teams and how those perceptions affect their training and preparation needs. Qualitative research methodologies were applied to textual data drawn from focus groups (n=21), interviews (n=2), and an online survey (n=167), supplemented by quantitative survey data. Phenomenological results show librarians experience strongly effective responses to clinical rounding. Important factors include personal confidence; relationships with team members, patients, and families; and the stressful environment. Analysis of librarians’ perceived educational needs indicates that training must address specialized subjects including medical knowledge, clinical culture, and institutional politics. PMID:26211792

  13. The Lived Experience and Training Needs of Librarians Serving at the Clinical Point-of-Care.

    PubMed

    Lyon, Jennifer A; Kuntz, Gretchen M; Edwards, Mary E; Butson, Linda C; Auten, Beth

    2015-01-01

    This study examines the emotional experiences and perceptions of librarians embedded into clinical care teams and how those perceptions affect their training and preparation needs. Qualitative research methodologies were applied to textual data drawn from focus groups (n = 21), interviews (n = 2), and an online survey (n = 167), supplemented by quantitative survey data. Phenomenological results show librarians experience strongly affective responses to clinical rounding. Important factors include personal confidence; relationships with team members, patients, and families; and the stressful environment. Analysis of librarians' perceived educational needs indicates that training must address specialized subjects including medical knowledge, clinical culture, and institutional politics.

  14. Plans and Recent Developments for Fluid Physics Experiments Aboard the ISS

    NASA Technical Reports Server (NTRS)

    McQuillen, John B.; Motil, Brian J.

    2016-01-01

    From the very first days of human spaceflight, NASA has been conducting experiments in space to understand the effect of weightlessness on physical and chemically reacting systems. NASA Glenn Research Center (GRC) in Cleveland, Ohio has been at the forefront of this research looking at both fundamental studies in microgravity as well as experiments targeted at reducing the risks to long duration human missions to the moon, Mars, and beyond. In the current International Space Station (ISS) era, we now have an orbiting laboratory that provides the highly desired condition of long-duration microgravity. This allows continuous and interactive research similar to Earth-based laboratories. Because of these capabilities, the ISS is an indispensable laboratory for low gravity research. NASA GRC has been actively involved in developing and operating facilities and experiments on the ISS since the beginning of a permanent human presence on November 2, 2000. As the lead Center for Fluid Physics, NASA GRC is developing and testing the Pack Bed Reactor Experiment (PBRE), Zero Boil Off (ZBOT) Two Phase Flow Separator Experiment (TPFSE), Multiphase Flow Heat Transfer (MFHT) Experiment and the Electro-HydroDynamic (EHD) experiment. An overview each experiment, including its objectives, concept and status will be presented. In addition, data will be made available after a nominal period to NASAs Physical Science Informatics PSI database to the scientific community to enable additional analyses of results.

  15. Dental Student Hand Hygiene Decreased With Increased Clinical Experience.

    PubMed

    Yaembut, Nanmanas; Ampornaramveth, Ruchanee S; Pisarnturakit, Pagaporn P; Subbalekha, Keskanya

    2016-01-01

    To investigate the effectiveness, related knowledge, attitudes, and practices of hand hygiene (HH) among dental students with different levels of clinical experience. This was a cross-sectional analytical study. Bacterial samples on the participants' hands were obtained using a swab technique before and after handwashing, for oral surgical procedures. After culturing, the colony-forming units were counted. Self-reported questionnaires reflecting the knowledge, attitudes, and practices related to HH were completed by the participants. This study was performed in a primary oral health care institution, Faculty of Dentistry, Chulalongkorn University (Bangkok, Thailand). Bacterial samples and self-reported questionnaires were collected in the Department of Oral and Maxillofacial Surgery. Bacterial culture was performed in the Department of Microbiology. The 120 participants comprised first, second, third-year clinical training students (CTs), and postgraduate dental students (PGs) (32, 34, 30, and 24 participants, respectively). More than 99% of the bacteria were eliminated from the participants' hands after handwashing. Significantly higher numbers of bacteria were recovered from the hands of the PGs compared with those of the CTs, and the hands of the third-year CTs compared with those of the first-year CTs (p < 0.001), after HH. The first-year CTs had the highest attitude scores, whereas the PGs had the lowest practice scores. The knowledge scores were similar in all groups. HH effectiveness, attitudes, and practices of dental students decreased as students gained more clinical experience, whereas knowledge did not. Our results suggest that HH instruction should be given throughout the duration of dental students' education. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  16. Developing more positive attitudes towards mental health nursing in undergraduate students: part 2--The impact of theory and clinical experience.

    PubMed

    Happell, B; Robins, A; Gough, K

    2008-09-01

    Previous research examining the impact of education on nursing students' attitudes towards mental health nursing as a career has highlighted clinical experience as the primary influencing factor and generally has not considered the impact of theory. The current study compared a cohort of second-year and a cohort of third-year nursing students from the same university. Second-year students had received more theory and clinical experience than their counterparts. Questionnaires were distributed to the total population of students before commencement of, and after completion of clinical placement. This paper examines students' perceived preparedness for and satisfaction with clinical experience, attitudes towards people with mental illness, and attitudes towards mental health nursing as a career option following the completion of differing amounts of theory and clinical experience. The results demonstrate some statistically significant differences with increased amounts of theory and clinical experience in the second-year cohort being positively influential. The findings suggest that an increased component of theoretical and clinical experience in psychiatric/mental health nursing is likely to produce more positive attitudes towards people with mental illness and psychiatric/mental health nursing. However, little difference in perceived preparedness for and satisfaction with clinical experience was noted between the two cohorts.

  17. NBME subject examination in surgery scores correlate with surgery clerkship clinical experience.

    PubMed

    Myers, Jonathan A; Vigneswaran, Yalini; Gabryszak, Beth; Fogg, Louis F; Francescatti, Amanda B; Golner, Christine; Bines, Steven D

    2014-01-01

    Most medical schools in the United States use the National Board of Medical Examiners Subject Examinations as a method of at least partial assessment of student performance, yet there is still uncertainty of how well these examination scores correlate with clinical proficiency. Thus, we investigated which factors in a surgery clerkship curriculum have a positive effect on academic achievement on the National Board of Medical Examiners Subject Examination in Surgery. A retrospective analysis of 83 third-year medical students at our institution with 4 unique clinical experiences on the general surgery clerkship for the 2007-2008 academic year was conducted. Records of the United States Medical Licensing Examination Step 1 scores, National Board of Medical Examiners Subject Examination in Surgery scores, and essay examination scores for the groups were compared using 1-way analysis of variance testing. Rush University Medical Center, Chicago IL, an academic institution and tertiary care center. Our data demonstrated National Board of Medical Examiners Subject Examination in Surgery scores from the group with the heavier clinical loads and least time for self-study were statistically higher than the group with lighter clinical services and higher rated self-study time (p = 0.036). However, there was no statistical difference of National Board of Medical Examiners Subject Examination in Surgery scores between the groups with equal clinical loads (p = 0.751). Students experiencing higher clinical volumes on surgical services, but less self-study time demonstrated statistically higher academic performance on objective evaluation, suggesting clinical experience may be of higher value than self-study and reading. Copyright © 2014 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  18. Trichomycosis (Trichobacteriosis): Clinical and Microbiological Experience with 56 Cases

    PubMed Central

    Bonifaz, Alexandro; Váquez-González, Denisse; Fierro, Leonel; Araiza, Javier; Ponce, Rosa María

    2013-01-01

    Background: Trichomycosis is asymptomatic bacterial infection of the axillary hairs caused by Corynebacterium sp. Objective: to bring a series of cases of trichomycosis, its clinical and microbiological experience. Materials and Methods: This report consists in a linear and observational retrospective study of 15 years of cases of trichomycosis confirmed clinically and microbiologically. Results: Fifty six confirmed cases of trichomycosis were included in this report. The majority were men 53/56 (94.6%), mean age was 32.5 years. The most commonly affected area was the axilla (92%), trichomycosis flava was the principal variant 55/56 (98.2%) and signs and symptoms associated were hyperhidrosis (87.5%), hairs’ texture change (57.1%) and odor (35.7%). Bacterial concretions were observed in all cases, and the predominant causative agent in 89.3% of all cases was Corynebacterium sp. Thirty patients were included in therapeutic portion of the study, and 28 (93.3%) of them experienced a clinical and microbiological cure. Conclusion: Trichomycosis is asymptomatic, superficial infection, which primarily affects axillary hairs. PMID:23960390

  19. Johnson Space Center Flight Medicine Clinic Experience

    NASA Technical Reports Server (NTRS)

    Landry, Trela

    2006-01-01

    Being a member of the Flight Medicine Clinic (FMC) Staff is a great experience. I joined the FMC staff 2 years ago when I became part of the Kelsey-Seybold team. The FMC staff consists of Flight Surgeons, Family Clinic Physician, Nursing staff, Wellness Coordinator and Support staff. We serve as the Primary Care Physicians for the astronauts and their families and provide annual physicals for the retired astronauts. We have approximately 800 patients in the FMC. As the Family Clinic Physician, I care for the astronaut spouses and children and provide annual physicals for the retired astronauts. Since we have a small patient population, we have the opportunity to spend increased personal time with our patients, which I enjoy. We have a pretty healthy patient population, who are very interested in their overall health and preventive care. In preparation for a shuttle launch, our nursing staff assists the flight surgeons with the astronaut physical exams, which occur 10 days prior to launch and again 3 days after their return. We also provide Primary Contact physicals for the families and guests, who will be in close contact with shuttle crew members. During these physicals, we provide education, emphasizing the importance of preventing the spread of communicable diseases to shuttle crew members. Being a part of the Space Medicine Program is an honor. To know that you contribute in some way to our nation s Space Program is very special. (This article was prepared by Dr. Trela Landry, M.D. for inclusion in a Kelsey-Seybold newsletter on 25 OCT 2006.)

  20. The significance of clinical experience on learning outcome from resuscitation training-a randomised controlled study.

    PubMed

    Jensen, Morten Lind; Lippert, Freddy; Hesselfeldt, Rasmus; Rasmussen, Maria Birkvad; Mogensen, Simon Skibsted; Jensen, Michael Kammer; Frost, Torben; Ringsted, Charlotte

    2009-02-01

    The impact of clinical experience on learning outcome from a resuscitation course has not been systematically investigated. To determine whether half a year of clinical experience before participation in an Advanced Life Support (ALS) course increases the immediate learning outcome and retention of learning. This was a prospective single blinded randomised controlled study of the learning outcome from a standard ALS course on a volunteer sample of the entire cohort of newly graduated doctors from Copenhagen University. The outcome measurement was ALS-competence assessed using a validated composite test including assessment of skills and knowledge. The intervention was half a year of clinical work before an ALS course. The intervention group received the course after a half-year of clinical experience. The control group participated in an ALS course immediately following graduation. Invitation to participate was accepted by 154/240 (64%) graduates and 117/154 (76%) completed the study. There was no difference between the intervention and control groups with regard to the immediate learning outcome. The intervention group had significantly higher retention of learning compared to the control group, intervention group mean 82% (CI 80-83), control group mean 78% (CI 76-80), P=0.002. The magnitude of this difference was medium (effect size=0.57). Half a year of clinical experience, before participation in an ALS course had a small but statistically significant impact on the retention of learning, but not on the immediate learning outcome.

  1. Confirmatory Factor Analysis of Scores on the Clinical Experience Rubric: A Measure of Dispositions for Preservice Teachers

    ERIC Educational Resources Information Center

    Flowers, Claudia

    2006-01-01

    This study examines the underlying structure of the Clinical Experience Rubric (CER), which is designed to assess preservice teachers' dispositions during the clinical experiences. Dispositions were conceptualized as being a multidimensional construct with three related factors: (a) professionalism, (b) teaching quality, and (c) relationship with…

  2. Nursing students' experiences of and satisfaction with the clinical learning environment: the role of educational models in the simulation laboratory and in clinical practice.

    PubMed

    Cremonini, Valeria; Ferri, Paola; Artioli, Giovanna; Sarli, Leopoldo; Piccioni, Enrico; Rubbi, Ivan

    2015-01-01

    Student satisfaction is an important element of the effectiveness of clinical placement, but there is little consensus in the literature as to the preferred model of clinical experience for undergraduate nursing students. The aim of this study was assess, for each academic year, students' perception of the roles of nurse teachers (NT) and clinical nurse supervisors (CNS) who perform tutoring in both apprenticeship and laboratories and to identify and evaluate students' satisfaction with the environment of clinical learning. This analytic cross-sectional study was conducted in a sample of 173 nursing students in the Northern Italy. The research instrument used is the Clinical learning environment, supervision and nurse teacher (CLES+T) evaluation scale. Data were statistically analysed. 94% of our sample answered questionnaires. Students expressed a higher level of satisfaction with their training experiences. The highest mean value was in the sub-dimension "Pedagogical atmosphere on the ward". Third year students expressed higher satisfaction levels in their relationship with the CNS and lower satisfaction levels in their relationship with the NT. This result may be due to the educational model that is adopted in the course, in which the simulation laboratory didactic activities of the third year are conducted by CNS, who also supervises experiences of clinical learning in the clinical practice. The main finding in this study was that the students' satisfaction with the supervisory relationship and the role of NT depend on how supervision in the clinical practice and in the simulation laboratory is organized.

  3. Using experience sampling methods/ecological momentary assessment (ESM/EMA) in clinical assessment and clinical research: introduction to the special section.

    PubMed

    Trull, Timothy J; Ebner-Priemer, Ulrich W

    2009-12-01

    This article introduces the special section on experience sampling methods and ecological momentary assessment in clinical assessment. We review the conceptual basis for experience sampling methods (ESM; Csikszentmihalyi & Larson, 1987) and ecological momentary assessment (EMA; Stone & Shiffman, 1994). Next, we highlight several advantageous features of ESM/EMA as applied to psychological assessment and clinical research. We provide a brief overview of the articles in this special section, each of which focuses on 1 of the following major classes of psychological disorders: mood disorders and mood dysregulation (Ebner-Priemer & Trull, 2009), anxiety disorders (Alpers, 2009), substance use disorders (Shiffman, 2009), and psychosis (Oorschot, Kwapil, Delespaul, & Myin-Germeys, 2009). Finally, we discuss prospects, future challenges, and limitations of ESM/EMA.

  4. Impact of Nursing Students' Free-Clinic Experiences on Subsequent Professional Nursing Practice

    ERIC Educational Resources Information Center

    Bell, Christina Lynn

    2017-01-01

    Bachelors of Science Nursing students at a small liberal arts college in the upper Midwest volunteer with an instructor at a free clinic as part of their curriculum. This study's purpose was to identify the impact of nursing students' free-clinic experiences on their subsequent professional nursing practice and their ability to attend to: (a)…

  5. Evaluation of the impact of resident work hour restrictions on resident outpatient clinical experience.

    PubMed

    Patel, Shweta V; Driggers, Rita W; Zahn, Christopher M

    2011-01-01

    To estimate the effect of work hour restrictions on resident outpatient clinical experience. Schedule templates from academic years 1998-1999 (before work hour restrictions), 2002-2003 (when night float rotation was added in anticipation of work hour restrictions), and 2008-2009 (during work hour restrictions) were compared for outpatient clinic experience before and after work hour restrictions were implemented. Actual clinics on specific rotations and estimated patient encounters per scheduled clinic were considered. Between academic year (AY) 1998-1999 and AY 2008-2009 there was a generalized downward trend in average outpatient encounters for postgraduate year (PGY)-2, PGY-3 and PGY-4 residents (45%, 34% and 36%, respectively). For obstetrics, gynecology and ambulatory rotations, there was a downward trend in average outpatient encounters for each rotation type (61%, 14% and 63%, respectively). The average number of scheduled clinics per week was slightly decreased when comparing AY 1998-1999 to either AY 2002-2003 or AY 2008-2009. Rotation schedules before and after work hour restrictions demonstrated a downward trend in the number of scheduled outpatient encounters. These findings indicate a potential negative impact on preparation for clinical practice.

  6. Resident Evaluation of a Required Telepsychiatry Clinical Experience.

    PubMed

    Teshima, John; Hodgins, Michael; Boydell, Katherine M; Pignatiello, Antonio

    2016-04-01

    The authors explored resident experiences of telepsychiatry clinical training. This paper describes an analysis of evaluation forms completed by psychiatry residents following a required training experience in telepsychiatry. Retrospective numeric and narrative data were collected from 2005 to 2012. Using a five-point Likert-type scale (1 = strongly disagree and 5 = strongly agree), residents ranked the session based on the following characteristics: the overall experience, interest in participating in telepsychiatry in the future, understanding service provision to underserved areas, telepsychiatry as mode of service delivery, and the unique aspects of telepsychiatry work. The authors also conducted a content analysis of narrative comments in response to open-ended questions about the positive and negative aspects of the training experience. In all, 88% of residents completed (n = 335) an anonymous evaluation following their participation in telepsychiatry consultation sessions. Numeric results were mostly positive and indicated that the experience was interesting and enjoyable, enhanced interest in participating in telepsychiatry in the future, and increased understanding of providing psychiatric services to underserved communities. Narrative data demonstrated that the most valuable aspects of training included the knowledge acquired in terms of establishing rapport and engaging with patients, using the technology, working collaboratively, identifying different approaches used, and awareness of the complexity of cases. Resident desire for more training of this nature was prevalent, specifically a wish for more detail, additional time for discussion and debriefing, and further explanation of the unique aspects of telepsychiatry as mode of delivery. More evaluation of telepsychiatry training, elective or required, is needed. The context of this training offered potential side benefits of learning about interprofessional and collaborative care for the

  7. Peer Experiences of Anxious and Socially Withdrawn Youth: An Integrative Review of the Developmental and Clinical Literature

    ERIC Educational Resources Information Center

    Kingery, Julie Newman; Erdley, Cynthia A.; Marshall, Katherine C.; Whitaker, Kyle G.; Reuter, Tyson R.

    2010-01-01

    Prior research indicates that both anxious youth and socially withdrawn youth tend to experience challenges and difficulties in various aspects of their peer relationships and social functioning. While clinical psychology researchers have examined how anxiety relates to peer experiences using normative and clinically anxious samples, developmental…

  8. Does recruitment lead to retention? Rural Clinical School training experiences and subsequent intern choices.

    PubMed

    Eley, D; Baker, P

    2006-01-01

    The Australian Rural Clinical Schools, established nationally in 2000-2001, have provided an opportunity for medical students to undertake their clinical training across a network of hospitals, general practice surgeries and community medical centres in locations throughout Australia. The Rural Clinical School at the University of Queensland was established in 2002, as the Rural Clinical Division (RCD) of the School of Medicine, which provides a four-year graduate MB BS program. Students may elect to train in their 3rd and/or 4th year in one of three clinical divisions, namely Central, Southern (both based in Brisbane) or Rural which comprises teaching sites in south west Queensland and central Queensland region. Training must be of an equivalent nature throughout these three divisions, because students all sit the same examinations. Rigorous evaluation of the RCD teaching program underpins the goals of continuing improvement of both education and resources, and is also a key component of the reporting mechanisms linked to ongoing Commonwealth funding. Students' perception of their medical education at the RCD is the major focus of such evaluations in order to assist both educational improvement and required student recruitment. With this in mind, a questionnaire, the 'Year 4 Exit Survey' was developed to evaluate medical student perceptions of their 4th year experience at the RCD. Coupled to this was an analysis of internship choices to evaluate the important related issue of medical graduate retention. The increasing popularity of the RCD has prompted further investigation into the intern placement choice by these students. The provision of a positive medical education experience in a Rural Clinical School might be expected to influence this intern choice to favour a rural location. This preliminary report provides the results of the evaluations by one cohort of year 4 students and explores the relationship between rural undergraduate medical training experiences

  9. Maternity groups in the postpartum period at well child clinics - mothers' experiences.

    PubMed

    Glavin, Kari; Tveiten, Sidsel; Økland, Toril; Hjälmhult, Esther

    2017-10-01

    To explore mothers' experiences as participants in maternity groups at well child clinics (WCCs). The level of psychological distress that new mothers have may be related to the quantity of social support they receive. Maternity groups to support new parents have a long tradition at WCCs in Norway, and most of the clinics have offered these groups. However, there is little knowledge about mothers' experiences of participating in these groups. Qualitative design. Focus group interviews with mothers who had participated in maternity groups facilitated by public health nurses (PHNs) at WCCs. Interpretive description was used to analyse the transcripts from the interviews. Eight focus group interviews were conducted with a total of 30 mothers who had participated in maternity groups at WCCs in two counties in eastern Norway. The analysis resulted in one main category, 'The maternity group's salutogenic importance' and three subcategories, 'Networks that can last for many years', 'Fellowship with others in the same situation' and 'Become confident in mothering'. Mothers wanted fellowship and found it important to share experiences with other mothers. Maternity groups offered to parents are essential to meet parents' need to discuss experiences and challenges related to parenting. Maternity groups can also create a basis for establishing a social network for those who want it. Well child clinics should offer all mothers the opportunity to participate in groups to strengthen their social relations and their confidence in parenting. PHNs play an important role in facilitating groups for first-time parents. Group leadership can influence how mothers in a group connect and whether the parental role is affected. © 2016 John Wiley & Sons Ltd.

  10. Key Issues in an International Clinical Experience for Graduate Students in Education: Implications for Policy and Practice

    ERIC Educational Resources Information Center

    Gaudino, Ann C.; Moss, David M.; Wilson, Eleanor V.

    2012-01-01

    This study examines international clinical experiences in England with graduate education students from The University of Connecticut (UConn) and The University of Virginia (UVA) in the United States of America. Limited research available about international clinical experiences in the field of Education focuses primarily to only describe programs…

  11. Clinical outcomes of stapled transanal rectal resection (STARR) for obstructed defecation syndrome (ODS): a single institution experience in South Korea.

    PubMed

    Song, Kee Ho; Lee, Du Seok; Shin, Jong Keun; Lee, So Jin; Lee, Jae Bum; Yook, Eui Gon; Lee, Doo Han; Kim, Do Sun

    2011-06-01

    The purpose of this study was to assess both the short- and long-term functional outcomes of stapled transanal rectal resection (STARR) in ODS patients. We performed a retrospective review of data that were collected from January 2005 to October 2008. Between January 2005 to June 2006, 58 patients who underwent STARR were enrolled in this study. Follow-up was scheduled for 3 months and 1 year after surgery with the Cleveland Clinic Florida (CCF) constipation score and satisfaction grade. To evaluate the long-term functional outcome, we interviewed the patients by telephone using questionnaires for the CCF score and satisfaction grade on October 2008. The median follow-up period was 34 months (range, 27-46 months). The mean age and sex ratio were 54 years (range, 19-85 years) and 8:50 (M/F). The mean CCF constipation scores were 17.6 before the surgery, 9.5 at 3 months, 9.6 at 12 months, and 10.3 at the time of the latest interview. The satisfaction grade, which was rated as excellent and good by 63.4% of the patients at the time of the latest interview, was worse than that at 3 months (37.8%). Among the cases of the excellent group (19 cases) at postoperative 3 months, 13 cases (68.4%) were classified as excellent or good at the time of the latest interview. The STARR is a safe and effective surgical procedure for restoring the anatomy and function in ODS patients. Strict selection of patients is needed in enhancing and maintaining the patients' satisfaction after the procedure.

  12. Nursing faculty teaching a module in clinical skills to medical students: a Lebanese experience.

    PubMed

    Abdallah, Bahia; Irani, Jihad; Sailian, Silva Dakessian; Gebran, Vicky George; Rizk, Ursula

    2014-01-01

    Nursing faculty teaching medical students a module in clinical skills is a relatively new trend. Collaboration in education among medical and nursing professions can improve students' performance in clinical skills and consequently positively impact the quality of care delivery. In 2011, the Faculty of Medicine in collaboration with the Faculty of Health Sciences at the University of Balamand, Beirut, Lebanon, launched a module in clinical skills as part of clinical skills teaching to first-year medical students. The module is prepared and delivered by nursing faculty in a laboratory setting. It consists of informative lectures as well as hands-on clinical practice. The clinical competencies taught are hand-washing, medication administration, intravenous initiation and removal, and nasogastric tube insertion and removal. Around sixty-five medical students attend this module every year. A Likert scale-based questionnaire is used to evaluate their experience. Medical students agree that the module provides adequate opportunities to enhance clinical skills and knowledge and favor cross-professional education between nursing and medical disciplines. Most of the respondents report that this experience prepares them better for clinical rotations while increasing their confidence and decreasing anxiety level. Medical students highly appreciate the nursing faculties' expertise and perceive them as knowledgeable and resourceful. Nursing faculty participating in medical students' skills teaching is well perceived, has a positive impact, and shows nurses are proficient teachers to medical students. Cross professional education is an attractive model when it comes to teaching clinical skills in medical school.

  13. Structured learning and self-reflection: strategies to decrease anxiety in the psychiatric mental health clinical nursing experience.

    PubMed

    Ganzer, Christine Anne; Zauderer, Cheryl

    2013-01-01

    The purpose of this qualitative study was to test a teaching-learning strategy to help nursing students decrease stress and anxiety that may be brought about by the psychiatric mental health clinical experience. Undergraduate nursing students are known to experience affective stress prior to their first psychiatric mental health clinical practicum. A stressful learning environment can affect the success of the student's clinical performance. Thirty nursing students participated in this study. A structured preclinical workshop combined with self-reflection provided insight into students' perceptions of the psychiatric mental health clinical experience. Overall, students reported that participating in the teaching-learning strategy and self-reflection helped mitigate Combining structured learning with self-reflection is a useful tool for helping nursing students increase self-awareness and ease anxiety that may interfere with learning.

  14. Junior physicians' workplace experiences in clinical fields in German-speaking Switzerland.

    PubMed

    Buddeberg-Fischer, Barbara; Klaghofer, Richard; Abel, Thomas; Buddeberg, Claus

    2005-01-08

    To date, there have been several prospective cohort studies investigating the workplace experiences of junior physicians, but with limited focus on gender issues. The objective of the present study is to explore the workplace experiences of first-year residents according to gender, type of training hospital, and clinical field. Data reported are from the second assessment of the longitudinal Swiss physicians' career development study, begun in 2001. In 2003, 497 residents (54.7% females, 45.3% males) assessed their workplace conditions, social support at work, and effort-reward imbalance. There are few, but relevant, gender related differences in workplace experiences, with female physicians experiencing less mentoring and higher over-commitment, yet more positive social relationships at work. In a multivariate model, significant differences in some workplace variables with regard to type of training hospital and/or clinical field are found: workplace conditions are rated worse in type "A" hospitals (university and cantonal hospitals) than in type "B"/"C"/"D" hospitals (regional hospitals and highly specialised units), and in surgical fields than in internal medicine. In "A" hospitals mentoring is assessed as better, but positive social relationships as worse. Both scales are rated worse in surgical fields than in internal medicine. The effort-reward imbalance (ERI) is rated significantly higher (unfavourable) in "A" hospitals than in "B"/"C"/"D" hospitals, regardless of gender and clinical field. Significantly more subjects with an ERI quotient above 1 (which is unfavourable) work in "A" hospitals, and in surgical fields regardless of hospital type. Of the total sample, 81 subjects (16.3%), 41 males and 40 females, show an ERI quotient above 1. The greater the workload, the worse the rating of workplace conditions, effort-reward imbalance, and over-commitment. Institutional determinants are crucial factors for the workplace experiences and first career steps of

  15. Does clinical supervision of healthcare professionals improve effectiveness of care and patient experience? A systematic review.

    PubMed

    Snowdon, David A; Leggat, Sandra G; Taylor, Nicholas F

    2017-11-28

    To ensure quality of care delivery clinical supervision has been implemented in health services. While clinical supervision of health professionals has been shown to improve patient safety, its effect on other dimensions of quality of care is unknown. The purpose of this systematic review is to determine whether clinical supervision of health professionals improves effectiveness of care and patient experience. Databases MEDLINE, PsychINFO, CINAHL, EMBASE and AMED were searched from earliest date available. Additional studies were identified by searching of reference lists and citation tracking. Two reviewers independently applied inclusion and exclusion criteria. The quality of each study was rated using the Medical Education Research Study Quality Instrument. Data were extracted on effectiveness of care (process of care and patient health outcomes) and patient experience. Seventeen studies across multiple health professions (medical (n = 4), nursing (n = 7), allied health (n = 2) and combination of nursing, medical and/or allied health (n = 4)) met the inclusion criteria. The clinical heterogeneity of the included studies precluded meta-analysis. Twelve of 14 studies investigating 38,483 episodes of care found that clinical supervision improved the process of care. This effect was most predominant in cardiopulmonary resuscitation and African health settings. Three of six studies investigating 1756 patients found that clinical supervision improved patient health outcomes, namely neurological recovery post cardiopulmonary resuscitation (n = 1) and psychological symptom severity (n = 2). None of three studies investigating 1856 patients found that clinical supervision had an effect on patient experience. Clinical supervision of health professionals is associated with effectiveness of care. The review found significant improvement in the process of care that may improve compliance with processes that are associated with enhanced patient health

  16. Use of Tablet Computers to Promote Physical Therapy Students' Engagement in Knowledge Translation During Clinical Experiences.

    PubMed

    Tilson, Julie K; Loeb, Kathryn; Barbosa, Sabrina; Jiang, Fei; Lee, Karin T

    2016-04-01

    Physical therapists strive to integrate research into daily practice. The tablet computer is a potentially transformational tool for accessing information within the clinical practice environment. The purpose of this study was to measure and describe patterns of tablet computer use among physical therapy students during clinical rotation experiences. Doctor of physical therapy students (n = 13 users) tracked their use of tablet computers (iPad), loaded with commercially available apps, during 16 clinical experiences (6-16 weeks in duration). The tablets were used on 70% of 691 clinic days, averaging 1.3 uses per day. Information seeking represented 48% of uses; 33% of those were foreground searches for research articles and syntheses and 66% were for background medical information. Other common uses included patient education (19%), medical record documentation (13%), and professional communication (9%). The most frequently used app was Safari, the preloaded web browser (representing 281 [36.5%] incidents of use). Users accessed 56 total apps to support clinical practice. Physical therapy students successfully integrated use of a tablet computer into their clinical experiences including regular activities of information seeking. Our findings suggest that the tablet computer represents a potentially transformational tool for promoting knowledge translation in the clinical practice environment.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A127).

  17. Changes in patient satisfaction related to hospital renovation: experience with a new clinical building.

    PubMed

    Siddiqui, Zishan K; Zuccarelli, Rebecca; Durkin, Nowella; Wu, Albert W; Brotman, Daniel J

    2015-03-01

    There is an increasing trend toward designing hospitals with patient-centered features like reduced noise, improved natural light, visitor friendly facilities, well-decorated rooms, and hotel-like amenities. It has also been suggested that because patients cannot reliably distinguish positive experiences with the physical environment from positive experience with care, an improved hospital environment leads to higher satisfaction with physicians, nursing, food service, housekeeping, and higher overall satisfaction. To characterize changes in patient satisfaction that occurred when clinical services (comprised of stable nursing, physician, and unit teams) were relocated to a new clinical building with patient-centered features. We hypothesized that new building features would positively impact provider, ancillary staff, and overall satisfaction, as well as improved satisfaction with the facility. Natural experiment utilizing a pre-post design with concurrent controls. Academic tertiary care hospital. We included all patients discharged from 12 clinical units that relocated to the new clinical building who returned surveys in the 7.5-month period following the move. Premove baseline data were captured from the year prior to the move. Patients on unmoved clinical units who returned satisfaction surveys served as concurrent controls. Patient-centered design features incorporated into the new clinical building. All patients during the baseline period and control patients during the study period were located in usual patient rooms with standard hospital amenities. The primary outcome was satisfaction scores on the Press Ganey and Hospital Consumer Assessment of Healthcare Providers and Systems survey, dichotomized at highest category versus lower categories. We performed logistic regression to identify predictors of "top-box" scores. The move was associated with improved room- and visitor-related satisfaction without significant improvement in satisfaction with clinical

  18. Moderate hypothermia technique for chronic implantation of a total artificial heart in calves.

    PubMed

    Karimov, Jamshid H; Grady, Patrick; Sinkewich, Martin; Sunagawa, Gengo; Dessoffy, Raymond; Byram, Nicole; Moazami, Nader; Fukamachi, Kiyotaka

    2017-06-01

    The benefit of whole-body hypothermia in preventing ischemic injury during cardiac surgical operations is well documented. However, application of hypothermia during in vivo total artificial heart implantation has not become widespread because of limited understanding of the proper techniques and restrictions implied by constitutional and physiological characteristics specific to each animal model. Similarly, the literature on hypothermic set-up in total artificial heart implantation has also been limited. Herein we present our experience using hypothermia in bovine models implanted with the Cleveland Clinic continuous-flow total artificial heart.

  19. Assessment of percutaneous renal access skills during Urology Objective Structured Clinical Examinations (OSCE)

    PubMed Central

    Noureldin, Yasser A.; Elkoushy, Mohamed A.; Andonian, Sero

    2015-01-01

    Introduction: The first objective was to assess percutaneous renal access (PCA) skills of urology postgraduate trainees (PGTs) during the Objective Structured Clinical Examinations (OSCEs). The second objective was to determine whether previous experience with percutaneous nephrolithotomy (PCNL) improved performance. Methods: After obtaining ethics approval, we recruited PGTs from two urology programs in Quebec between postgraduate years (PGY-3 to PGY-5). Each trainee was asked to answer a short questionnaire regarding previous experience in endourologic procedures. After a 3-minute orientation on the PERC Mentor simulator (Simbionix, Cleveland, OH), each trainee was asked to perform task 4, where they had to correctly access all of the renal calyces and pop the balloons in a normal left kidney model. We collected and analyzed data from the questionnaire and the performance report generated by the simulator. Results: In total, 13 PGTs participated in this study. PGTs had performed a median of 200 (range: 50–1000) cystoscopies, 50 (range: 10–125) TURBTs, 30 (range: 0–100) TURPs, 5 (range: 0–50) laser prostatectomies, and 50 (range: 2–125) ureteroscopies prior to this OSCE. PGTs with previous PCNL experience (8/13) had performed a mean of 18.6 ± 6.3 PCNLs. PGTs with previous PCNL experience performed significantly better in terms of shorter fluoroscopy time (10 ± 1.5 vs. 5.1 ± 0.7 min; p = 0.04), fewer attempts required for successful puncture of the pelvi-calyceal system (PCS) (21 ± 2.3 vs. 13 ± 1.8; p = 0.02), and had significantly lower complications in terms of fewer infundibular injury (7.4 ± 1.5 vs. 2 ± 0.4; p = 0.004) and fewer PCS perforations (11 ± 1.7 vs. 4.5 ± 1.2; p = 0.01). Conclusion: It is feasible to use the PERC Mentor simulator during OSCEs to assess PCA skills of urology PGTs. PGTs who had previous PCNL experience performed significantly better with fewer complications. PMID:25844094

  20. Nurses' Lived Experience of Working with Nursing Students in Clinical Wards: a Phenomenological Study

    PubMed Central

    Parvan, Kobra; Shahbazi, Shahla; Ebrahimi, Hossein; Valizadeh, Susan; Rahmani, Azad; Jabbarzadeh Tabrizi, Faranak; Esmaili, Fariba

    2018-01-01

    Introduction: Despite being aware of the importance of nurses’ role in providing clinical training to nursing students, studies show that sufficient research has not yet been conducted on the experience of clinical nurses who are engaged in training nursing students outside their normal working hours. The present study aim to describe the experience of these nurses who are training outside their routine working hours. Methods: This study was conducted using descriptive-phenomenology method. Twelve nurses was participated in this research. Data were collected using purposive sampling method and face to face interviews based on nurses’ real life experience of students’ learning in clinical settings through answering open-ended questions. Spiegel burg analysis method was used to analyze the data. Results: The result of data analysis was the derivation of four themes and eight sub-themes. Themes included "nurses as teaching sources", "changes in the balance of doing routine tasks", "professional enthusiasm", and "nurses as students' professional socialization source of inspiration". Sub-themes included "efficient education", "poor education", "support", "interference in the role," "self-efficacy development", "inner satisfaction", "positive imaging" and "being a model". Conclusion: It is necessary that academic centers plan for teaching nurses working on a contractual basis in the field of the evaluation method and various methods of teaching. The findings also suggested the development of individual self-efficacy in clinical nurses who train students. PMID:29637056

  1. Breaking significant news: The experience of clinical nurse specialists in cancer and palliative care.

    PubMed

    Mishelmovich, Nina; Arber, Anne; Odelius, Anki

    2016-04-01

    The aim of the research was to explore specialist cancer and palliative care nurses experience of delivering significant news to patients with advanced cancer. A qualitative phenomenological research study was conducted to capture nurses' experiences with the aim of understanding how cancer and palliative care clinical nurse specialists work towards disclosure of advanced and terminal cancer. Data were collected through semi-structured interviews with 10 clinical nurse specialists working in one acute NHS trust. Clinical nurse specialists were recruited from the following specialities: lung cancer, breast cancer, gynaecological cancer, upper and lower gastrointestinal cancer and palliative care. Four themes emerged from the data: importance of relationships; perspective taking; ways to break significant news; feeling prepared and putting yourself forward. The findings revealed that highly experienced clinical nurse specialists (CNSs) felt confident in their skills in delivering significant news and they report using patient centred communication to build a trusting relationship so significant news was easier to share with patients. CNSs were aware of guidelines and protocols for breaking significant and bad news but reported that they used guidelines flexibly and it was their years of clinical experience that enabled them to be effective in disclosing significant news. Some areas of disclosure were found to be challenging in particular news of a terminal prognosis to patients who were of a younger age. CNSs have become more directly involved in breaking significant news to those with advanced cancer by putting themselves forward and feeling confident in their skills. Copyright © 2015 Elsevier Ltd. All rights reserved.

  2. The relationship between voice climate and patients’ experience of timely care in primary care clinics

    PubMed Central

    Nembhard, Ingrid M.; Yuan, Christina T.; Shabanova, Veronika; Cleary, Paul D.

    2017-01-01

    Background Aspects of the patient care experience, despite being central to quality care, are often problematic. In particular, patients frequently report problems with timeliness of care. As yet, research offers little insight on setting characteristics that contribute to patients’ experience of timely care. Purpose The aims of this study were to assess the relationship between organizational climate and patients’ reports of timely care in primary care clinics and to broadly examine the link between staff’s work environment and patient care experiences. We test hypotheses about the relationship between voice climate—staff feeling safe to speak up about issues—and reported timeliness of care, consistency in reported voice climate across professions, and how climate differences for various professions relate to timely care. Methodology We conducted a cross-sectional study of employees (n = 1,121) and patients (n = 8,164) affiliated with 37 clinics participating in a statewide reporting initiative. Employees were surveyed about clinics’ voice climate, and patients were surveyed about the timeliness of care. Hypotheses were tested using analysis of variance and generalized estimating equations. Findings Clinical and administrative staff (e.g., nurses and office assistants) reported clinics’ climates to be significantly less supportive of voice than did clinical leaders (e.g., physicians). The greater the difference in reported support for voice between professional groups, the less patients reported experiencing timely care in three respects: obtaining an appointment, seeing the doctor within 15 minutes of appointment time, and receiving test results. In clinics where staff reported climates supportive of voice, patients indicated receiving more timely care. Clinical leaders’ reports of voice climate had no relationship to reported timeliness of care. Practical Implications Our findings suggest the importance of clinics developing a strong climate for

  3. Use of Tablet Computers to Promote Physical Therapy Students' Engagement in Knowledge Translation During Clinical Experiences

    PubMed Central

    Loeb, Kathryn; Barbosa, Sabrina; Jiang, Fei; Lee, Karin T.

    2016-01-01

    Background and Purpose: Physical therapists strive to integrate research into daily practice. The tablet computer is a potentially transformational tool for accessing information within the clinical practice environment. The purpose of this study was to measure and describe patterns of tablet computer use among physical therapy students during clinical rotation experiences. Methods: Doctor of physical therapy students (n = 13 users) tracked their use of tablet computers (iPad), loaded with commercially available apps, during 16 clinical experiences (6-16 weeks in duration). Results: The tablets were used on 70% of 691 clinic days, averaging 1.3 uses per day. Information seeking represented 48% of uses; 33% of those were foreground searches for research articles and syntheses and 66% were for background medical information. Other common uses included patient education (19%), medical record documentation (13%), and professional communication (9%). The most frequently used app was Safari, the preloaded web browser (representing 281 [36.5%] incidents of use). Users accessed 56 total apps to support clinical practice. Discussion and Conclusions: Physical therapy students successfully integrated use of a tablet computer into their clinical experiences including regular activities of information seeking. Our findings suggest that the tablet computer represents a potentially transformational tool for promoting knowledge translation in the clinical practice environment. Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A127). PMID:26945431

  4. Relationships of perceived public stigma of mental illness and psychosis-like experiences in a non-clinical population sample.

    PubMed

    Lien, Yin-Ju; Kao, Yu-Chen; Liu, Yia-Ping; Chang, Hsin-An; Tzeng, Nian-Sheng; Lu, Chien-Wen; Lin, Shwu-Jon; Loh, Ching-Hui

    2015-02-01

    Studies on the association between psychopathology, perceived public stigma, and labeling in mental illness have focused primarily on severe but rare mental disorders, especially schizophrenia, or other clinically defined psychotic disorders. Although evidence is mounting that psychosis-like experiences show high prevalence in the general population and lead to an increased risk of psychotic disorders, little is known about how psychosis-like experiences independently affect perceived public stigma in the non-clinical population. The aim of the present study was to examine the relationship between psychosis-like experiences and perceived public stigma in a non-clinical sample. For this cross-sectional study, we recruited 524 individuals (239 male, 285 female) who had no lifetime history of psychiatric disorder. Participants completed questionnaires that asked for sociodemographic and clinical information, a measure of perceived public stigma (Perceived Psychiatric Stigma Scale [PPSS]), and two measures of psychosis-like experiences (Peters et al. Delusions Inventory [PDI]; Cardiff Anomalous Perceptions Scale [CAPS]). Of the sociodemographic characteristics analyzed in this study-gender, age, education level, marital status, and religion-only age simultaneously influenced PPSS, PDI, and CAPS scores. As hypothesized, perceived public stigma was positively correlated with measures of psychosis-like experiences, even after controlling for age. Furthermore, the perceived stigma was more strongly associated with delusion proneness than with anomalous perceptual experiences. The association between psychopathology and perceived public stigma appears to extend beyond clinically defined psychosis to more common psychosis-like experiences in a sample drawn from the general Han Chinese population.

  5. Comprehensive experiment-clinical biochemistry: determination of blood glucose and triglycerides in normal and diabetic rats.

    PubMed

    Jiao, Li; Xiujuan, Shi; Juan, Wang; Song, Jia; Lei, Xu; Guotong, Xu; Lixia, Lu

    2015-01-01

    For second year medical students, we redesigned an original laboratory experiment and developed a combined research-teaching clinical biochemistry experiment. Using an established diabetic rat model to detect blood glucose and triglycerides, the students participate in the entire experimental process, which is not normally experienced during a standard clinical biochemistry exercise. The students are not only exposed to techniques and equipment but are also inspired to think more about the biochemical mechanisms of diseases. When linked with lecture topics about the metabolism of carbohydrates and lipids, the students obtain a better understanding of the relevance of abnormal metabolism in relation to diseases. Such understanding provides a solid foundation for the medical students' future research and for other clinical applications. © 2014 Biochemistry and Molecular Biology Education.

  6. Impact of the University of Colorado's Advanced Clinical Training and Service (ACTS) Program on dental students' clinical experience and cognitive skills, 1994-2006.

    PubMed

    Berg, Rob; Call, Richard L; Maguire, Kerry; Berkey, Douglas B; Karshmer, Bernard A; Guyton, Brad; Tawara-Jones, Karen

    2010-04-01

    The University of Colorado Denver School of Dental Medicine has operated a community-based dental education program for all of its students since 1985. A database of student productivity has been maintained in a standardized format, capable of multiyear compilation, since 1994. This study utilizes twelve years of these data to profile the type and amount of clinical treatment that can be provided by a typical fourth-year dental student during a 100-day community-based training experience. Between 1994 and 2006, the school's 423 graduates provided a mean of 922 treatment procedures per student at a mean of 498 patient visits per student. During a typical four-week clinical affiliation, each student provided a mean of approximately twenty-seven restorations on permanent teeth, sixteen restorations on primary teeth, and twenty-four oral surgery procedures (extractions). Students also gained considerable experience in periodontics, fixed and removable prosthodontics, and endodontics. Self-assessed competency ratings tended to increase after completing the program, as did willingness to treat underserved populations after graduation. About 16 percent of graduates reported planning to practice in the public sector after completing dental school. A community-based experience such as this appears to offer an opportunity to substantially augment dental students' clinical training experiences.

  7. Integrating Doulas Into First-Trimester Abortion Care: Physician, Clinic Staff, and Doula Experiences.

    PubMed

    Chor, Julie; Lyman, Phoebe; Ruth, Jean; Patel, Ashlesha; Gilliam, Melissa

    2018-01-01

    Balancing the need to provide individual support for patients and the need for an efficient clinic can be challenging in the abortion setting. This study explores physician, staff, and specially trained abortion doula perspectives on doula support, one approach to patient support. We conducted separate focus groups with physicians, staff members, and doulas from a high-volume, first-trimester aspiration abortion clinic with a newly established volunteer abortion doula program. Focus groups explored 1) abortion doula training, 2) program implementation, 3) program benefits, and 4) opportunities for improvement. Interviews were transcribed and computer-assisted content analysis was performed; salient findings are presented. Five physicians, 5 staff members, and 4 abortion doulas participated in separate focus group discussions. Doulas drew on both their prior personal skills and experiences in addition to their abortion doula training to provide women with support at the time of abortion. Having doulas in the clinic to assist with women's emotional needs allowed physicians and staff to focus on technical aspects of the procedure. In turn, both physicians and staff believed that introducing doulas resulted in more patient-centered care. Although staff did not experience challenges to integrating doulas, physicians and doulas experienced initial challenges in incorporating doula support into the clinical flow. Staff and doulas reported exchanging skills and techniques that they subsequently used in their interactions with patients. Physicians, clinic staff, and doulas perceive abortion doula support as an approach to provide more patient-centered care in a high-volume aspiration abortion clinic. © 2018 by the American College of Nurse-Midwives.

  8. Instant messaging and nursing students' clinical learning experience.

    PubMed

    Pimmer, Christoph; Brühlmann, Florian; Odetola, Titilayo Dorothy; Dipeolu, Oluwafemi; Gröhbiel, Urs; Ajuwon, Ademola J

    2018-05-01

    Although learning in clinical settings is a key element of nursing education, for many learners these are challenging developmental contexts often marked by isolation and a lack of belongingness. Despite the massive appropriation of mobile instant messaging (MIM) platforms and the connective properties attendant to them, very little is known about their role in and impact on nursing students' clinical learning experiences. To address this gap, the study, which was part of a multinational research project on the use of mobile social media in health professions education in developing countries, examined the use of the instant messaging platform WhatsApp by nursing students during placements and potential associations with socio-professional indicators. The survey involved a total number of 196 nursing students from 5 schools in Oyo State, Nigeria. The findings suggest that students used WhatsApp relatively frequently and they perceived that this platform strongly enhanced their communication with other students and nurses. WhatsApp use during placements was positively associated with students' maintained social capital with peer students, the development of a professional identity, placement satisfaction and with reduced feelings of isolation from professional communities. The determinants that influenced WhatsApp use during placements were perceived usefulness and perceived ease of use. No associations were found between WhatsApp use during placement and age, attitude, subjective norms and placement duration. This study is one of the first of its kind that points to the relevance of mobile instant messaging as part of nursing students' (inter)personal learning environments in clinical settings and, particularly, in the development setting under investigation. Further research is needed to corroborate these findings, to enhance the understanding of the impact mechanisms, and to evaluate a more systematic use of MIM in clinical learning contexts. Copyright © 2018

  9. ACTS Aeronautical Terminal Experiment (AERO-X)

    NASA Technical Reports Server (NTRS)

    1995-01-01

    During the summer of 1994, the performance of an experimental mobile satellite communication system was demonstrated. Using the Advanced Communications Technology Satellite (ACTS) and the ACTS Mobile Terminal (AMT), the system demonstrated an active Monolithic Microwave Integrated Circuit (MMIC) phased-array antenna system. The antenna system was installed onboard one of NASA Lewis Research Center's research aircraft, a Learjet Model 25. It proved the viability of in-flight satellite communications services via small, flush, mountable electronic phased-array antennas. The overall system setup for the ACTS Aeronautical Terminal Experiment (AERO-X) is illustrated. The Link Evaluation Terminal (LET) at Lewis in Cleveland, Ohio, interfaced with fixed-AMT equipment, providing a seamless connection with the Public Service Telephone Network. As the Learjet was flown over several major cities across the U.S., this demonstration system allowed passengers onboard to make telephone calls as if they were using a cellular system. ACTS was operated in its microwave switch matrix mode with a spot beam for the Learjet and another spot beam dedicated to the LET.

  10. First experience with clinical use of an original hemoperfusion system.

    PubMed

    Horký, J; Horák, J; Tlustáková, M; Kálal, J

    1981-01-01

    1. The authors present their experience with the use of an original charcoal hemoperfusion system Hemosorb in clinical application, in 9 patients with a heavy metabolic disturbance (failure of the liver and kidney) and after an intoxication with drugs. 2. In two patients the consciousness was remarkably recovered and in one patient it was improved already in the course of the hemoperfusion process, in further two cases the consciousness was recovered in short time after the Hemosorb was used, 7 were completely healed. 3. During the hemoperfusion with Hemosorb there were no symptoms of bad tolerance and no complications except for temporary pyretic reaction in one case. In unique cases manifestations of an enhanced bleeding occurred at the end of the long-term process, which were, however, rather easily corrected. The drop of thrombocytes was essentially reasonable and their restriction after the hemoperfusion was good. 4. Out of metabolic parameters of interest, in the patients with the heavy metabolic failure the drop of total phenol substances, uric acid and creatinine in the blood serum were observed at first stages of the hemoperfusion. The clearance of the total phenol substances and creatinine in the hemoperfusion system was ever rather high. 5. In a patient intoxicated with drugs, there was a remarkable drop of the metaqualone in the blood serum in the course of the hemoperfusion with Hemosorb; the clearance of this compound in the hemoperfusion system was still high after 4 hrs. 6. The first experiences with the clinical application of a new, original hemoperfusion system demonstrated its non-harmful character and biocompatibility as well as clinical, metabolic and toxicologic efficiency.

  11. Decontamination and decorporation: the clinical experience

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

    Poda, G.A.

    1979-01-01

    Decontamination and decorporation are quite interrelated when dealing with a contaminated person. Some clinical experiences from a transuranium production facility are offered. Skin decontamination is accomplished by washing with detergent and water. Stubborn cases are treated with sodium hypochlorite followed by rinsing, and emery cloth is used on more stubborn nail or finger pad contamination. If inhaled, the usual skin cleansing followed by nasal douche with normal saline decontaminates reachable areas and one of the DTPA salts given via aerosol both decontaminates and decorporates the inner recesses. Saline laxative reduces the time inhaled, and ingested particles remain in the gastro-intestinalmore » tract. Conservatism prevails in general, but most persons found to have inhaled contamination are given a single chelation within the hour of discovery and if subsequently found to have over 10% M.P.P.B. of a soluble actinide are offered further chelation. Single dose chelation has been found to be relatively innocuous and usually sufficient. The longest case of chelation therapy spanned 2-1/4 years and encompassed 123 doses of CaNa-DTPA.« less

  12. Polymers Erosion and Contamination Experiment Being Developed

    NASA Technical Reports Server (NTRS)

    deGroh, Kim K.; Banks, Bruce A.; Barney-Barton, Elyse A.; Sechkar, Edward; Hunt, Patricia

    1999-01-01

    The Polymers Erosion and Contamination Experiment (PEACE) is currently being developed at the NASA Lewis Research Center by the Electro-Physics Branch in conjunction with students and faculty from Hathaway Brown School in Cleveland. The experiment is a Get Away Special Canister shuttle flight experiment sponsored by the American Chemical Society. The two goals of this experiment are (1) to measure ram atomic oxygen erosion rates of approximately 40 polymers that have potential use in space applications and (2) to validate a method for identifying sources of silicone contamination that occur in the shuttle bay. Equipment to be used in this flight experiment is shown in the schematic diagram. Spacecraft materials subjected to attack by atomic oxygen in the space environment experience significant degradation over the span of a typical mission. Therefore, learning the rates of atomic oxygen erosion of a wide variety of polymers would be of great benefit to future missions. PEACE will use two independent techniques to determine the atomic oxygen erosion rates of polymers. Large (1-in.-diameter) samples will be used for obtaining mass loss. Preflight and postflight dehydrated masses will be obtained, and the mass lost during flight will be determined. Small (0.5-in.-diameter) samples will be protected with isolated particles (such as NaCl crystals) and then exposed to the space environment. After flight, the protective particles will be removed (washed off) and atomic force microscopy (AFM) will be used to measure the erosion depth from protected mesas. Erosion depth measurements are more sensitive than traditional mass measurements and are very useful for materials with low erosion yields or with very low fluence missions.

  13. Internal Medicine Residents' Clinical and Didactic Experiences After Work Hour Regulation

    PubMed Central

    Horwitz, Leora I; Krumholz, Harlan M; Huot, Stephen J; Green, Michael L

    2006-01-01

    BACKGROUND Work hour regulations for house staff were intended in part to improve resident clinical and educational performance. OBJECTIVE To characterize the effect of work hour regulation on internal medicine resident inpatient clinical experience and didactic education. DESIGN Cross-sectional mail survey. PARTICIPANTS Chief residents at all accredited U.S. internal medicine residency programs outside New York. MEASUREMENTS AND MAIN RESULTS The response rate was 62% (202/324). Most programs (72%) reported no change in average patient load per intern after work hour regulation. Many programs (48%) redistributed house staff admissions through the call cycle. The number of admissions per intern on long call (the day interns have the most admitting responsibility) decreased in 31% of programs, and the number of admissions on other days increased in 21% of programs. Residents on outpatient rotations were given new ward responsibilities in 36% of programs. Third-year resident ward and float time increased in 34% of programs, while third-year elective time decreased in 22% of programs. The mean weekly hours allotted to educational activities did not change significantly (12.7 vs 12.4, P = .12), but 56% of programs reported a decrease in intern attendance at educational activities. CONCLUSIONS In response to work hour regulation, many internal medicine programs redistributed rather than reduced residents' inpatient clinical experience. Hours allotted to educational activities did not change; however, most programs saw a decrease in intern attendance at conferences, and many reduced third-year elective time. PMID:16918742

  14. How do clinical clerkship students experience simulator-based teaching? A qualitative analysis.

    PubMed

    Takayesu, James K; Farrell, Susan E; Evans, Adelaide J; Sullivan, John E; Pawlowski, John B; Gordon, James A

    2006-01-01

    To critically analyze the experience of clinical clerkship students exposed to simulator-based teaching, in order to better understand student perspectives on its utility. A convenience sample of clinical students (n = 95) rotating through an emergency medicine, surgery, or longitudinal patient-doctor clerkship voluntarily participated in a 2-hour simulator-based teaching session. Groups of 3-5 students managed acute scenarios including respiratory failure, myocardial infarction, or multisystem trauma. After the session, students completed a brief written evaluation asking for free text commentary on the strengths and weaknesses of the experience; they also provided simple satisfaction ratings. Using a qualitative research approach, the textual commentary was transcribed and parsed into fragments, coded for emergent themes, and tested for inter-rater agreement. Six major thematic categories emerged from the qualitative analysis: The "Knowledge & Curriculum" domain was described by 35% of respondents, who commented on the opportunity for self-assessment, recall and memory, basic and clinical science learning, and motivation. "Applied Cognition and Critical Thought" was highlighted by 53% of respondents, who commented on the value of decision-making, active thought, clinical integration, and the uniqueness of learning-by-doing. "Teamwork and Communication" and "Procedural/Hands-On Skills" were each mentioned by 12% of subjects. Observations on the "Teaching/Learning Environment" were offered by 80% of students, who commented on the realism, interactivity, safety, and emotionality of the experience; here they also offered feedback on format, logistics, and instructors. Finally, "Suggestions for Use/Place in Undergraduate Medical Education" were provided by 22% of subjects, who primarily recommended more exposure. On a simple rating scale, 94% of students rated the quality of the simulator session as "excellent," whereas 91% felt the exercises should be "mandatory

  15. Senior dental students' experience with Cariogram in a pediatric dentistry clinic.

    PubMed

    Gonzalez, Cesar D; Okunseri, Christopher

    2010-02-01

    The study objective was to assess predoctoral dental students' experience with a caries risk assessment computer program in the pediatric dentistry clinic at Marquette University School of Dentistry. In 2005, spring semester sophomore dental students (class of 2008) were introduced to the caries risk assessment computer program "Cariogram." The students received a fifty-minute lecture on caries risk assessment and a demonstration on how to use Cariogram in the clinic. After two years of clinical exposure to Cariogram, sixty-six out of eighty senior dental students completed an anonymous eleven-item questionnaire on their experience with the tool. Each item on the questionnaire was scored on a five-point Likert scale with the exception of two questions. Full- and part-time faculty members in the pediatric dentistry clinic were involved in teaching and supervising students in the use of Cariogram for caries risk assessment after their training and calibration. Forty-five percent of the students who participated in the study agreed that Cariogram was easy to understand, and 18 percent disagreed. Thirty-six percent felt that it was easy to apply, and 25 percent reported that it was useful in determining caries preventive procedures. The students reported that 60 percent of full-time and 33 percent of part-time faculty were knowledgeable about Cariogram use. A majority of the students felt that Cariogram was not easy to understand, and eighty-two percent of them reported that they would not be using Cariogram in their private offices. Future studies should explore reasons why students do not feel inclined to use Cariogram as a caries risk assessment tool in their private practices even after being exposed to the tool in dental school.

  16. What Students Really Learn: Contrasting Medical and Nursing Students' Experiences of the Clinical Learning Environment

    ERIC Educational Resources Information Center

    Liljedahl, Matilda; Boman, Lena Engqvist; Fält, Charlotte Porthén; Bolander Laksov, Klara

    2015-01-01

    This paper explores and contrasts undergraduate medical and nursing students' experiences of the clinical learning environment. Using a sociocultural perspective of learning and an interpretative approach, 15 in-depth interviews with medical and nursing students were analysed with content analysis. Students' experiences are described using a…

  17. Comprehensive Experiment--Clinical Biochemistry: Determination of Blood Glucose and Triglycerides in Normal and Diabetic Rats

    ERIC Educational Resources Information Center

    Jiao, Li; Xiujuan, Shi; Juan, Wang; Song, Jia; Lei, Xu; Guotong, Xu; Lixia, Lu

    2015-01-01

    For second year medical students, we redesigned an original laboratory experiment and developed a combined research-teaching clinical biochemistry experiment. Using an established diabetic rat model to detect blood glucose and triglycerides, the students participate in the entire experimental process, which is not normally experienced during a…

  18. The experience of clinical supervision for nurses and healthcare assistants in a secure adolescent service: Affecting service improvement.

    PubMed

    McCarron, R H; Eade, J; Delmage, E

    2018-04-01

    WHAT IS KNOWN ON THE SUBJECT?: Regular and effective clinical supervision for mental health nurses and healthcare assistants (HCAs) is an important tool in helping to reduce stress and burnout, and in ensuring safe, effective and high-quality mental health care. Previous studies of clinical supervision within secure mental health environments have found both a low availability of clinical supervision, and a low level of staff acceptance of its value, particularly for HCAs. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: In previous studies, the understanding shown by HCAs and nurses around the benefits of clinical supervision may have been limited by the methods used. This study was specifically designed to help them best express their views. In contrast to previous studies, both nurses and HCAs showed a good understanding of the function and value of clinical supervision. Significant improvements in the experience of, and access to, clinical supervision for nurses and HCAs working in secure mental health services may be achieved by raising staff awareness, demonstrating organizational support and increasing monitoring of clinical supervision. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Organizations should consider reviewing their approach to supervision to include raising staff awareness, multidisciplinary supervision, group supervision, and recording and tracking of supervision rates. Organizations should be mindful of the need to provide effective clinical supervision to HCAs as well as nurses. Introduction Studies have found a low availability and appreciation of clinical supervision, especially for healthcare assistants (HCAs). Qualitative research is needed to further understand this. Aims Increase understanding of nurses' and HCAs' experiences of, and access to, clinical supervision. Identify nurses' and HCAs' perceptions of the value and function of clinical supervision. Assess how interventions affect staff's experiences of clinical supervision. Methods In

  19. Experiences of Student Speech-Language Pathology Clinicians in the Initial Clinical Practicum: A Phenomenological Study

    ERIC Educational Resources Information Center

    Nelson, Lori A.

    2011-01-01

    Speech-language pathology literature is limited in describing the clinical practicum process from the student perspective. Much of the supervision literature in this field focuses on quantitative research and/or the point of view of the supervisor. Understanding the student experience serves to enhance the quality of clinical supervision. Of…

  20. [Threats to Identity: A Grounded Theory Approach on Student Nurses' Experience of Incivility during Clinical Placement].

    PubMed

    Kang, Jiyeon; Jeong, Yeon Jin; Kong, Kyoung Ran

    2018-02-01

    This qualitative study aimed to explore the experience of incivility among nursing students. Sixteen nursing students who had experienced incivility during their clinical placement were invited for one-on-one interviews until the point of theoretical saturation. The grounded theory approach of Corbin and Strauss was adopted to analyze transcribed interview contents. Incivility occurred in the context of a hierarchical organizational culture, due to nursing students' position as outsiders, non-systematic clinical education, and poor nursing work environment. The experience of incivility was identified as "being mistreated as a marginal person," and nursing students responded to this phenomenon in the following three steps: reality shock, passive action, and submissive acceptance. This process caused students to lose self-esteem and undergo role conflict. Furthermore, nursing students' experience of incivility could eventually lead to workplace bullying in nurses. The results of this study suggest that nursing students' experience of incivility can be a process that threatens their identity. It is necessary to develop educational programs and provide appropriate counseling services so that nursing students can actively cope with the incivility. In addition, institutional plans are needed to ensure safe and supportive clinical learning environments. © 2018 Korean Society of Nursing Science.

  1. Constructing Baccalaureate Nursing Students' Ethical Experiences of Classroom Lessons and Clinical Practice

    ERIC Educational Resources Information Center

    Knowles, Amy J. B.

    2014-01-01

    Ethics is an integral component of the nursing profession. This phenomenological study aimed to describe how baccalaureate nursing students experience learning ethics both in the classroom and clinical setting. The interviews in this study were conducted with eight second semester senior nursing students. Four themes emerged from analyses of the…

  2. Cancer Therapy

    NASA Technical Reports Server (NTRS)

    1979-01-01

    The patient shown is undergoing cancer radiation treatment in a hospital-like atmosphere but he is not in a hospital. The treatment room is at NASA's Lewis Research Center, Cleveland, Ohio. It is a converted portion of the Center's cyclotron facility, originally designed for radiation studies related to nuclear propulsion for aircraft and spacecraft. Under an agreement between the Center and the Cleveland Clinic Foundation, the 50 million volt cyclotron is now being used to evaluate the effectiveness of "fast neutron" therapy in the treatment of cancerous tumors.

  3. Field data collection, analysis, and adaptive management of green infrastructure in the urban water cycle in Cleveland and Columbus, OH

    NASA Astrophysics Data System (ADS)

    Darner, R.; Shuster, W.

    2016-12-01

    Expansion of the urban environment can alter the landscape and creates challenges for how cities deal with energy and water. Large volumes of stormwater in areas that have combined septic and stormwater systems present on challenge. Managing the water as near to the source as possible by creates an environment that allows more infiltration and evapotranspiration. Stormwater control measures (SCM) associated with this type of development, often called green infrastructure, include rain gardens, pervious or porous pavements, bioswales, green or blue roofs, and others. In this presentation, we examine the hydrology of green infrastructure in urban sewersheds in Cleveland and Columbus, OH. We present the need for data throughout the water cycle and challenges to collecting field data at a small scale (single rain garden instrumented to measure inflows, outflow, weather, soil moisture, and groundwater levels) and at a macro scale (a project including low-cost rain gardens, highly engineered rain gardens, groundwater wells, weather stations, soil moisture, and combined sewer flow monitoring). Results will include quantifying the effectiveness of SCMs in intercepting stormwater for different precipitation event sizes. Small scale deployment analysis will demonstrate the role of active adaptive management in the ongoing optimization over multiple years of data collection.

  4. Deregulation Impact in Negotiating a New Electrical Contract Between NASA Glenn Research Center at Lewis Field and FirstEnergy Corp., Cleveland, Ohio, USA

    NASA Technical Reports Server (NTRS)

    Quach, Quyen T.; Zala, Laszlo F.

    2002-01-01

    The governor of the State of Ohio signed amended substitute Senate bill 3 on July 6, 1999, requiring Ohio's electric industry to change from a monopoly environment to a competitive electric environment for generation services. The start date for competitive retail generation services was set for January 1, 2001. This new deregulation law allowed all Ohioans to choose the supplier of generation service, but the transmission and distribution would remain regulated. It also required electric utilities to unbundle the three main components (generation, transmission, and distribution) and make other changes designed to produce a competitive electric generation market. While deregulation was taking shape, the NASA Glenn Research Center electrical contract with FirstEnergy Corp. of Cleveland, Ohio, was to expire on September 7, 1999. Glenn strategically evaluated and incorporated the impacts of electric deregulation in the negotiations. Glenn and FirstEnergy spent over a year in negotiations until the Glenn utility team and the FirstEnergy negotiating team came to an agreement in the fall of 2000, and a new contract became effective on January 1, 2001.

  5. [Ovarian tissue cryopreservation in cancer patients--six years of clinical experience].

    PubMed

    Huser, M; Záková, J; Crha, I; Smardová, L; Král, Z; Revel, A; Ventruba, P

    2012-04-01

    Presentation of clinical results and experience with this technique during past six years. Original paper. Gynekologicko-porodnická klinika LF MU a FN Brno, Interní hemato-onkologická klinika LF MU a FN Brno, Department of Obstetrics and Gynecology. Hadassah University Hospital Ein-Karem, Jerusalem, Izrael. Ovarian tissue cryopreservation (OTC) and its future auto-transplantation becomes an alternative for patients to prevent serious damage of ovarian function by oncology treatment. Patient is indicated to OTC in case of high risk of ovarian failure due to planned chemotherapy and impossibility to use other oncofertility techniques. Ovarian tissue harvesting is done by laparoscopy in short-term general anesthesia. After tissue processing the samples are cryopreserved in programmable automatic freezer or by vitrification. The auto-transplantation of ovarian tissue is planned after the complete cure of patient's malignancy. Our workplace doesn't have own experience with tissue transplantation - until now cryopreserved tissue has not yet been utilized by the patients. Clinical experience with this technique gained by our team during academic stay in abroad Israeli clinic is presented. During the years of 2005-2011 the OTC was performed in 19 cancer patients before chemotherapy. In majority of cases, patients suffered from blood or lymph node systemic malignancy (84%). Average age of women was 26 years. The patient set consisted of mostly nulliparous women (88%). Patient's average body mass index was 23,9 kg/m2. The length of systemic chemotherapy averaged 7.1 months. Time from fertility preservation counseling to chemotherapy was not exceeding one week (7.2 days on average). Ovarian tissue harvesting was conducted by laparoscopic surgery in all cases. The length of surgery did not exceed 60 minutes and no surgical complications were observed. The case of ovarian tissue transplantation performed on abroad university settings is discussed. In the consensus of with

  6. Seeing Students Squirm: Nursing Students’ Experiences of Bullying Behaviors During Clinical Rotations

    PubMed Central

    Smith, Carolyn R.; Gillespie, Gordon Lee; Brown, Kathryn C.; Grubb, Paula L.

    2016-01-01

    Background Bullying remains a troubling problem in the nursing profession. Nursing students may encounter bullying behavior in clinical settings. However nursing students may not be adequately prepared to recognize and handle bullying behavior when it occurs. The purpose of this study was to gain greater understanding of nursing students’ experiences of bullying behaviors in the clinical setting. Method Using a descriptive qualitative approach, eight focus groups were held with 56 undergraduate baccalaureate nursing students from four college campuses. Focus group data were coded and analyzed for themes. Results Four categories of themes were identified: bullying behaviors, rationale for bullying, response to bullying, and recommendations to address bullying. Each category and its corresponding themes are presented. Conclusion Interventions for nurse educators to address bullying of nursing students in clinical settings are presented. PMID:27560118

  7. Measuring performance improvement: total organizational commitment or clinical specialization.

    PubMed

    Caron, Aleece; Jones, Paul; Neuhauser, Duncan; Aron, David C

    2004-01-01

    Resources for hospitals are limited when they are faced with multiple publicly reported performance measures as tools to assess quality. The leadership in these organizations may choose to focus on 1 or 2 of these outcomes. An alternative approach is that the leadership may commit resources or create conditions that result in improved quality over a broad range of measures. We used aggregated data on mortality, length of stay, and obstetrical outcomes from Greater Cleveland Health Quality Choice data to test these theories. We used Pearson correlation analysis to determine of outcomes were correlated with one another. We used repeated-measures ANOVA to determine if an association existed between outcome and time and outcome and hospital. All of the outcomes across all hospitals demonstrate a trend of overall improvement. Both the Pearson and ANOVA result support the hypothesis for the organization-wide approach to quality improvement. Hospital that make improvements in one clinical area trend to make improvements in others. Hospitals that produce improvements in limited clinical or administrative areas may not have completely adopted CQI into their culture or may not have yet realized the benefits of their organizational commitments, but use some of the concepts to improve quality outcomes.

  8. Recreational cannabis use: pleasures and pitfalls.

    PubMed

    Rella, Joseph G

    2015-11-01

    Cannabis is widely used for a variety of reasons, and its changing legal status may foster more new users. Although the acute clinical effects of cannabis are generally benign, clinicians should be aware of health complications and testing limitations. Copyright © 2015 Cleveland Clinic.

  9. Clinicians' experiences of becoming a clinical manager: a qualitative study.

    PubMed

    Spehar, Ivan; Frich, Jan C; Kjekshus, Lars Erik

    2012-11-22

    There has been an increased interest in recruiting health professionals with a clinical background to management positions in health care. We know little about the factors that influence individuals' decisions to engage in management. The aim of this study is to explore clinicians' journeys towards management positions in hospitals, in order to identify potential drivers and barriers to management recruitment and development. We did a qualitative study which included in-depth interviews with 30 clinicians in middle and first-line management positions in Norwegian hospitals. In addition, participant observation was conducted with 20 of the participants. The informants were recruited from medical and surgical departments, and most had professional backgrounds as medical doctors or nurses. Interviews were analyzed by systemic text condensation. We found that there were three phases in clinicians' journey into management; the development of leadership awareness, taking on the manager role and the experience of entering management. Participants' experiences suggest that there are different journeys into management, in which both external and internal pressure emerged as a recurrent theme. They had not anticipated a career in clinical management, and experienced that they had been persuaded to take the position. Being thrown into the position, without being sufficiently prepared for the task, was a common experience among participants. Being left to themselves, they had to learn management "on the fly". Some were frustrated in their role due to increasing administrative workloads, without being able to delegate work effectively. Path dependency and social pressure seems to influence clinicians' decisions to enter into management positions. Hospital organizations should formalize pathways into management, in order to identify, attract, and retain the most qualified talents. Top managers should make sure that necessary support functions are available locally, especially

  10. Clinicians’ experiences of becoming a clinical manager: a qualitative study

    PubMed Central

    2012-01-01

    Background There has been an increased interest in recruiting health professionals with a clinical background to management positions in health care. We know little about the factors that influence individuals’ decisions to engage in management. The aim of this study is to explore clinicians’ journeys towards management positions in hospitals, in order to identify potential drivers and barriers to management recruitment and development. Methods We did a qualitative study which included in-depth interviews with 30 clinicians in middle and first-line management positions in Norwegian hospitals. In addition, participant observation was conducted with 20 of the participants. The informants were recruited from medical and surgical departments, and most had professional backgrounds as medical doctors or nurses. Interviews were analyzed by systemic text condensation. Results We found that there were three phases in clinicians’ journey into management; the development of leadership awareness, taking on the manager role and the experience of entering management. Participants’ experiences suggest that there are different journeys into management, in which both external and internal pressure emerged as a recurrent theme. They had not anticipated a career in clinical management, and experienced that they had been persuaded to take the position. Being thrown into the position, without being sufficiently prepared for the task, was a common experience among participants. Being left to themselves, they had to learn management “on the fly”. Some were frustrated in their role due to increasing administrative workloads, without being able to delegate work effectively. Conclusions Path dependency and social pressure seems to influence clinicians’ decisions to enter into management positions. Hospital organizations should formalize pathways into management, in order to identify, attract, and retain the most qualified talents. Top managers should make sure that necessary

  11. Management Development in Health Care: Exploring the Experiences of Clinical Nurse Managers

    ERIC Educational Resources Information Center

    Purcell, Laura; Milner, Brigid

    2005-01-01

    Purpose--The purpose of this paper is to investigate the dramatic reforms in the health service in recent years. Design/methodology/approach--Examines management development in health care, and explores the experiences of clinical nurse managers. Findings--Duplication of agencies and multiplication of roles have led to tensions in terms of both…

  12. A Comprehensive Lifestyle Randomized Clinical Trial: Design and Initial Patient Experience.

    PubMed

    Arun, Banu; Austin, Taylor; Babiera, Gildy V; Basen-Engquist, Karen; Carmack, Cindy L; Chaoul, Alejandro; Cohen, Lorenzo; Connelly, Lisa; Haddad, Robin; Harrison, Carol; Li, Yisheng; Mallaiah, Smitha; Nagarathna, Raghuram; Parker, Patricia A; Perkins, George H; Reuben, James M; Shih, Ya-Chen Tina; Spelman, Amy; Sood, Anil; Yang, Peiying; Yeung, Sai-Ching J

    2017-03-01

    Although epidemiological research demonstrates that there is an association between lifestyle factors and risk of breast cancer recurrence, progression of disease, and mortality, no comprehensive lifestyle change clinical trials have been conducted to determine if changing multiple risk factors leads to changes in biobehavioral processes and clinical outcomes in women with breast cancer. This article describes the design, feasibility, adherence to the intervention and data collection, and patient experience of a comprehensive lifestyle change clinical trial (CompLife). CompLife is a randomized, controlled trial of a multiple-behavior intervention focusing on diet, exercise, and mind-body practice along with behavioral counseling to support change. The initial exposure to the intervention takes place during the 4 to 6 weeks of radiotherapy (XRT) for women with stage III breast cancer and then across the subsequent 12 months. The intervention group will have 42 hours of in-person lifestyle counseling during XRT (7-10 hours a week) followed by up to 30 hours of counseling via video connection for the subsequent 12 months (weekly sessions for 6 months and then monthly for 6 months). The primary outcome is disease-free survival. Multiple secondary outcomes are being evaluated, including: (1) biological pathways; (2) overall survival; (3) patient-reported outcomes; (4) dietary patterns/fitness levels, anthropometrics, and body composition; and (5) economic outcomes. Qualitative data of the patient experience in the trial is collected from exit interviews, concluding remarks, direct email correspondences, and web postings from patients. Fifty-five patients have been recruited and randomized to the trial to date. Accrual of eligible patients is high (72%) and dropout rates extremely low (5%). Attendance to the in-person sessions is high (95% attending greater than 80% of sessions) as well as to the 30 hours of video counseling (88% attending more than 70% of sessions

  13. Medical academia clinical experiences of Ward Round Teaching curriculum.

    PubMed

    Haghani, Fariba; Arabshahi, Seyed Kamran Soltani; Bigdeli, Shoaleh; Alavi, Mousa; Omid, Athar

    2014-01-01

    Medical students spend most of their time in hospital wards and it is necessary to study clinical educational opportunities. This study was aimed to explore faculty members' experience on Ward Round Teaching content. This qualitative study was conducted by purposive sampling with the maximum variation of major clinical departments faculty members in Isfahan University of Medical Sciences (n = 9). Data gathering was based on deep and semi-structured interviews. Data gathering continued till data saturation. Data was analyzed through the Collaizzi method and validated. Strategies to ensure trustworthiness of data (credibility, dependability, conformability, transferability) were employed (Guba and Lincoln). Basic codes extracted from the analyzed data were categorized into two main themes and related subthemes, including (1) tangible teachings (analytic intelligence, technical intelligence, legal duties) and (2) implied teachings (professionalism, professional discipline, professional difficulties). Ward round teaching is a valuable opportunity for learners to learn not only patient care aspects but also ethical values. By appropriate planning, opportunities can be used to teach capabilities that are expected of general practitioners.

  14. Medical academia clinical experiences of Ward Round Teaching curriculum

    PubMed Central

    Haghani, Fariba; Arabshahi, Seyed Kamran Soltani; Bigdeli, Shoaleh; Alavi, Mousa; Omid, Athar

    2014-01-01

    Background: Medical students spend most of their time in hospital wards and it is necessary to study clinical educational opportunities. This study was aimed to explore faculty members’ experience on Ward Round Teaching content. Methods and Materials: This qualitative study was conducted by purposive sampling with the maximum variation of major clinical departments faculty members in Isfahan University of Medical Sciences (n = 9). Data gathering was based on deep and semi-structured interviews. Data gathering continued till data saturation. Data was analyzed through the Collaizzi method and validated. Strategies to ensure trustworthiness of data (credibility, dependability, conformability, transferability) were employed (Guba and Lincoln). Results: Basic codes extracted from the analyzed data were categorized into two main themes and related subthemes, including (1) tangible teachings (analytic intelligence, technical intelligence, legal duties) and (2) implied teachings (professionalism, professional discipline, professional difficulties). Conclusion: Ward round teaching is a valuable opportunity for learners to learn not only patient care aspects but also ethical values. By appropriate planning, opportunities can be used to teach capabilities that are expected of general practitioners. PMID:24627858

  15. Preservice Special Education Teachers' Perceptions: The Influence of University Coursework, Context, and Relationships, during the Clinical Teaching Experience

    ERIC Educational Resources Information Center

    McElwee, Christine B.; Regan, Kelley; Baker, Pamela Hudson; Weiss, Margaret P.

    2018-01-01

    The purpose of this study was to investigate to what extent context and relationships influence preservice teachers' appropriation of coursework during the clinical experience. While there is a dearth of research regarding the clinical experience in teacher preparation programs, there are even fewer studies investigating special education teacher…

  16. Who am I now? The experience of being a post-registration children's student nurse in the first clinical placement.

    PubMed

    Begley, Thelma

    2007-07-01

    Role transition from staff nurse to post-registration student is not a well researched area of nursing. Two previous Irish studies have been reported of the experiences of post-registration midwifery students [McCrea, H., Thompson, K., Carswell, L., Whittington, D., 1994. Student midwives' learning experience on the wards. Journal of Clinical Nursing 3, 97-102; Begley, C., 1997. Midwives in the making: a longitudinal study of the experiences of student midwives during their two-year training in Ireland. Unpublished PhD Thesis, School of Nursing and Midwifery, Trinity College, Dublin.] but there is limited research into post-registration children's student nurses experiences. A broadly phenomenological approach was employed to interpret what it means to be a post-registration children's student nurse during the first clinical placement. Data was collected from a purposive sample of six students, using unstructured tape recorded interviews. Thematic content analysis was utilised to produce an interpretation of nurses' experience within the first clinical placement. The findings reflect the participants' role confusion when changing from being a staff nurse in one discipline of nursing to being a post-registration student in another. They find previous experience is not recognised and that students originating from different disciplines in nursing have different experiences within the first placement. Coping mechanisms are discussed along with preparation for and supports available in the clinical area.

  17. An eight-year clinic experience with clozapine use in a Parkinson's disease clinic setting.

    PubMed

    Hack, Nawaz; Fayad, Sarah M; Monari, Erin H; Akbar, Umer; Hardwick, Angela; Rodriguez, Ramon L; Malaty, Irene A; Romrell, Janet; Shukla, Aparna A Wagle; McFarland, Nikolaus; Ward, Herbert E; Okun, Michael S

    2014-01-01

    To examine our eight year clinic-based experience in a Parkinson's disease expert clinical care center using clozapine as a treatment for refractory psychosis in Parkinson's disease (PD). The study was a retrospective chart review which covered eight years of clozapine registry use. Statistical T-tests, chi-square, correlations and regression analysis were used to analyze treatment response for potential associations of age, disease duration, and Hoehn & Yahr (H&Y) score, and degree of response to clozapine therapy. There were 36 participants included in the analysis (32 PD, 4 parkinsonism-plus). The characteristics included 30.6% female, age 45-87 years (mean 68.3±10.15), disease duration of 17-240 months (mean 108.14±51.13) and H&Y score of 2 to 4 (mean 2.51±0.51). The overall retention rate on clozapine was 41% and the most common reasons for discontinuation were frequent blood testing (28%), nursing home (NH) placement (11%) and leucopenia (8%). Responses to clozapine across the cohort were: complete (33%), partial (33%), absent (16%), and unknown (16%). Age (r = -0.36, p<0.01) and H&Y score (r = -0.41, p<0.01) were shown to be related to response to clozapine therapy, but disease duration was not an associated factor (r = 0.21, p>0.05). This single-center experience highlights the challenges associated with clozapine therapy in PD psychosis. Frequent blood testing remains a significant barrier for clozapine, even in patients with therapeutic benefit. Surprisingly, all patients admitted to a NH discontinued clozapine due to logistical issues of administration and monitoring within that setting. Consideration of the barriers to clozapine therapy will be important to its use and to its continued success in an outpatient setting.

  18. Fees for Service in Medical Library Networks

    PubMed Central

    Cheshier, Robert G.

    1972-01-01

    In 1969 the Cleveland Health Sciences Library began an Institutional Membership. This was to be a fee-for-service arrangement to provide for library service, consultation on library and related matters, and development of educational programs for a wide range of institutional staff. Over fifty institutions now belong. Experience suggests that serious questions are raised by such a relationship between a resource library and libraries in a number of institutions. The membership involves a per capita cost for Cleveland hospitals with house staff, and a cost-plus-fixed-fee for others. Total access has been provided in hopes that experience in use can lead to the development of costs and policies. PMID:16017608

  19. Results From the Physics of Colloids Experiment on ISS

    NASA Technical Reports Server (NTRS)

    Weitz, David; Bailey, Arthur; Manley, Suliana; Prasad, Vikram; Christianson, Rebecca; Sankaran, Subramanian; Doherty, Michael; Jankovsky, Amy; Lorik, Tibor; Shiley, William

    2002-01-01

    The Physics of Colloids in Space (PCS) experiment was accommodated within International Space Station (ISS) EXpedite the PRocessing of Experiments to Space Station (EXPRESS) Rack 2 and was remotely operated from early June 2001 until February 2002 from NASA Glenn Research Center's Telescience Support Center (TSC) in Cleveland, Ohio, and from the remote site at Harvard University in Cambridge, Massachusetts. PCS was launched on 4/19/2001 on Space Shuttle STS-100. The experiment was activated on 5/31/2001. The entire experimental setup performed remarkably well, and accomplished 2400 hours of science operations on-orbit. The sophisticated instrumentation in PCS is capable of dynamic and static light scattering from 11 to 169 degrees, Bragg scattering over the range from 10 to 60 degrees, dynamic and static light scattering at low angles from 0.3 to 6.0 degrees, and color imaging. The long duration microgravity environment on the ISS facilitated extended studies on the growth and coarsening characteristics of binary crystals. The de-mixing of the colloid-polymer critical-point sample was also studied as it phase-separated into two phases. Further, aging studies on a col-pol gel, gelation rate studies in extremely low concentration fractal gels over several days, and studies on a glass sample, all provided valuable information. Several exciting and unique aspects of these results are discussed here.

  20. Seeing Students Squirm: Nursing Students' Experiences of Bullying Behaviors During Clinical Rotations.

    PubMed

    Smith, Carolyn R; Gillespie, Gordon Lee; Brown, Kathryn C; Grubb, Paula L

    2016-09-01

    Bullying remains a troubling problem in the nursing profession. Nursing students may encounter bullying behavior in clinical settings. However, they may not be adequately prepared to recognize and handle bullying behavior when it occurs. This study's purpose was to gain a greater understanding of nursing students' experiences of bullying behaviors in the clinical setting. Using a descriptive qualitative approach, eight focus groups were held with 56 undergraduate baccalaureate nursing students from four college campuses. Focus group data were coded and analyzed for themes. Four categories were identified: Bullying Behaviors, Rationale for Bullying, Response to Bullying, and Recommendations to Address Bullying. Each category and its corresponding themes are presented. Interventions for nurse educators to address the bullying of nursing students in clinical settings are presented. [J Nurs Educ. 2016;55(9):505-513.]. Copyright 2016, SLACK Incorporated.

  1. Experience with the lathe cut Bausch & Lomb SOFLENS: Part 1--Clinical study.

    PubMed

    Weissman, B A; Levinson, A

    1978-03-01

    This study consists of clinical experience with the recently produced lathe cut Bausch & lomb SOFTLENS. Sixteen patients were fitted with the spin cast and then lathe cut lens. Visual acuities were better with the lathe cut lens. Comfort was good with both lenses. Some degree of circum-corneal injection was noted with the larger lathe cut design.

  2. Children's Views Matter Too! A Pilot Project Assessing Children's and Adolescents' Experiences of Clinical Psychology Services

    ERIC Educational Resources Information Center

    Gordon, Michael; Russo, Kate

    2009-01-01

    This pilot study explored the experiences and understanding of clinical psychology practices and services of children and adolescents attending clinical psychology outpatient appointments. Fifteen young participants took part in the study. A content analysis indicated that young children and adolescents have an appropriate understanding of the…

  3. Midwifery students' experiences of learning clinical skills in Iran: a qualitative study.

    PubMed

    Ahmadi, Golnoosh; Shahriari, Mohsen; Keyvanara, Mahmood; Kohan, Shahnaz

    2018-03-09

    A qualitative study was used. Midwifery students from three universities in Iran participated. The study used a convenience sample of eighteen students. Data for this study was collected using semi-structured interviews (N=12) and focus groups (N=6). Data were recorded on a digital audio recorder and then transcribed. The qualitative data were analyzed using a content analysis approach. Six broad themes emerged from the analysis: Limited opportunities to experience skills, difficulties with course plan gaps, need for creating a supportive clinical environment, learning drives, confusion between different methods, and stress in the clinical setting. Short verbatim quotations from the participants were presented to provide evidence for the interpretation of data. The findings of this study have provided a clear picture of the factors and mechanisms involved in learning clinical skills by midwifery students. This study showed that students had some difficulties and concerns during learning of clinical midwifery skills. The findings of this study suggest that midwifery educators conduct further studies to tackle these issues in clinical skills learning. The findings of this study are subject to some limitations which are discussed.

  4. Mental health pre-registration nursing students' experiences of group clinical supervision: a UK longitudinal qualitative study.

    PubMed

    Carver, Neil; Clibbens, Nicola; Ashmore, Russell; Sheldon, Julie

    2014-03-01

    There is widespread international interest in the use of clinical supervision in nursing as well as recognition of the need to introduce nursing students to its concepts and value. This article reports on a three-year longitudinal qualitative focus group study which explored students' views and experiences of a group clinical supervision initiative. Students attended supervision groups facilitated by teaching staff over their three year pre-registration mental health nursing course, with a main aim of developing skills, knowledge and attitudes as supervisees. The findings showed that students derived benefit from the experience, gained greater awareness of the nature of supervision and became active supervisees within their groups. These benefits took time to emerge and were not universal however. While the findings support the value of exposing students to the experience of group clinical supervision educators wishing to implement such a programme need to address a host of issues. These include; the preparation of students, structural and resource concerns, and issues relating to group dynamics. Copyright © 2013 Elsevier Ltd. All rights reserved.

  5. International students in speech-language pathology clinical education placements: Perceptions of experience and competency development.

    PubMed

    Attrill, Stacie; Lincoln, Michelle; McAllister, Sue

    2015-06-01

    This study aimed to describe perceptions of clinical placement experiences and competency development for international speech-language pathology students and to determine if these perceptions were different for domestic students. Domestic and international students at two Australian universities participated in nine focus group interviews. Thematic analysis led to the identification of two themes shared by international and domestic students and several separate themes. Shared themes identified the important influence of students' relationships with clinical educators, unique opportunities and learning that occurs on placement. International student themes included concerns about their communication skills and the impact of these skills on client progress. They also explored their adjustment to unfamiliar placement settings and relationships, preferring structured placements to assist this adjustment. Domestic student themes explored the critical nature of competency attainment and assessment on placement, valuing placements that enabled them to achieve their goals. The findings of this study suggest that international students experience additional communication, cultural and contextual demands on clinical placement, which may increase their learning requirements. Clinical education practices must be responsive to the learning needs of diverse student populations. Strategies are suggested to assist all students to adjust to the professional and learning expectations of clinical education placements.

  6. Pediatric residents' experiences of a clinical rotation in Adolescent Medicine

    PubMed Central

    2010-01-01

    Background Although Adolescent Medicine is a pediatric subspecialty, it addresses many issues that differ from other aspects of pediatrics clinical training. The aim of this study was to explore the general experiences of pediatric residents during their rotations in Adolescent Medicine. Methods Qualitative methods were applied. Semi-structured individual interviews were conducted with pediatric residents who had completed a rotation in Adolescent Medicine. Emergent themes were identified. Results Three key themes emerged: gaining exposure, taking on a professional role, and achieving self-awareness. Subcategories were also identified. There was particular emphasis on the multidisciplinary team and the biopsychosocial approach to adolescent health care. Conclusions The experiences in Adolescent Medicine reflected residents' learning, notably gains in the "non-expert" as well as "medical expert" physician competencies. Future studies should explore how the interprofessional nature of an Adolescent Medicine team and the patient populations themselves contribute to this learning. PMID:21122143

  7. Combustion, Complex Fluids, and Fluid Physics Experiments on the ISS

    NASA Technical Reports Server (NTRS)

    Motil, Brian; Urban, David

    2012-01-01

    From the very early days of human spaceflight, NASA has been conducting experiments in space to understand the effect of weightlessness on physical and chemically reacting systems. NASA Glenn Research Center (GRC) in Cleveland, Ohio has been at the forefront of this research looking at both fundamental studies in microgravity as well as experiments targeted at reducing the risks to long duration human missions to the moon, Mars, and beyond. In the current International Space Station (ISS) era, we now have an orbiting laboratory that provides the highly desired condition of long-duration microgravity. This allows continuous and interactive research similar to Earth-based laboratories. Because of these capabilities, the ISS is an indispensible laboratory for low gravity research. NASA GRC has been actively involved in developing and operating facilities and experiments on the ISS since the beginning of a permanent human presence on November 2, 2000. As the lead Center for combustion, complex fluids, and fluid physics; GRC has led the successful implementation of the Combustion Integrated Rack (CIR) and the Fluids Integrated Rack (FIR) as well as the continued use of other facilities on the ISS. These facilities have supported combustion experiments in fundamental droplet combustion; fire detection; fire extinguishment; soot phenomena; flame liftoff and stability; and material flammability. The fluids experiments have studied capillary flow; magneto-rheological fluids; colloidal systems; extensional rheology; pool and nucleate boiling phenomena. In this paper, we provide an overview of the experiments conducted on the ISS over the past 12 years.

  8. Beginning level nursing students' experiences with cancer patients in their first clinical placement: a qualitative appraisal in Turkey.

    PubMed

    Yildiz, Hicran; Akansel, Neriman

    2011-01-01

    This study was conducted to evaluate beginning nursing students' point of view related to caring cancer patients in their first clinical placement. Data were collected by evaluating the diaries kept by four beginning level nursing students who were assigned to do their fundamentals of nursing clinical practice in hematology clinic from February to May 2011. A qualitative research method was used and data were analyzed using inductive method. Nursing students experienced anxiety, had difficulties while communicating with cancer patients and observed some negative practices related to patient care and treatment. During their clinical placement nursing students were able to differentiate right and wrong practices in clinical environment, they tried to tailor their theoretical knowledge to the clinical practice and reported decrease in their anxiety by the end of clinical rotation. Being assigned to care for cancer patients was a stressful experience for the first year students. According to these results, it can be said that clinics such as hematology can be used as a clinical placement only in mandatory conditions for beginning level nursing students because of their limited clinical experience and the knowledge requirement related to these patients.

  9. Learning by playing: A cross-sectional descriptive study of nursing students' experiences of learning clinical reasoning.

    PubMed

    Koivisto, Jaana-Maija; Multisilta, Jari; Niemi, Hannele; Katajisto, Jouko; Eriksson, Elina

    2016-10-01

    Clinical reasoning is viewed as a problem-solving activity; in games, players solve problems. To provide excellent patient care, nursing students must gain competence in clinical reasoning. Utilising gaming elements and virtual simulations may enhance learning of clinical reasoning. To investigate nursing students' experiences of learning clinical reasoning process by playing a 3D simulation game. Cross-sectional descriptive study. Thirteen gaming sessions at two universities of applied sciences in Finland. The prototype of the simulation game used in this study was single-player in format. The game mechanics were built around the clinical reasoning process. Nursing students from the surgical nursing course of autumn 2014 (N=166). Data were collected by means of an online questionnaire. In terms of the clinical reasoning process, students learned how to take action and collect information but were less successful in learning to establish goals for patient care or to evaluate the effectiveness of interventions. Learning of the different phases of clinical reasoning process was strongly positively correlated. The students described that they learned mainly to apply theoretical knowledge while playing. The results show that those who played digital games daily or occasionally felt that they learned clinical reasoning by playing the game more than those who did not play at all. Nursing students' experiences of learning the clinical reasoning process by playing a 3D simulation game showed that such games can be used successfully for learning. To ensure that students follow a systematic approach, the game mechanics need to be built around the clinical reasoning process. Copyright © 2016 Elsevier Ltd. All rights reserved.

  10. Quantifying medical student clinical experiences via an ICD Code Logging App.

    PubMed

    Rawlins, Fred; Sumpter, Cameron; Sutphin, Dean; Garner, Harold R

    2018-03-01

    The logging of ICD Diagnostic, Procedure and Drug codes is one means of tracking the experience of medical students' clinical rotations. The goal is to create a web-based computer and mobile application to track the progress of trainees, monitor the effectiveness of their training locations and be a means of sampling public health status. We have developed a web-based app in which medical trainees make entries via a simple and quick interface optimized for both mobile devices and personal computers. For each patient interaction, users enter ICD diagnostic, procedure, and drug codes via a hierarchical or search entry interface, as well as patient demographics (age range and gender, but no personal identifiers), and free-text notes. Users and administrators can review and edit input via a series of output interfaces. The user interface and back-end database are provided via dual redundant failover Linux servers. Students master the interface in ten minutes, and thereafter complete entries in less than one minute. Five hundred-forty 3rd year VCOM students each averaged 100 entries in the first four week clinical rotation. Data accumulated in various Appalachian clinics and Central American medical mission trips has demonstrated the public health surveillance utility of the application. PC and mobile apps can be used to collect medical trainee experience in real time or near real-time, quickly, and efficiently. This system has collected 75,596 entries to date, less than 2% of trainees have needed assistance to become proficient, and medical school administrators are using the various summaries to evaluate students and compare different rotation sites. Copyright © 2017. Published by Elsevier B.V.

  11. Social justice as a framework for undergraduate community health clinical experiences in the United States.

    PubMed

    Boutain, Doris M

    2008-01-01

    Educating future registered nurses for social justice is an urgent, yet complex undertaking in undergraduate education. Although the need for social justice education is often highlighted, few articles describe practical teaching strategies for ensuring that undertaking. The purpose of this article is to illustrate how a curricular focus on social justice framed and supported the development of a clinical evaluation tool for undergraduate community health clinical experiences. First, social justice is defined and its relationship to baccalaureate nursing education explained. Then a description is provided of how social justice was highlighted in the vision, curriculum, and community health clinical evaluation tool of a College of Nursing. The article subsequently showcases the content and evaluation of students' journal entries about social justice. The development of the social justice component presented in this article may be useful to nurse educators striving to match theory and practice in the evaluation of social justice in students' community health experience.

  12. Vertigo in childhood: proposal for a diagnostic algorithm based upon clinical experience.

    PubMed

    Casani, A P; Dallan, I; Navari, E; Sellari Franceschini, S; Cerchiai, N

    2015-06-01

    The aim of this paper is to analyse, after clinical experience with a series of patients with established diagnoses and review of the literature, all relevant anamnestic features in order to build a simple diagnostic algorithm for vertigo in childhood. This study is a retrospective chart review. A series of 37 children underwent complete clinical and instrumental vestibular examination. Only neurological disorders or genetic diseases represented exclusion criteria. All diagnoses were reviewed after applying the most recent diagnostic guidelines. In our experience, the most common aetiology for dizziness is vestibular migraine (38%), followed by acute labyrinthitis/neuritis (16%) and somatoform vertigo (16%). Benign paroxysmal vertigo was diagnosed in 4 patients (11%) and paroxysmal torticollis was diagnosed in a 1-year-old child. In 8% (3 patients) of cases, the dizziness had a post-traumatic origin: 1 canalolithiasis of the posterior semicircular canal and 2 labyrinthine concussions, respectively. Menière's disease was diagnosed in 2 cases. A bilateral vestibular failure of unknown origin caused chronic dizziness in 1 patient. In conclusion, this algorithm could represent a good tool for guiding clinical suspicion to correct diagnostic assessment in dizzy children where no neurological findings are detectable. The algorithm has just a few simple steps, based mainly on two aspects to be investigated early: temporal features of vertigo and presence of hearing impairment. A different algorithm has been proposed for cases in which a traumatic origin is suspected.

  13. Healthcare students' experiences of an interprofessional, student-led neuro-rehabilitation community-based clinic.

    PubMed

    Gustafsson, Louise; Hutchinson, Laura; Theodoros, Deborah; Williams, Katrina; Copley, Anna; Fagan, Amy; Desha, Laura

    2016-01-01

    Student-led clinics are becoming more prominent as educators seek alternate models of clinical education for health professionals. The purpose of this study was to evaluate healthcare students' experiences of an interprofessional student-led clinic for clients with neurological conditions. Thirteen students representing occupational therapy, physiotherapy, and speech pathology were recruited for the study. A sequential mixed-methods evaluation was employed and the results from the Interprofessional Education Scale and focus group revealed that the students experienced positive perceptions of working collaboratively with other professions, forming good relationships with others, as well as an increased respect for the roles of other professions. The findings suggest that providing a capstone opportunity, where students can work as part of an interprofessional team with a real client, in a format they may come across in future clinical practice, may be beneficial in providing them with essential interprofessional skills as new graduate health professionals.

  14. Clinical experience of surgically treating giant neurofibromatosis-1.

    PubMed

    Chen, Baoguo; Xu, Minghuo; Song, Huifeng; Gao, Quanwen

    2017-02-01

    The surgical treatment for giant neurofibromatosis-1 (NF-1) requires comprehensive measures. Presently, there is no systematic description of surgical treatment. Because of its high level of risk, we want to share our clinical experience. From 2011 to 2014, patients (n = 8, 5 female and 3 male patients, aging from 31 to 45 years-old) were included in the study. The tumours were located on the trunk (n = 5) or face (n = 3). In addition to routine examination, blood storage was also prepared. Preoperative consultation from related departments was critical at first. Related artery embolisation was also carried out. In the operation, we checked thromboelastography, based on which reasonable blood component transfusion was implemented. Autologous blood transfusion was also ready. An instrument of copper needle or ring ligation was used to reduce haemorrhage before the surgery. Protruding or drooping portions of the tumours were excised. A pressurised bandage was applied when the surgery was completed. After the surgery, besides the routine monitoring of vital signs, re-haemorrhage should be detected in time. Then, we should decide whether blood transfusion or surgery was required again. Expanders were implanted in one female patient with facial injuries before removing the tumour. Then, expanded flaps were applied to repair the secondary wound. According to the above clinical route, after an average of 1-year follow-up, no patients died, and other unforeseen events did not occur. Wounds healed well in all patients. The tumor was excised as much as possible. No facial nerve paralysis occurred in the facial sites. Expanded flaps necrosis WAS not encountered. It is essential to design the educational clinical route for treating NF-1 when a giant protruding tumour is advised to be excised, which can minimise the risk of surgery and assure us of the maximum range of resection. © 2016 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  15. Asian Americans and Cancer Clinical Trials: A Mixed-Methods Approach to Understanding Awareness and Experience

    PubMed Central

    Paterniti, Debora A.; Chen, Moon S.; Chiechi, Christine; Beckett, Laurel A.; Horan, Nora; Turrell, Corinne; Smith, Ligaya; Morain, Claudia; Montell, Lisa; Gonzalez, Jose Luis; Davis, Sharon; Lara, Primo N.

    2006-01-01

    Cancer clinical trials have been based on low accrual rates. Barriers to recruitment of minority populations affect the generalizability and impact of trial findings for those populations. The authors undertook a mixed-methods approach to understanding levels of awareness and experiences with cancer clinical trials. A survey was administered to new cancer patients and their caretakers (family, close friends, or other social support) at outpatient oncology clinics. Field observations of the trial accrual process also were conducted by employing the grounded theory approach in qualitative methods. Comparison of survey results for Asian-American respondents and non-Asian respondents indicated that Asians were less likely to have heard the term “clinical trial” and were more likely to define a clinical trial as “an experiment” or “a test procedure in a clinic” than non-Asians. Asians were more likely to have employer-based insurance and to report understanding issues related to cost reimbursement. Asians were less likely to have been involved in or to know someone in a trial and reported less willingness than white respondents to consider trial participation. Qualitative observations suggested that Asians who presented for a potential trial were interested in the availability of a novel cancer therapy but were not eligible for available trials. Multiple strategies will be necessary to enhance awareness of and experience with accrual to cancer clinical trials for Asians, including richer understanding and increased involvement of Asians in cancer clinical trials and greater attention to the location and diversity of the Asian population in structuring study centers and evaluating trial results. PMID:16247795

  16. Concentrations of trace elements and compounds in the airborne suspended particulate matter in Cleveland, Ohio, from August 1971 to August 1972 and their dependence on wind direction: Complete data listing and concentration roses

    NASA Technical Reports Server (NTRS)

    King, R. B.; Neustadter, H. E.

    1976-01-01

    Concentrations of 75 chemical constituents in the airborne particulate matter were measured in Cleveland, Ohio during 1971 and 1972. Daily values, maxima, geometric means and their standard deviations covering a 1-year period (45 to 50 sampling days) at each of 16 sites are presented on microfiche for 60 elements, and for a lesser number of days for 10 polycyclic aromatic hydrocarbon compounds (PAH), the aliphatic hydrocarbon compounds (AH) as a group and carbon. In addition, concentration roses showing directional properties are presented for 39 elements, 10 PAH and the AH as a group. The elements (except carbon) are shown both in terms of concentration and percentage of the suspended particulate matter.

  17. Predictive power of individual factors and clinical learning experience on academic success: findings from a longitudinal study.

    PubMed

    Dante, Angelo; Fabris, Stefano; Palese, Alvisa

    2015-01-01

    Academic failure is the inability of a nursing student to graduate or to complete the nursing degree on time. This longitudinal cohort study, involving 2 Italian universities, documents the effects of selected individual variables and the quality of the clinical learning experience as perceived by students on academic success. Factors related to the clinical learning experience were the quality of the supervisory relationship, pedagogical atmosphere, and commitment of the ward related to the level of personalized nursing care delivered and clarity of nursing documentation.

  18. Eight months of clinical experience with the Self-Adjusting File system.

    PubMed

    Solomonov, Michael

    2011-06-01

    The Self-Adjusting File (SAF) system (ReDent-Nova, Ra'anana, Israel) has been recently introduced for the simultaneous instrumentation and irrigation of root canals. The SAF is claimed to adapt itself three dimensionally to the root canal, including its cross-section. It is operated with a continuous flow of sodium hypochlorite that is delivered into the root canal through the hollow file and claimed to be activated by sonic agitation of the irrigant. Our aim was to present for the first time clinical cases prepared with the SAF system and to describe a clinical classification of canals, according to their difficulty, with recommendations for endodontic treatment sequences for each category. This report is based on the experience of a single endodontist, who used the system to treat more than 50 consecutive primary endodontic cases over the prior 8 months. A clinical classification was developed which enabled the operator to select a treatment protocol for easy and optimal glide path preparation to be effectively used with the SAF file in the various root canals encountered in the clinical environment. Clinical classification of canal difficulty makes root canal treatment sequences with the SAF simple and predictable. Many types of cases can be treated with the SAF system although a novice user is advised to advance slowly along the learning curve from simpler to more complicated canals. Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  19. Mentor experiences of international healthcare students' learning in a clinical environment: A systematic review.

    PubMed

    Mikkonen, Kristina; Elo, Satu; Tuomikoski, Anna-Maria; Kääriäinen, Maria

    2016-05-01

    Globalisation has brought new possibilities for international growth in education and professional mobility among healthcare professionals. There has been a noticeable increase of international degree programmes in non-English speaking countries in Europe, creating clinical learning challenges for healthcare students. The aim of this systematic review was to describe mentors' experiences of international healthcare students' learning in a clinical environment. The objective of the review was to identify what influences the success or failure of mentoring international healthcare students when learning in the clinical environment, with the ultimate aim being to promote optimal mentoring practice. A systematic review was conducted according to the guidelines of the Centre for Reviews and Dissemination. Seven electronic databases were used to search for the published results of previous research: CINAHL, Medline Ovid, Scopus, the Web of Science, Academic Search Premiere, Eric, and the Cochrane Library. Search inclusion criteria were planned in the PICOS review format by including peer-reviewed articles published in any language between 2000 and 2014. Five peer-reviewed articles remained after the screening process. The results of the original studies were analysed using a thematic synthesis. The results indicate that a positive intercultural mentor enhanced reciprocal learning by improving the experience of international healthcare students and reducing stress in the clinical environment. Integrating international healthcare students into work with domestic students was seen to be important for reciprocal learning and the avoidance of discrimination. Many healthcare students were found to share similar experiences of mentoring and learning irrespective of their cultural background. However, the role of a positive intercultural mentor was found to make a significant difference for international students: such mentors advocated and mediated cultural differences and

  20. Learning experience of Chinese nursing students in an online clinical English course: qualitative study.

    PubMed

    Tang, Anson C Y; Wong, Nick; Wong, Thomas K S

    2015-02-01

    The low English proficiency of Chinese nurse/nursing students affects their performance when they work in English-speaking countries. However, limited resources are available to help them improve their workplace English, i.e. English used in a clinical setting. To this end, it is essential to look for an appropriate and effective means to assist them in improving their clinical English. The objective of this study is to evaluate the learning experience of Chinese nursing students after they have completed an online clinical English course. Focus group interview was used to explore their learning experience. 100 students in nursing programs at Tung Wah College were recruited. The inclusion criteria were: (1) currently enrolled in a nursing program; and (2) having clinical experience. Eligible participants self-registered for the online English course, and were required to complete the course within 3 months. After that, semi-structured interviews were conducted on students whom completed the whole and less than half of the course. One of the researchers joined each of the interviews as a facilitator and an observer. Thematic analysis was used to analyze the data. Finally, 7 themes emerged from the interviews: technical issues, adequacy of support, time requirement, motivation, clarity of course instruction, course design, and relevancy of the course. Participants had varied opinions on the 2 themes: motivation and relevancy of the course. Overall, results of this study suggest that the online English course helped students improve their English. Factors which support their learning are interactive course design, no time constraint, and relevancy to their work/study. Factors which detracted from their learning are poor accessibility, poor technical and learning support and no peer support throughout the course. Copyright © 2014. Published by Elsevier Ltd.

  1. Perceptions of Co-Teaching in the Clinical Experience: How Well Is It Working?

    ERIC Educational Resources Information Center

    Kinne, Lenore J.; Ryan, Carol; Faulkner, Shawn A.

    2016-01-01

    This study examined the perceptions of teacher candidates, cooperating teachers, and university supervisors in the first year of state-mandated co-teaching in the clinical experience. Study results suggest the need (a) to emphasize the importance of the teacher candidate exerting leadership, (b) to develop and communicate specific criteria for…

  2. Internet-based virtual classroom and educational management software enhance students' didactic and clinical experiences in perfusion education programs.

    PubMed

    Riley, Jeffrey B; Austin, Jon W; Holt, David W; Searles, Bruce E; Darling, Edward M

    2004-09-01

    A challenge faced by many university-based perfusion education (PE) programs is the need for student clinical rotations at hospital locations that are geographically disparate from the main educational campus. The problem has been addressed through the employment of distance-learning environments. The purpose of this educational study is to evaluate the effectiveness of this teaching model as it is applied to PE. Web-based virtual classroom (VC) environments and educational management system (EMS) software were implemented independently and as adjuncts to live, interactive Internet-based audio/video transmission from classroom to classroom in multiple university-based PE programs. These Internet environments have been used in a variety of ways including: 1) forum for communication between the university faculty, students, and preceptors at clinical sites, 2) didactic lectures from expert clinicians to students assigned to distant clinical sites, 3) small group problem-based-learning modules designed to enhance students analytical skills, and 4) conversion of traditional face-to-face lectures to asynchronous learning modules. Hypotheses and measures of student and faculty satisfaction, clinical experience, and learning outcomes are proposed, and some early student feedback was collected. For curricula that emphasize both didactic and clinical education, the use of Internet-based VC and EMS software provides significant advancements over traditional models. Recognized advantages include: 1) improved communications between the college faculty and the students and clinical preceptors, 2) enhanced access to a national network of clinical experts in specialized techniques, 3) expanded opportunity for student distant clinical rotations with continued didactic course work, and 4) improved continuity and consistency of clinical experiences between students through implementation of asynchronous learning modules. Students recognize the learning efficiency of on

  3. The importance of surgeon experience for clinical and economic outcomes from thyroidectomy.

    PubMed Central

    Sosa, J A; Bowman, H M; Tielsch, J M; Powe, N R; Gordon, T A; Udelsman, R

    1998-01-01

    OBJECTIVE: To determine whether individual surgeon experience is associated with improved short-term clinical and economic outcomes for patients with benign and malignant thyroid disease who underwent thyroid procedures in Maryland between 1991 and 1996. SUMMARY BACKGROUND DATA: There is a prevailing belief that surgeon experience affects patient outcomes in endocrine surgery, but there is a paucity of objective evidence outside of clinical series published by experienced surgeons that supports this view. METHODS: A cross-sectional analysis of all patients who underwent thyroidectomy in Maryland between 1991 and 1996 was conducted using a computerized statewide hospital discharge data base. Surgeons were categorized by volume of thyroidectomies over the 6-year study period: A (1 to 9 cases), B (10 to 29 cases), C (30 to 100 cases), and D (>100 cases). Multivariate regression was used to assess the relation between surgeon caseload and in-hospital complications, length of stay, and total hospital charges, adjusting for case mix and hospital volume. RESULTS: The highest-volume surgeons (group D) performed the greatest proportion of total thyroidectomies among the 5860 discharges, and they were more likely to operate on patients with cancer. After adjusting for case mix and hospital volume, highest-volume surgeons had the shortest length of stay (1.4 days vs. 1.7 days for groups B and C and 1.9 days for group A) and the lowest complication rate (5.1 % vs. 6.1% for groups B and C and 8.6% for group A). Length of stay and complications were more determined by surgeon experience than hospital volume, which had no consistent association with outcomes. CONCLUSIONS: Individual surgeon experience is significantly associated with complication rates and length of stay for thyroidectomy. PMID:9742915

  4. Exploring factors related to the translation of collaborative research learning experiences into clinical practice: Opportunities and tensions.

    PubMed

    Fletcher, Simon; Whiting, Cheryl; Boaz, Annette; Reeves, Scott

    2017-07-01

    Providing training opportunities to develop research skills for clinical staff has been prioritised in response to the need for improving the evidence base underpinning the delivery of care. By exploring the experiences of a number of former participants of a multidisciplinary postgraduate research course, this article explores the factors that have enabled and impeded staff to translate their learnt research skills into clinical practice. Adopting an exploratory case study approach, 16 interviews with 5 cohorts of Masters by Research in Clinical Practice (MResCP) graduates were undertaken. The interviews explored graduates' course experiences and their subsequent attempts to undertake clinical research. Analysis of the data indicated that although participants valued their interactions with colleagues from different professions and felt they gained useful research skills/knowledge, upon returning to clinical practice, they encountered a number of barriers which restricted their ability to apply their research expertise. Professional isolation, issues of hierarchy, and a lack of organisational support were key to limiting their ability to undertake clinical research. Further work is needed to explore in more depth how (i) these barriers can be overcome and (ii) how taught collaborative research skills can be more effectively translated into practice.

  5. Clinical Experience in Late Antiquity: Alexander of Tralles and the Therapy of Epilepsy

    PubMed Central

    Bouras-vallianatos, Petros

    2014-01-01

    Alexander of Tralles, writing in the late sixth century, combined his wide-ranging practical knowledge with earlier medical theories. This article shows how clinical experience is used in Alexander’s works by concentrating on his therapeutic advice on epilepsy and, in particular, on pharmacology and the group of so-called natural remedies. I argue that clinical testing is used not only for the introduction of new medicines but also as an instrument for checking the therapeutic effect of popular healing practices. On another level, this article discusses Alexander’s role as the author of a medical compendium; it suggests that by marking the cases of clinical testing with a set of recurrent expressions, Alexander leads his audience to reflect on his medical authority and personal contribution. PMID:25045178

  6. 42 CFR 482.80 - Condition of participation: Data submission, clinical experience, and outcome requirements for...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... center. (3) A pancreas transplant center is not required to comply with the clinical experience... pancreas transplants performed at the center. (4) A center that is requesting initial Medicare approval to...

  7. An Eight-Year Clinic Experience with Clozapine Use in a Parkinson’s Disease Clinic Setting

    PubMed Central

    Hack, Nawaz; Fayad, Sarah M.; Monari, Erin H.; Akbar, Umer; Hardwick, Angela; Rodriguez, Ramon L.; Malaty, Irene A.; Romrell, Janet; Shukla, Aparna A. Wagle.; McFarland, Nikolaus; Ward, Herbert E.; Okun, Michael S.

    2014-01-01

    Background To examine our eight year clinic-based experience in a Parkinson’s disease expert clinical care center using clozapine as a treatment for refractory psychosis in Parkinson's disease (PD). Methods The study was a retrospective chart review which covered eight years of clozapine registry use. Statistical T-tests, chi-square, correlations and regression analysis were used to analyze treatment response for potential associations of age, disease duration, and Hoehn & Yahr (H&Y) score, and degree of response to clozapine therapy. Results There were 36 participants included in the analysis (32 PD, 4 parkinsonism-plus). The characteristics included 30.6% female, age 45–87 years (mean 68.3±10.15), disease duration of 17–240 months (mean 108.14±51.13) and H&Y score of 2 to 4 (mean 2.51±0.51). The overall retention rate on clozapine was 41% and the most common reasons for discontinuation were frequent blood testing (28%), nursing home (NH) placement (11%) and leucopenia (8%). Responses to clozapine across the cohort were: complete (33%), partial (33%), absent (16%), and unknown (16%). Age (r = −0.36, p<0.01) and H&Y score (r = −0.41, p<0.01) were shown to be related to response to clozapine therapy, but disease duration was not an associated factor (r = 0.21, p>0.05). Conclusions This single-center experience highlights the challenges associated with clozapine therapy in PD psychosis. Frequent blood testing remains a significant barrier for clozapine, even in patients with therapeutic benefit. Surprisingly, all patients admitted to a NH discontinued clozapine due to logistical issues of administration and monitoring within that setting. Consideration of the barriers to clozapine therapy will be important to its use and to its continued success in an outpatient setting. PMID:24646688

  8. Experience of isolated sleep paralysis in clinical practice in Nigeria.

    PubMed

    Ohaeri, J U

    1992-06-01

    The supernatural fears associated with the experience of isolated sleep paralysis in the culture of developing countries is sometimes associated with the evolution of somatic symptoms of psychological origin in patients predisposed to neurotic illness. Patients rarely spontaneously volunteer these fears and doctors pay them scant attention. Illustrative case histories that demonstrate the dynamics of the clinical presentation, as well as the treatment approach, are highlighted. It is hoped that doctors in general medical practice and in psychological medicine in developing countries where belief in supernatural causation of illness is rife will consider these factors in order to provide more effective treatment.

  9. Association of Research Self-Efficacy with Medical Student Career Interests, Specialization, and Scholarship: A Case Study

    ERIC Educational Resources Information Center

    Bierer, S. Beth; Prayson, Richard A.; Dannefer, Elaine F.

    2015-01-01

    This study used variables proposed in social cognitive career theory (SCCT) to focus the evaluation of a research curriculum at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University (CCLCM). Eight cohorts of CCLCM medical students completed a web-based version of the six-scale Clinical Research Appraisal…

  10. Outcomes of transoral robotic surgery: a preliminary clinical experience.

    PubMed

    Hurtuk, Agnes; Agrawal, Amit; Old, Matthew; Teknos, Theodoros N; Ozer, Enver

    2011-08-01

    To report a single institution's experience with transoral robotic surgery (TORS) and its clinical outcomes. Preliminary clinical data from a prospective TORS study. University tertiary care facility. Patients who underwent TORS at The Ohio State University Medical Center. Demographic, intraoperative, clinicopathological, and follow-up functional data were collected. Sixty-four patients underwent TORS with a median age of 56.9 years. A total of 113 TORS procedures were performed. Fifty-four patients with squamous cell cancer (SCCA) were included in the final analysis. Mean follow-up time was 11.8 months (range, 2-29). There was a trend toward longer TORS setup time, operative time, estimated blood loss, and hospital length of stay with advanced (T(3)) compared with early-stage tumors (T(1-2)). There were no major intraoperative complications, and none of the procedures were aborted because of inability to remove the tumor. Negative resection margins were achieved in 93% of cases of SCCA. No patients experienced immediate postoperative complications, and all of the patients tolerated an oral diet without any airway compromise on the day of surgery. Forty-nine patients (91%) underwent adjuvant radiation therapy (RT), with 11 patients requiring gastrostomy tube placement during RT. Addition of TORS to overall management of head and neck SCCA spared adjuvant RT or combined chemotherapy and RT (CRT) in 50% of stage I/II tumors and spared chemotherapy in 34% of stage III/IV tumors. TORS is a safe procedure with minimal complications and favorable clinical and functional outcomes. It is a promising future alternative surgical treatment for laryngopharyngeal tumors.

  11. CDC Kerala 5: Developmental therapy clinic experience--use of Child Development Centre grading for motor milestones.

    PubMed

    Nair, M K C; Resmi, V R; Krishnan, Rajee; Harikumaran Nair, G S; Leena, M L; Bhaskaran, Deepa; George, Babu; Russell, Paul Swamidhas Sudhakar

    2014-12-01

    To document the experiences of the intervention given to children who attended the developmental therapy clinic of Child Development Centre (CDC) Kerala, a specialized clinic for providing developmental intervention/therapy for babies less than two years with developmental delay/disability. All the babies referred to this speciality clinic from developmental screening/evaluation clinics of CDC were registered in the clinic and re-evaluation was done using CDC grading for head holding, sitting, standing, Amiel Tison passive angles, and Trivandrum Developmental Screening Chart (TDSC) 0-2 y. Out of a total of 600 consecutive babies below 2 y with developmental delay/disability referred to developmental therapy clinic, on comparing the test results at enrollment and after 6 mo of intervention, a statistically significant reduction was observed (i) in the 2-4 mo age group with regard to abnormal TDSC (25.5%), (ii) in the 4-8 mo age group with regard to abnormal head holding grade (87.1%) and abnormal TDSC (19.4%), (iii) in the 8-12 mo age group, with regard to abnormal sitting grade (71.7%) and (iv) in the above 12 mo age group with regard to abnormal sitting grade (35.3%) and abnormal standing grade (78.8%). The experience of organizing the developmental intervention/therapy clinic at CDC Kerala has shown that therapy services by developmental therapists in a centre and supportive therapy by mother at home is useful in improving the developmental status of children with developmental delay.

  12. Does reflective web-based discussion strengthen nursing students' learning experiences during clinical training?

    PubMed

    Mettiäinen, Sari; Vähämaa, Kristiina

    2013-09-01

    The aim of this research was to study how a web-based discussion forum can be used as a supervision tool during nursing students' clinical training. The study emphasises peer support and its importance for the students. The empirical research was carried out at a Finnish university of applied sciences. 25 nursing students took part in web-based discussion during their eight-week clinical training period. All in all, 395 comments were submitted. The material was analysed by using categorisation and a thematic analysis process. Finally, the results were reported using a modified Salmon's (2002) 5-stage model of Teaching and Learning On-line and Mezirow's (1981) levels of reflection. The students motivated each other by sharing their feelings and experiences. They noticed the value of peer support and started to learn from each other as well. By reflecting on their experiences, the students progressed in their learning process and at the same time advanced their reflective thinking process. This combination of theoretical knowledge and practice, based on the students' needs and interests, could lead to a deeper understanding which could also result in better clinical skills. This method offers the lecturers the possibility to support and follow the professional growth process in a new evidence-based manner. Copyright © 2012 Elsevier Ltd. All rights reserved.

  13. Athletic Training Students' and Preceptors' Perceptions of Active Learning Time and Bug-in-Ear Technology during Clinical Education Experiences

    ERIC Educational Resources Information Center

    Nottingham, Sara L.; Kasamatsu, Tricia M.; Montgomery, Melissa M.

    2017-01-01

    Context: Engaging clinical experiences that allow extensive active learning and patient care interactions are important for the professional development of athletic training students. Understanding students' use of clinical time is important when attempting to improve these experiences. Objective: To gain participants' perspectives on active…

  14. Doctors' experience with handheld computers in clinical practice: qualitative study.

    PubMed

    McAlearney, Ann Scheck; Schweikhart, Sharon B; Medow, Mitchell A

    2004-05-15

    To examine doctors' perspectives about their experiences with handheld computers in clinical practice. Qualitative study of eight focus groups consisting of doctors with diverse training and practice patterns. Six practice settings across the United States and two additional focus group sessions held at a national meeting of general internists. 54 doctors who did or did not use handheld computers. Doctors who used handheld computers in clinical practice seemed generally satisfied with them and reported diverse patterns of use. Users perceived that the devices helped them increase productivity and improve patient care. Barriers to use concerned the device itself and personal and perceptual constraints, with perceptual factors such as comfort with technology, preference for paper, and the impression that the devices are not easy to use somewhat difficult to overcome. Participants suggested that organisations can help promote handheld computers by providing advice on purchase, usage, training, and user support. Participants expressed concern about reliability and security of the device but were particularly concerned about dependency on the device and over-reliance as a substitute for clinical thinking. Doctors expect handheld computers to become more useful, and most seem interested in leveraging (getting the most value from) their use. Key opportunities with handheld computers included their use as a stepping stone to build doctors' comfort with other information technology and ehealth initiatives and providing point of care support that helps improve patient care.

  15. Running a postmortem service--a business case and clinical experience.

    PubMed

    Cohen, Marta C; Whitby, Elspeth; Fink, Michelle A; Collett, Jacquelene M; Offiah, Amaka C

    2015-04-01

    The purpose of the postmortem examination is to offer answers to explain the cause and manner of death. In the case of perinatal, infant and paediatric postmortem examinations, the goal is to identify unsuspected associated features, to describe pathogenic mechanisms and new conditions, and to evaluate the clinical management and diagnosis. Additionally, the postmortem examination is useful to counsel families regarding the probability of recurrence in future pregnancies and to inform family planning. Worldwide the rate of paediatric autopsy examinations has significantly declined during the last few decades. Religious objections to postmortem dissection and organ retention scandals in the United Kingdom provided some of the impetus for a search for non-invasive alternatives to the traditional autopsy; however, until recently, imaging studies remained an adjunct to, rather than a replacement for, the traditional autopsy. In 2012, Sheffield Children's Hospital National Health Service Foundation Trust set up the service provision of minimally invasive fetal, perinatal and neonatal autopsy, while a postmortem imaging service has been running in Melbourne, Australia, since 2008. Here we summarise the essentials of a business case and practical British and Australian experiences in terms of the pathological and radiologic aspects of setting up a minimally invasive clinical service in the United Kingdom and of developing a clinical postmortem imaging service as a complementary tool to the traditional autopsy in Australia.

  16. Building capacity in Clinical Epidemiology in Africa: experiences from Masters programmes.

    PubMed

    Young, Taryn; Naude, Celeste; Brodovcky, Tania; Esterhuizen, Tonya

    2017-02-27

    To describe and contrast programmatic offering of Clinical Epidemiology Masters programmes in Africa, to evaluate experiences of graduates and faculty, and assess if graduates are playing roles in research, practice and teaching of Clinical Epidemiology. We searched and identified relevant programmes, reviewed programmatic documentation, interviewed convenors and surveyed graduates. Participants provided informed consent, interviews with faculty were recorded and transcribed for analysis purposes, and graduates participated in an online survey. Five structured Masters programmes requiring health science professionals to complete modules and research projects were assessed. Demand for programmes was high. Graduates enjoyed the variety of modules, preferred blended teaching, and regarded assessments as fair. Graduates felt that career paths were not obvious after graduating. Despite this, some have gone on to promote and teach evidence-based health care, and conduct and disseminate research. Areas of concern raised by faculty were quality assurance; research project initiation, implementation and supervisory capacity; staff availability; funding to support implementation and lack of experiential learning. Although faced with challenges, these programmes build capacity of health professionals to practice in an evidence-informed way, and conduct rigorous research, which are central to advancing the practice of Clinical Epidemiology in Africa.

  17. The role of religiosity, coping strategies, self-efficacy and personality dimensions in the prediction of Iranian undergraduate rehabilitation interns' satisfaction with their clinical experience.

    PubMed

    Mirsaleh, Y R; Rezai, H; Kivi, S R; Ghorbani, R

    2010-12-01

    to investigate the relationship between religiosity, coping styles, self-efficacy and personality dimensions as predictors of satisfaction with clinical experience in rehabilitation interns during transition from academic study to clinical internship. a cross-sectional survey design. five rehabilitation faculties. three hundred and eighteen undergraduate rehabilitation interns, including physical therapy, occupational therapy and speech and language pathology students. Islamic Religiosity Scale, Ways of Coping Questionnaire, General Self-efficacy Scale, NEO Five Factor Inventory, and Satisfaction with Clinical Experiences Questionnaire. religiosity, problem-focused coping and general self-efficacy had significant positive correlation with satisfaction with clinical internship in rehabilitation students. Among personality dimensions, openness, agreement and consciousness had significant positive correlation with satisfaction with clinical experience and neuroticism had significant negative correlation with satisfaction with clinical experience. The results of regression analysis demonstrated that religiosity and self-efficacy had important roles in the prediction of satisfaction with clinical experience in all the rehabilitation intern students of three disciplines (physical therapy, occupational therapy, and speech and language pathology). religiosity, problem-focused coping and general self-efficacy seem to be good predictors of satisfaction with clinical internship in rehabilitation students.

  18. Clinical experiences with an ASP model backup archive for PACS images

    NASA Astrophysics Data System (ADS)

    Liu, Brent J.; Cao, Fei; Documet, Luis; Huang, H. K.; Muldoon, Jean

    2003-05-01

    Last year we presented a Fault-Tolerant Backup Archive using an Application Service Provider (ASP) model for disaster recovery. The purpose of this paper is to update and provide clinical experiences related towards implementing the ASP model archive solution for short-term backup of clinical PACS image data as well as possible applications other than disaster recovery. The ASP backup archive provides instantaneous, automatic backup of acquired PACS image data and instantaneous recovery of stored PACS image data all at a low operational cost and with little human intervention. This solution can be used for a variety of scheduled and unscheduled downtimes that occur on the main PACS archive. A backup archive server with hierarchical storage was implemented offsite from the main PACS archive location. Clinical data from a hospital PACS is sent to this ASP storage server in parallel to the exams being archived in the main server. Initially, connectivity between the main archive and the ASP storage server is established via a T-1 connection. In the future, other more cost-effective means of connectivity will be researched such as the Internet 2. We have integrated the ASP model backup archive with a clinical PACS at Saint John's Health Center and has been operational for over 6 months. Pitfalls encountered during integration with a live clinical PACS and the impact to clinical workflow will be discussed. In addition, estimations of the cost of establishing such a solution as well as the cost charged to the users will be included. Clinical downtime scenarios, such as a scheduled mandatory downtime and an unscheduled downtime due to a disaster event to the main archive, were simulated and the PACS exams were sent successfully from the offsite ASP storage server back to the hospital PACS in less than 1 day. The ASP backup archive was able to recover PACS image data for comparison studies with no complex operational procedures. Furthermore, no image data loss was

  19. Student Reflection Papers on a Global Clinical Experience: A Qualitative Study.

    PubMed

    Margolis, Carmi Z; Rohrbaugh, Robert M; Tsang, Luisa; Fleischer, Jennifer; Graham, Mark J; Kellett, Anne; Hafler, Janet P

    Many of the 70,000 graduating US medical students [per year] have reported participating in a global health activity at some stage of medical school. This case study design provided a method for understanding the student's experience that included student's learning about culture, health disparities, exposure and reaction to a range of diseases actually encountered. The broad diversity of themes among students indicated that the GCE provided a flexible, personalized experience. We need to understand the student's experience in order to help design appropriate curricular experiences [and valid student assessment]. Our research aim was to analyze medical student reflection papers to understand how they viewed their Global Clinical Experience (GCE). A qualitative case study design was used to analyze student reflection papers. All 28 students who participated in a GCE from 2008-2010 and in 2014-2015 and submitted a reflection paper on completion of the GCE were eligible to participate in the study. One student did not submit a reflection paper and was not included in the study. All 27 papers were coded by paragraph for reflection and for themes. System of Care/Range of Care was mentioned most often, Aids to Adjustment Process was mentioned least. The theme, "Diseases," referred to any mention of a disease in the reflection papers, and 44 diseases were mentioned in the papers. The analysis for depth of reflection yielded the following data: Observation, 81/248 paragraphs; Observation and Interpretation, 130/248 paragraphs; and Observation, Interpretation, and Suggestions for change, 36/248 paragraphs; 9 reflection papers contained 27 separate accounts of a transformational experience. This study provided a method for understanding the student's experience that included student's learning about culture, health disparities, and exposure and reaction to a range of diseases actually encountered. The broad diversity of themes among students indicated that the GCE provided a

  20. Teachers' Perceptions of Their Mentoring Role in Three Different Clinical Settings: Student Teaching, Early Field Experiences, and Entry Year Teaching

    ERIC Educational Resources Information Center

    Gut, Dianne M.; Beam, Pamela C.; Henning, John E.; Cochran, Deborah C.; Knight, Rhonda Talford

    2014-01-01

    The purpose of this study was to determine the differences in mentoring across three different clinical settings: student teaching, early field experiences, and entry year teachers. Eighteen teachers with mentoring experience in all three clinical settings were selected and interviewed. The teachers' expectations for teacher development,…

  1. Diversity characteristics and the experiences of nursing students' during clinical placements: A qualitative study of students and supervisors views.

    PubMed

    Koch, Jane; Everett, Bronwyn; Phillips, Jane; Davidson, Patricia M

    2014-11-10

    Abstract Background: Little is known about which diversity characteristics if any, impact on nursing students' clinical placements or how these may affect the quality of their learning experiences. There is therefore a need to better understand these effects not only from the student's perspective but also from the perspective of the staff who supervise them, in order to ensure students obtain maximal benefit from their placements. Aim: To describe the clinical experiences of nursing students and the diversity characteristics that affect this learning experience. Methods: Data were collected from a series of open-ended questions embedded within a larger anonymous web-based survey, from August 2011 to March 2012. Participants included first, second and third year undergraduate Bachelor of Nursing students (N=704) and faculty members involved in the clinical learning environment (N = 165) from seven Australian universities. Findings: Qualitative findings were clustered into three main themes, differences, difficulty and discrimination, each with three subthemes. Conclusion: Findings suggest a need to offer appropriate support for nursing students who feel different because of diversity characteristics. Whilst some of the participant perceptions are confronting they provide valuable insights for universities developing curricula and the clinical placement facilities where students obtain their experience.

  2. Experience with the Implementation of Clinical Pharmacy Services and Processes in a University Hospital in Belgium.

    PubMed

    Somers, Annemie; Claus, Barbara; Vandewoude, Koen; Petrovic, Mirko

    2016-03-01

    This article summarizes the experience with the development of clinical pharmacy services in the Ghent University Hospital in Belgium. Implementation of clinical pharmacy services in Belgian hospitals has not been evident because these activities were initially not structurally financed. The aim is to describe the strengths and weaknesses of the clinical pharmacy development process, and the milestones that enhanced the progress. Furthermore, the organisation of clinical pharmacy in the Ghent University Hospital is explained, including back- and front-office activities, seamless pharmaceutical care and medication safety improvement. Some working methods, procedures and tools are explained for different clinical pharmacy services. In particular, the clinical pharmacy projects for geriatric patients as well as the preparation of clinical pharmacy services for the accreditation process are explained. We also reflect on the organisation model and the future development of clinical pharmacy, taking into consideration facilitators and potential barriers.

  3. Evaluating the impact of a pre-rotation workshop on student preparation for clinical advanced pharmacy practice experiences.

    PubMed

    Medina, Melissa S; Stark, Jennifer E; Vesta, Kimi S; Lockhart, Staci M

    2008-10-01

    This pilot study was designed to evaluate the impact of a pre-rotation workshop (PRW) on pharmacy students' clinical skills and preparation for clinical Advanced Pharmacy Practice Experiences (APPE) involving direct patient care. Randomized controlled trial of an educational intervention with Institutional Review Board approval. PRW activities designed to simulate rotation activities around five competencies, patient charts, medication histories, SOAP notes, patient presentations, and professionalism. Endpoints were evaluated using clinical rotation preceptors' evaluation of performance and students' performance on objective structured clinical exams (OSCE). Eight fourth-year students and eight GPA matched controls (20% of the total class) were selected to voluntarily participate. The PRW demonstrated a positive impact on students' clinical skills and preparation for rotations by improving OSCE performance. However, no significant differences were found between groups when comparing preceptor evaluations of skills on rotations. These results are limited by the small sample size, potential OSCE "test-wiseness" effects, lack of OSCE evaluator blinding to study groups, potential case specificity effects due to the limited number of cases used on the OSCE and possible lack of sensitivity of the rotation evaluation tool to capture true differences among the experimental and control group participants. The PRW was successful at advancing students' clinical skills and preparation for rotations and may be considered as a tool to help bridge didactic to clinical experiences in the Pharm.D. curriculum.

  4. Web-based objective structured clinical examination with remote standardized patients and Skype: resident experience.

    PubMed

    Langenau, Erik; Kachur, Elizabeth; Horber, Dot

    2014-07-01

    Using Skype and remote standardized patients (RSPs), investigators sought to evaluate user acceptance of a web-based objective structured clinical examination (OSCE) among resident physicians. After participating in four web-based clinical encounters addressing pain with RSPs, 59 residents from different training programs, disciplines and geographic locations completed a 52-item questionnaire regarding their experience with Skype and RSPs. Open-ended responses were solicited as well. The majority of participants (97%) agreed or strongly agreed the web-based format was convenient and a practical learning exercise, and 90% agreed or strongly agreed the format was effective in teaching communication skills. Although 93% agreed or strongly agreed they could communicate easily with RSPs using Skype, 80% preferred traditional face-to-face clinical encounters, and 58% reported technical difficulties during the encounters. Open-ended written responses supported survey results. Findings from this study expose challenges with technology and human factors, but positive experiences support the continued investigation of web-based OSCEs as a synchronous e-learning initiative for teaching and assessing doctor-patient communication. Such educational programs are valuable but unlikely to replace face-to-face encounters with patients. This web-based OSCE program provides physician learners with additional opportunity to improve doctor-patient communication. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  5. What factors facilitate good learning experiences in clinical studies in nursing: bachelor students' perceptions.

    PubMed

    Dale, Bjørg; Leland, Arne; Dale, Jan Gunnar

    2013-12-17

    Clinical studies constitute 50% of the bachelor program in nursing education in Norway, and the quality of these studies may be decisive for the students' opportunities to learn and develop their professional competences. The aim of this study was to explore what bachelor students' in nursing perceived to be important for having good learning experiences in clinical studies. Data was collected in a focus group interview with eight nursing students who were in the last year of the educational program. The interview was transcribed verbatim, and qualitative content analysis was used for exploring and interpreting the content of the interview text. One main theme emerged from the analysis: "being in a vulnerable and exposed position characterized by conflicting needs." Four categories were found: "aspects related to the clinical setting", "aspects related to the nurse supervisor," "aspects related to the student," and "aspects related to the student-supervisor relationship". The findings revealed that the students' learning experiences and motivation were related to individual, relational, and organizational aspects. The students highlighted their own as well as their supervisors' attitudes and competences and the importance of positive relationships. In addition, feeling welcomed, included, and valued in the ward improved their motivation, self-confidence, and self-respect.

  6. Diversity characteristics and the experiences of nursing students during clinical placements: A qualitative study of student, faculty and supervisors' views.

    PubMed

    Koch, Jane; Everett, Bronwyn; Phillips, Jane; Davidson, Patricia M

    2014-01-01

    Abstract Background: Little is known about which diversity characteristics if any, impact on nursing students' clinical placements or how these may affect the quality of their learning experiences. There is therefore a need to better understand these effects not only from the student's perspective but also from the perspective of the staff who supervise them, in order to ensure students obtain maximal benefit from their placements. To describe the clinical experiences of nursing students and the diversity characteristics that affect this learning experience. Data were collected from a series of open-ended questions embedded within a larger anonymous web-based survey, from August 2011 to March 2012. Participants included first, second and third year undergraduate Bachelor of Nursing students (N = 704) and faculty members involved in the clinical learning environment (N = 165) from seven Australian universities. Qualitative findings were clustered into three main themes: differences, difficulty and discrimination, each with three sub-themes. FINDINGS suggest a need to offer appropriate support for nursing students who feel different because of diversity characteristics. Whilst some of the participant perceptions are confronting they provide valuable insights for universities developing curricula and the clinical placement facilities where students obtain their experience.

  7. Feasibility Study of Economics and Performance of Solar Photovoltaics at the Kolthoff Landfill in Cleveland, Ohio. A Study Prepared in Partnership with the Environmental Protection Agency for the RE-Powering America's Land Initiative: Siting Renewable Energy on Potentially Contaminated Land and Mine Sites

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

    Salasovich, J.; Geiger, J.; Mosey, G.

    2013-06-01

    The U.S. Environmental Protection Agency (EPA), Region 5, in accordance with the RE-Powering America's Land initiative, selected the Kolthoff Landfill site in Cleveland, Ohio, for a feasibility study of renewable energy production. The National Renewable Energy Laboratory (NREL) provided technical assistance for this project. The purpose of this report is to assess the site for a possible photovoltaic (PV) system installation and estimate the cost, performance, and site impacts of different PV options. In addition, the report recommends financing options that could assist in the implementation of a PV system at the site.

  8. Experiences of undergraduate nursing students in peer assisted learning in clinical practice: a qualitative systematic review.

    PubMed

    Carey, Matthew C; Kent, Bridie; Latour, Jos M

    2018-05-01

    The objective of this qualitative systematic review was to identify and synthesize the best available evidence on experiences of peer assisted learning (PAL) among student nurses in clinical practice so as to understand the value of PAL for this population. Peer-assisted learning considers the benefits of peers working in collaboration and supporting each other in professional roles. This approach to facilitate learning is effective within universities, but there is limited exploration within the clinical practice environment. Within the UK, 50% of student nurses' learning is undertaken within clinical practice, providing a large portion of student allocation within these areas, but is unexplored in relation to PAL. Therefore, existing evidence examining PAL in clinical practice needs further exploration for a better understanding of its value to student nurses' learning. The systematic review considered studies that included male and female nursing students aged 18-50 years that explored undergraduate nursing students' experiences of PAL within the clinical practice environment. Studies that utilized designs such as phenomenology, grounded theory, ethnography, action research and feminist research were considered. Other text such as opinion papers and reports were to be considered if no qualitative studies could be located. The review excluded quantitative studies, as well as those addressing PAL outside the nursing profession and students within the nursing profession but not including undergraduate student nurses. This review considered studies that included aspects related to experiences of PAL in the clinical practice setting, as seen by undergraduate nursing students and the researcher. A three-step search strategy was undertaken to find both published and unpublished studies in English from 2003 to 2017 in various databases, and included searching of reference lists within articles selected for appraisal. Each of the included studies were assessed for

  9. Physiotherapy students' experiences of bullying on clinical internships: an exploratory study.

    PubMed

    Stubbs, Brendon; Soundy, Andy

    2013-06-01

    To consider the prevalence and type of bullying behaviours experienced whilst on clinical placement in a cohort of final-year BSc undergraduate students. Cross-sectional survey. University in the West Midlands, UK. Fifty-two final-year undergraduate students. Prevalence of incivility and bullying behaviours. Twenty-five percent of students reported at least one incident of bullying behaviour. The perpetrator of the bullying behaviour was most often the clinical educator (8/13, 62%). Despite the negative effects caused, the majority of students (11/13, 84%) did not report this experience to the university. Bullying behaviour may take many forms and can have a negative effect on the well-being of students. It should be addressed by all stakeholders including universities, National Health Service trusts and researchers. Possible strategies to move forwards and better protect the future of the physiotherapy profession are briefly considered. Copyright © 2013 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

  10. Doctors' experience with handheld computers in clinical practice: qualitative study

    PubMed Central

    McAlearney, Ann Scheck; Schweikhart, Sharon B; Medow, Mitchell A

    2004-01-01

    Objective To examine doctors' perspectives about their experiences with handheld computers in clinical practice. Design Qualitative study of eight focus groups consisting of doctors with diverse training and practice patterns. Setting Six practice settings across the United States and two additional focus group sessions held at a national meeting of general internists. Participants 54 doctors who did or did not use handheld computers. Results Doctors who used handheld computers in clinical practice seemed generally satisfied with them and reported diverse patterns of use. Users perceived that the devices helped them increase productivity and improve patient care. Barriers to use concerned the device itself and personal and perceptual constraints, with perceptual factors such as comfort with technology, preference for paper, and the impression that the devices are not easy to use somewhat difficult to overcome. Participants suggested that organisations can help promote handheld computers by providing advice on purchase, usage, training, and user support. Participants expressed concern about reliability and security of the device but were particularly concerned about dependency on the device and over-reliance as a substitute for clinical thinking. Conclusions Doctors expect handheld computers to become more useful, and most seem interested in leveraging (getting the most value from) their use. Key opportunities with handheld computers included their use as a stepping stone to build doctors' comfort with other information technology and ehealth initiatives and providing point of care support that helps improve patient care. PMID:15142920

  11. Clinical Interpretations of Patient Experience in a Trial of Psilocybin-Assisted Psychotherapy for Alcohol Use Disorder.

    PubMed

    Bogenschutz, Michael P; Podrebarac, Samantha K; Duane, Jessie H; Amegadzie, Sean S; Malone, Tara C; Owens, Lindsey T; Ross, Stephen; Mennenga, Sarah E

    2018-01-01

    After a hiatus of some 40 years, clinical research has resumed on the use of classic hallucinogens to treat addiction. Following completion of a small open-label feasibility study, we are currently conducting a double-blind placebo-controlled clinical trial of psilocybin-assisted treatment of alcohol use disorder. Although treatment effects cannot be analyzed until the study is complete, descriptive case studies provide a useful window into the therapeutic process of psychedelic-assisted treatment of addiction. Here we describe treatment trajectories of three participants in the ongoing trial to illustrate the range of experiences and persisting effects of psilocybin treatment. Although it is difficult to generalize from a few cases, several qualitative conclusions can be drawn from the data presented here. Although participants often find it difficult to describe much of their psilocybin experience, pivotal moments tend to be individualized, extremely vivid, and memorable. Often, the qualitative content extends beyond the clinical problem that is being addressed. The participants discussed in this paper experienced acute and lasting alterations in their perceptions of self, in the quality of their baseline consciousness, and in their relationship with alcohol and drinking. In these cases, experiences of catharsis, forgiveness, self-compassion, and love were at least as salient as classic mystical content. Finally, feelings of increased "spaciousness" or mindfulness, and increased control over choices and behavior were reported following the drug administration sessions. Ultimately, psilocybin-assisted treatment appears to elicit experiences that are extremely variable, yet seem to meet the particular needs of the individual.

  12. Clinical Interpretations of Patient Experience in a Trial of Psilocybin-Assisted Psychotherapy for Alcohol Use Disorder

    PubMed Central

    Bogenschutz, Michael P.; Podrebarac, Samantha K.; Duane, Jessie H.; Amegadzie, Sean S.; Malone, Tara C.; Owens, Lindsey T.; Ross, Stephen; Mennenga, Sarah E.

    2018-01-01

    After a hiatus of some 40 years, clinical research has resumed on the use of classic hallucinogens to treat addiction. Following completion of a small open-label feasibility study, we are currently conducting a double-blind placebo-controlled clinical trial of psilocybin-assisted treatment of alcohol use disorder. Although treatment effects cannot be analyzed until the study is complete, descriptive case studies provide a useful window into the therapeutic process of psychedelic-assisted treatment of addiction. Here we describe treatment trajectories of three participants in the ongoing trial to illustrate the range of experiences and persisting effects of psilocybin treatment. Although it is difficult to generalize from a few cases, several qualitative conclusions can be drawn from the data presented here. Although participants often find it difficult to describe much of their psilocybin experience, pivotal moments tend to be individualized, extremely vivid, and memorable. Often, the qualitative content extends beyond the clinical problem that is being addressed. The participants discussed in this paper experienced acute and lasting alterations in their perceptions of self, in the quality of their baseline consciousness, and in their relationship with alcohol and drinking. In these cases, experiences of catharsis, forgiveness, self-compassion, and love were at least as salient as classic mystical content. Finally, feelings of increased “spaciousness” or mindfulness, and increased control over choices and behavior were reported following the drug administration sessions. Ultimately, psilocybin-assisted treatment appears to elicit experiences that are extremely variable, yet seem to meet the particular needs of the individual. PMID:29515439

  13. Who benefits most from THC:CBD spray? Learning from clinical experience.

    PubMed

    Koehler, Jürgen

    2014-01-01

    Patients with multiple sclerosis (MS) represent a diverse and heterogeneous population varying in terms of disease type, its severity and variable progression/time-course, and with regard to the wide range of presenting symptoms. Consequently, detailed experience with individual patients is important to provide examples of therapy to specific patient types. In this article, real-life data from clinical practice showing specific aspects relating to use of 9-delta-tetrahydocannabinol and cannabidiol (THC:CBD) oromucosal spray (Sativex®) in patients with moderate to severe spasticity resistant to usual therapy will be presented. Three common clinical scenarios will be considered: MS patients with resistance to usual spasticity therapies; patients with impairment in MS spasticity symptoms; MS patients with relevant impairment in quality of life/activities of daily living (QoL/ADL). These case reports highlight the diverse nature of the MS spasticity population and they show the possible usefulness of THC:CBD oromucosal spray in individual patients with moderate to severe spasticity resistant to existing therapies, within the frame of use approved after large clinical trial results. Perhaps the most important finding is the possibility of obtaining relevant improvements in QoL/ADL in some patients with resistant MS spasticity, allowing them to engage back in physical and social activities. © 2014 S. Karger AG, Basel.

  14. DPT Student Perceptions of the Physical Therapist Assistant's Role: Effect of Collaborative Case-Based Learning Compared to Traditional Content Delivery and Clinical Experience.

    PubMed

    Colgrove, Yvonne M; VanHoose, Lisa D

    2017-01-01

    Doctor of physical therapy (DPT) student learning about role delineation of physical therapist assistants (PTAs) is essential to ethical and legal practice. Survey assessment of three DPT student cohorts compared collaborative interprofessional case-based learning with PTA students to traditional curriculum delivery strategies. Control cohorts were assessed one time. The intervention group was assessed pre-intervention, immediately post-intervention, and after completing a full-time clinical experience. The case-based learning covered 46% of survey content, allowing for the assessment of content-specific material and potential learning through collaboration. Following the educational intervention, the intervention group improved significantly in areas inside and outside the case-based study content, outscoring both control groups on 25-34% of the survey items. Following the clinical experience, the intervention group declined answer accuracy for patient evaluation and treatment implementation, suggesting unlearning. Improvement in the administrative section was observed after the clinical experience. Perceptions of the tasks within the PTA role were diminished while tasks outside the scope of practice appeared clarified following the clinical experience. While case-based collaborative intraprofessional learning proves effective in student learning about the PTA role, changes following the clinical experience raise questions about the influence of the clinical environment on learning and the practical application of recently learned knowledge.

  15. Midwifery students׳ experiences of an innovative clinical placement model embedded within midwifery continuity of care in Australia.

    PubMed

    Carter, Amanda G; Wilkes, Elizabeth; Gamble, Jenny; Sidebotham, Mary; Creedy, Debra K

    2015-08-01

    midwifery continuity of care experiences can provide high quality clinical learning for students but can be challenging to implement. The Rural and Private Midwifery Education Project (RPMEP) is a strategic government funded initiative to (1) grow the midwifery workforce within private midwifery practice and rural midwifery, by (2) better preparing new graduates to work in private midwifery and rural continuity of care models. this study evaluated midwifery students׳ experience of an innovative continuity of care clinical placement model in partnership with private midwifery practice and rural midwifery group practices. a descriptive cohort design was used. All students in the RPMEP were invited to complete an online survey about their experiences of clinical placement within midwifery continuity models of care. Responses were analysed using descriptive statistics. Correlations between total scale scores were examined. Open-ended responses were analysed using content analysis. Internal reliability of the scales was assessed using Cronbach׳s alpha. sixteen out of 17 completed surveys were received (94% response rate). Scales included in the survey demonstrated good internal reliability. The majority of students felt inspired by caseload approaches to care, expressed overall satisfaction with the mentoring received and reported a positive learning environment at their placement site. Some students reported stress related to course expectations and demands in the clinical environment (e.g. skill acquisition and hours required for continuity of care). There were significant correlations between scales on perceptions of caseload care and learning culture (r=.87 p<.001) and assessment (r=.87 p<.001). Scores on the clinical learning environment scale were significantly correlated with perceptions of the caseload model (rho=.86 p<.001), learning culture (rho=.94 p<.001) and assessment (rho=.65 p<.01) scales. embedding students within midwifery continuity of care models

  16. Experience of quality management system in a clinical laboratory in Nigeria

    PubMed Central

    Sylvester-Ikondu, Ugochukwu; Onwuamah, Chika K.; Salu, Olumuyiwa B.; Ige, Fehintola A.; Meshack, Emily; Aniedobe, Maureen; Amoo, Olufemi S.; Okwuraiwe, Azuka P.; Okhiku, Florence; Okoli, Chika L.; Fasela, Emmanuel O.; Odewale, Ebenezer. O.; Aleshinloye, Roseline O.; Olatunji, Micheal; Idigbe, Emmanuel O.

    2012-01-01

    Issues Quality-management systems (QMS) are uncommon in clinical laboratories in Nigeria, and until recently, none of the nation’s 5 349 clinical laboratories have been able to attain the certifications necessary to begin the process of attaining international accreditation. Nigeria’s Human Virology Laboratory (HVL), however, began implementation of a QMS in 2006, and in 2008 it was determined that the laboratory conformed to the requirements of ISO 9001:2000 (now 2008), making it the first diagnostic laboratory to be certified in Nigeria. The HVL has now applied for the World Health Organization (WHO) accreditation preparedness scheme. The experience of the QMS implementation process and the lessons learned therein are shared here. Description In 2005, two personnel from the HVL spent time studying quality systems in a certified clinical laboratory in Dakar, Senegal. Following this peer-to-peer technical assistance, several training sessions were undertaken by HVL staff, a baseline assessment was conducted, and processes were established. The HVL has monitored its quality indicators and conducted internal and external audits; these analyses (from 2007 to 2009) are presented herein. Lessons learned Although there was improvement in the pre-analytical and analytical indicators analysed and although data-entry errors decreased in the post-analytical process, the delay in returning laboratory test results increased significantly. There were several factors identified as causes for this delay and all of these have now been addressed except for an identified need for automation of some high-volume assays (currently being negotiated). Internal and external audits showed a trend of increasing non-conformities which could be the result of personnel simply becoming lax over time. Application for laboratory accreditation, however, could provide the renewed vigour needed to correct these non-conformities. Recommendation This experience shows that sustainability of the QMS

  17. Clinical experience of scoring criteria for Familial Hypercholesterolaemia (FH) genetic testing in Wales.

    PubMed

    Haralambos, K; Whatley, S D; Edwards, R; Gingell, R; Townsend, D; Ashfield-Watt, P; Lansberg, P; Datta, D B N; McDowell, I F W

    2015-05-01

    Familial Hypercholesterolaemia (FH) is caused by mutations in genes of the Low Density Lipoprotein (LDL) receptor pathway. A definitive diagnosis of FH can be made by the demonstration of a pathogenic mutation. The Wales FH service has developed scoring criteria to guide selection of patients for DNA testing, for those referred to clinics with hypercholesterolaemia. The criteria are based on a modification of the Dutch Lipid Clinic scoring criteria and utilise a combination of lipid values, physical signs, personal and family history of premature cardiovascular disease. They are intended to provide clinical guidance and enable resources to be targeted in a cost effective manner. 623 patients who presented to lipid clinics across Wales had DNA testing following application of these criteria. The proportion of patients with a pathogenic mutation ranged from 4% in those scoring 5 or less up to 85% in those scoring 15 or more. LDL-cholesterol was the strongest discriminatory factor. Scores gained from physical signs, family history, coronary heart disease, and triglycerides also showed a gradient in mutation pick-up rate according to the score. These criteria provide a useful tool to guide selection of patients for DNA testing when applied by health professionals who have clinical experience of FH. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  18. Supervising international students in clinical placements: perceptions of experiences and factors influencing competency development.

    PubMed

    Attrill, Stacie; Lincoln, Michelle; McAllister, Sue

    2016-07-16

    Health professional education programs attract students from around the world and clinical supervisors frequently report that international students find learning in clinical placement contexts particularly challenging. In existing literature clinical supervisors, who support international students on placement have identified concerns about their communication and interactions within clinical environments. However, clinical supervisors' perspectives about their experiences with international students on placement and the strategies they utilise to facilitate international student learning have not been described. As a result we have little insight into the nature of these concerns and what clinical supervisors do to support international students' competency development. Five focus group interviews were conducted with twenty Speech-Language Pathology clinical supervisors, recruited from 2 Australian universities. Interview data were analysed thematically. Themes identified were interpreted using cognitive load and sociocultural learning theories to enhance understanding of the findings. Four themes were identified: 'Complex teaching and learning relationships', 'Conceptions of students as learners'; Student communication skills for professional practice', and 'Positive mutual learning relationships'. Findings indicated that clinical supervisors felt positive about supporting international students in clinical placements and experienced mutual learning benefits. However, they also identified factors inherent to international students and the placement environment that added to workload, and made facilitating student learning complex. Clinical supervisors described strategies they used to support international students' cultural adjustment and learning, but communication skills were reported to be difficult to facilitate within the constraints of placements. Future research should address the urgent need to develop and test strategies for improving international

  19. Nursing students' experiences of the clinical learning environment in nursing homes: a questionnaire study using the CLES+T evaluation scale.

    PubMed

    Carlson, Elisabeth; Idvall, Ewa

    2014-07-01

    One major challenge facing the health care systems worldwide is the growing demand for registered nurses able to provide qualified nursing care for a vulnerable population. Positive learning experiences during clinical practice influence not only learning outcomes, but also how students reason in relation to future career choices. To investigate student nurses' experiences of the clinical learning environment during clinical practice in nursing homes, and to compare perceptions among student nurses with or without prior work experience as health care assistants in elderly care. A cross-sectional study was designed, utilising the Swedish version of the CLES+T evaluation scale. 260 student nurses (response rate 76%) who had completed a five week long clinical placement in nursing homes returned the questionnaire during the data collection period in 2011-2012. Data were analysed using descriptive statistics. Mann-Whitney U-test was used to examine differences in relation to students with or without prior experience of elderly care. Overall, the clinical learning environment was evaluated in a predominantly positive way. The sub-dimension Supervisory relationship displayed the highest mean value, and the lowest score was calculated for the sub-dimension Leadership style of the ward manager. Statistical significant differences between sub-groups were displayed for four out of 34 items. The supervisory relationship had the greatest impact on how student nurses experienced the clinical learning environment in nursing homes. It is therefore, of utmost importance that collaborative activities, between educational and nursing home settings, supporting the work of preceptors are established and maintained. Copyright © 2014 Elsevier Ltd. All rights reserved.

  20. Teacher Candidates' Experiences with Clinical Teaching in Reading Instruction: A Comparison between the Professional Development School Environment and the Non-Professional Development School Environment

    ERIC Educational Resources Information Center

    Hopper, Cynthia J.

    2016-01-01

    Teacher candidates experience a variety of school settings when enrolled in teacher education methods courses. Candidates report varied experiences when in public school classrooms. This dissertation investigated clinical experiences of teacher candidates when placed in two different environments for clinical teaching. The two environments were a…

  1. Early experiences in evolving an enterprise-wide information model for laboratory and clinical observations.

    PubMed

    Chen, Elizabeth S; Zhou, Li; Kashyap, Vipul; Schaeffer, Molly; Dykes, Patricia C; Goldberg, Howard S

    2008-11-06

    As Electronic Healthcare Records become more prevalent, there is an increasing need to ensure unambiguous data capture, interpretation, and exchange within and across heterogeneous applications. To address this need, a common, uniform, and comprehensive approach for representing clinical information is essential. At Partners HealthCare System, we are investigating the development and implementation of enterprise-wide information models to specify the representation of clinical information to support semantic interoperability. This paper summarizes our early experiences in: (1) defining a process for information model development, (2) reviewing and comparing existing healthcare information models, (3) identifying requirements for representation of laboratory and clinical observations, and (4) exploring linkages to existing terminology and data standards. These initial findings provide insight to the various challenges ahead and guidance on next steps for adoption of information models at our organization.

  2. Evaluation of chest tomosynthesis for the detection of pulmonary nodules: effect of clinical experience and comparison with chest radiography

    NASA Astrophysics Data System (ADS)

    Zachrisson, Sara; Vikgren, Jenny; Svalkvist, Angelica; Johnsson, Åse A.; Boijsen, Marianne; Flinck, Agneta; Månsson, Lars Gunnar; Kheddache, Susanne; Båth, Magnus

    2009-02-01

    Chest tomosynthesis refers to the technique of collecting low-dose projections of the chest at different angles and using these projections to reconstruct section images of the chest. In this study, a comparison of chest tomosynthesis and chest radiography in the detection of pulmonary nodules was performed and the effect of clinical experience of chest tomosynthesis was evaluated. Three senior thoracic radiologists, with more than ten years of experience of chest radiology and 6 months of clinical experience of chest tomosynthesis, acted as observers in a jackknife free-response receiver operating characteristics (JAFROC-1) study, performed on 42 patients with and 47 patients without pulmonary nodules examined with both chest tomosynthesis and chest radiography. MDCT was used as reference and the total number of nodules found using MDCT was 131. To investigate the effect of additional clinical experience of chest tomosynthesis, a second reading session of the tomosynthesis images was performed one year after the initial one. The JAFROC-1 figure of merit (FOM) was used as the principal measure of detectability. In comparison with chest radiography, chest tomosynthesis performed significantly better with regard to detectability. The observer-averaged JAFROC-1 FOM was 0.61 for tomosynthesis and 0.40 for radiography, giving a statistically significant difference between the techniques of 0.21 (p<0.0001). The observer-averaged JAFROC-1 FOM of the second reading of the tomosynthesis cases was not significantly higher than that of the first reading, indicating no improvement in detectability due to additional clinical experience of tomosynthesis.

  3. Is there a relationship between the diversity characteristics of nursing students and their clinical placement experiences? A literature review.

    PubMed

    Koch, Jane; Everett, Bronwyn; Phillips, Jane; Davidson, Patricia M

    2015-01-01

    There has been an increase in ethno-cultural, linguistic, and socio-demographical diversity in students enrolling in undergraduate nursing programs. Diversity also involves other characteristics, but little is known about how diversity impacts on the clinical experiences of nursing students. The aim of this review is to identify studies which describe the clinical placement experiences of nursing students who have a broad range of diversity characteristics. Major databases were searched and original studies published from 2003 to 30 June 2013 were eligible for inclusion. An expanded definition of diversity was used to include characteristics such as ethnicity, language, age, religion, gender, socioeconomic status, carer responsibilities, sexual orientation and special needs/disability. Male gender and speaking English as a second language are diversity characteristics associated with a less positive clinical experience. These students are also more likely to leave their nursing program. Mature-aged students and those from ethnic minority groups were also noted to have a less positive clinical experience and in some cases, this also increased attrition. However, it was difficult to determine the impact of these characteristics alone as they appeared to be linked with other characteristics such as financial difficulties and carer responsibilities in the case of mature-aged students, and language and international student status in the case of ethnicity. Given the significant benefits associated with preparing a diverse nursing workforce, it is an imperative to better understand the impact of diversity on nursing students to ensure that every placement becomes a positive and valuable learning experience.

  4. Dasatinib first-line: Multicentric Italian experience outside clinical trials.

    PubMed

    Breccia, Massimo; Stagno, Fabio; Luciano, Luigiana; Abruzzese, Elisabetta; Annunziata, Mario; D'Adda, Mariella; Maggi, Alessandro; Sgherza, Nicola; Russo-Rossi, Antonella; Pregno, Patrizia; Castagnetti, Fausto; Iurlo, Alessandra; Latagliata, Roberto; Cedrone, Michele; Di Renzo, Nicola; Sorà, Federica; Rege-Cambrin, Giovanna; La Nasa, Giorgio; Scortechini, Anna Rita; Greco, Giovanna; Franceschini, Luca; Sica, Simona; Bocchia, Monica; Crugnola, Monica; Orlandi, Esther; Guarini, Attilio; Specchia, Giorgina; Rosti, Gianantonio; Saglio, Giuseppe; Alimena, Giuliana

    2016-01-01

    Dasatinib was approved for the treatment of chronic phase (CP) chronic myeloid leukemia (CML) patients in first line therapy based on the demonstration of efficacy and safety reported in patients enrolled in clinical trials. We describe a multicentric Italian "real-life" experience of dasatinib used as frontline treatment outside clinical trials. One hundred and nine patients (median age 54 years) were treated from January 2012 to December 2013. Increased incidence of high risk patients were detected according to stratification (26% according to Sokal score, 19% according to Euro score and 16% according to EUTOS) when compared to company sponsored studies. Median time from diagnosis to start of dasatinib was 18 days. Ten patients received unscheduled starting dose (6 patients 50mg and 4 patients 80 mg QD), whereas 99 patients started with 100mg QD. At 3 months, 92% of patients achieved a BCR-ABL ratio less than 10%. At 6 months, the rate of CCyR was 91% and the rate of MR3 was 40%, with 8% of the patients reaching MR4.5. Ninety-three patients were evaluable at 12 months: the rate of MR3 was 62%, with MR4.5 being achieved by 19% of the patients. At a median follow-up of 12 months, 27 patients (24.7%) were receiving the drug at reduced dose. Two patients (1.8%) experienced a lymphoid blast crisis and the overall incidence of resistance was 8%. As regards safety, the major side effects recorded were thrombocytopenia, neutropenia and pleural effusions, which occurred in 22%, 10% and 8% of patients, respectively. Present results, achieved in a large cohort of patients treated outside clinical trials, further confirm the efficacy and safety of dasatinib as firstline treatment in CML. Copyright © 2015 Elsevier Ltd. All rights reserved.

  5. The Influence of Clinical Experience and Photographic Presentation on Age Assessment of Women.

    PubMed

    Nielsen, Barbara Rubek; Linneberg, Allan; Christensen, Kaare; Forman, Julie Lyng; Schwarz, Peter

    2016-01-01

    Epidemiological studies have reported that a higher perceived age is associated with poor health and higher mortality. However, the method used for the assessment of perceived age differs between studies with regard to age, gender, the number and occupation of assessors as well as the presentation of participants. It is not known whether the clinical experience of the assessor or photographic presentation have an influence on the assessment of perceived age, which the present study aimed to investigate. In a cross-sectional study of 460 women aged 25-93 years, 10 consultants and 10 residents were asked to estimate the age of each participant using three different photographic presentations: facial photograph, whole-body photograph, and combined facial and whole-body photographs. Data were analyzed by means of summary statistics and linear mixed models. The inter-class correlation coefficient within each assessor group and photographic presentation varied from 0.66 to 0.75. Limits of agreement were in a broad range but were similar in the two assessor groups. The best inter-assessor agreement was obtained from photographs of both the face and the whole body. Intra- and inter-assessor agreements between photographic presentations were similar among both assessor groups. The accuracy in age assessment was significantly influenced by the photographic presentation but not by the clinical experience of the assessor. The difference in the mean perceived age of a participant of average age was estimated as +0.40 years (95% CI: -1.80; 2.59) for consultants versus residents, -2.05 years (95% CI: -2.90; -1.19) for facial photographs versus both facial and whole-body photographs, and -1.44 years (95% CI: -2.30; -0.58) for whole-body photographs versus both facial and whole-body photographs. A regression towards the mean age was seen. The assessment of perceived age was influenced by the photographic presentation but not by the clinical experience of the assessor. © 2015 S

  6. The artificial organ museum in Cleveland (1979-1999) moved to Houston, Texas, and named in 2002 as the ICMT Museum for Artificial Organs.

    PubMed

    Nosé, Yukihiko

    2003-09-01

    The artificial organ museum established in Cleveland, Ohio, in 1979 organized by the International Center for Artificial Organs and Transplantation (ICAOT), was moved to Houston, Texas, in 1999. The museum with expanded and renewed artificial organ exhibits was officially opened on the 8th and 9th of November, 2002, at the Cullen Pavilion of the original Memorial Hermann Hospital. This building is the oldest in the Texas Medical Center, which was built in 1922. The ICMT (International Center for Medical Technologies) Museum for Artificial Organs (Museum) was completed after phase I, II, and III expansions of the exhibit booths, which were made over the last two years. Approximately 250 historically important and currently widely used artificial organs are exhibited in the Museum. The official opening of the Museum was coordinated with the "Symposium on Artificial Organs: Past, Present, and Future" during two days in November. There were approximately 225 participants at these events, and approximately 40 pioneers and clinical experts in the development and practice of various types of artificial organs contributed. During these programs, a proposal to maintain human resources in addition to artificial organ hardware and software was made in addition to the Museum. This new organization would be called the International Academy of Artificial Organ Pioneers (Academy). All contributors to the symposium were invited to be members of the Academy. The attendants of the symposium accepted this proposal unanimously. An additional 40 individuals, who were recognized as contributors to artificial organ technologies, were later added to the original Academy members. Later, the effective utilization of the Museum and Academy was encompassed in the International Faculty for Health and Medical Technologies (Faculty), a new addition to the activities of the ICMT. Dr. Michael DeBakey was elected as Dean of the Faculty. This is considered a "university without walls," a "university

  7. Nursing Clinical Instructor Experiences of Empowerment in Rwanda: Applying Kanter's and Spreitzer's Theories.

    PubMed

    Thuss, Mary; Babenko-Mould, Yolanda; Andrusyszyn, Mary-Anne; Laschinger, Heather K S

    2016-10-15

    The purpose of this study was to explore Rwandan nursing clinical instructors' (CIs) experiences of structural and psychological empowerment. CIs play a vital role in students' development by facilitating learning in health care practice environments. Quality nursing education hinges on the CI's ability to enact a professional role. A descriptive qualitative method was used to obtain an understanding of CIs empowerment experiences in practice settings. Kanter's Theory of Structural Power in Organizations and Spreitzer's Psychological Empowerment Theory were used as theoretical frameworks to interpret experiences. Interview data from 21 CIs were used to complete a secondary analysis. Most participants perceived the structural components of informal power, resources, and support while formal power and opportunity were limited, diminishing their sense of structural empowerment. Psychological empowerment for CIs stemmed from a sense of competence, meaning, impact and self-determination they had for their teaching roles and responsibilities in the practice setting.

  8. Two decades of pharmacovigilance and clinical experience with highly purified rabies immunoglobulin F(ab')2 fragments.

    PubMed

    Reveneau, Elisa; Cottin, Pascale; Rasuli, Anvar

    2017-03-01

    Rabies is a worldwide zoonotic viral disease with no specific treatment once symptoms occur; manifest disease is almost always fatal. WHO recommendations for exposed individuals include immediate attention to the wound and use of rabies immunoglobulin and/or vaccine for post-exposure prophylaxis (PEP). Here, we provide an overview of the clinical experience with a highly purified preparation of F(ab') 2 fragments from equine rabies immunoglobulin (F(ab') 2 pERIG; Favirab TM ) in rabies PEP. Areas covered: Our review comprises a retrospective analysis of adverse event reports in the Sanofi Pasteur global pharmacovigilance database for F(ab') 2 pERIG, including adverse event reports from eight Sanofi Pasteur-sponsored clinical trials and post-market surveillance data collected between 1995 and 2014. The general safety profile of F(ab') 2 pERIG is discussed, as are the occurrence of rare anaphylactic reactions, and suspected intervention failure. Expert commentary: Over 20 years of clinical development and post-licensure experience has established the safety and effectiveness of F(ab') 2 pERIG (Favirab TM ) in rabies PEP.

  9. Medical students' and residents' clinical and educational experiences with defensive medicine.

    PubMed

    O'Leary, Kevin J; Choi, Jennifer; Watson, Katie; Williams, Mark V

    2012-02-01

    To assess medical students' and residents' experiences with defensive medicine, which is any deviation from sound medical practice due to a perceived threat of liability through either assurance or avoidance behaviors. Assurance behaviors include providing additional services of minimal clinical value. Avoidance behaviors include withholding services that are, or avoiding patients who are, perceived as high risk. The authors conducted a cross-sectional survey of fourth-year medical students and third-year residents in 2010. Respondents rated how often malpractice liability concerns caused their teams to engage in four types of assurance and two types of avoidance behaviors using a four-point scale (never, rarely, sometimes, often). Respondents also rated how often their attending physicians explicitly recommended that liability concerns be taken into account when making clinical decisions. Overall, 126 of 194 medical students (65%) and 76 of 141 residents (54%) completed the survey. Of the responding medical students, 116 (92%) reported sometimes or often encountering at least one assurance practice, and 43 (34%) reported encountering at least one avoidance practice. Of the responding residents, 73 (96%) reported encountering at least one assurance practice, and 33 (43%) reported encountering at least one avoidance practice. Overall, 50 of 121 medical students (41%) and 36 of 68 residents (53%) reported that their attending physicians sometimes or often explicitly taught them to take liability into account when making clinical decisions. Medical trainees reported frequently encountering defensive medicine practices and often being taught to take malpractice liability into consideration during clinical decision making.

  10. Experiences from the Merger of Clinics in the Swedish Public Dental Service - the Employee Perspective

    PubMed Central

    Gustafsson, Christina Hassel; Östberg, Anna-Lena

    2017-01-01

    Objectives: The purpose of this study was to investigate the experiences of employees regarding the merger of clinics within the Public Dental Service (PDS), Västra Götaland Region, Sweden. Methods: Employees (dentists, dental hygienists, dental nurses) affected by both administrative and geographical mergers of dental clinics answered a web-based survey about experiences and effects of the merger process (n = 99, 47%). The Swedish short-form version of “The Nordic Questionnaire for Psychological and Social Factors at Work” (QPSNordic), the QPSNordic-34+ was used. Chi-squared tests and logistic regression analyses were used. Results: Two thirds of the participants were aged ≥ 50 years. The respondents stated that the reasons for the merger were often made clear (78%). Satisfaction with and involvement in the merger process received lower scores (45%). Work was often perceived as stressful, irrespective of the merger. Job demands and engagement scored positively, but control at work was given a low score (one fifth stated fairly high or high control). Dentists (OR 5.9; 95%, CI 1.1-32.3), but not dental hygienists (OR 2.8; 95%, CI 0.9-9.0), indicated stress significantly more often than dental nurses (reference) (adjusted for age and gender). Conclusion: Employees in the Public Dental Service (PDS) in a Swedish region had mainly positive experiences after the merger of clinics; however, their involvement in the process was low. Work demands were perceived as high. These findings should be considered when planning mergers in dental organizations. PMID:29151991

  11. Hospital Value-Based Purchasing: The Association Between Patient Experience and Clinical Outcome.

    PubMed

    Haley, D Rob; Hamadi, Hanadi; Zhao, Mei; Xu, Jing; Wang, Yi

    The Affordable Care Act of 2010 introduced a Hospital Value-Based Purchasing Total Performance Score for payment purposes and to evaluate hospital quality of care. In fiscal year 2016, Total Performance Score was composed of (1) Clinical Processes of Care, (2) Patient Experience of Care, (3) Outcome, and (4) Efficiency domains. The objective of this study was to examine the association between the Patient Experience of Care and Outcome domains. The Donabedian model of structure, process, and outcome was used as a conceptual framework for this study. Data from the 2015-2016 Area Health Resource File, the 2016 American Hospital Association database, and the 2016 Hospital Value-Based Purchasing were used. Univariate, bivariate, and multivariate analyses were conducted to examine the impact of patient experience on outcome of care and hospitals. From a sample of 1866 hospitals across the United States, patient experience was significantly and positively associated with patient outcome. In addition, for-profit hospitals, hospitals with more beds, nonteaching hospitals, and hospitals located in less competitive markets were found to have a significant association with better outcomes. The study's findings are important as policy makers consider additional or alternative indicators that may better represent and encourage higher quality of care within acute care hospitals.

  12. Clinical psychologists' experiences of reflective staff groups in inpatient psychiatric settings: a mixed methods study.

    PubMed

    Heneghan, Cara; Wright, John; Watson, Gilli

    2014-01-01

    Background Reflective practice groups have been recommended for improving staff wellbeing and team functioning in inpatient psychiatric services, and clinical psychologists have been identified as potential leaders in this type of work. Research is limited with little information about reflective practice group guidelines, prevalence and effectiveness. Aims The aims of this study were to describe clinical psychologists' practice in reflective groups for staff in inpatient psychiatric services and to explore how such groups are conceptualized and implemented. Methods Online questionnaires and follow-up interviews were used to gain broad descriptions of practice and in-depth information about participants' experiences. The sample consisted of 73 clinical psychologists working in the UK, six of whom were interviewed. Data were analysed using descriptive statistics, content analysis and thematic analysis. Results Clinical psychologists regularly facilitate reflective staff groups in inpatient psychiatric settings in the UK. Common outcomes related to staff wellbeing, service culture and teamwork. Engagement, group dynamics and lack of management support were common challenges. Group experiences were influenced by the organizational context. Conclusions Clinical psychologists' practices regarding reflective staff groups were in line with recent professional developments. Several difficulties were described, which may be indicative of both a difficulty inherent to the task and a training gap in reflective staff group process. The study had methodological limitations but offers a useful contribution to the literature, and enables practice and training implications to be drawn. The need for further research exploring facilitator characteristics, views of group participants and the impact of reflective staff groups on patients is indicated. The term 'reflective practice group' encompasses a range of practices, but a typical group structure was found with common aims

  13. A balancing act: a phenomenological exploration of medical students' experiences of using mobile devices in the clinical setting

    PubMed Central

    Rashid-Doubell, F; Mohamed, S; Elmusharaf, K; O'Neill, C S

    2016-01-01

    Objective The aims of this study were to describe the experiences of senior students using mobile devices in a clinical setting while learning and interacting with clinical teachers, patients and each other, and to identify challenges that facilitated or impeded the use of such devices in the hospital. Design Interpretative phenomenology was chosen to guide our enquiry. Semi-structured interviews were conducted to examine the experiences of five senior medical students using mobile devices in the clinical setting. Setting and participants Senior medical students at an international medical school in the Middle East. Results Three main themes emerged from the data analysis: learning; professional identity and transitioning from student to doctor. The findings showed that using mobile devices in the clinical area as a learning tool was not a formalised process. Rather, it was opportunistic learning at the bedside and on occasion a source of distraction from clinical teaching. Students needed to negotiate relationships between themselves, the clinical teacher and patients in order to ensure that they maintained an acceptable professional image. Participants experienced and negotiated the change from student to doctor making them mindful of using their devices at the bedside. Conclusions Mobile devices are part of daily life for a medical student and there is a need to adapt medical education in the clinical setting, to allow the students to use their devices in a sensitive manner. PMID:27142860

  14. Challenges of the ward round teaching based on the experiences of medical clinical teachers.

    PubMed

    Arabshahi, Kamran Soltani; Haghani, Fariba; Bigdeli, Shoaleh; Omid, Athar; Adibi, Peyman

    2015-03-01

    Holding educational sessions in a clinical environment is a major concern for faculty members because of its special difficulties and restrictions. This study attempts to recognize the challenges of the ward round teaching through investigating the experiences of clinical teachers in 2011. This qualitative research is carried out through purposive sampling with maximum variation from among the clinical teachers of major departments in Isfahan University of Medical Sciences (9 persons). The sampling continued until data saturation. Data were collected through semi-structured interview and analyzed through Collaizzi method. Data reliability and validity was confirmed through the four aspects of Lincoln and Guba method (credibility, conformability, transferability, and dependability). Three major themes and their related sub-themes (minor themes) were found out including the factors related to the triad of clinical teaching (patient, learner, and clinical teacher) (concern about patient's welfare, poor preparation, lack of motivation, ethical problems), factors related to the educational environment (stressful environment, humiliating environment and poor communication) and the factors related to the educational system of the clinical environment (poor organizing and arrangement of resources, poor system's monitoring, bad planning and inadequate resource). Ward round teaching has many concerns for teachers, and this should be recognized and resolved by authorities and teachers. If these problems are not resolved, it would affect the quality of clinical teaching.

  15. Challenges of the ward round teaching based on the experiences of medical clinical teachers

    PubMed Central

    Arabshahi, Kamran Soltani; Haghani, Fariba; Bigdeli, Shoaleh; Omid, Athar; Adibi, Peyman

    2015-01-01

    Background: Holding educational sessions in a clinical environment is a major concern for faculty members because of its special difficulties and restrictions. This study attempts to recognize the challenges of the ward round teaching through investigating the experiences of clinical teachers in 2011. Materials and Methods: This qualitative research is carried out through purposive sampling with maximum variation from among the clinical teachers of major departments in Isfahan University of Medical Sciences (9 persons). The sampling continued until data saturation. Data were collected through semi-structured interview and analyzed through Collaizzi method. Data reliability and validity was confirmed through the four aspects of Lincoln and Guba method (credibility, conformability, transferability, and dependability). Results: Three major themes and their related sub-themes (minor themes) were found out including the factors related to the triad of clinical teaching (patient, learner, and clinical teacher) (concern about patient's welfare, poor preparation, lack of motivation, ethical problems), factors related to the educational environment (stressful environment, humiliating environment and poor communication) and the factors related to the educational system of the clinical environment (poor organizing and arrangement of resources, poor system's monitoring, bad planning and inadequate resource). Conclusion: Ward round teaching has many concerns for teachers, and this should be recognized and resolved by authorities and teachers. If these problems are not resolved, it would affect the quality of clinical teaching. PMID:26109975

  16. Environmental factors that distinguish between clinical and healthy samples with childhood experiences of abuse and neglect.

    PubMed

    Infurna, Maria Rita; Giannone, Francesca; Guarnaccia, Cinzia; Lo Cascio, Maria; Parzer, Peter; Kaess, Michael

    2015-01-01

    Childhood maltreatment is associated with a wide range of problems in adulthood. However, specific environmental factors (either positive or negative) influence mental health outcomes in maltreated children. The present study investigated the effect of environmental factors by comparing a group of clinical participants with experiences of abuse/neglect with a healthy group with similar patterns of experiences. Environmental factors selected were: separation from parents, financial hardship, parental psychiatric disorders, and low social involvement. The study included 55 mixed clinical participants and 23 healthy participants. All participants were investigated using the Childhood Experience of Care and Abuse (CECA) interview. The two groups were specifically matched with regard to patterns of childhood maltreatment. The findings indicated that psychopathological outcome was associated with a greater presence of negative environmental factors (p < 0.001). In particular, lack of social support seemed to be the only one predictor (OR = 27.86). This study is the first to investigate the influence of specific environmental factors in two groups with similar childhood experiences of abuse/neglect but different mental health outcomes. These findings suggest that efforts should be made to incorporate both familial and external sources of social support in promoting mental health for maltreated children. © 2015 S. Karger AG, Basel.

  17. The experience of adolescents participating in a randomised clinical trial in the field of mental health: a qualitative study.

    PubMed

    Midgley, Nick; Isaacs, Danny; Weitkamp, Katharina; Target, Mary

    2016-07-28

    This descriptive study aimed to investigate adolescents' motivations for participating in a randomised controlled trial (RCT), to explore the understanding that the young people had regarding a number of aspects of the trial design, to examine whether or not they found participation in the trial to be acceptable and what affected this, and to identify whether and how the young people felt that their participation in the RCT impacted on their experience of therapy and on therapeutic change. Seventy-six adolescents who were taking part in a large-scale RCT to evaluate the clinical and cost effectiveness of psychological therapies for depression were interviewed at two time-points after completing therapy. The semi-structured interviews, which included a focus on the young people's experience of the research study, were analysed using framework analysis. The vast majority of adolescents found it acceptable to participate in the clinical trial, and many agreed to participate for reasons of 'conditional altruism'. However consent was often given without great understanding of the key elements of the trial, including the difference between treatment arms and the randomisation process. Although the adolescents were largely positive about their experiences from taking part, the study raises questions about whether clinical outcomes may be influenced by participation in the research elements of the trial. Although adolescents are under-represented in clinical trials, those who do participate are generally positive about the experience; however, careful thought needs to be given to key elements of the trial design and the potential impact of the research participation on clinical outcomes. ISRCTN registry, ISRCTN83033550 . Registered on 15 October 2009.

  18. Discordance between 'actual' and 'scheduled' check-in times at a heart failure clinic.

    PubMed

    Gorodeski, Eiran Z; Joyce, Emer; Gandesbery, Benjamin T; Blackstone, Eugene H; Taylor, David O; Tang, W H Wilson; Starling, Randall C; Hachamovitch, Rory

    2017-01-01

    A 2015 Institute Of Medicine statement "Transforming Health Care Scheduling and Access: Getting to Now", has increased concerns regarding patient wait times. Although waiting times have been widely studied, little attention has been paid to the role of patient arrival times as a component of this phenomenon. To this end, we investigated patterns of patient arrival at scheduled ambulatory heart failure (HF) clinic appointments and studied its predictors. We hypothesized that patients are more likely to arrive later than scheduled, with progressively later arrivals later in the day. Using a business intelligence database we identified 6,194 unique patients that visited the Cleveland Clinic Main Campus HF clinic between January, 2015 and January, 2017. This clinic served both as a tertiary referral center and a community HF clinic. Transplant and left ventricular assist device (LVAD) visits were excluded. Punctuality was defined as the difference between 'actual' and 'scheduled' check-in times, whereby negative values (i.e., early punctuality) were patients who checked-in early. Contrary to our hypothesis, we found that patients checked-in late only a minority of the time (38% of visits). Additionally, examining punctuality by appointment hour slot we found that patients scheduled after 8AM had progressively earlier check-in times as the day progressed (P < .001 for trend). In both a Random Forest-Regression framework and linear regression models the most important risk-adjusted predictors of early punctuality were: later in the day appointment hour slot, patient having previously been to the hospital, age in the early 70s, and white race. Patients attending a mixed population ambulatory HF clinic check-in earlier than scheduled times, with progressive discrepant intervals throughout the day. This finding may have significant implications for provider utilization and resource planning in order to maximize clinic efficiency. The impact of elective early arrival on

  19. A Decade of Experience in Creating and Maintaining Data Elements for Structured Clinical Documentation in EHRs

    PubMed Central

    Zhou, Li; Collins, Sarah; Morgan, Stephen J.; Zafar, Neelam; Gesner, Emily J.; Fehrenbach, Martin; Rocha, Roberto A.

    2016-01-01

    Structured clinical documentation is an important component of electronic health records (EHRs) and plays an important role in clinical care, administrative functions, and research activities. Clinical data elements serve as basic building blocks for composing the templates used for generating clinical documents (such as notes and forms). We present our experience in creating and maintaining data elements for three different EHRs (one home-grown and two commercial systems) across different clinical settings, using flowsheet data elements as examples in our case studies. We identified basic but important challenges (including naming convention, links to standard terminologies, and versioning and change management) and possible solutions to address them. We also discussed more complicated challenges regarding governance, documentation vs. structured data capture, pre-coordination vs. post-coordination, reference information models, as well as monitoring, communication and training. PMID:28269927

  20. Experiences of Master's Students Regarding Clinical Supervision in an Applied Psychology Programme in South Africa

    ERIC Educational Resources Information Center

    Nel, Lindi; Fouche, Paul

    2017-01-01

    This study explored and described the experiences regarding clinical supervision of master's students in professional psychology programmes in South Africa. Four participants were purposively selected from four different universities. The participants engaged in reflective writings and in-depth interviews over a one-year span. Data were analysed…

  1. Experiences of women with a diagnosis of breast cancer: a clinical pathway approach.

    PubMed

    Lindop, E; Cannon, S

    2001-06-01

    The study presented in this paper formed the first part of a large survey of breast cancer patients in one health authority in England, UK looking at individual needs expressed by women with a diagnosis of breast cancer. The paper provides an account of the experiences of 12 women with a diagnosis of breast cancer. The women represent a wide age range and different stages of illness. The transcribed accounts of the women were analysed by means of Qualitative Solutions and Research, Non-Numerical Unstructured Data Indexing Searching and Theorising (QSR*NUDIST). The study examined the individual experiences of women with a diagnosis of breast cancer and its aftermath as they passed through different stages related to it. The women's experiences are presented within the conceptual framework of the clinical pathway and their accounts represent their journey along the pathway. Various significant points in this journey are portrayed representing the women's reactions to diagnosis, treatment, femininity and body image, support, family and friends, information and after care.

  2. Clinical profiles and outcomes in idiopathic duct-centric chronic pancreatitis (type 2 autoimmune pancreatitis): the Mayo Clinic experience.

    PubMed

    Hart, Phil A; Levy, Michael J; Smyrk, Thomas C; Takahashi, Naoki; Abu Dayyeh, Barham K; Clain, Jonathan E; Gleeson, Ferga C; Pearson, Randall K; Petersen, Bret T; Topazian, Mark D; Vege, Santhi S; Zhang, Lizhi; Chari, Suresh T

    2016-10-01

    Idiopathic duct-centric chronic pancreatitis (IDCP), also known as type 2 autoimmune pancreatitis (AIP), is an uncommon subtype of AIP. International Consensus Diagnostic Criteria for IDCP propose that the diagnosis requires pancreatic histology and/or concurrent IBD. We examined our experience with IDCP (type 2 AIP) to assess the appropriateness of these criteria, and identify unique characteristics in patients presenting with acute pancreatitis. We reviewed the Mayo Clinic AIP database through May 2014 to identify subjects with either definitive (n=31) or probable (n=12) IDCP. We compared demographic and clinical factors based on strength of diagnostic confidence (definitive versus probable), presence of IBD, and acute pancreatitis as the presenting manifestation. Relapse-free survival was determined using the Kaplan-Meier method. The clinical profiles were similar irrespective of the diagnostic criteria fulfilled. Common clinical presentations included acute pancreatitis (n=25, 58.1%, 12 of whom (27.9%) had recurrent pancreatitis) and pancreatic mass/obstructive jaundice (n=15, 34.9%). The cumulative relapse rate was 10.6% at 3 years (median follow-up 2.9 years). Relapse-free survival was similar for the different diagnostic categories, but was decreased in those initially presenting with acute pancreatitis (p=0.047) or treated with steroids (vs surgery, p=0.049). The current diagnostic classification of probable IDCP and the inclusion of IBD as a supportive criterion appear valid, because patients have similar clinical profiles and disease-related outcomes to those with definitive IDCP. Concurrent IBD, especially in young patients, may suggest when IDCP is the underlying cause of recurrent acute pancreatitis, but additional studies are needed for validation. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  3. Caries detection and diagnostics with near-infrared light transillumination: clinical experiences.

    PubMed

    Söchtig, Friederike; Hickel, Reinhard; Kühnisch, Jan

    2014-06-01

    The aim of this paper was to present the function and potential of diagnosing caries lesions using a recently introduced near-infrared (NIR) transillumination technique (DIAGNOcam, KaVo). The study included 130 adolescents and adults with complete permanent dentition (age > 12). All patients underwent visual examination and, if necessary, bitewing radiographs. Proximal and occlusal surfaces, which had not yet been restored, were photographed by a NIR transillumination camera system using light with a wavelength of 780 nm rather than ionizing radiation. Of the study patients, 85 showed 127 proximal dentin caries lesions that were treated operatively. A cross table shows the correlation of radiography and NIR transillumination. Based on our practical clinical experiences to date, a possible classifi cation of diagnosis is introduced. The main result of our study was that NIR light was able to visualize caries lesions on proximal and occlusal surfaces. The study suggests that NIR transillumination is a method that may help to avoid bitewing radiographs for diagnosis of caries in everyday clinical practice.

  4. Junior nursing students' experiences of vertical violence during clinical rotations.

    PubMed

    Thomas, Sandra P; Burk, Renee

    2009-01-01

    Horizontal violence is a form of workplace violence, a phenomenon that is prevalent in the nursing profession. Research has revealed a variety of negative peer-to-peer behaviors that lower morale and lead to turnover. However, little research has been conducted on "eating our young" (violence occurring between individuals with unequal power, such as staff nurse and student). We propose "vertical violence" as the appropriate term when abusive registered nurse (RN) behavior is directed towards students. We report a content analysis of stories written by junior nursing students about incidents of injustice perpetrated by staff RNs during their clinical experiences. Four levels of injustice were described. Nursing leadership, both in hospitals and educational institutions, must become engaged in efforts to eradicate vertical violence towards students.

  5. Preventative health, diversity, and inclusion: a qualitative study of client experience aboard a mobile health clinic in Boston, Massachusetts.

    PubMed

    Bouchelle, Zoe; Rawlins, Yasmin; Hill, Caterina; Bennet, Jennifer; Perez, Leonor Xochitl; Oriol, Nancy

    2017-11-03

    There are approximately 2000 mobile health clinics operating in the United States. While researchers have established that mobile health clinics can be cost effective and improve outcomes, there is scant research examining the healthcare experience on a mobile health clinic from patients' perspectives. Data were gathered from interviews with 25 clients receiving care on a Boston-based mobile health clinic and analyzed using grounded theory methodology. Emerging patterns in the data revealed three relational and three structural factors most significant to participants' experience of care on The Family Van. Relational factors include providers who 1) Communicate understandably, 2) Create a culture of respect and inclusivity, and 3) Are diverse with knowledge of the community. Structural factors include 1) A focus on preventative health and managing chronic disease, 2) Expeditious, free, and multiple services, and 3) Location. The participant accounts in this report serve to expand on prior research exploring mobile health clinics' role in patients' healthcare, to more clearly define the most salient aspects of the mobile health clinic model for the patients they serve, and to give voice to patients too seldom heard in the academic literature.

  6. Augmentative and alternative communication in adolescents with severe intellectual disability: a clinical experience.

    PubMed

    Uliano, D; Falciglia, G; Del Viscio, C; Picelli, A; Gandolfi, M; Passarella, A

    2010-06-01

    Augmentative and alternative communication devices proved to be effective in patients with severe intellectual disability to overcome their communication impairments. In order to give a contribution for design of augmentative and alternative communication systems that better meet the needs of beginning communicators we decided to report our clinical experience about using augmentative and alternative communication in adolescents with severe intellectual disability. Five patients who underwent a long time traditional speech rehabilitation program (at least 5 years) with scant improvements in linguistic function were recruited and evaluated by means of the Vineland Adaptive Behaviour Scale before and after a three years augmentative and alternative communication intervention carried out by a multidisciplinary team. After the rehabilitative intervention patients showed an improvement in communication, daily living skills and socialization as measured by the Vineland Adaptive Behaviour Scale. Augmentative and alternative communication is an effective rehabilitation approach to people with severe intellectual disability and impairments in linguistic expression. Moreover augmentative and alternative communication is a useful tool allowing these patients to increase their social participation also enhancing their self-esteem. Our clinical experience confirmed these topics also in adolescents who underwent a long time traditional speech rehabilitation program with scant improvements, providing practical information to clinicians.

  7. Facilitating Dental Student Reflections: Using Mentor Groups to Discuss Clinical Experiences and Personal Development.

    PubMed

    Koole, Sebastiaan; Christiaens, Veronique; Cosyn, Jan; De Bruyn, Hugo

    2016-10-01

    Despite the consensus on the importance of reflection for dental professionals, a lack of understanding remains about how students and clinicians should develop their ability to reflect. The aim of this study was to investigate dental students' and mentors' perceptions of mentor groups as an instructional method to facilitate students' reflection in terms of the strategy's learning potential, role of the mentor, group dynamics, and feasibility. At Ghent University in Belgium, third- and fourth-year dental students were encouraged to reflect on their clinical experiences and personal development in three reflective mentor sessions. No preparation or reports afterwards were required; students needed only to participate in the sessions. Sessions were guided by trained mentors to establish a safe environment, frame clinical discussions, and stimulate reflection. Students' and mentors' perceptions of the experience were assessed with a 17-statement questionnaire with response options on a five-point Likert scale (1=totally disagree to 5=totally agree). A total of 50 students and eight mentors completed the questionnaire (response rates 81% and 89%, respectively). Both students and mentors had neutral to positive perceptions concerning the learning potential, role of the mentor, group dynamics, and feasibility. The mean ideal total time for sessions in a year was 99 minutes (third-year students), 111 minutes (fourth-year students), and 147 minutes (mentors). Reported reflective topics related to patient management, frustrations, and practice of dentistry. Overall mean appreciation for the experience ranged from 14.50 to 15.14 on the 20-point scale. These findings about students' and mentors' positive perceptions of the experience suggest that mentor groups may be a potentially valuable strategy to promote dental students' reflection.

  8. Experiences of the gender climate in clinical training - a focus group study among Swedish medical students.

    PubMed

    Kristoffersson, Emelie; Andersson, Jenny; Bengs, Carita; Hamberg, Katarina

    2016-10-26

    Research shows that medical education is characterized by unequal conditions for women and men, but there is a lack of qualitative studies investigating the social processes that enable and maintain gender inequalities that include both male and female students. In this focus group study, we therefore explored male as well as female medical students' experiences of the gender climate - i.e., how beliefs, values, and norms about gender were communicated - during clinical training and how the students dealt with these experiences. Focus group interviews were conducted with 24 medical students (nine men) at Umeå University, Sweden. The interviews were structured around personal experiences in clinical training where the participants perceived that gender had mattered. Data were analysed using qualitative content analysis. The students described gender-stereotyped expectations, discriminatory treatment, compliments, comments, and demeaning jargon. Female students gave more personal and varied examples than the men. The students' ways of handling their experiences were marked by efforts to fit in, for example, by adapting their appearance and partaking in the prevailing jargon. They felt dependent on supervisors and staff, and due to fear of repercussions they kept silent and avoided unpleasant situations and people rather than challenging humiliating jargon or supervisors who were behaving badly. Everyday communication of gender beliefs combined with students' adaptation to stereotyped expectations and discrimination came across as fundamental features through which unequal conditions for male and female students are reproduced and maintained in the clinic. Because they are in a dependent position, it is often difficult for students to challenge problematic gender attitudes. The main responsibility for improvements, therefore, lies with medical school leadership who need to provide students and supervisors with knowledge about gendered processes, discrimination, and

  9. GERD: Diagnosing and treating the burn.

    PubMed

    Alzubaidi, Mohammed; Gabbard, Scott

    2015-10-01

    Gastroesophageal reflux disease (GERD) is chronic, very common, and frequently encountered in internal medicine and subspecialty clinics. It is often diagnosed on clinical grounds, but specialized testing such as endoscopy and pH monitoring may be necessary in certain patients. Although proton pump inhibitors (PPIs) are the mainstay of treatment, clinicians should be aware of their short-term and long-term side effects. Copyright © 2015 Cleveland Clinic.

  10. Initial clinical experience with a sac-anchoring endoprosthesis for aortic aneurysm repair.

    PubMed

    Donayre, Carlos E; Zarins, Christopher K; Krievins, Dainis K; Holden, Andrew; Hill, Andrew; Calderas, Carlos; Velez, Jaime; White, Rodney A

    2011-03-01

    All current aortic endografts depend on proximal and distal fixation to prevent migration. However, migration and rupture can occur, particularly in patients with aortic necks that are short or angulated, or both. We present our initial clinical experience with a new sac-anchoring endoprosthesis designed to anchor and seal the device within the aneurysm sac. The initial worldwide experience using a new endoprosthesis for the treatment of aortic aneurysms (Nellix Endovascular, Palo Alto, Calif) was reviewed. The endoprosthesis consists of dual balloon-expandable endoframes surrounded by polymer-filled endobags designed to obliterate the aneurysm sac and maintain endograft position. Clinical results and follow-up contrast computed tomography (CT) scans at 30 days and 6 and 12 months were reviewed. The endograft was successfully deployed in 21 patients with infrarenal aortic aneurysms measuring 5.7 ± 0.7 cm (range, 4.3-7.4 cm). Two patients with common iliac aneurysms were treated with sac-anchoring extenders that maintained patency of the internal iliac artery. Infusion of 71 ± 37 mL of polymer (range, 19-158 mL) into the aortic endobags resulted in complete aneurysm exclusion in all patients. Mean implant time was 76 ± 35 minutes, with 33 ± 17 minutes of fluoroscopy time and 180 ± 81 mL of contrast; estimated blood loss was 174 ± 116 mL. One patient died during the postoperative period (30-day mortality, 4.8%), and one died at 10 months from non-device-related causes. During a mean follow-up of 8.7 ± 3.1 months and a median of 6.3 months, there were no late aneurysm- or device-related adverse events and no secondary procedures. CT imaging studies at 6 months and 1 year revealed no increase in aneurysm size, no device migration, and no new endoleaks. One patient had a limited proximal type I endoleak at 30 days that resolved at 60 days and remained sealed. One patient has an ongoing distal type I endoleak near the iliac bifurcation, with no change in aneurysm

  11. Transforming Experience: The Potential of Augmented Reality and Virtual Reality for Enhancing Personal and Clinical Change

    PubMed Central

    Riva, Giuseppe; Baños, Rosa M.; Botella, Cristina; Mantovani, Fabrizia; Gaggioli, Andrea

    2016-01-01

    During life, many personal changes occur. These include changing house, school, work, and even friends and partners. However, the daily experience shows clearly that, in some situations, subjects are unable to change even if they want to. The recent advances in psychology and neuroscience are now providing a better view of personal change, the change affecting our assumptive world: (a) the focus of personal change is reducing the distance between self and reality (conflict); (b) this reduction is achieved through (1) an intense focus on the particular experience creating the conflict or (2) an internal or external reorganization of this experience; (c) personal change requires a progression through a series of different stages that however happen in discontinuous and non-linear ways; and (d) clinical psychology is often used to facilitate personal change when subjects are unable to move forward. Starting from these premises, the aim of this paper is to review the potential of virtuality for enhancing the processes of personal and clinical change. First, the paper focuses on the two leading virtual technologies – augmented reality (AR) and virtual reality (VR) – exploring their current uses in behavioral health and the outcomes of the 28 available systematic reviews and meta-analyses. Then the paper discusses the added value provided by VR and AR in transforming our external experience by focusing on the high level of personal efficacy and self-reflectiveness generated by their sense of presence and emotional engagement. Finally, it outlines the potential future use of virtuality for transforming our inner experience by structuring, altering, and/or replacing our bodily self-consciousness. The final outcome may be a new generation of transformative experiences that provide knowledge that is epistemically inaccessible to the individual until he or she has that experience, while at the same time transforming the individual’s worldview. PMID:27746747

  12. Transforming Experience: The Potential of Augmented Reality and Virtual Reality for Enhancing Personal and Clinical Change.

    PubMed

    Riva, Giuseppe; Baños, Rosa M; Botella, Cristina; Mantovani, Fabrizia; Gaggioli, Andrea

    2016-01-01

    During life, many personal changes occur. These include changing house, school, work, and even friends and partners. However, the daily experience shows clearly that, in some situations, subjects are unable to change even if they want to. The recent advances in psychology and neuroscience are now providing a better view of personal change, the change affecting our assumptive world: (a) the focus of personal change is reducing the distance between self and reality (conflict); (b) this reduction is achieved through (1) an intense focus on the particular experience creating the conflict or (2) an internal or external reorganization of this experience; (c) personal change requires a progression through a series of different stages that however happen in discontinuous and non-linear ways; and (d) clinical psychology is often used to facilitate personal change when subjects are unable to move forward. Starting from these premises, the aim of this paper is to review the potential of virtuality for enhancing the processes of personal and clinical change. First, the paper focuses on the two leading virtual technologies - augmented reality (AR) and virtual reality (VR) - exploring their current uses in behavioral health and the outcomes of the 28 available systematic reviews and meta-analyses. Then the paper discusses the added value provided by VR and AR in transforming our external experience by focusing on the high level of personal efficacy and self-reflectiveness generated by their sense of presence and emotional engagement. Finally, it outlines the potential future use of virtuality for transforming our inner experience by structuring, altering, and/or replacing our bodily self-consciousness. The final outcome may be a new generation of transformative experiences that provide knowledge that is epistemically inaccessible to the individual until he or she has that experience, while at the same time transforming the individual's worldview.

  13. [A new psycho-dermatology clinic in Israel: our first year experience].

    PubMed

    Orion, Edith; Ben-Avi, Orit

    2011-01-01

    Psychodermatology involves the interrelationships between the skin and the mind, especially when considering the formation and evolution of certain common skin conditions. It appears that 30-40% of dermatology patients suffer from certain psychological problems as defined by the ICD-10, in a way that influences their disease severity and progression, as well as their quality of Life. Treatment of such cases requires a multi-disciplinary approach and should involve both a dermatologist and a mental health specialist working together In this article, the authors summarize the preliminary experience of the first year of the only psychodermatology clinic in Israel in several decades, work methods and patients' characteristics and preliminary conclusions.

  14. Research trends and perspectives of male infertility: a bibliometric analysis of 20 years of scientific literature.

    PubMed

    Zhang, Y; Xiao, F; Lu, S; Song, J; Zhang, C; Li, J; Gu, K; Lan, A; Lv, B; Zhang, R; Mo, F; Jiang, G; Zhang, X; Yang, X

    2016-11-01

    To carry out an in-depth analysis of the scientific research on male infertility, we performed the first bibliometric analysis focusing on studies involving male infertility worldwide during the period 1995-2014. Analysis of 6357 articles in the field of male infertility showed a significant increasing trend in the number of publications over the period 1995-2014. Obstetrics and Gynecology was an important subject category and Multidisciplinary Sciences was the newest interest. Authors were mainly from Europe and USA, with researchers from Cleveland Clinic producing the most articles, and those from the Tel Aviv Sourasky Medical Center and the University of Utah having the highest-quality articles. The USA contributed the most independent and international collaborative articles. The Cleveland Clinic and the University of Munster were the most productive institutions. The Cleveland Clinic and the University of Giessen had the most international collaboration publications. Harvard University had the most collaborators. The most common interests were pathogenesis and therapy, and new interests were hypogonadism, obesity, and cryopreservation. In conclusion, rapid development of the male infertility field was observed. Overall, collaborative and multidisciplinary science research has become more popular. The USA and its institutions play a dominant role, followed by European countries. Thanks to the common research focus worldwide, more insight into male fertility has been gained in the scientific literature over the past 20 years. [Correction added on September 21, 2016, after online publication: the term "institute" has been replaced by the term "institution" throughout the text.]. © 2016 American Society of Andrology and European Academy of Andrology.

  15. My personal experiences at the BEST Medical Center: A day in the clinic-the morning.

    PubMed

    Cohen, Philip R; Kurzrock, Razelle

    2016-01-01

    Dr. Ida Lystic is a gastroenterologist who trained at the OTHER (Owen T. Henry and Eugene Rutherford) Medical Center, after having completed her MD degree at the prestigious Harvey Medical School (recently renamed the Harvey Provider School). She accepted a faculty position at the BEST (Byron Edwards and Samuel Thompson) Medical Center. Dr. Lystic shares her experiences on a typical morning in gastroenterology clinic. Although her clinic start date was delayed by 2 months after becoming sick following a mandatory flu shot and having to complete more than 70 hours of compliance training modules, she is now familiar with the BEST system. Clinic scheduling priorities include ensuring that the staff can eat lunch together and depart at 5:00 pm. It is a continual challenge to find time to complete the electronic medical record after BEST changed from the SIMPLE (Succinct Input Making Patients Lives Electronic) system to LEGEND (referred to as Lengthy and Excessively Graded Evaluation and Nomenclature for Diagnosis by her colleagues). To maintain clinic punctuality, a compliance spreadsheet is e-mailed monthly to the Wait Time Committee. Their most recent corrective action plan for tardy physicians included placing egg timers on the doors and having nurses interrupt visits that exceed the allotted time. Administrative decisions have resulted in downsizing personnel. Patients are required to schedule their own tests and procedures and follow-up appointments-causing low patient satisfaction scores; however, the money saved lead to a large year-end bonus for the vice president of BEST Efficiency, who holds "providers" accountable for the poor patient experience. Although Dr. Ida Lystic and the gastroenterology clinic at "the BEST Medical Center" are creations of the authors' imagination, the majority of the anecdotes are based on actual events. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. The Appalachian Tri-State Node Experiences with the National Institute on Drug Abuse Clinical Trials Network.

    PubMed

    Kelly, Thomas M; Daley, Dennis C; Byrne, Mimmie; Demarzo, Larry; Smith, Doris; Madl, Stephanie

    2011-07-01

    The National Institute on Drug Abuse (NIDA)-sponsored Clinical Trial Network (CTN) recently celebrated 10 years of conducting "real world" research into the treatment of addiction. This article reviews the history and results of the most recent CTN studies and describes the experiences of one of the 13 participating research affiliates, the Appalachian Tri-State (ATS) Node. We discuss our "bidirectional" collaboration with multiple community treatment programs (CTPs) on research and dissemination activities and include their experiences as a member of our ATS Node.Results of CTN clinical trials have found unexpectedly that treatment as usual (TAU) is often almost as good as evidence-based interventions such as Motivational Interviewing (MI), possibly due to the difficulty in implementing evidence-based practices most effectively among divergent treatment sites and heterogeneous clinical populations. Some expected findings from the reviewed research are that severity of addiction and comorbidity moderate treatment outcomes and must be accounted for in future CTN-sponsored studies. Notwithstanding these results, much has been learned and recommendations are suggested for changes in CTN research designs that will address methodological limitations and increase treatment effectiveness in future CTN studies.

  17. Short-term clinical experience with hip resurfacing arthroplasty.

    PubMed

    Cieliński, Łukasz; Kusz, Damian; Wojciechowski, Piotr; Dziuba, Anna

    2007-01-01

    This paper discusses the authors' experience with hip resurfacing arthroplasty. Although introduced many years ago, the method did not gain wide popularity because of poor long-term outcomes. At present, owing to the introduction of metal-on-metal bearings and hybrid fixation techniques, short- and mid-term results are very good and encourage wider use of this technique, especially in the younger and more active patients whose results with standard total hip replacements would be unsatisfactory. We performed 13 hip resurfacing arthroplasties at our institution between August 1, 2005, and May 1, 2006. Twelve patients reported for the scheduled follow-up and were included in the study. Treatment outcomes were assessed according to the Harris Hip Score. The short-term outcomes of hip resurfacing arthroplasties are encouraging. In the study group there were no intraoperative complications, infections, peripheral nerve palsy, hip dislocations or clinically overt vein thrombosis. All of the patients reported complete or major pain relief. Clinical assessment according to the Harris Hip Score revealed improvement from an average of 57.7 (20.1) points preoperatively to an average of 87.7 (12) points after the surgery. Crutches were used for a maximum of 6 weeks postoperatively. All of the patients are currently able to walk without crutches with full weight-bearing. 1) Hip resurfacing arthroplasty seems to be an advisable method of operative management of younger, active patients, in whom standard THR would be associated with a high risk of failure; it allows THR to be postponed and carried out as a revision surgery with the acetabular component already in place. 2) Despite the good short- and mid-term results, the utility of this method should be evaluated with caution due to the lack of adequate long-term follow-up data.

  18. Against the odds: experiences of nurse leaders in Clinical Development Units (Nursing) in Australia.

    PubMed

    Atsalos, Christine; O'Brien, Louise; Jackson, Debra

    2007-06-01

    This paper is a report of a longitudinal study to develop an understanding of the phenomena of Clinical Development Unit (Nursing) leadership by exploring the experiences of the nurse leaders of nine Australian units as they attempted to develop their existing wards or units into recognized centres of nursing excellence. The concept of Clinical Development Unit (Nursing) in Australia originated in the British Nursing Development Unit movement, which has been widely credited with introducing innovative approaches to developing nurses and nursing. A network of nine Clinical Development Units (Nursing) was set up in a suburban area health service in Australia. The aim was to develop existing wards or units into centres of excellence by disseminating a new vision for Australian nurses that was based on the pioneering work of the British Nursing Development Unit movement. Principles of Heideggerian hermeneutic phenomenology provided a framework for the study. Nine Clinical Development Unit (Nursing) leaders participated in qualitative interviews from 1998 to 2002. These interviews were transcribed into text and thematically analysed. Despite attempts to implement a variety of measures to nurture these Clinical Development Units (Nursing) until they had become well established, the new Clinical Development Unit (Nursing) leaders were unable to maintain the Clinical Development Unit (Nursing) vision with which they had been entrusted. This paper discusses their reactions to the problems they faced and the new understandings they developed of their Clinical Development Unit (Nursing) role over time. The findings illuminate the difficulties involved in maintaining the commitment of all levels of staff and management when attempting to introduce new nursing projects.

  19. Clinical experience with a high-performance ATM-connected DICOM archive for cardiology

    NASA Astrophysics Data System (ADS)

    Solomon, Harry P.

    1997-05-01

    A system to archive large image sets, such as cardiac cine runs, with near realtime response must address several functional and performance issues, including efficient use of a high performance network connection with standard protocols, an architecture which effectively integrates both short- and long-term mass storage devices, and a flexible data management policy which allows optimization of image distribution and retrieval strategies based on modality and site-specific operational use. Clinical experience with such as archive has allowed evaluation of these systems issues and refinement of a traffic model for cardiac angiography.

  20. Combustion, Complex Fluids, and Fluid Physics Experiments on the ISS

    NASA Technical Reports Server (NTRS)

    Motil, Brian; Urban, David

    2012-01-01

    From the very first days of human spaceflight, NASA has been conducting experiments in space to understand the effect of weightlessness on physical and chemically reacting systems. NASA Glenn Research Center (GRC) in Cleveland, Ohio has been at the forefront of this research looking at both fundamental studies in microgravity as well as experiments targeted at reducing the risks to long duration human missions to the moon, Mars, and beyond. In the current International Space Station (ISS) era, we now have an orbiting laboratory that provides the highly desired condition of long-duration microgravity. This allows continuous and interactive research similar to Earth-based laboratories. Because of these capabilities, the ISS is an indispensible laboratory for low gravity research. NASA GRC has been actively involved in developing and operating facilities and experiments on the ISS since the beginning of a permanent human presence on November 2, 2000. As the lead Center both Combustion, Fluid Physics, and Acceleration Measurement GRC has led the successful implementation of an Acceleration Measurement systems, the Combustion Integrated Rack (CIR), the Fluids Integrated Rack (FIR) as well as the continued use of other facilities on the ISS. These facilities have supported combustion experiments in fundamental droplet combustion fire detection fire extinguishment soot phenomena flame liftoff and stability and material flammability. The fluids experiments have studied capillary flow magneto-rheological fluids colloidal systems extensional rheology pool and nucleate boiling phenomena. In this paper, we provide an overview of the experiments conducted on the ISS over the past 12 years. We also provide a look to the future development. Experiments presented in combustion include areas such as droplet combustion, gaseous diffusion flames, solid fuels, premixed flame studies, fire safety, and super critical oxidation processes. In fluid physics, experiments are discussed in

  1. 15. Stress Sheet, Truss number 2, span number 6, Superior ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    15. Stress Sheet, Truss number 2, span number 6, Superior Avenue viaduct. Drawing courtesy Engineering Dept., City of Cleveland. - Superior Avenue Viaduct, Cleveland East & West side, Cuyahoga Valley Vicinity, Cleveland, Cuyahoga County, OH

  2. Self-Reported Training Adequacy, Experience, and Comfort Level in Performing Schizophrenia-Related Clinical Skills among Psychiatry Residents and Fellows.

    PubMed

    Greene, Laurence; Moreo, Kathleen; Nasrallah, Henry; Tandon, Rajiv; Sapir, Tamar

    2017-08-01

    In the context of an educational program on schizophrenia for psychiatry trainees, this survey study analyzed associations between self-reported training adequacy, experience in providing patient care, and comfort level in performing schizophrenia-related clinical skills. The influence of the education on comfort level was also assessed for each skill. Survey respondents were psychiatry residents and fellows who participated in a schizophrenia education program at an in-person workshop or through online videos recorded at the workshop. In a pre-program survey, participants reported their experience in providing schizophrenia patient care and rated their training adequacy and comfort level for performing seven clinical skills involved in diagnosing and treating schizophrenia. The post-program survey included items for reassessing comfort level in performing the skills. Across the seven clinical skills, the proportion of respondents (n = 79) who agreed or strongly agreed that their training was adequate ranged from 29 to 88 %. The proportion of high ratings for comfort level in skill performance ranged from 45 to 83 %. Comfort level was significantly associated with training adequacy for all seven clinical skills and with experience in providing patient care for four skills. For all skills, comfort level ratings were significantly higher after versus before the educational workshop. Commonly indicated needs for further training included education on new therapies, exposure to a broader range of patients, and opportunities for longitudinal patient management. Psychiatry trainees' self-reported, disease-specific training adequacy, experiences, and comfort level have unique applications for developing and evaluating graduate medical curriculum.

  3. Experiences of using the Theoretical Domains Framework across diverse clinical environments: a qualitative study.

    PubMed

    Phillips, Cameron J; Marshall, Andrea P; Chaves, Nadia J; Jankelowitz, Stacey K; Lin, Ivan B; Loy, Clement T; Rees, Gwyneth; Sakzewski, Leanne; Thomas, Susie; To, The-Phung; Wilkinson, Shelley A; Michie, Susan

    2015-01-01

    The Theoretical Domains Framework (TDF) is an integrative framework developed from a synthesis of psychological theories as a vehicle to help apply theoretical approaches to interventions aimed at behavior change. This study explores experiences of TDF use by professionals from multiple disciplines across diverse clinical settings. Mixed methods were used to examine experiences, attitudes, and perspectives of health professionals in using the TDF in health care implementation projects. Individual interviews were conducted with ten health care professionals from six disciplines who used the TDF in implementation projects. Deductive content and thematic analysis were used. Three main themes and associated subthemes were identified including: 1) reasons for use of the TDF (increased confidence, broader perspective, and theoretical underpinnings); 2) challenges using the TDF (time and resources, operationalization of the TDF) and; 3) future use of the TDF. The TDF provided a useful, flexible framework for a diverse group of health professionals working across different clinical settings for the assessment of barriers and targeting resources to influence behavior change for implementation projects. The development of practical tools and training or support is likely to aid the utility of TDF.

  4. Experiences of using the Theoretical Domains Framework across diverse clinical environments: a qualitative study

    PubMed Central

    Phillips, Cameron J; Marshall, Andrea P; Chaves, Nadia J; Jankelowitz, Stacey K; Lin, Ivan B; Loy, Clement T; Rees, Gwyneth; Sakzewski, Leanne; Thomas, Susie; To, The-Phung; Wilkinson, Shelley A; Michie, Susan

    2015-01-01

    Background The Theoretical Domains Framework (TDF) is an integrative framework developed from a synthesis of psychological theories as a vehicle to help apply theoretical approaches to interventions aimed at behavior change. Purpose This study explores experiences of TDF use by professionals from multiple disciplines across diverse clinical settings. Methods Mixed methods were used to examine experiences, attitudes, and perspectives of health professionals in using the TDF in health care implementation projects. Individual interviews were conducted with ten health care professionals from six disciplines who used the TDF in implementation projects. Deductive content and thematic analysis were used. Results Three main themes and associated subthemes were identified including: 1) reasons for use of the TDF (increased confidence, broader perspective, and theoretical underpinnings); 2) challenges using the TDF (time and resources, operationalization of the TDF) and; 3) future use of the TDF. Conclusion The TDF provided a useful, flexible framework for a diverse group of health professionals working across different clinical settings for the assessment of barriers and targeting resources to influence behavior change for implementation projects. The development of practical tools and training or support is likely to aid the utility of TDF. PMID:25834455

  5. The visualisation of clinical leadership in the content of nursing education--a qualitative study of nursing students' experiences.

    PubMed

    Démeh, Waddah; Rosengren, Kristina

    2015-07-01

    The aim of this study was to describe nursing students' experiences of clinical leadership during their last year of education. Work as a nurse is complex with several demands from stakeholders who are colleagues, managers, patients and relatives. Therefore, it is important to provide students with tools for a forthcoming professional life as a nurse. A qualitative descriptive study was carried out in Jordan. Narratives (n=20) written by nursing students in their last year before graduation as a registered nurse were collected. The data were analysed by a manifest content analysis. The results formed one category: (Clinical leadership-safety in being a nurse), and three subcategories (eye-opener, a role model and bridging the gap) described the students' clinical leadership experiences due to the preparation process for being a nurse. Clinical leadership applies theory to practice by using a holistic view in nursing. Clinical leadership is a valuable tool for bridging the gap between theory and practice in nursing education. Skills within nursing management clarify and simplify nursing activities, which facilitates the transition from student to nurse. Focus on learning needs in nursing management is needed for stakeholders within education and health care organisations to facilitate graduation of well skilled nurses. Copyright © 2015 Elsevier Ltd. All rights reserved.

  6. Classification of adults with problematic internet experiences: linking internet and conventional problems from a clinical perspective.

    PubMed

    Mitchell, Kimberly J; Finkelhor, David; Becker-Blease, Kathryn A

    2007-06-01

    This article utilizes data from clinical reports of 929 adults to examine whether various problematic Internet experiences are distinctly different from or extensions of conventional problems. A TwoStep Cluster Analysis identified three mutually exclusive groups of adults, those with (1) online relationship problems and victimization; (2) online and offline problems; and (3) marital discord. Results suggest some initial support for the idea that problematic Internet experiences are often extensions of experiences and behaviors that pre-date the Internet. However, the Internet may be introducing some qualitatively new dimensions-such as an increased severity, an increased frequency, or unique dynamics-that require new responses or interventions.

  7. Development of clinical sites.

    PubMed

    O'Brien, Mary

    2015-02-01

    Clinical experiences are vital to all types of healthcare educational programs. Supervised clinical experiences provide the opportunity for the learner to apply didactic knowledge and theory to real world situations and hone skills necessary for entry into practice. Nurse anesthesia programs utilize a wide variety of clinical sites to expose student registered nurse anesthetists to experiences that will prepare them clinically, academically and professionally to enter practice as a Certified Registered Nurse Anesthetist. This article describes the process of developing a clinical site. A thorough evaluation will determine the types of experiences meant to be offered at the site, the resources available to house and educate the students, and how to evaluate the effectiveness of the clinical site. Open communication between the clinical coordinator and the program director or designee is essential to ensure success of the clinical site. The Council on Accreditation of Nurse Anesthesia Educational Programs has resources available to guide those interested in becoming a clinical site, as well as for program administrators who seek to add new experiences to their programs.

  8. The experience of older patients with cancer in phase 1 clinical trials: a qualitative case series.

    PubMed

    Kvale, Elizabeth A; Woodby, Lesa; Williams, Beverly Rosa

    2010-11-01

    This article explores the experiences of older patients with cancer in phase 1 clinical trials. Conducting a case series of face-to-face, in-depth, open-ended interviews and using qualitative methods of analysis, we find that the psychosocial process of social comparison is relevant for understanding older adults' phase 1 clinical trial participation. Social comparison influences decisions to enroll in a phase 1 clinical trial, shapes perceptions of supportive care needs, and encourages the utilization of hope. Additional research should develop strategies for addressing supportive care needs among this patient cohort whose use of social comparison can inhibit articulation of pain, suffering, and symptom burden as well as use of informal support systems.

  9. Quality assurance of research protocols conducted in the community: the National Institute on Drug Abuse Clinical Trials Network experience.

    PubMed

    Rosa, Carmen; Campbell, Aimee; Kleppinger, Cynthia; Sampson, Royce; Tyson, Clare; Mamay-Gentilin, Stephanie

    2009-04-01

    Quality assurance (QA) of clinical trials is essential to protect the welfare of trial participants and the integrity of the data collected. However, there is little detailed information available on specific procedures and outcomes of QA monitoring for clinical trials. This article describes the experience of the National Institute on Drug Abuse's (NIDA) National Drug Abuse Treatment Clinical Trials Network (CTN) in devising and implementing a three-tiered QA model for rigorous multi-site randomized clinical trials implemented in community-based substance abuse treatment programs. The CTN QA model combined local and national resources and was developed to address the unique needs of clinical trial sites with limited research experience. The authors reviewed internal records maintained by the sponsor, a coordinating site (Lead Nodes), and a local site detailing procedural development, training sessions, protocol violation monitoring, and site visit reporting. Between January 2001 and September 2005, the CTN implemented 21 protocols, of which 18 were randomized clinical trials, one was a quality improvement study and two were surveys. Approximately 160 community-based treatment programs participated in the 19 studies that were monitored, with a total of 6560 participants randomized across the sites. During this time 1937 QA site visits were reported across the three tiers of monitoring and the cost depended on the location of the sites and the salaries of the staff involved. One study reported 109 protocol violations (M = 15.6). Examples are presented to highlight training, protocol violation monitoring, site visit frequency and intensity and cost considerations. : QA data from the entire network were not easily available for review as much of the data were not electronically accessible. The authors reviewed and discussed a representative sample of internal data from the studies and participating sites. The lessons learned from the CTN's experience include the need

  10. Quality assurance of research protocols conducted in the community: The National Institute on Drug Abuse Clinical Trials Network Experience

    PubMed Central

    Rosa, Carmen; Campbell, Aimee; Kleppinger, Cynthia; Sampson, Royce; Tyson, Clare; Mamay-Gentilin, Stephanie

    2009-01-01

    Background: Quality assurance (QA) of clinical trials is essential to protect the welfare of trial participants and the integrity of the data collected. However, there is little detailed information available on specific procedures and outcomes of QA monitoring for clinical trials. Purpose: This article describes the experience of the National Institute on Drug Abuse's (NIDA) National Drug Abuse Treatment Clinical Trials Network (CTN) in devising and implementing a three-tiered QA model for rigorous multi-site randomized clinical trials implemented in community-based substance abuse treatment programs. The CTN QA model combined local and national resources and was developed to address the unique needs of clinical trial sites with limited research experience. Methods: The authors reviewed internal records maintained by the sponsor, a coordinating site (Lead Nodes), and a local site detailing procedural development, training sessions, protocol violation monitoring, and site visit reporting. Results: Between January 2001 and September 2005, the CTN implemented 21 protocols, of which 18 were randomized clinical trials, one was a quality improvement study and two were surveys. Approximately 160 community-based treatment programs participated in the 19 studies that were monitored, with a total of 6560 participants randomized across the sites. During this time 1937 QA site visits were reported across the three tiers of monitoring and the cost depended on the location of the sites and the salaries of the staff involved. One study reported 109 protocol violations (M = 15.6). Examples are presented to highlight training, protocol violation monitoring, site visit frequency and intensity and cost considerations. Limitations: QA data from the entire network were not easily available for review as much of the data were not electronically accessible. The authors reviewed and discussed a representative sample of internal data from the studies and participating sites. Conclusions

  11. Direct booking colposcopy clinic -- the Portsmouth experience.

    PubMed

    Lukman, H; Bevan, J R; Greenwood, E

    2004-08-01

    We present 2 years data on direct booking in our colposcopy clinic. The new booking system has improved our efficiency and helped us to achieve the national quality standards on clinic waiting time. The non-attendance (DNA) rate has also improved.

  12. 'Maternity clinic on the net service' and its introduction into practice: experiences of maternity-care professionals.

    PubMed

    Kouri, Pirkko; Turunen, Hannele; Palomäki, Tuula

    2005-06-01

    To describe the experiences of maternity-care professionals using an Internet-based network service, called Net Clinic, and the opportunities and obstacles they encountered in Net Clinic while organising their work and developing their know-how. Qualitative information gathered from semi-structured thematic interviews. Four maternity care units in Eastern Finland (one antenatal ward in a university hospital, one antenatal ward in a central hospital, two maternity clinics in the community). Five midwives, two public health nurses and three doctors. All participants considered adequate privacy protection a prerequisite for development. They anticipated that because of their computer skills, young people would be able to use information and communication technology (ICT) as part of maternity-care services naturally. Managerial support, such as allocation of time and equipment, was extremely important during the introductory phase. The participants were divided into three groups based on their experiences of implementing Net Clinic: (1) 'doubters' did not believe in their own ICT competence and were afraid of using Net Clinic. They also showed resistance to Net Clinic. Doubters wanted versatile and personal guidance in ICT skills; (2) 'accepters' agreed that progress in ICT would inevitably affect their work. Development was considered difficult without awareness of the benefits of ICT, and Net Clinic was expected to increase their workload. Accepters preferred to have one-to-one ICT training; (3) 'future confidents' saw ICT as a useful tool for developing maternity care. They recognised the opportunities implicit in network collaboration and wanted versatile user training in ICT. They wanted successful network service models and were eager to develop them. IMPLICATIONS FOR THE FUTURE: Families will increase their knowledge levels, as those who will be future parents are learning to use public network services at school. The increasing diversity of family structure

  13. Clinical learning environment and supervision: experiences of Norwegian nursing students - a questionnaire survey.

    PubMed

    Skaalvik, Mari Wolff; Normann, Hans Ketil; Henriksen, Nils

    2011-08-01

    To measure nursing students' experiences and satisfaction with their clinical learning environments. The primary interest was to compare the results between students with respect to clinical practice in nursing homes and hospital wards. Clinical learning environments are important for the learning processes of nursing students and for preferences for future workplaces. Working with older people is the least preferred area of practice among nursing students in Norway. A cross-sectional design. A validated questionnaire was distributed to all nursing students from five non-randomly selected university colleges in Norway. A total of 511 nursing students completed a Norwegian version of the questionnaire, Clinical Learning Environment, Supervision and Nurse Teacher (CLES+T) evaluation scale in 2009. Data including descriptive statistics were analysed using the Statistical Program for the Social Sciences. Factor structure was analysed by principal component analysis. Differences across sub-groups were tested with chi-square tests and Mann-Whitney U test for categorical variables and t-tests for continuous variables. Ordinal logistic regression analysis of perceptions of the ward as a good learning environment was performed with supervisory relationships and institutional contexts as independent variables, controlling for age, sex and study year. The participating nursing students with clinical placements in nursing homes assessed their clinical learning environment significantly more negatively than those with hospital placements on nearby all sub-dimensions. The evidence found in this study indicates that measures should be taken to strengthen nursing homes as learning environments for nursing students. To recruit more graduated nurses to work in nursing homes, actions to improve the learning environment are needed. © 2011 Blackwell Publishing Ltd.

  14. A balancing act: a phenomenological exploration of medical students' experiences of using mobile devices in the clinical setting.

    PubMed

    Rashid-Doubell, F; Mohamed, S; Elmusharaf, K; O'Neill, C S

    2016-05-03

    The aims of this study were to describe the experiences of senior students using mobile devices in a clinical setting while learning and interacting with clinical teachers, patients and each other, and to identify challenges that facilitated or impeded the use of such devices in the hospital. Interpretative phenomenology was chosen to guide our enquiry. Semi-structured interviews were conducted to examine the experiences of five senior medical students using mobile devices in the clinical setting. Senior medical students at an international medical school in the Middle East. Three main themes emerged from the data analysis: learning; professional identity and transitioning from student to doctor. The findings showed that using mobile devices in the clinical area as a learning tool was not a formalised process. Rather, it was opportunistic learning at the bedside and on occasion a source of distraction from clinical teaching. Students needed to negotiate relationships between themselves, the clinical teacher and patients in order to ensure that they maintained an acceptable professional image. Participants experienced and negotiated the change from student to doctor making them mindful of using their devices at the bedside. Mobile devices are part of daily life for a medical student and there is a need to adapt medical education in the clinical setting, to allow the students to use their devices in a sensitive manner. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  15. Dental Students' Perceived Value of Peer-Mentoring Clinical Leadership Experiences.

    PubMed

    Sheridan, Rachel A; Hammaker, Daniel J; de Peralta, Tracy L; Fitzgerald, Mark

    2016-03-01

    This pilot study compared second- and fourth-year dental students' perceived values of newly implemented clinical leadership experiences (CLEs) at one U.S. dental school during the 2012-13 academic year. In the CLEs, fourth-year (D4) students mentored second-year (D2) dental students during faculty-supervised patient treatment. The two cohorts' perceived value of the experiences was measured with questionnaires consisting of five-point Likert scale questions and open text responses. Out of a total of 114 D2 and 109 D4 students, 46 D2 students and 35 D4 students participated (response rates of 40.4% and 32.1%, respectively). While responses from both cohorts showed they highly valued the CLEs, the D2s perceived greater value: 4.07 (0.53) v. 3.51 (0.95), p<0.003. Both cohorts reported feeling that D4s were prepared to mentor D2s, that the CLEs had educational benefits, and that the CLEs increased their comfort with peer communication. Theme analysis of open text questions revealed that the respondents perceived the D4s were more accessible than faculty and provided guidance and individual attention; the CLEs increased student comfort; the CLEs reinforced D4 skills, knowledge, and confidence; and the CLEs provided management, leadership, and collaborative work experience. Theme analysis also highlighted student concerns about a lack of program structure. Overall, the majority of both groups valued CLEs in their dental education. Particular advantages they perceived were increased comfort, guidance, and attention. Further program development should address student concerns. These results suggest that similar programs should be considered and/or expanded in other dental schools' curricula.

  16. Early experiences in establishing a regional quantitative imaging network for PET/CT clinical trials.

    PubMed

    Doot, Robert K; Thompson, Tove; Greer, Benjamin E; Allberg, Keith C; Linden, Hannah M; Mankoff, David A; Kinahan, Paul E

    2012-11-01

    The Seattle Cancer Care Alliance (SCCA) is a Pacific Northwest regional network that enables patients from community cancer centers to participate in multicenter oncology clinical trials where patients can receive some trial-related procedures at their local center. Results of positron emission tomography (PET) scans performed at community cancer centers are not currently used in SCCA Network trials since clinical trials customarily accept results from only trial-accredited PET imaging centers located at academic and large hospitals. Oncologists would prefer the option of using standard clinical PET scans from Network sites in multicenter clinical trials to increase accrual of patients for whom additional travel requirements for imaging are a barrier to recruitment. In an effort to increase accrual of rural and other underserved populations to Network trials, researchers and clinicians at the University of Washington, SCCA and its Network are assessing the feasibility of using PET scans from all Network sites in their oncology clinical trials. A feasibility study is required because the reproducibility of multicenter PET measurements ranges from approximately 3% to 40% at national academic centers. Early experiences from both national and local PET phantom imaging trials are discussed, and next steps are proposed for including patient PET scans from the emerging regional quantitative imaging network in clinical trials. There are feasible methods to determine and characterize PET quantitation errors and improve data quality by either prospective scanner calibration or retrospective post hoc corrections. These methods should be developed and implemented in multicenter clinical trials employing quantitative PET imaging of patients. Copyright © 2012 Elsevier Inc. All rights reserved.

  17. Implementation of Electronic Checklists in an Oncology Medical Record: Initial Clinical Experience

    PubMed Central

    Albuquerque, Kevin V.; Miller, Alexis A.; Roeske, John C.

    2011-01-01

    Purpose: The quality of any medical treatment depends on the accurate processing of multiple complex components of information, with proper delivery to the patient. This is true for radiation oncology, in which treatment delivery is as complex as a surgical procedure but more dependent on hardware and software technology. Uncorrected errors, even if small or infrequent, can result in catastrophic consequences for the patient. We developed electronic checklists (ECLs) within the oncology electronic medical record (EMR) and evaluated their use and report on our initial clinical experience. Methods: Using the Mosaiq EMR, we developed checklists within the clinical assessment section. These checklists are based on the process flow of information from one group to another within the clinic and enable the processing, confirmation, and documentation of relevant patient information before the delivery of radiation therapy. The clinical use of the ECL was documented by means of a customized report. Results: Use of ECL has reduced the number of times that physicians were called to the treatment unit. In particular, the ECL has ensured that therapists have a better understanding of the treatment plan before the initiation of treatment. An evaluation of ECL compliance showed that, with additional staff training, > 94% of the records were completed. Conclusion: The ECL can be used to ensure standardization of procedures and documentation that the pretreatment checks have been performed before patient treatment. We believe that the implementation of ECLs will improve patient safety and reduce the likelihood of treatment errors. PMID:22043184

  18. "I couldn't do this with opposition from my colleagues": A qualitative study of physicians' experiences as clinical tutors

    PubMed Central

    2011-01-01

    Background Clinical contact in the early curriculum and workplace learning with active tutorship are important parts of modern medical education. In a previously published study, we found that medical students' tutors experienced a heavier workload, less reasonable demands and less encouragement, than students. The aim of this interview study was to further illuminate physicians' experiences as clinical tutors. Methods Twelve tutors in the Early Professional Contact course were interviewed. In the explorative interviews, they were asked to reflect upon their experiences of working as tutors in this course. Systematic text condensation was used as the analysis method. Results In the analysis, five main themes of physicians' experiences as clinical tutors in the medical education emerged: (a) Pleasure and stimulation. Informants appreciated tutorship and meeting both students and fellow tutors, (b) Disappointment and stagnation. Occasionally, tutors were frustrated and expressed negative feelings, (c) Demands and duty. Informants articulated an ambition to give students their best; a desire to provide better medical education but also a duty to meet demands of the course management, (d) Impact of workplace relations. Tutoring was made easier when the clinic's management provided active support and colleagues accepted students at the clinic, and (e) Multitasking difficulties. Combining several duties with those of a tutorship was often reported as difficult. Conclusions It is important that tutors' tasks are given adequate time, support and preparation. Accordingly, it appears highly important to avoid multitasking and too heavy a workload among tutors in order to facilitate tutoring. A crucial factor is acceptance and active organizational support from the clinic's management. This implies that tutoring by workplace learning in medical education should play an integrated and accepted role in the healthcare system. PMID:21975057

  19. LapSim virtual reality laparoscopic simulator reflects clinical experience in German surgeons.

    PubMed

    Langelotz, C; Kilian, M; Paul, C; Schwenk, W

    2005-11-01

    The aim of this study was to analyze the ability of a training module on a virtual laparoscopic simulator to assess surgical experience in laparoscopy. One hundred and fifteen participants at the 120th annual convent of the German surgical society took part in this study. All participants were stratified into two groups, one with laparoscopic experience of less than 50 operations (group 1, n=61) and one with laparoscopic experience of more than 50 laparoscopic operations (group 2, n=54). All subjects completed a laparoscopic training module consisting of five different exercises for navigation, coordination, grasping, cutting and clipping. The time to perform each task was measured, as were the path lengths of the instruments and their respective angles representing the economy of the movements. Results between groups were compared using chi(2) or Mann-Whitney U-test. Group 1 needed more time for completion of the exercises (median 424 s, range 99-1,376 s) than group 2 (median 315 s, range 168-625 s) (P<0.01). Instrument movements were less economic in group 1 with larger angular pathways, e.g. in the cutting exercise (median 352 degrees , range 104-1,628 degrees vs median 204 degrees , range 107-444 degrees , P<0.01), and longer path lengths (each instrument P<0.05). As time for completion of exercises, instrument path lengths and angular paths are indicators of clinical experience, it can be concluded that laparoscopic skills acquired in the operating room transfer into virtual reality. A laparoscopic simulator can serve as an instrument for the assessment of experience in laparoscopic surgery.

  20. The experience of physicians in pharmacogenomic clinical decision support within eight German university hospitals.

    PubMed

    Hinderer, Marc; Boeker, Martin; Wagner, Sebastian A; Binder, Harald; Ückert, Frank; Newe, Stephanie; Hülsemann, Jan L; Neumaier, Michael; Schade-Brittinger, Carmen; Acker, Till; Prokosch, Hans-Ulrich; Sedlmayr, Brita

    2017-06-01

    The aim of this study was to assess the physicians' attitude, their knowledge and their experience in pharmacogenomic clinical decision support in German hospitals. We conducted an online survey to address physicians of 13 different medical specialties across eight German university hospitals. In total, 564 returned questionnaires were analyzed. The remaining knowledge gap, the uncertainty of test reimbursement and the physicians' lack of awareness of existing pharmacogenomic clinical decision support systems (CDSS) are the major barriers for implementing pharmacogenomic CDSS into German hospitals. Furthermore, pharmacogenomic CDSS are most effective in the form of real-time decision support for internists. Physicians in German hospitals require additional education of both genetics and pharmacogenomics. They need to be provided with access to relevant pharmacogenomic CDSS.

  1. Learner-centred teaching in a non-learner-centred world: An interpretive phenomenological study of the lived experience of clinical nursing faculty.

    PubMed

    Oyelana, Olabisi; Martin, Donna; Scanlan, Judith; Temple, Beverley

    2018-08-01

    With the growing complexities in the contemporary health care system, there is a challenge of preparing nurses for the practice demands. To this end, learner-centred teaching has emerged in many nursing curricula in Canada and evidence indicates its effectiveness in developing the essential practice skills in nursing students. It is important to examine the experience of the clinical faculty members who implement learner-centred teaching, as doing so would provide an insight to the factors that may hinder the implementation of learner-centred teaching in the practice settings. This phenomenological study aimed to address two research questions: what does learner-centred teaching mean to clinical nurse faculty? What is the lived experience of clinical nursing faculty who incorporate learner-centred teaching? Ten clinical nurse faculty members who had at least two years of clinical teaching experience volunteered to participate in the study. Data were collected using a semi-structured interview guide and audio recorder. Additional data sources included a demographic survey and a reflective journal. Multiple sub-themes emerged from this study from which three significant themes were consolidated: diversity of meanings, facilitators of LCT, and barriers to LCT. However, an overarching theme of "learner-centred teaching in a non-learner-centred world" was coined from participants' accounts of their experiences of barriers in incorporating LCT in the practice settings. A collaborative effort between faculty and the stakeholders is paramount to a successful implementation of learner-centred teaching in practice settings. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

  2. Dengue fever outbreak: a clinical management experience.

    PubMed

    Ahmed, Shahid; Ali, Nadir; Ashraf, Shahzad; Ilyas, Mohammad; Tariq, Waheed-Uz-Zaman; Chotani, Rashid A

    2008-01-01

    To determine the frequency of dengue as a cause of fever and compare the clinical and haematological characteristics of Dengue-probable and Dengue-proven cases. An observational study. The Combined Military Hospital, Malir Cantt., Karachi, from August 2005 to December 2006. All patients with age above 14 years, who were either hospitalized or treated in medical outdoor clinic due to acute febrile illness, were evaluated for clinical features of Dengue Fever (DF), Dengue haemorrhagic fever (DHF) and Dengue Shock Syndrome (DSS). Patients showing typical clinical features and haematological findings suggestive of Dengue fever (As per WHO criteria) were evaluated in detail for comparison of probable and confirmed cases of Dengue fever. All other cases of acute febrile illness, not showing clinical features or haematological abnormalities of Dengue fever, were excluded. The clinical and laboratory features were recorded on SPSS 11.0 programme and graded where required, for descriptive and statistical analysis. Out of 5200 patients with febrile illness, 107(2%) presented with typical features of DF, 40/107(37%) were Dengue-proven while 67/107(63%) were Dengue-probable. Out of Dengue-proven cases, 38 were of DF and 2 were of DHF. Day 1 temperature ranged from 99-1050C (mean 1010C). Chills and rigors were noticed in 86 (80%), myalgia in 67%, headache in 54%, pharyngitis in 35%, rash in 28%, and bleeding manifestations in 2% cases. Hepatomegaly in 1(0.5%), lymphadenopathy in 1(0.5%) and splenomegaly in 12 (11.2%) cases. Leucopoenia (count<4x109 /L) was noted in 73%, platelet count<150 x109 /L in 84% and ALT>40 U/L in 57% cases. Frequency of clinically suspected dengue virus infection was 107 (2%), while confirmed dengue fever cases were 40 (0.8%) out of 5200 fever cases. Fever with chills and rigors, body aches, headache, myalgia, rash, haemorrhagic manifestations, platelet count, total leukocyte count, and ALT, are parameters to screen the cases of suspected dengue virus

  3. Students' experiences of learning manual clinical skills through simulation.

    PubMed

    Johannesson, Eva; Silén, Charlotte; Kvist, Joanna; Hult, Håkan

    2013-03-01

    Learning manual skills is a fundamental part of health care education, and motor, sensory and cognitive learning processes are essential aspects of professional development. Simulator training has been shown to enhance factors that facilitate motor and cognitive learning. The present study aimed to investigate the students' experiences and thoughts about their learning through simulation skills training. The study was designed for an educational setting at a clinical skills centre. Ten third-year undergraduate nursing students performed urethral catheterisation, using the virtual reality simulator UrecathVision™, which has haptic properties. The students practised in pairs. Each session was videotaped and the video was used to stimulate recall in subsequent interviews. The interviews were analysed using qualitative content analysis. The analysis from interviews resulted in three themes: what the students learn, how the students learn, and the simulator's contribution to the students' learning. Students learned manual skills, how to perform the procedure, and professional behaviour. They learned by preparing, watching, practising and reflecting. The simulator contributed by providing opportunities for students to prepare for the skills training, to see anatomical structures, to feel resistance, and to become aware of their own performance ability. The findings show that the students related the task to previous experiences, used sensory information, tested themselves and practised techniques in a hands-on fashion, and reflected in and on action. The simulator was seen as a facilitator to learning the manual skills. The study design, with students working in pairs combined with video recording, was found to enhance opportunities for reflection.

  4. Satellite Remote Sensing for Developing Time and Space Resolved Estimates of Ambient Particulate in Cleveland, OH.

    PubMed

    Kumar, Naresh; Chu, Allen D; Foster, Andrew D; Peters, Thomas; Willis, Robert

    2011-09-01

    This article empirically demonstrates the use of fine resolution satellite-based aerosol optical depth (AOD) to develop time and space resolved estimates of ambient particulate matter (PM) ≤2.5 µm and ≤10 µm in aerodynamic diameters (PM(2.5) and PM(10), respectively). AOD was computed at three different spatial resolutions, i.e., 2 km (means 2 km × 2 km area at nadir), 5 km, and 10 km, by using the data from MODerate Resolution Imaging Spectroradiometer (MODIS), aboard the Terra and Aqua satellites. Multiresolution AOD from MODIS (AOD(MODIS)) was compared with the in situ measurements of AOD by NASA's AErosol RObotic NETwork (AERONET) sunphotometer (AOD(AERONET)) at Bondville, IL, to demonstrate the advantages of the fine resolution AOD(MODIS) over the 10-km AOD(MODIS), especially for air quality prediction. An instrumental regression that corrects AOD(MODIS) for meteorological conditions was used for developing a PM predictive model.The 2-km AOD(MODIS) aggregated within 0.025° and 15-min intervals shows the best association with the in situ measurements of AOD(AERONET). The 2-km AOD(MODIS) seems more promising to estimate time and space resolved estimates of ambient PM than the 10-km AOD(MODIS), because of better location precision and a significantly greater number of data points across geographic space and time. Utilizing the collocated AOD(MODIS) and PM data in Cleveland, OH, a regression model was developed for predicting PM for all AOD(MODIS) data points. Our analysis suggests that the slope of the 2-km AOD(MODIS) (instrumented on meteorological conditions) is close to unity with the PM monitored on the ground. These results should be interpreted with caution, because the slope of AOD(MODIS) ranges from 0.52 to 1.72 in the site-specific models. In the cross validation of the overall model, the root mean square error (RMSE) of PM(10) was smaller (2.04 µg/m(3) in overall model) than that of PM(2.5) (2.5 µg/m(3)). The predicted PM in the AOD

  5. Satellite Remote Sensing for Developing Time and Space Resolved Estimates of Ambient Particulate in Cleveland, OH

    PubMed Central

    Kumar, Naresh; Chu, Allen D.; Foster, Andrew D.; Peters, Thomas; Willis, Robert

    2011-01-01

    This article empirically demonstrates the use of fine resolution satellite-based aerosol optical depth (AOD) to develop time and space resolved estimates of ambient particulate matter (PM) ≤2.5 µm and ≤10 µm in aerodynamic diameters (PM2.5 and PM10, respectively). AOD was computed at three different spatial resolutions, i.e., 2 km (means 2 km × 2 km area at nadir), 5 km, and 10 km, by using the data from MODerate Resolution Imaging Spectroradiometer (MODIS), aboard the Terra and Aqua satellites. Multiresolution AOD from MODIS (AODMODIS) was compared with the in situ measurements of AOD by NASA’s AErosol RObotic NETwork (AERONET) sunphotometer (AODAERONET) at Bondville, IL, to demonstrate the advantages of the fine resolution AODMODIS over the 10-km AODMODIS, especially for air quality prediction. An instrumental regression that corrects AODMODIS for meteorological conditions was used for developing a PM predictive model. The 2-km AODMODIS aggregated within 0.025° and 15-min intervals shows the best association with the in situ measurements of AODAERONET. The 2-km AODMODIS seems more promising to estimate time and space resolved estimates of ambient PM than the 10-km AODMODIS, because of better location precision and a significantly greater number of data points across geographic space and time. Utilizing the collocated AODMODIS and PM data in Cleveland, OH, a regression model was developed for predicting PM for all AODMODIS data points. Our analysis suggests that the slope of the 2-km AODMODIS (instrumented on meteorological conditions) is close to unity with the PM monitored on the ground. These results should be interpreted with caution, because the slope of AODMODIS ranges from 0.52 to 1.72 in the site-specific models. In the cross validation of the overall model, the root mean square error (RMSE) of PM10 was smaller (2.04 µg/m3 in overall model) than that of PM2.5 (2.5 µg/m3). The predicted PM in the AODMODIS data (∼2.34 million data points) was

  6. NASA Glenn's Kilopower Media Day

    NASA Image and Video Library

    2018-05-03

    NASA announced the results of the demonstration, called the Kilopower Reactor Using Stirling Technology (KRUSTY) experiment, during a news conference Wednesday at its Glenn Research Center in Cleveland. Media toured Glenn’s Stirling Research Lab and other facilities after the press conference.

  7. How can experience in clinical and community settings contribute to early medical education? A BEME systematic review.

    PubMed

    Dornan, T; Littlewood, S; Margolis, S A; Scherpbier, A; Spencer, J; Ypinazar, V

    2006-02-01

    Review period January 1992-December 2001. Final analysis July 2004-January 2005. BACKGROUND AND REVIEW CONTEXT: There has been no rigorous systematic review of the outcomes of early exposure to clinical and community settings in medical education. OBJECTIVES OF REVIEW: Identify published empirical evidence of the effects of early experience in medical education, analyse it, and synthesize conclusions from it. Identify the strengths and limitations of the research effort to date, and identify objectives for future research. Ovid search of: BEI, ERIC, Medline, CINAHL and EMBASE Additional electronic searches of: Psychinfo, Timelit, EBM reviews, SIGLE, and the Cochrane databases. Hand-searches of:Medical Education, Medical Teacher, Academic Medicine, Teaching and Learning in Medicine, Advances in Health Sciences Education, Journal of Educational Psychology. Authentic (real as opposed to simulated) human contact in a social or clinical context that enhances learning of health, illness and/or disease, and the role of the health professional. Early: What would traditionally have been regarded as the preclinical phase, usually the first 2 years. Inclusions: All empirical studies (verifiable, observational data) of early experience in the basic education of health professionals, whatever their design or methodology, including papers not in English. Evidence from other health care professions that could be applied to medicine was included. Not empirical; not early; post-basic; simulated rather than 'authentic' experience. Careful validation of selection processes. Coding by two reviewers onto an extensively modified version of the standard BEME coding sheet. Accumulation into an Access database. Secondary coding and synthesis of an interpretation. A total of 73 studies met the selection criteria and yielded 277 educational outcomes; 116 of those outcomes (from 38 studies) were rated strong and important enough to include in a narrative synthesis of results; 76% of those

  8. Transplant Ethics: Let's Begin the Conversation Anew : A Critical Look at One Institute's Experience with Transplant Related Ethical Issues.

    PubMed

    Shafran, David; Smith, Martin L; Daly, Barbara J; Goldfarb, David

    2016-06-01

    Standardizing consultation processes is increasingly important as clinical ethics consultation (CEC) becomes more utilized in and vital to medical practice. Solid organ transplant represents a relatively nascent field replete with complex ethical issues that, while explored, have not been systematically classified. In this paper, we offer a proposed taxonomy that divides issues of resource allocation from viable solutions to the issue of organ shortage in transplant and then further distinguishes between policy and bedside level issues. We then identify all transplant related ethics consults performed at the Cleveland Clinic (CC) between 2008 and 2013 in order to identify how consultants conceptually framed their consultations by the domains they ascribe to the case. We code the CC domains to those in the Core Competencies for Healthcare Consultation Ethics in order to initiate a broader conversation regarding best practices in these highly complex cases. A discussion of the ethical issues underlying living donor and recipient related consults ensues. Finally, we suggest that the ethical domains prescribed in the Core Competencies provide a strong starting ground for a common intra-disciplinary language in the realm of formal CEC.

  9. Evaluation of undergraduate clinical learning experiences in the subject of pediatric dentistry using critical incident technique.

    PubMed

    Vyawahare, S; Banda, N R; Choubey, S; Parvekar, P; Barodiya, A; Dutta, S

    2013-01-01

    In pediatric dentistry, the experiences of dental students may help dental educators better prepare graduates to treat the children. Research suggests that student's perceptions should be considered in any discussion of their education, but there has been no systematic examination of India's undergraduate dental students learning experiences. This qualitative investigation aimed to gather and analyze information about experiences in pediatric dentistry from the students' viewpoint using critical incident technique (CIT). The sample group for this investigation came from all 240 3rd and 4th year dental students from all the four dental colleges in Indore. Using CIT, participants were asked to describe at least one positive and one negative experience in detail. They described 308 positive and 359 negative experiences related to the pediatric dentistry clinic. Analysis of the data resulted in the identification of four key factors related to their experiences: 1) The instructor; 2) the patient; 3) the learning process; and 4) the learning environment. The CIT is a useful data collection and analysis technique that provides rich, useful data and has many potential uses in dental education.

  10. 2. Photocopy of early 20th century photo, showing the Euclid ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    2. Photocopy of early 20th century photo, showing the Euclid Avenue facade of the branch assembly building. Photograph owned by the Cleveland Public Library. - Ford Motor Company, Cleveland Branch Assembly Plant, Euclid Avenue & East 116th Street, Cleveland, Cuyahoga County, OH

  11. 1. Photocpy of early 20th century photograph, looking east, of ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    1. Photocpy of early 20th century photograph, looking east, of east facade of assembly building on Euclid Ave. Photo owned by the Cleveland Public Library. - Ford Motor Company, Cleveland Branch Assembly Plant, Euclid Avenue & East 116th Street, Cleveland, Cuyahoga County, OH

  12. The Working Practices and Clinical Experiences of Paediatric Speech and Language Therapists: A National UK Survey

    ERIC Educational Resources Information Center

    Pring, Tim; Flood, Emma; Dodd, Barbara; Joffe, Victoria

    2012-01-01

    Background: The majority of speech and language therapists (SLTs) work with children who have speech, language and communication needs. There is limited information about their working practices and clinical experience and their views of how changes to healthcare may impact upon their practice. Aims: To investigate the working practices and…

  13. Biocompatibility of new peritoneal dialysis solutions: clinical experience.

    PubMed

    Garcia-Lopez, E; Lindholm, B; Tranaeus, A

    2000-01-01

    The successful development of peritoneal dialysis (PD) during the last two decades has been made possible by using well-established glucose-based solutions with lactate as buffer. On the other hand, awareness has been increasing about the potentially negative effects of the high concentrations of glucose and lactate, and the low pH of conventional PD solutions. This awareness has prompted an intensive effort to search for and test alternative solutions. As a result, three new, more biocompatible solutions-containing either less glucose or less lactate--are available. Amino acid-based solution uses amino acids instead of glucose as the osmotic agent; it is indicated for treatment of malnutrition. The higher pH and absence of glucose in this solution may prevent alterations of the peritoneal membrane caused by acidity and high glucose concentrations. Bicarbonate/lactate-buffered solution contains a physiologic concentration of bicarbonate and a reduced concentration of lactate; it also has a physiologic pH and markedly reduced levels of glucose degradation products (GDPs). Icodextrin-based solution contains icodextrin as the osmotic agent; it is indicated for long dwells, delivering sustained ultrafiltration for more than 16 hours. This iso-osmolar glucose-free solution may reduce peritoneal membrane alterations caused by glucose or the hyperosmolality (or both) of conventional solutions. Clinical experience of the new solutions is now extensive, and their efficacy and safety are well documented. It therefore seems appropriate to state that we have entered a new era of PD therapy. Each of the new solutions may be less damaging to the peritoneal membrane than conventional solution. In addition, they permit better management of malnutrition and fluid status, and may thus help to improve PD patient survival. Although the effects of each of these new solutions have been well described, clinical documentation of the combined use of these new biocompatible PD solutions is

  14. Validation of a Method for Measuring Medical Students' Critical Reflections on Professionalism in Gross Anatomy

    ERIC Educational Resources Information Center

    Wittich, Christopher M.; Pawlina, Wojciech; Drake, Richard L.; Szostek, Jason H.; Reed, Darcy A.; Lachman, Nirusha; McBride, Jennifer M.; Mandrekar, Jayawant N.; Beckman, Thomas J.

    2013-01-01

    Improving professional attitudes and behaviors requires critical self reflection. Research on reflection is necessary to understand professionalism among medical students. The aims of this prospective validation study at the Mayo Medical School and Cleveland Clinic Lerner College of Medicine were: (1) to develop and validate a new instrument for…

  15. Experience and perception of sexual harassment during the clinical practice of korean nursing students.

    PubMed

    Lee, Sun-Kyoung; Song, Ju-Eun; Kim, Sue

    2011-09-01

    The purpose of this study was to identify the experience and perception of sexual harassment during the clinical practice of Korean nursing students. The descriptive study was conducted using a self-report questionnaire from December 2009 to January 2010. Participants were 542 nursing students recruited from 12 nursing colleges in Korea, who had finished 1,000 hours of clinical practice which is the minimum requirement for graduation. Data were analyzed by descriptive statistics. Ninety-seven participants (17.9%) reported that they experienced sexual harassment during clinical practice and 36 participants (6.7%) answered whether it was a sexual harassment or not. When sexual harassment was asked by the specific 18 items in the sexual harassment checklist, 52.0% (n = 282) of participants reported that they experienced at least 1 item among 18 items of sexual harassment. Sexual harassments were frequently made by the persons in their 40s (41.2%), men (97.9%) and patients (96.9%) and in the psychiatric wards (67.0%). Many respondents recognized that sexual harassment during clinical practice was caused by abnormal sexual desire of a pervert (34.5%) or men's sexual impulse (26.2%). Also, sexual harassment was perceived as a serious problem (19.4%) and education was necessary for prevention (88.3%). Education program is needed to prevent sexual harassment and enhance the gender sensitivity of nursing students, who are in the high-risk group of sexual harassment during clinical practice. This will in turn contribute to a safe educational environment for clinical practice. Copyright © 2011. Published by Elsevier B.V.

  16. Two birds with one stone: experiences of combining clinical and research training in addiction medicine.

    PubMed

    Klimas, J; McNeil, R; Ahamad, K; Mead, A; Rieb, L; Cullen, W; Wood, E; Small, W

    2017-01-23

    Despite a large evidence-base upon which to base clinical practice, most health systems have not combined the training of healthcare providers in addiction medicine and research. As such, addiction care is often lacking, or not based on evidence or best practices. We undertook a qualitative study to assess the experiences of physicians who completed a clinician-scientist training programme in addiction medicine within a hospital setting. We interviewed physicians from the St. Paul's Hospital Goldcorp Addiction Medicine Fellowship and learners from the hospital's academic Addiction Medicine Consult Team in Vancouver, Canada (N = 26). They included psychiatrists, internal medicine and family medicine physicians, faculty, mentors, medical students and residents. All received both addiction medicine and research training. Drawing on Kirkpatrick's model of evaluating training programmes, we analysed the interviews thematically using qualitative data analysis software (Nvivo 10). We identified five themes relating to learning experience that were influential: (i) attitude, (ii) knowledge, (iii) skill, (iv) behaviour and (v) patient outcome. The presence of a supportive learning environment, flexibility in time lines, highly structured rotations, and clear guidance regarding development of research products facilitated clinician-scientist training. Competing priorities, including clinical and family responsibilities, hindered training. Combined training in addiction medicine and research is feasible and acceptable for current doctors and physicians in training. However, there are important barriers to overcome and improved understanding of the experience of addiction physicians in the clinician-scientist track is required to improve curricula and research productivity.

  17. The Mayo Clinic Arizona Spasmodic Dysphonia Experience: A Demographic Analysis of 718 Patients.

    PubMed

    Patel, Alpen B; Bansberg, Stephen F; Adler, Charles H; Lott, David G; Crujido, Lisa

    2015-11-01

    Analyze demographic data collected over a 25-year experience of 718 patients with spasmodic dysphonia (SD) who have been treated with botulinum toxin-A (BoNT-A) and compare our data with previously published studies. Seven hundred eighteen patients with SD were treated with 6621 BoNT-A injections at Mayo Clinic Arizona between 1989 and 2014. All patients were treated by the same physician team. Background demographic data for each patient were recorded. Of 718 patients, 557 patients were female (77.6%). Six hundred sixty of 718 (91.8%) patients had adductor SD (AdSD), and 58 of 718 (8.1%) patients had abductor SD (AbSD). Average age of onset was 51 years. Of 718 patients, 378 (52.6%) had vocal tremor (VT); VT was present in 54.4% of AdSD patients and 32.1% of AbSD patients. Thirty-seven of 718 (5.2%) patients had other dystonias, including cervical dystonia (2.3%), blepharospasm (1.4%), limb dystonia (1.1%), and oromandibular dystonia (0.3%). A positive family history of SD was present in only 6 of 718 patients (0.8%) and of other dystonias in 11 of 718 patients (1.5%). Spasmodic dysphonia is a chronic and potentially disabling focal laryngeal dystonia. The Mayo Clinic Arizona SD experience compares to prior reports and reveals a female preponderance, onset in middle age, infrequent hereditary pattern, high co-occurrence of VT, and low co-occurrence of other dystonias. © The Author(s) 2015.

  18. VA OpenNotes: exploring the experiences of early patient adopters with access to clinical notes.

    PubMed

    Nazi, Kim M; Turvey, Carolyn L; Klein, Dawn M; Hogan, Timothy P; Woods, Susan S

    2015-03-01

    To explore the experience of early patient adopters who accessed their clinical notes online using the Blue Button feature of the My HealtheVet portal. A web-based survey of VA patient portal users from June 22 to September 15, 2013. 33.5% of respondents knew that clinical notes could be viewed, and nearly one in four (23.5%) said that they had viewed their notes at least once. The majority of VA Notes users agreed that accessing their notes will help them to do a better job of taking medications as prescribed (80.1%) and be better prepared for clinic visits (88.6%). Nine out of 10 users agreed that use of visit notes will help them understand their conditions better (91.8%), and better remember the plan for their care (91.9%). In contrast, 87% disagreed that VA Notes will make them worry more, and 88.4% disagreed that access to VA Notes will be more confusing than helpful. Users who had either contacted their provider or healthcare team (11.9%) or planned to (13.5%) primarily wanted to learn more about a health issue, medication, or test results (53.7%). Initial assessment of the patient experience within the first 9 months of availability provides evidence that patients both value and benefit from online access to clinical notes. These findings are congruent with OpenNotes study findings on a broader scale. Additional outreach and education is needed to enhance patient awareness. Healthcare professionals should author notes keeping in mind the opportunity patient access presents for enhanced communication. © The Author 2014. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  19. Creating an educationally minded schedule: one approach to minimize the impact of duty hour standards on intern continuity clinic experience.

    PubMed

    DeBlasio, Dominick; Kerrey, M Kathleen; Sucharew, Heidi; Klein, Melissa

    2014-11-01

    To determine if implementing an educationally minded schedule utilizing consecutive night shifts can moderate the impact of the 2011 duty hour standards on education and patient continuity of care in longitudinal primary care experience (continuity clinic). A 14-month pre-post study was performed in continuity clinic with one supervising physician group and two intern groups. Surveys to assess attitudes and education were distributed to the supervising physicians and interns before and after the changes in duty hour standards. Intern groups' schedules were reviewed for the number of regular and alternative day clinic (i.e. primary care experience on a different weekday) sessions and patient continuity of care. Fifteen supervising physicians and 51 interns participated (25 in 2011, 26 in 2012). Intern groups' comfort when discussing patient issues, educational needs and teamwork perception did not differ. Supervising physicians' understanding of learning needs and provision of feedback did not differ between groups. Supervising physicians indicated a greater ability to provide feedback and understand learning needs during regular continuity clinic sessions compared with alternative day clinics (all p < 0.05). No significant difference was detected between intern groups in the number of regularly scheduled continuity clinics, alternative day clinics or patient continuity of care. The 2011 duty hour standards required significant alterations to intern schedules, but educationally minded scheduling limited impact on education and patient continuity in care.

  20. Responsibly managing students' learning experiences in student-run clinics: a virtues-based ethical framework.

    PubMed

    Coverdale, John H; McCullough, Laurence B

    2014-01-01

    Many medical schools now offer students a distinctive clinical and learning opportunity, the student-run clinic (SRC), in which generalist physicians often play the major role. Although SRCs have become popular, they pose as-yet unexplored ethical challenges for the learning experiences of students. In SRCs students not only take on a significant administrative role especially in coordinating care, but also provide direct patient care for a clinically challenging, biopsychosocially vulnerable, medically indigent population of patients. SRCs provide an exemplar of the ethical challenges of care for such patients. The ethical framework proposed in this article emphasizes that these valued learning opportunities for students should occur in the context of professional formation, with explicit attention to developing the professional virtues, with faculty as role models for these virtues. The valued learning opportunities for students in SRCs should occur in the context of professional formation, with explicit attention to developing the professional virtues of integrity, compassion, self-effacement, self-sacrifice, and courage, which are required for the appropriate care of the vulnerable populations served by SRCs.