Towards the development of day one competences in veterinary behaviour medicine: survey of veterinary professionals experience in companion animal practice in Ireland.

PubMed

Golden, Olwen; Hanlon, Alison J

2018-01-01

Veterinary behaviour medicine should be a foundation subject of the veterinary curriculum because of its wide scope of applications to veterinary practice. Private practitioners are likely to be the primary source of information on animal behaviour for most pet owners, however studies indicate that behavioural issues are not frequently discussed during companion animal consultations and many practitioners lack confidence in dealing with behavioural problems, likely due to poor coverage of this subject in veterinary education.There is a need to identify learning outcomes to support day one competences in veterinary behaviour medicine and these should be informed by practice-based evidence. This study aimed to investigate the nature and frequency of behavioural queries experienced by veterinary professionals in Ireland, the provision of behavioural services at companion animal practices, behaviour referral practices and challenges associated with providing a behaviour service. Two online surveys were developed, one for private veterinary practitioners (PVP) and one for veterinary nurses (VN). Invitations to participate were distributed using contact details from the Premises Accreditation Scheme database on the Veterinary Council of Ireland website. Thirty-eight PVPs and 69 VNs completed the survey. Results indicated that less than half of companion animal practices offer behavioural consults and under a third of practices provide training and socialization events. Over half of the practices surveyed have referred cases to a behavioural specialist.The majority of respondents encountered behavioural queries weekly. Ninety-eight percent reported receiving queries regarding dog behaviour. Toilet training and unruly behaviour were two issues encountered frequently. Behavioural issues in cats were also common. House soiling and destructive behaviour were the problems most frequently encountered by respondents.The two most commonly cited barriers to providing behavioural consultations were lack of in-house or personal expertise, and that clients were not willing to pay for these services.Furthermore over half of all veterinary professionals surveyed indicated that they had received inadequate undergraduate training in veterinary behaviour medicine. Behavioural problems in companion animals can affect the quality of life of pets and their owners. Our survey findings indicate that many veterinary professionals frequently encounter behavioural problems and identify an opportunity for improved provision in behaviour medicine in veterinary education.

Teachers Teaching Teachers (T3). Volume 6, Number 3

ERIC Educational Resources Information Center

Armstrong, Anthony, Ed.

2010-01-01

"Teachers Teaching Teachers" ("T3") focuses on coaches' roles in the professional development of teachers. Each issue also explores the challenges and rewards that teacher leaders encounter. This issue includes: (1) Teaching English Language Learners: Mainstream Teachers Make a Stellar Journey as a Team to Transform Classroom Practices (Elsa M.…

Introduction to High-Impact Feminist Pedagogies: Points of Encounter, Tactics of Change

ERIC Educational Resources Information Center

Lidinsky, April; Jespersen, T. Christine; Stein, Rachel; Hogan, Katie

2014-01-01

This article introduces a four-paper cluster, included in this issue of "Feminist Teacher," in which the authors take up the challenge to dismantle the perceived dichotomy between feminism theory and practice. The authors analyze specific theory based feminist pedagogical practices, which are employed on four very different campuses with…

Otherness in Pedagogical Theory and Practice: The Case of Roma

ERIC Educational Resources Information Center

Kirova, Anna; Prochner, Larry

2015-01-01

This paper addresses the topic of the inclusion of Roma children in education in Europe through an examination of theory and practice in relation to the issues of Otherness and foreignness. Roma children entering school encounter a vastly different world from their home culture, with different expectations for teaching and learning, for…

Racial Microaggressions: A Primer with Implications for Counseling Practice

ERIC Educational Resources Information Center

Houshmand, Sara; Spanierman, Lisa B.; De Stefano, Jack

2017-01-01

Given their societal toll and ubiquitous nature, counselors and other mental health professionals inevitably will encounter clients who have experienced racial microaggressions in their practice. In this primer, we examine key issues relative to racial microaggressions and their impact on the lives of members of racial and ethnic minority groups.…

An online forum as a qualitative research method: practical issues.

PubMed

Im, Eun-Ok; Chee, Wonshik

2006-01-01

Despite the positive aspects of online forums as a qualitative research method, very little is known on the practical issues involved in using online forums for data collection, especially for a qualitative research project. The aim of this study was to describe the practical issues encountered in implementing an online forum as a qualitative component of a larger study on cancer pain experience. Throughout the study process, the research staff recorded issues ranging from minor technical problems to serious ethical dilemmas as they arose and wrote memos about them. The memos and written records of the discussions were reviewed and analyzed using content analysis. Two practical issues related to credibility were identified: (a) a high response and retention rate and (b) automatic transcripts. An issue related to dependability was the participants' forgetfulness. The issues related to confirmability were difficulties in theoretical saturation and unstandardized computer and Internet jargon. A security issue related to hacking attempts was noted as well. The analysis of these issues suggests several implications for future researchers who want to use online forums as a qualitative data collection method.

Medication-Related Practice Roles: An Ethical and Legal Primer for School Psychologists

ERIC Educational Resources Information Center

Shahidullah, Jeffrey D.

2014-01-01

Given the prevalence of school-age children and adolescents who are prescribed with and are taking psychotropic medications, a critical issue that school psychologists may likely encounter in contemporary practice is providing both quality and continuity of care to these students in the context of relevant legal and ethical parameters. With a…

Therapeutic boundaries in telepsychology: Unique issues and best practice recommendations

PubMed Central

Drum, Katherine B.; Littleton, Heather L.

2014-01-01

Technology-assisted mental health services are becoming much more routinely utilized by clients and practitioners alike. Clinicians practicing telepsychology must prepare themselves in order to provide competent care in this ever-evolving context of service delivery. Although much has been written with regards to considerations of ethical and legal practice, practical and logistical guidelines, and the advantages and disadvantages of the delivery of services via the use of technology, little to no attention has been paid to issues related to therapeutic boundaries in the telepsychology relationship. Clinicians must consider how to maintain appropriate boundaries in telepsychology settings in order to prevent harm and optimize treatment gains. Such considerations are also necessary given that it is probable that the telepsychology clinician will encounter novel boundary issues that are unlikely to occur in the traditional face-to-face therapy setting. We discuss the clinical utility of boundaries, potential boundary issues in telepsychology settings, and suggested best practice recommendations to ensure competent, ethical, and efficacious treatment in this novel context of service delivery. PMID:25414540

Therapeutic boundaries in telepsychology: Unique issues and best practice recommendations.

PubMed

Drum, Katherine B; Littleton, Heather L

2014-10-01

Technology-assisted mental health services are becoming much more routinely utilized by clients and practitioners alike. Clinicians practicing telepsychology must prepare themselves in order to provide competent care in this ever-evolving context of service delivery. Although much has been written with regards to considerations of ethical and legal practice, practical and logistical guidelines, and the advantages and disadvantages of the delivery of services via the use of technology, little to no attention has been paid to issues related to therapeutic boundaries in the telepsychology relationship. Clinicians must consider how to maintain appropriate boundaries in telepsychology settings in order to prevent harm and optimize treatment gains. Such considerations are also necessary given that it is probable that the telepsychology clinician will encounter novel boundary issues that are unlikely to occur in the traditional face-to-face therapy setting. We discuss the clinical utility of boundaries, potential boundary issues in telepsychology settings, and suggested best practice recommendations to ensure competent, ethical, and efficacious treatment in this novel context of service delivery.

Ethical Issues Raised by Private Practice Physiotherapy Are More Diverse than First Meets the Eye: Recommendations from a Literature Review

PubMed Central

Drolet, Marie-Josée; Williams-Jones, Bryn

2015-01-01

ABSTRACT Purpose: Physiotherapy in private practice differs from physiotherapy practised in a public setting in several ways, the most evident of which is the for-profit nature of private physiotherapy clinics; these differences can generate distinct and challenging ethical issues. The objectives of this article are to identify ethical issues encountered by physiotherapists in private practice settings and to identify potential solutions and recommendations to address these issues. Method: After a literature search of eight databases, 39 studies addressing ethical issues in a private practice context were analyzed. Results: A total of 25 ethical issues emerging from the included studies were classified into three main categories: (1) business and economic issues (e.g., conflicts of interests, inequity in a managed care context, lack of time affecting quality of care); (2) professional issues (e.g., professional autonomy, clinical judgment, treatment effectiveness, professional conduct); and (3) patients' rights and welfare issues (e.g., confidentiality, power asymmetries, paternalism vs. patient autonomy, informed consent). Recommendations as to how physiotherapists could better manage these issues were then identified and categorized. Conclusions: The physiotherapy community should reflect on the challenges raised by private practice so that professionals can be supported—through education, research, and good governance—in providing the best possible care for their patients. PMID:25931663

Integrated health practices: development of a graduate nursing program.

PubMed

Jossens, Marilyn O R; Ganley, Barbara J

2006-01-01

This article describes pedagogical issues in the development of a graduate nursing program in Integrated Health Practices (IHP), reports early experiences in the program, and asserts the importance of a graduate program in the specialty. The experience is described, and unique pedagogical issues encountered are discussed. While noting the contributions made to health and health care by Western medicine and nursing practice, the authors elaborate on the benefits of integrating western health care with less technological, less invasive, and less expensive holistic approaches. Diverse populations often require attention to specific chronic conditions, rather than to acute conditions, and constitutional requirements for overall health may be influenced by diverse health philosophies and practices. These requirements may be grounded in cultural and religious beliefs that must be incorporated into culturally sensitive plans of care. Clinical nurse specialists in IHP can offer knowledge and leadership to nursing practice, which address these complex, yet subtle health care issues.

An Online Forum As a Qualitative Research Method: Practical Issues

PubMed Central

Im, Eun-Ok; Chee, Wonshik

2008-01-01

Background Despite positive aspects of online forums as a qualitative research method, very little is known about practical issues involved in using online forums for data collection, especially for a qualitative research project. Objectives The purpose of this paper is to describe the practical issues that the researchers encountered in implementing an online forum as a qualitative component of a larger study on cancer pain experience. Method Throughout the study process, the research staff recorded issues ranged from minor technical problems to serious ethical dilemmas as they arose and wrote memos about them. The memos and written records of discussions were reviewed and analyzed using the content analysis suggested by Weber. Results Two practical issues related to credibility were identified: a high response and retention rate and automatic transcripts. An issue related to dependability was the participants’ easy forgetfulness. The issues related to confirmability were difficulties in theoretical saturation and unstandardized computer and Internet jargon. A security issue related to hacking attempts was noted as well. Discussion The analysis of these issues suggests several implications for future researchers who want to use online forums as a qualitative data collection method. PMID:16849979

The supervisory encounter and the senior GP trainee: managing for, through and with.

PubMed

Brown, James; Nestel, Debra; Clement, Tim; Goldszmidt, Mark

2018-02-01

Help-seeking supervisory encounters provide important learning experiences for trainees preparing for independent practice. Although there is a body of expert opinion and theories on how supervisor encounters should happen, supporting empirical data are limited. This is particularly true for the senior general practice (GP) trainee. Without knowing what happens during these encounters, we cannot know how to maximise their educational potential. This study aimed to understand what happens when senior GP trainees call on their supervisor when caring for patients and how learning can be enhanced when this occurs. This is an analysis of data from a multi-case study of five GP supervisory pairs, each with a GP registrar and their supervisor. The data are recordings of 45 supervisory encounters, 78 post-encounter reflections and six interviews. We used Wenger's communities of practice theory and rhetorical genre theory as analytical lenses. The supervisory encounters followed a consistent format, which fitted the form of a genre. Within this genre, three dominant interactional patterns were identified, which we labelled 'managing for', 'managing through' and 'managing with'. Each pattern presented different opportunities and drew on different skills. The primary agenda was always developing a plan for the patient. Education agendas included acquiring knowledge, developing skills and achieving independence. Other agendas were issues of control, credibility and relationship building. Both supervisor and trainee could be purposeful in their supervisory engagement. For supervisors and trainees to achieve the educational potential of their supervisory encounters they require flexibility. This depends on understanding the genre of the supervisory encounter, the agendas at play, the options they have in engaging and having the skills to utilise these options. Educators can facilitate supervisors and trainees in acquiring this understanding and these skills. We recommend further research into the genre of the supervisory encounter. © 2017 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

Everyday Ethics: Reflections on Practice

ERIC Educational Resources Information Center

Rossman, Gretchen B.; Rallis, Sharon F.

2010-01-01

This introductory article frames the contributions for this issue on everyday ethics--moments that demand moral considerations and ethical choices that researchers encounter. We discuss concerns raised within the research community about the tendency to observe merely obligatory ethical procedures as outlined in Human Subjects Review regulations.…

Clinical encounters between nurses and First Nations women in a Western Canadian hospital.

PubMed

Browne, Annette J

2007-05-01

Based on findings from an ethnographic study, this paper explores the sociopolitical context of nurses' encounters with First Nations women in a Western Canadian hospital. Data were collected using in-depth interviews and participant observation of clinical encounters involving nurses and First Nations women who were in-patients in the hospital. Four themes in the data are discussed: relating across presumed "cultural differences"; constructing the Other; assumptions influencing clinical practice; and responding to routine patient requests. The findings illustrate how discourses and assumptions about Aboriginal people, culture, and presumed differences can become interwoven into routine clinical encounters. These results highlight the importance of analyzing health-care encounters in light of the wider sociopolitical and historical forces that give rise to racialization, culturalism and Othering, and underscore the need for critical awareness of these issues among nurses and other heath-care providers.

Disrespect, harassment, and abuse: all in a day's work for family physicians.

PubMed

Miedema, Baukje; Easley, Julie; Fortin, Pierrette; Hamilton, Ryan; Tatemichi, Sue

2009-03-01

To examine harassment and abusive encounters between family physicians and their patients or colleagues in the workplace. Qualitative case study using semistructured interviews. Province of New Brunswick. Forty-eight family physicians from across the province. A collective case-study approach was developed, with 24 cases of 2 individuals per case. Cases were selected based on sex, location (urban or rural), language (French or English), and number of years since medical school graduation (< 10 years, 10 to 20 years, or > 20 years). Physicians were interviewed in either French or English. Participants were recruited using the College of Physicians and Surgeons of New Brunswick's physician directory. Based on the rates of response and participation, some cases were overrepresented, while others were not completed. All interviews were audiotaped, transcribed verbatim, and analyzed thematically using a categorical aggregation approach. A coding scheme for the thematic analysis was developed by the research team before the interviews were transcribed. Although the original intent of this study was to examine the work environment of family physicians in light of the increasing number of women entering the profession, harassment and abusive encounters in the workplace emerged as a main theme. These encounters ranged from minor to severe. Minor abusive encounters included disrespectful behaviour and verbal threats by patients, their families, and occasionally colleagues. More severe forms of harassment involved physical threats, physical encounters, and stalking. Demanding patients, such as heavy drug users, were often seen as threatening. Location of practice, years in practice, and sex of the physician seemed to affect abusive encounters--young, female, rural physicians appeared to experience such encounters most often. Abusive encounters in the workplace are concerning. It is essential to address these issues of workplace harassment and abuse in order to protect physician safety and avoid workplace dissatisfaction. Abusive encounters might push family physicians to leave clinical practice prematurely or refuse to work in higher-risk environments, such as emergency departments or rural areas.

Unmasking the predicament of cultural voyeurism: a postcolonial analysis of international nursing placements.

PubMed

Racine, Louise; Perron, Amélie

2012-09-01

The growing interest in international nursing placements cannot be left unnoticed. After 11 years into this twenty-first century, violations of human rights and freedom of speech, environmental disasters, and armed conflicts still create dire living conditions for men and women around the world. Nurses have an ethical duty to address issues of social justice and global health as a means to fulfil nursing's social mandate. However, international placements raise some concerns. Drawing on the works of postcolonial theorists in nursing and social sciences, we examine the risk of replicating colonialist practices and discourses of health in international clinical placements. Referring to Bakhtin's notions of dialogism and unfinalizability, we envision a culturally safe nursing practice arising from dialogical encounters between the Self as an Other and with the Other as an Other. We suggest that exploring the intricacies of cultural and race relations in everyday nursing practice are the premises upon which nurses can understand the broader historic, racial, gendered, political and economic contexts of global health issues. Finally, we make suggestions for developing culturally safe learning opportunities at the international level without minimizing the impact of dialogical cultural encounters occurring at the local and community levels. © 2011 Blackwell Publishing Ltd.

Engineering Encounters: An Engineering Design Process for Early Childhood

ERIC Educational Resources Information Center

Lottero-Perdue, Pamela; Bowditch, Michelle; Kagan, Michelle; Robinson-Cheek, Linda; Webb, Tedra; Meller, Megan; Nosek, Theresa

2016-01-01

This column presents ideas and techniques to enhance your science teaching. This month's issue shares information about trying (again) to engineer an egg package. Engineering is an essential part of science education, as emphasized in the "Next Generation Science Standards" (NGSS Lead States 2013). Engineering practices and performance…

Mathematics & Economics: Connections for Life, Grades 6-8.

ERIC Educational Resources Information Center

Hoff, Jody; McCorkle, Sarapage; Suiter, Mary; Bettendorf, James; Breidenbach, Lisa; Cornwell, Pamela

This book contains a set of 12 lessons for middle school students that demonstrate how mathematical processes and concepts may be applied to the study of economics and personal finance. Mathematics educators can find lessons connecting mathematics instruction to practical problems and issues that students encounter throughout their life. The…

Five Approaches to Avoid When Managing the Middle School Classroom

ERIC Educational Resources Information Center

Englehart, Joshua M.

2013-01-01

Too often, teachers encountering difficulties with classroom management focus only on the students rather than critically examining the influence of their own approaches on student behavior. Given the particular challenges that middle school students present, certain practices and expectations exacerbate management issues, and a lack of awareness…

Encountering Student Texts: Interpretive Issues in Reading Student Writing.

ERIC Educational Resources Information Center

Lawson, Bruce, Ed.; And Others

Designed to raise the full range of hermeneutic concerns regarding evaluation of student writing, and to spur further research and discussion, this collection of essays focuses on a reconsideration of the interpretation and evaluation practices of writing teachers. Essays include: "A Reflective Conversation: 'Tempos of Meaning'"…

Counseling Older Women: Curriculum Guidelines and Strategies.

ERIC Educational Resources Information Center

Cavallaro, Marion L.

Since the population of older persons is predominantly female, counselor educators need to incorporate into their curriculum topics related to the unique issues faced by older women. Most counselors in their practice will be encountering at some point the problems of older women. Therefore, the preparation of counselors needs to incorporate…

Choosing and using a lawyer. What every medical practice administrator needs to know.

PubMed

Crow, N R

1994-01-01

Attorney Nancy Crow, J.D., L.L.M., writes about some of the legal issues encountered by medical groups, such as business law, real estate and land use, taxes and employee benefits, among many others, and what types of attorneys are more appropriate for particular concerns.

Pharmacists' Assessment of the Difficulty and Frequency of Ethical Issues Encountered in Community Pharmacy Settings.

PubMed

Crnjanski, Tatjana; Krajnovic, Dusanka; Savic, Mirko

2017-05-23

Researching ethical problems and their frequency could give us a complex picture and greater insight into the types of ethical issues that pharmacists face in providing health care. The overall aim of this study was to assess the pharmacist's perception of difficulty and frequency of selected ethical issues encountered by the community pharmacists in their everyday practice. A quantitative cross sectional multicenter study was performed using a validated survey instrument - Ethical Issue Scale for Community Pharmacy (EISP). The results of the analysis of 690 completely filled out instruments (response rate 78.49%) showed the difference between the ethical issues which always occurred ("A pharmacist is prevented from dispensing a medicine to the patient due to an administrative error in the prescription"), and the ones that pharmacists found most difficult ("A pharmacist dispenses a medicine he/she personally considers inadequate for the therapeutic treatment of the patient, in order to avoid any conflicts with the physician" and "A pharmacist is considering violating the rules and regulations in order to perform an act of humanity"). The majority of respondents (84.78%) were familiar with the Code of Ethics but the correlation between the familiarity and the perceived usefulness of the code in resolving problems in everyday practice was negative (ρ = -0.17, p < 0.001). Results showed that patients' well-being had a high influence on pharmacists' behavior. The results provided quantitative data by the examination of specific ethical issues and their occurrence. Further empirical research is recommended in order to systematically identify the ethical issues faced by community pharmacists.

Investigating the role of content knowledge, argumentation, and situational features to support genetics literacy

NASA Astrophysics Data System (ADS)

Shea, Nicole Anne

Science curriculum is often used as a means to train students as future scientists with less emphasis placed on preparing students to reason about issues they may encounter in their daily lives (Feinstein, Allen, & Jenkins, 2013; Roth & Barton, 2004). The general public is required to think scientifically to some degree throughout their life and often across a variety of issues. From an empirical standpoint, we do not have a robust understanding of what scientific knowledge the public finds useful for reasoning about socio-scientific issues in their everyday lives (Feinstein, 2011). We also know very little about how the situational features of an issue influences reasoning strategy (i.e., the use of knowledge to generate arguments). Rapid advances in science - particularly in genetics - increasingly challenge the public to reason about socio-scientific issues. This raises questions about the public's ability to participate knowledgeably in socio-scientific debates, and to provide informed consent for a variety of novel scientific procedures. This dissertation aims to answer the questions: How do individuals use their genetic content knowledge to reason about authentic issues they may encounter in their daily lives? Individuals' scientific knowledge is a critical aspect of scientific literacy, but what scientific literacy looks like in practice as individuals use their content knowledge to reason about issues comprised of different situational features is still unclear. The purpose of this dissertation is to explore what knowledge is actually used by individuals to generate and support arguments about a variety of socio-scientific issues, and how the features of those issues influences reasoning strategy. Three studies were conducted to answer questions reflecting this purpose. Findings from this dissertation provide important insights into what scientific literacy looks like in practice.

Surrogacy in modern obstetric practice.

PubMed

Burrell, Celia; Edozien, Leroy C

2014-10-01

Surrogacy is rising in profile and prevalence, which means that perinatal care providers face an increasing likelihood of encountering a case in their clinical practice. Rapidly expanding scientific knowledge (for example, fetal programming) and technological advances (for example, prenatal screening and diagnosis) pose challenges in the management of the surrogate mother; in particular, they could exacerbate conflict between the interests of the baby, the surrogate mother, and the intending parent(s). Navigating these often-tranquil-but-sometimes-stormy waters is facilitated if perinatal care providers are aware of the relevant ethical, legal, and service delivery issues. This paper describes the ethical and legal context of surrogacy, and outlines key clinical practice issues in management of the surrogate mother. Copyright © 2014 Elsevier Ltd. All rights reserved.

Disrespect, harassment, and abuse

PubMed Central

Miedema, Baukje; Easley, Julie; Fortin, Pierrette; Hamilton, Ryan; Tatemichi, Sue

2009-01-01

ABSTRACT OBJECTIVE To examine harassment and abusive encounters between family physicians and their patients or colleagues in the workplace. DESIGN Qualitative case study using semistructured interviews. SETTING Province of New Brunswick. PARTICIPANTS Forty-eight family physicians from across the province. METHODS A collective case-study approach was developed, with 24 cases of 2 individuals per case. Cases were selected based on sex, location (urban or rural), language (French or English), and number of years since medical school graduation (< 10 years, 10 to 20 years, or > 20 years). Physicians were interviewed in either French or English. Participants were recruited using the College of Physicians and Surgeons of New Brunswick’s physician directory. Based on the rates of response and participation, some cases were overrepresented, while others were not completed. All interviews were audiotaped, transcribed verbatim, and analyzed thematically using a categorical aggregation approach. A coding scheme for the thematic analysis was developed by the research team before the interviews were transcribed. MAIN FINDINGS Although the original intent of this study was to examine the work environment of family physicians in light of the increasing number of women entering the profession, harassment and abusive encounters in the workplace emerged as a main theme. These encounters ranged from minor to severe. Minor abusive encounters included disrespectful behaviour and verbal threats by patients, their families, and occasionally colleagues. More severe forms of harassment involved physical threats, physical encounters, and stalking. Demanding patients, such as heavy drug users, were often seen as threatening. Location of practice, years in practice, and sex of the physician seemed to affect abusive encounters—young, female, rural physicians appeared to experience such encounters most often. CONCLUSION Abusive encounters in the workplace are concerning. It is essential to address these issues of workplace harassment and abuse in order to protect physician safety and avoid workplace dissatisfaction. Abusive encounters might push family physicians to leave clinical practice prematurely or refuse to work in higher-risk environments, such as emergency departments or rural areas. PMID:19282539

Optimization of the convection volume in online post-dilution haemodiafiltration: practical and technical issues

PubMed Central

Chapdelaine, Isabelle; de Roij van Zuijdewijn, Camiel L.M.; Mostovaya, Ira M.; Lévesque, Renée; Davenport, Andrew; Blankestijn, Peter J.; Wanner, Christoph; Nubé, Menso J.; Grooteman, Muriel P.C.

2015-01-01

In post-dilution online haemodiafiltration (ol-HDF), a relationship has been demonstrated between the magnitude of the convection volume and survival. However, to achieve high convection volumes (>22 L per session) detailed notion of its determining factors is highly desirable. This manuscript summarizes practical problems and pitfalls that were encountered during the quest for high convection volumes. Specifically, it addresses issues such as type of vascular access, needles, blood flow rate, recirculation, filtration fraction, anticoagulation and dialysers. Finally, five of the main HDF systems in Europe are briefly described as far as HDF prescription and optimization of the convection volume is concerned. PMID:25815176

Human Rights: Its Meaning and Practice in Social Work Field Settings.

PubMed

Steen, Julie A; Mann, Mary; Restivo, Nichole; Mazany, Shellene; Chapple, Reshawna

2017-01-01

The goal of the study reported in this article was to explore the conceptualizations of human rights and human rights practice among students and supervisors in social work field settings. Data were collected from 35 students and 48 supervisors through an online survey system that featured two open-ended questions regarding human rights issues in their agency and human rights practice tasks. Responses suggest that participants encountered human rights issues related to poverty, discrimination, participation/self-determination/autonomy, violence, dignity/respect, privacy, and freedom/liberty. They saw human rights practice as encompassing advocacy, service provision, assessment, awareness of threats to clients' rights, and the nature of the worker-client relationship. These results have implications for the social work profession, which has an opportunity to focus more intently on change efforts that support clients' rights. The study points to the possibilities of expanding the scope of the human rights competency within social work education and addressing the key human rights issues in field education. © 2016 National Association of Social Workers.

Addressing mental health disparities through clinical competence not just cultural competence: the need for assessment of sociocultural issues in the delivery of evidence-based psychosocial rehabilitation services.

PubMed

Yamada, Ann-Marie; Brekke, John S

2008-12-01

Recognition of ethnic/racial disparities in mental health services has not directly resulted in the development of culturally responsive psychosocial interventions. There remains a fundamental need for assessment of sociocultural issues that have been linked with the expectations, needs, and goals of culturally diverse consumers with severe and persistent mental illness. The authors posit that embedding the assessment of sociocultural issues into psychosocial rehabilitation practice is one step in designing culturally relevant empirically supported practices. It becomes a foundation on which practitioners can examine the relevance of their interventions to the diversity encountered in everyday practice. This paper provides an overview of the need for culturally and clinically relevant assessment practices and asserts that by improving the assessment of sociocultural issues the clinical competence of service providers is enhanced. The authors offer a conceptual framework for linking clinical assessment of sociocultural issues to consumer outcomes and introduce an assessment tool adapted to facilitate the process in psychosocial rehabilitation settings. Emphasizing competent clinical assessment skills will ultimately offer a strategy to address disparities in treatment outcomes for understudied populations of culturally diverse consumers with severe and persistent mental illness.

76 FR 9544 - Antidumping Methodologies in Proceedings Involving Non-Market Economies: Valuing the Factor of...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-18

... parties to comment on these methodological issues described above. Request for Comment on Interim Industry... comments. \\15\\ Indicator: GNI per capita, Atlas Method (current US$) is obtained from http://data.worldbank... methodology, the Department has encountered a number of methodological and practical challenges that must be...

Methodological Complications of Matching Designs under Real World Constraints: Lessons from a Study of Deeper Learning

ERIC Educational Resources Information Center

Zeiser, Kristina; Rickles, Jordan; Garet, Michael S.

2014-01-01

To help researchers understand potential issues one can encounter when conducting propensity matching studies in complex settings, this paper describes methodological complications faced when studying schools using deeper learning practices to improve college and career readiness. The study uses data from high schools located in six districts…

Reflection and Reflexivity in Practice versus in Theory: Challenges of Conceptualization, Complexity, and Competence

ERIC Educational Resources Information Center

Alexander, Patricia A.

2017-01-01

In this commentary, theoretical principles pertaining to the role of epistemic cognition in teaching and professional development, synthesized from the content of this special issue on reflection and reflexivity, are proffered. These theoretical notions are then followed with a critical analysis of specific challenges encountered in enacting these…

International Students and American University Culture: Adjustment Issues.

ERIC Educational Resources Information Center

Robinson, Jennifer

This paper discusses two types of adjustments that foreign students face when they encounter university culture in the United States. The central section lists and describes four key groups of underlying principles, values, and practices in American education and discusses the reasons why these may be difficult for foreign students to understand.…

Methodological Issues and Practical Strategies in Research on Child Maltreatment Victims' Abilities and Experiences as Witnesses

ERIC Educational Resources Information Center

Chae, Yoojin; Goodman, Gail S.; Bederian-Gardner, Daniel; Lindsay, Adam

2011-01-01

Scientific studies of child maltreatment victims' memory abilities and court experiences have important legal, psychological, and clinical implications. However, state-of-the-art research on child witnesses is often hindered by methodological challenges. In this paper, we address specific problems investigators may encounter when attempting such…

Debates in Religious Education. The Debates in Subject Teaching Series

ERIC Educational Resources Information Center

Barnes, L. Philip, Ed.

2011-01-01

What are the key debates in Religious Education teaching today? "Debates in Religious Education" explores the major issues all RE teachers encounter in their daily professional lives. It encourages critical reflection and aims to stimulate both novice and experienced teachers to think more deeply about their practice, and link research…

Statistics and Data Interpretation for Social Work

ERIC Educational Resources Information Center

Rosenthal, James A.

2011-01-01

Written by a social worker for social work students, this is a nuts and bolts guide to statistics that presents complex calculations and concepts in clear, easy-to-understand language. It includes numerous examples, data sets, and issues that students will encounter in social work practice. The first section introduces basic concepts and terms to…

Campus-Based Practices for Promoting Student Success: Faculty Policy Issues. Research Brief

ERIC Educational Resources Information Center

Horn, Aaron S.; Reinert, Leah; Kamata, Takehito

2014-01-01

The academic profession has encountered significant change over the past several decades, such as a higher priority on research; increasing enrollment of non-traditional students; the need to manage, advise, and instruct larger student bodies; and greater expectations to use instructional technologies (Gappa & Leslie, 1993: Geiger, 2011;…

Systematic Quality Development Work in a Swedish Leisure-Time Centre

ERIC Educational Resources Information Center

Lager, Karin; Sheridan, Sonja; Gustafsson, Jan

2016-01-01

There is increasing activity in the area of quality issues in education in Europe. Diverse discourses of policy for quality are encountered in daily practice. This article explores systematic quality development work in a Swedish educational setting: the leisure-time centre. By following 2 teachers' enactments of policy in planning, organising,…

Need of risk management practice amongst bumiputera contractors in Malaysia construction industries

NASA Astrophysics Data System (ADS)

Syuhada Fadzil, Nur; Noor, Nurazuwa Md; Rahman, Ismail Abdul

2017-11-01

Malaysia construction industry has been growing continuously with double-digit growth for the past two decades. There are many issues surrounded the industry such as delay in delivery, cost overrun, quality and safety. In bumiputera contractor’s context, the literature review found that 32 issues were encountered in the construction project. These issues can be handled properly with the application of risk management. According to previous researchers, application of risk management in Malaysia construction industry is at the low level where it is implemented in traditional ways that are brainstorming and checklist. These were due to lack of knowledge, the high cost of hiring experts and avoiding extra cost. Besides that, this study also intentions to analyse the risk categories in the construction industry as well as identify risk management process to resolve the construction issues. Hence, this paper presents issues engulfed by Bumiputera contractors which can partly be resolved by applying risk management practice in carrying out the construction activity. This may inspire the contractors to apply the risk management practice in ensuring the success of their construction project.

A day in the life of a junior doctor: everyday ethical encounters.

PubMed

Quarini, Catherine J

2010-11-01

This paper presents a hypothetical 'day in the life' of junior doctors working on a busy hospital ward. It illustrates the fact that, although the everyday ethical encounters faced by doctors are generally not as dramatic as some of the ethical issues discussed at medical school, the underlying principles, such as consent, confidentiality and resource allocation, are highly relevant to daily practice. After presenting some of the ethical challenges faced by junior doctors, from patients confused by poor explanations to inadequate consent procedures, the paper ends with suggestions on how to improve the situation.

Clinical application of pharmacogenetics: focusing on practical issues.

PubMed

Chang, Matthew T; McCarthy, Jeanette J; Shin, Jaekyu

2015-01-01

Recent large-scale genetic-based studies have transformed the field of pharmacogenetics to identify, characterize and leverage genetic information to inform patient care. Genetic testing can be used to alter drug selection, optimize drug dosing and prevent unnecessary adverse events. As precision medicine becomes the mainstay in the clinic, it becomes critical for clinicians to utilize pharmacogenetics to guide patient care. One primary challenge is identifying patients where genetic tests that can potentially impact patient care. To address this challenge, our review highlights many practical issues clinicians may encounter: identifying candidate patients and clinical laboratories for pharmacogenetic testing, selecting highly curated resources to help asses test validity, reimbursing costs of pharmacogenetic tests, and interpreting of pharmacogenetic test results.

Ethical issues in physiotherapy--reflected from the perspective of physiotherapists in private practice.

PubMed

Praestegaard, Jeanette; Gard, Gunvor

2013-02-01

An important aspect of physiotherapy professional autonomy is the ethical code of the profession, both collectively and for the individual member of the profession. The aim of this study is to explore and add additional insight into the nature and scope of ethical issues as they are understood and experienced by Danish physiotherapists in outpatient, private practice. A qualitative approach was chosen and semi-structured interviews with 21 physiotherapists were carried out twice and analyzed, using a phenomenological hermeneutic framework. One main theme emerged: The ideal of being beneficent toward the patient. Here, the ethical issues uncovered in the interviews were embedded in three code-groups: 1) ethical issues related to equality; 2) feeling obligated to do one's best; and 3) transgression of boundaries. In an ethical perspective, physiotherapy in private practice is on a trajectory toward increased professionalism. Physiotherapists in private practice have many reflections on ethics and these reflections are primarily based on individual common sense arguments and on deontological understandings. As physiotherapy by condition is characterized by asymmetrical power encounters where the parties are in close physical and emotional contact, practiced physiotherapy has many ethical issues embedded. Some physiotherapists meet these issues in a professional manner, but others meet them in unconscious or unprofessional ways. An explicit ethical consciousness among Danish physiotherapists in private practice seems to be needed. A debate of how to understand and respect the individual physiotherapist's moral versus the ethics of the profession needs to be addressed.

Debates in History Teaching. The Debates in Subject Teaching Series

ERIC Educational Resources Information Center

Davies, Ian, Ed.

2010-01-01

"Debates in History Teaching" explores the major issues all history teachers encounter in their daily professional lives. It encourages critical reflection and aims to stimulate both novice and experienced teachers to think more deeply about their practice, and link research and evidence to what they have observed in schools. Written by a range of…

Didactic and Technical Considerations When Developing e-Learning and CME

ERIC Educational Resources Information Center

te Pas, Ellen; Wieringa-de Waard, Margreet; Blok, Bernadette Snijders; Pouw, Henny; van Dijk, Nynke

2016-01-01

Several usability issues were encountered during the design of a blended e-learning program for a course in evidence-based medicine for general practice trainers. The program was developed in four steps. We focused in this article on step 2 and 3. Step 2 focused on which educational principles to apply, that is, which learning theories,…

Problems and Practical Solutions of Web-Based Courses: Lessons Learned from Three Educational Institutions.

ERIC Educational Resources Information Center

Miltiadou, Marios; McIsaac, Marina S.

The purpose of this paper is to review problems encountered in World Wide Web-based courses delivered at three different educational institutions (i.e., two community colleges and a university) in the metropolitan Phoenix (Arizona) area. Implications are discussed based on distance education theories of interaction. Interaction is a vital issue to…

Materialist Mappings of Knowing in Being: Researchers Constituted in the Production of Knowledge

ERIC Educational Resources Information Center

Mazzei, Lisa A.

2013-01-01

In keeping with the editor's call for this special issue, this paper demonstrates how reading data "with" and "through" a new materialist lens opens up different ways of seeing and thinking. Drawing on material feminist theory, the author presents an illustration of how such practices produce a different encounter with…

A Mixed Methods Content Analysis of the Research Literature in Science Education

ERIC Educational Resources Information Center

Schram, Asta B.

2014-01-01

In recent years, more and more researchers in science education have been turning to the practice of combining qualitative and quantitative methods in the same study. This approach of using mixed methods creates possibilities to study the various issues that science educators encounter in more depth. In this content analysis, I evaluated 18…

Withdrawal of ventilation at the patient's request in MND: a retrospective exploration of the ethical and legal issues that have arisen for doctors in the UK.

PubMed

Phelps, Kay; Regen, Emma; Oliver, David; McDermott, Chris; Faull, Christina

2017-06-01

Ventilatory support has benefits including prolonging survival for respiratory failure in motor neurone disease (MND). At some point some patients may wish to stop the intervention. The National Institute of Health and Care Excellence (NICE) guidance recommends research is needed on ventilation withdrawal. There is little literature focusing on the issues doctors encounter when withdrawing ventilation at the request of a patient. To identify and explore with doctors the ethical and legal issues that they had encountered in the withdrawal of ventilation at the request of a patient with MND. A retrospective thematic analysis of interviews of 24 doctors (including palliative care, respiratory, neurology and general practice) regarding their experiences with withdrawal of ventilation support from patients with MND. Respondents found withdrawal of ventilation at the request of patients with MND to pose legal, ethical and moral challenges in five themes: ethical and legal rights to withdrawal from treatment; discussions with family; discussions with colleagues; experiences of legal advice; issues contributing to ethical complexity. Though clear about the legality of withdrawal of treatment in theory, the practice led to ethical and moral uncertainty and mixed feelings. Many respondents had experienced negative reactions from other healthcare professionals when these colleagues were unclear of the distinction between palliation of symptoms, withdrawal of treatment and assisted death. Legal, ethical and practical guidance is needed for professionals who support a patient with MND who wishes to withdraw from ventilation. Open discussion of the ethical challenges is needed as well as education and support for professionals. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Withdrawal of ventilation at the patient's request in MND: a retrospective exploration of the ethical and legal issues that have arisen for doctors in the UK

PubMed Central

Phelps, Kay; Regen, Emma; Oliver, David; McDermott, Chris; Faull, Christina

2017-01-01

Background Ventilatory support has benefits including prolonging survival for respiratory failure in motor neurone disease (MND). At some point some patients may wish to stop the intervention. The National Institute of Health and Care Excellence (NICE) guidance recommends research is needed on ventilation withdrawal. There is little literature focusing on the issues doctors encounter when withdrawing ventilation at the request of a patient. Aim To identify and explore with doctors the ethical and legal issues that they had encountered in the withdrawal of ventilation at the request of a patient with MND. Method A retrospective thematic analysis of interviews of 24 doctors (including palliative care, respiratory, neurology and general practice) regarding their experiences with withdrawal of ventilation support from patients with MND. Results Respondents found withdrawal of ventilation at the request of patients with MND to pose legal, ethical and moral challenges in five themes: ethical and legal rights to withdrawal from treatment; discussions with family; discussions with colleagues; experiences of legal advice; issues contributing to ethical complexity. Though clear about the legality of withdrawal of treatment in theory, the practice led to ethical and moral uncertainty and mixed feelings. Many respondents had experienced negative reactions from other healthcare professionals when these colleagues were unclear of the distinction between palliation of symptoms, withdrawal of treatment and assisted death. Conclusions Legal, ethical and practical guidance is needed for professionals who support a patient with MND who wishes to withdraw from ventilation. Open discussion of the ethical challenges is needed as well as education and support for professionals. PMID:26362794

Theoretical frameworks used to discuss ethical issues in private physiotherapy practice and proposal of a new ethical tool.

PubMed

Drolet, Marie-Josée; Hudon, Anne

2015-02-01

In the past, several researchers in the field of physiotherapy have asserted that physiotherapy clinicians rarely use ethical knowledge to solve ethical issues raised by their practice. Does this assertion still hold true? Do the theoretical frameworks used by researchers and clinicians allow them to analyze thoroughly the ethical issues they encounter in their everyday practice? In our quest for answers, we conducted a literature review and analyzed the ethical theoretical frameworks used by physiotherapy researchers and clinicians to discuss the ethical issues raised by private physiotherapy practice. Our final analysis corpus consisted of thirty-nine texts. Our main finding is that researchers and clinicians in physiotherapy rarely use ethical knowledge to analyze the ethical issues raised in their practice and that gaps exist in the theoretical frameworks currently used to analyze these issues. Consequently, we developed, for ethical analysis, a four-part prism which we have called the Quadripartite Ethical Tool (QET). This tool can be incorporated into existing theoretical frameworks to enable professionals to integrate ethical knowledge into their ethical analyses. The innovative particularity of the QET is that it encompasses three ethical theories (utilitarism, deontologism, and virtue ethics) and axiological ontology (professional values) and also draws on both deductive and inductive approaches. It is our hope that this new tool will help researchers and clinicians integrate ethical knowledge into their analysis of ethical issues and contribute to fostering ethical analyses that are grounded in relevant philosophical and axiological foundations.

Addressing Mental Health Disparities through Clinical Competence Not Just Cultural Competence: The Need for Assessment of Sociocultural Issues in the Delivery of Evidence-Based Psychosocial Rehabilitation Services

PubMed Central

Yamada, Ann-Marie; Brekke, John S

2008-01-01

Recognition of ethnic/racial disparities in mental health services has not directly resulted in the development of culturally responsive psychosocial interventions. There remains a fundamental need for assessment of sociocultural issues that have been linked with the expectations, needs, and goals of culturally diverse consumers with severe and persistent mental illness. The authors posit that embedding the assessment of sociocultural issues into psychosocial rehabilitation practice is one step in designing culturally relevant empirically supported practices. It becomes a foundation on which practitioners can examine the relevance of their interventions to the diversity encountered in everyday practice. This paper provides an overview of the need for culturally and clinically relevant assessment practices and asserts that by improving the assessment of sociocultural issues the clinical competence of service providers is enhanced. The authors offer a conceptual framework for linking clinical assessment of sociocultural issues to consumer outcomes and introduce an assessment tool adapted to facilitate the process in psychosocial rehabilitation settings. Emphasizing competent clinical assessment skills will ultimately offer a strategy to address disparities in treatment outcomes for understudied populations of culturally diverse consumers with severe and persistent mental illness. PMID:18778881

Cross-cultural adaptation and translation of a quality of life tool for new mothers: a methodological and experiential account from six countries.

PubMed

Symon, Andrew; Nagpal, Jitender; Maniecka-Bryła, Irena; Nowakowska-Głąb, Agata; Rashidian, Arash; Khabiri, Roghayeh; Mendes, Isabel; Pinheiro, Ana Karina Bezerra; de Oliveira, Mirna Fontenele; Wu, Liping

2013-04-01

To examine the challenges and solutions encountered in the translation and cross-cultural adaptation of an English language quality of life tool in India, China, Iran, Portugal, Brazil, and Poland. Those embarking on research involving translation and cross-cultural adaptation must address certain practical and conceptual issues. These include instrument choice, linguistic factors, and cultural or philosophical differences, which may render an instrument inappropriate, even when expertly translated. Publication bias arises when studies encountering difficulties do not admit to these, or are not published at all. As an educative guide to the potential pitfalls involved in the cross-cultural adaptation process, this article reports the conceptual, linguistic, and methodological experiences of researchers in six countries, who translated and adapted the Mother-Generated Index, a quality of life tool originally developed in English. Principal investigator experience from six stand-alone studies (two published) ranging from postgraduate research to citywide surveys. DISCUSSION/IMPLICATIONS FOR NURSING: This analysis of a series of stand-alone cross-cultural studies provides lessons about how conceptual issues, such as the uniqueness of perceived quality of life and the experience of new motherhood, can be addressed. This original international approach highlights practical lessons relating to instrument choice, and the resources available to researchers with different levels of experience. Although researchers may be confident of effective translation, conceptual and practical difficulties may be more problematic. Instrument choice is crucial. Researchers must negotiate adequate resources for cross-cultural research, including time, translation facilities, and expert advice about conceptual issues. © 2012 Blackwell Publishing Ltd.

Quota sampling in internet research: practical issues.

PubMed

Im, Eun-Ok; Chee, Wonshik

2011-07-01

Quota sampling has been suggested as a potentially good method for Internet-based research and has been used by several researchers working with Internet samples. However, very little is known about the issues or concerns in using a quota sampling method in Internet research. The purpose of this article was to present the practical issues using quota sampling in an Internet-based study. During the Internet study, the research team recorded all recruitment issues that arose and made written notes indicating the possible reasons for the problems. In addition, biweekly team discussions were conducted for which written records were kept. Overall, quota sampling was effective in ensuring that an adequate number of midlife women were recruited from the targeted ethnic groups. However, during the study process, we encountered the following practical issues using quota sampling: (1) difficulty reaching out to women in lower socioeconomic classes, (2) difficulty ensuring authenticity of participants' identities, (3) participants giving inconsistent answers for the screening questions versus the Internet survey questions, (4) potential problems with a question on socioeconomic status, (5) resentment toward the research project and/or researchers because of rejection, and (6) a longer time and more expense than anticipated.

One dozen considerations when working with women in substance abuse groups.

PubMed

Bright, Charlotte Lyn; Osborne, Victoria A; Greif, Geoffrey L

2011-01-01

Women and men have different histories, presentations, and behaviors in substance abuse groups. Twelve considerations are offered for the beginning group leader when encountering women with substance abuse issues. These include understanding sexism, what brings women to treatment, and how women behave in group treatment. Implications for clinical practice with women in single-gender and mixed-gender groups are included.

Towards the Reform of Science Teaching in Spain: The Social and Personal Relevance of Junior Secondary School Science Projects for a Socially Responsible Understanding of Science.

ERIC Educational Resources Information Center

Membiela, Pedro

1999-01-01

Discusses aspects of more than a decade of research and implementation of cross-curriculum themes as part of the curriculum for secondary school students in Spain. Comments on theoretical and practical issues encountered in developing similar projects. Contains 45 references. (Author/WRM)

Engineering Encounters: The Cat in the Hat Builds Satellites. A Unit Promoting Scientific Literacy and the Engineering Design Process

ERIC Educational Resources Information Center

Rehmat, Abeera P.; Owens, Marissa C.

2016-01-01

This column presents ideas and techniques to enhance your science teaching. This month's issue shares information about a unit promoting scientific literacy and the engineering design process. The integration of engineering with scientific practices in K-12 education can promote creativity, hands-on learning, and an improvement in students'…

Cultural competency: providing quality care to diverse populations.

PubMed

Betancourt, Joseph R

2006-12-01

The goal of this paper is to define cultural competence and present a practical framework to address crosscultural challenges that emerge in the clinical encounter, with a particular focus on the issue of nonadherence. English-language literature, both primary and reports from various agencies, and the author's personal experiences in clinical practice. Relevant literature on patient-centered care and cultural competence. There is a growing literature that delineates the impact of sociocultural factors, race, ethnicity, and limited-English proficiency on health and clinical care. The field of cultural competence focuses on addressing these issues. Health care providers need a practical set of tools and skills that will enable them to provide quality care to patients during a brief encounter, whatever differences in background that may exist. Cultural competence has evolved from the gathering of information and making of assumptions about patients on the basis of their sociocultural background to the development of skills to implement the principles of patient-centered care. This patient-based approach to cross-cultural care consists of first, assessing core cross-cultural issues; second, exploring the meaning of the illness to the patient; third, determining the social context in which the patient lives; and fourth, engaging in negotiation with the patient to encourage adherence. Addressing adherence is a particularly challenging issue, the determinants of which are multifactorial, and the ESFT (explanatory/social/fears/treatment) model--derived from the patient-based approach--is a tool that identifies barriers to adherence and provides strategies to address them. It obviously is impossible to learn everything about every culture and that should not be expected. Instead, we should learn about the communities we care for. More important, we should have a framework that allows us to provide appropriate care for any patient--one that deals with issues of adherence--regardless of the patient's race, ethnicity, or cultural background.

Practical lessons in remote connectivity.

PubMed Central

Kouroubali, A.; Starren, J.; Barrows, R. C.; Clayton, P. D.

1997-01-01

Community Health Information Networks (CHINs) require the ability to provide computer network connections to many remote sites. During the implementation of the Washington Heights and Inwood Community Health Management Information System (WHICHIS) at the Columbia-Presbyterian Medical Center (CPMC), a number of remote connectivity issues have been encountered. Both technical and non-technical issues were significant during the installation. We developed a work-flow model for this process which may be helpful to any health care institution attempting to provide seamless remote connectivity. This model is presented and implementation lessons are discussed. PMID:9357643

Examining our privileges and oppressions: incorporating an intersectionality paradigm into nursing.

PubMed

Van Herk, Kimberley A; Smith, Dawn; Andrew, Caroline

2011-03-01

An intersectionality paradigm is a means by which nurses can attend to issues of oppression and privilege within their practice and profession. Intersectionality is introduced as an essential theory to help debunk the hegemony of the 'white, middle class' perspective that often directs nursing research, practice, and education. The values and benefits of using an intersectionality paradigm in nursing are shown through recent research done with Aboriginal women. These findings contribute to an increased understanding of the importance and necessity of attending to the power relations that dominate nursing care encounters and influence the way nurses provide care. By acknowledging and responding to the presence of privilege and oppression and the associated power dynamics within the therapeutic encounter, nursing can strive further in helping to alleviate social injustices and health disparities that arise from unequal power relations. © 2011 Blackwell Publishing Ltd.

Communication practices that encourage and constrain shared decision making in health-care encounters: Systematic review of conversation analytic research.

PubMed

Land, Victoria; Parry, Ruth; Seymour, Jane

2017-12-01

Shared decision making (SDM) is generally treated as good practice in health-care interactions. Conversation analytic research has yielded detailed findings about decision making in health-care encounters. To map decision making communication practices relevant to health-care outcomes in face-to-face interactions yielded by prior conversation analyses, and to examine their function in relation to SDM. We searched nine electronic databases (last search November 2016) and our own and other academics' collections. Published conversation analyses (no restriction on publication dates) using recordings of health-care encounters in English where the patient (and/or companion) was present and where the data and analysis focused on health/illness-related decision making. We extracted study characteristics, aims, findings relating to communication practices, how these functioned in relation to SDM, and internal/external validity issues. We synthesised findings aggregatively. Twenty-eight publications met the inclusion criteria. We sorted findings into 13 types of communication practices and organized these in relation to four elements of decision-making sequences: (i) broaching decision making; (ii) putting forward a course of action; (iii) committing or not (to the action put forward); and (iv) HCPs' responses to patients' resistance or withholding of commitment. Patients have limited opportunities to influence decision making. HCPs' practices may constrain or encourage this participation. Patients, companions and HCPs together treat and undertake decision making as shared, though to varying degrees. Even for non-negotiable treatment trajectories, the spirit of SDM can be invoked through practices that encourage participation (eg by bringing the patient towards shared understanding of the decision's rationale). © 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd.

Patient perspectives of telemedicine quality

PubMed Central

LeRouge, Cynthia M; Garfield, Monica J; Hevner, Alan R

2015-01-01

Background The purpose of this study was to explore the quality attributes required for effective telemedicine encounters from the perspective of the patient. Methods We used a multi-method (direct observation, focus groups, survey) field study to collect data from patients who had experienced telemedicine encounters. Multi-perspectives (researcher and provider) were used to interpret a rich set of data from both a research and practice perspective. Results The result of this field study is a taxonomy of quality attributes for telemedicine service encounters that prioritizes the attributes from the patient perspective. We identify opportunities to control the level of quality for each attribute (ie, who is responsible for control of each attribute and when control can be exerted in relation to the encounter process). This analysis reveals that many quality attributes are in the hands of various stakeholders, and all attributes can be addressed proactively to some degree before the encounter begins. Conclusion Identification of the quality attributes important to a telemedicine encounter from a patient perspective enables one to better design telemedicine encounters. This preliminary work not only identifies such attributes, but also ascertains who is best able to address quality issues prior to an encounter. For practitioners, explicit representation of the quality attributes of technology-based systems and processes and insight on controlling key attributes are essential to implementation, utilization, management, and common understanding. PMID:25565781

Bilingual Encounters: Spanish-English Medical and Legal Dialogues. A Practical Resource for Educators and Students of Interpreting. Interpreting and Translation Publications Series, No. 1.

ERIC Educational Resources Information Center

Hale, Sandra

Thirty-eight dialogues are presented, each illustrating a common, real-life interpreting situation involving medical and/or legal issues and terminology. Each involves both Spanish and English languages, and the situations are specific to New South Wales, Australia. They are designed to be used as a resource in teaching interpreting. The…

Teaching ethics to paediatrics residents: the centrality of the therapeutic alliance.

PubMed

Taylor, Holly A; McDonald, Erin L; Moon, Margaret; Hughes, Mark T; Carrese, Joseph A

2009-10-01

Previous research on ethical issues encountered by medical professionals in training and practice have presented the thematic content of the cases they encounter rather than the activities in which clinicians engage and in which they most often encounter ethical issues. We conducted a direct observation study of paediatrics residents and their preceptors seeing patients in an out-patient general paediatrics clinic. Our objectives were to describe the everyday ethics-related issues paediatrics residents encounter as they interact with patients. Our ultimate goal is to use this knowledge to enhance current efforts to teach ethics to paediatrics residents. The study team directly observed paediatrics residents discussing patients with their faculty preceptors (19 half-day sessions, 76 hours) in an out-patient general paediatrics clinic located in an urban academic medical centre. Each interaction between resident and preceptor about a single patient was considered a case for further analysis. A total of 247 cases were recorded. Forty-one of the cases were coded as having ethics-related content. A constant comparative method of qualitative data analysis revealed that residents were most likely to encounter ethical issues when engaged in the following activities: (i) maintaining a therapeutic alliance with the caregiver (e.g. the parent); (ii) prioritising patient or family needs; (iii) adjusting to the power embodied by the role of doctors, and (iv) distinguishing suboptimal care from abuse or neglect. In addition, our findings indicate that it is through their efforts to maintain the therapeutic alliance with the caregivers of their patients that residents engage in and integrate three processes: developing their medical knowledge; adhering to professional norms, and balancing the power inherent in the doctor's role with their responsibility to serve the patient's interests. Medical faculty tasked with teaching ethics to paediatrics residents can utilise the results of this project to better target and enhance their ethics education efforts directed at residents in the out-patient setting. Future research could further examine and test these findings in other clinical settings (e.g. adult general medicine).

Transformative Theatre: A Promising Educational Tool for Improving Health Encounters With LGBT Older Adults.

PubMed

Hughes, Anne K; Luz, Clare; Hall, Dennis; Gardner, Penny; Hennessey, Chris Walker; Lammers, Lynn

2016-01-01

Lesbian, gay, bisexual, or transgender (LGBT) older adults are often unaware or fearful of aging services that contribute to greater vulnerability, isolation, and risk when services are needed. In addition, they may perceive or experience bias in health care encounters. Providers may not recognize their own biases or their impact on such encounters. In response, a group of LGBT community activists, aging professionals, researchers, and a theatre ensemble developed an interactive theatre experience, described herein, that portrays challenges faced by LGBT older adults needing services. Goals included raising awareness among LGBT older adults and providers about issues such as the limited legal rights of partners, limited family support, and fear of being mistreated as a result of homophobia. Evaluations and feedback reflected the potential of interactive theatre to engage people in sensitive discussions that can lead to increased awareness, reduced bias, practice change, and ultimately improved care for LGBT older adults.

[Tubal sterilization in mentally handicapped women].

PubMed

Barjot, P; Hervé, C

2001-09-22

When performed for contraception purposes, tubular sterilization for mentally handicapped women poses important ethical issues, including patient's rights, body integrity, and the notion of informed consent. French law guarantees the respect and safety of all patients, but in everyday practice, patient's rights must be upheld by family and healthcare workers searching for the most adapted solutions for each individual situation. We present here our proposals for everyday practice. Our conclusions are based on an analysis of the notion of handicap as defined by the WHO and on the observed sexual activities of this type of patient. In this context, informed consent involves a number of subjective factors pointing out the difficulty encountered in providing dear comprehensible information. Finally we discuss the ethical issue of tubular sterilization which many consider to be a masked form of eugenism.

Coordination and resource-related difficulties encountered by Quebec's public health specialists and infectious diseases/medical microbiologists in the management of A (H1N1)--a mixed-method, exploratory survey.

PubMed

Nhan, Charles; Laprise, Réjean; Douville-Fradet, Monique; Macdonald, Mary Ellen; Quach, Caroline

2012-02-10

In Quebec, the influenza A (H1N1) pandemic was managed using a top-down style that left many involved players with critical views and frustrations. We aimed to describe physicians' perceptions--infectious diseases specialists/medical microbiologists (IDMM) and public health/preventive medicine specialists (PHPMS)--in regards to issues encountered with the pandemics management at the physician level and highlight suggested improvements for future healthcare emergencies. In April 2010, Quebec IDMM and PHPMS physicians were invited to anonymously complete a web-based learning needs assessment. The survey included both open-ended and multiple-choice questions. Descriptive statistics were used to report on the frequency distribution of multiple choice responses whereas thematic content analysis was used to analyse qualitative data generated from the survey and help understand respondents' experience and perceptions with the pandemics. Of the 102 respondents, 85.3% reported difficulties or frustrations in their practice during the pandemic. The thematic analysis revealed two core themes describing the problems experienced in the pandemic management: coordination and resource-related difficulties. Coordination issues included communication, clinical practice guidelines, decision-making, roles and responsibilities, epidemiological investigation, and public health expert advisory committees. Resources issues included laboratory resources, patient management, and vaccination process. Together, the quantitative and qualitative data suggest a need for improved coordination, a better definition of roles and responsibilities, increased use of information technologies, merged communications, and transparency in the decisional process. Increased flexibility and less contradiction in clinical practice guidelines from different sources and increased laboratory/clinical capacity were felt critical to the proper management of infectious disease emergencies.

Ethical Challenges in Promoting the Implementation of Preventive Interventions: Report of the SPR Task Force.

PubMed

Leadbeater, Bonnie J; Dishion, Tom; Sandler, Irwin; Bradshaw, Catherine P; Dodge, Kenneth; Gottfredson, Denise; Graham, Phillip W; Lindstrom Johnson, Sarah; Maldonado-Molina, Mildred M; Mauricio, Anne M; Smith, Emilie Phillips

2018-06-23

Prevention science researchers and practitioners are increasingly engaged in a wide range of activities and roles to promote evidence-based prevention practices in the community. Ethical concerns invariably arise in these activities and roles that may not be explicitly addressed by university or professional guidelines for ethical conduct. In 2015, the Society for Prevention Research (SPR) Board of Directors commissioned Irwin Sandler and Tom Dishion to organize a series of roundtables and establish a task force to identify salient ethical issues encountered by prevention scientists and community-based practitioners as they collaborate to implement evidence-based prevention practices. This article documents the process and findings of the SPR Ethics Task Force and aims to inform continued efforts to articulate ethical practice. Specifically, the SPR membership and task force identified prevention activities that commonly stemmed from implementation and scale-up efforts. This article presents examples that illustrate typical ethical dilemmas. We present principles and concepts that can be used to frame the discussion of ethical concerns that may be encountered in implementation and scale-up efforts. We summarize value statements that stemmed from our discussion. We also conclude that the field of prevention science in general would benefit from standards and guidelines to promote ethical behavior and social justice in the process of implementing evidence-based prevention practices in community settings. It is our hope that this article serves as an educational resource for students, investigators, and Human Subjects Review Board members regarding some of the complexity of issues of fairness, equality, diversity, and personal rights for implementation of preventive interventions.

The Full Scope of Family Physicians' Work Is Not Reflected by Current Procedural Terminology Codes.

PubMed

Young, Richard A; Burge, Sandy; Kumar, Kaparaboyna Ashok; Wilson, Jocelyn

2017-01-01

The purpose of this study was to characterize the content of family physician (FP) clinic encounters, and to count the number of visits in which the FPs addressed issues not explicitly reportable by 99211 to 99215 and 99354 Current Procedural Terminology (CPT) codes with current reimbursement methods and based on examples provided in the CPT manual. The data collection instrument was modeled on the National Ambulatory Medical Care Survey. Trained assistants directly observed every other FP-patient encounter and recorded every patient concern, issue addressed by the physician (including care barriers related to health care systems and social determinants), and treatment ordered in clinics affiliated with 10 residencies of the Residency Research Network of Texas. A visit was deemed to include physician work that was not explicitly reportable if the number or nature of issues addressed exceeded the definitions or examples for 99205/99215 or 99214 + 99354 or a preventive service code, included the physician addressing health care system or social determinant issues, or included the care of a family member. In 982 physician-patient encounters, patients raised 517 different reasons for visit (total, 5278; mean, 5.4 per visit; range, 1 to 16) and the FPs addressed 509 different issues (total issues, 3587; mean, 3.7 per visit; range, 1 to 10). FPs managed 425 different medications, 18 supplements, and 11 devices. A mean of 3.9 chronic medications were continued per visit (range, 0 to 21) and 4.6 total medications were managed (range, 0 to 22). In 592 (60.3%) of the visits the FPs did work that was not explicitly reportable with available CPT codes: 582 (59.3%) addressed more numerous issues than explicitly reportable, 64 (6.5%) addressed system barriers, and 13 (1.3%) addressed concerns for other family members. FPs perform cognitive work in a majority of their patient encounters that are not explicitly reportable, either by being higher than the CPT example number of diagnoses per code or the type of problems addressed, which has implications for the care of complex multi-morbid patients and the growth of the primary care workforce. To address these limitations, either the CPT codes and their associated rules should be updated to reflect the realities of family physicians' practices or new billing and coding approaches should be developed. © Copyright 2017 by the American Board of Family Medicine.

Launching a Laboratory Testing Process Quality Improvement Toolkit: From the Shared Networks of Colorado Ambulatory Practices and Partners (SNOCAP).

PubMed

Fernald, Douglas; Hamer, Mika; James, Kathy; Tutt, Brandon; West, David

2015-01-01

Family medicine and internal medicine physicians order diagnostic laboratory tests for nearly one-third of patient encounters in an average week, yet among medical errors in primary care, an estimated 15% to 54% are attributed to laboratory testing processes. From a practice improvement perspective, we (1) describe the need for laboratory testing process quality improvements from the perspective of primary care practices, and (2) describe the approaches and resources needed to implement laboratory testing process quality improvements in practice. We applied practice observations, process mapping, and interviews with primary care practices in the Shared Networks of Colorado Ambulatory Practices and Partners (SNOCAP)-affiliated practice-based research networks that field-tested in 2013 a laboratory testing process improvement toolkit. From the data collected in each of the 22 participating practices, common testing quality issues included, but were not limited to, 3 main testing process steps: laboratory test preparation, test tracking, and patient notification. Three overarching qualitative themes emerged: practices readily acknowledge multiple laboratory testing process problems; practices know that they need help addressing the issues; and practices face challenges with finding patient-centered solutions compatible with practice priorities and available resources. While practices were able to get started with guidance and a toolkit to improve laboratory testing processes, most did not seem able to achieve their quality improvement aims unassisted. Providing specific guidance tools with practice facilitation or other rapid-cycle quality improvement support may be an effective approach to improve common laboratory testing issues in primary care. © Copyright 2015 by the American Board of Family Medicine.

Prescriptive authority for advanced practice nurses: current and future perspectives.

PubMed

McDermott, K C

1995-09-01

To present an overview of the issues related to prescriptive authority and advanced practice nurses (APNs) in oncology. Professional journals and books, print media, and professional and government releases. Discussion of issues related to complex political, educational, economic, and healthcare environmental factors. Strategies to achieve increased recognition for APN prescriptive authority include increasing APNs' knowledge about the effects of the political process on prescriptive authority, educating legislators and consumers, promoting standardization of pharmacology curricula, and encouraging formation of coalitions. Failure to pass a national healthcare plan, escalating managed-care markets, and the reform efforts of individual states to forge their own healthcare initiatives will challenge the APN's ability to practice and prescribe. The subject of prescriptive authority highlights the controversies and debates that APNs encounter in a dynamic healthcare environment. These include the complexity of state-to-state regulations, non-nursing professions making key decisions regarding scope of practice and prescriptive authority, and the challenge for APNs to carve out new roles while overcoming state regulatory inconsistencies and market-reform barriers. If not resolved, these issues will continue to prevent qualified APNs from providing appropriate and comprehensive care to patients with cancer.

Moral distress experienced by health care professionals who provide home-based palliative care.

PubMed

Brazil, Kevin; Kassalainen, Sharon; Ploeg, Jenny; Marshall, Denise

2010-11-01

Health care providers regularly encounter situations of moral conflict and distress in their practice. Moral distress may result in unfavorable outcomes for both health care providers and those in their care. The purpose of this study was to examine the experience of moral distress from a broad range of health care occupations that provide home-based palliative care as the initial step of addressing the issue. A critical incident approach was used in qualitative interviews to elicit the experiences on moral distress from 18 health care providers drawn from five home visiting organizations in south central Ontario, Canada. Most participants described at least two critical incidents in their interview generating a total of 47 critical incidents. Analyses of the critical incidents revealed 11 issues that triggered moral distress which clustered into three themes, (a) the role of informal caregivers, b) challenging clinical situations and (c) service delivery issues. The findings suggest that the training and practice environments for health care providers need to be designed to recognize the moral challenges related to day-to-day practice. Copyright © 2010 Elsevier Ltd. All rights reserved.

Cyberdermatoethics I: ethical, legal, technologic, and clinical aspects of patient-physician e-mail.

PubMed

Luo, John; Logan, Christopher; Long, Thomas P; Bercovitch, Lionel

2009-01-01

As Internet access has become ubiquitous, electronic mail (e-mail) is becoming more widely used as a means of communication between patient and dermatologist. Dealing with the ethical, legal, and clinical consequences has lagged behind the technology. Privacy of e-mail cannot exist without security, and as a foundation for understanding e-mail security, the elements of e-mail technology are reviewed. One of the greatest risks of e-mail is compromise of privacy. Although self-documenting and convenient, e-mail lacks the emotional cues of face-to-face encounters, is asynchronous and not always read in timely fashion, and is not suitable for certain clinical concerns such as urgent matters and cancer diagnoses. Legal issues relating to federal privacy regulations, ethical issues such as autonomy and justice, and guidelines for the use of e-mail in clinical practice are reviewed. Case scenarios are used to present the pitfalls in clinical e-mail encounters, including establishment of the doctor-patient relationship, diagnosis and treatment over the Internet, and curbside consultations.

Reflections on Ethics and Humanity in Pediatric Neurology: the Value of Recognizing Ethical Issues in Common Clinical Practice.

PubMed

Ronen, Gabriel M; Rosenbaum, Peter L

2017-05-01

Our goals in this reflection are to (i) identify the ethical dimensions inherent in any clinical encounter and (ii) bring to the forefront of our pediatric neurology practice the myriad of opportunities to explore and learn from these ethical questions. We highlight specifically Beauchamp and Childress's principles of biomedical ethics. We use the terms ethics in common clinical practice and an ethical lens to remind people of the ubiquity of ethical situations and the usefulness of using existing ethical principles to analyze and resolve difficult situations in clinical practice. We start with a few common situations with which many of us tend to struggle. We describe what we understand as ethics and how and why developments in technology, novel potential interventions, policies, and societal perspectives challenge us to think about and debate ethical issues. Individual patients are not a singular population; each patient has their own unique life situations, culture, goals, and expectations that need to be considered with a good dose of humanity and humility. We believe that using an ethical lens-by which we mean making an explicit effort to identify and consider these issues openly-will help us to achieve this goal in practice, education, and research.

Ethical considerations in aesthetic rhinoplasty: a survey, critical analysis, and review.

PubMed

Karimi, Kian; McKneally, Martin F; Adamson, Peter A

2012-11-01

Although the practice of medicine is built on a foundation of ethics, science, and common sense, the increasing complexity of medical interventions, social interactions, and societal norms of behavior challenges the ethical practice of aesthetic surgeons. We report a survey of the opinions, practices, and attitudes of experienced and novice facial plastic surgeons. The survey consisted of 15 clinical vignettes addressing ethical quandaries in aesthetic rhinoplasty. The vignettes are based on the experience and observations of the senior author (P.A.A.) over nearly 30 years of practice and teaching. Fellowship directors and facial plastic surgery fellows of the American Academy of Facial Plastic and Reconstructive Surgery were surveyed anonymously. Five of the 15 vignettes demonstrated significant differences between the responses of the fellowship directors and the fellows. No single vignette had a unanimous consensus in either group. Aesthetic rhinoplasty surgeons encounter ethical issues that should be reflected on by both experienced and inexperienced facial plastic surgeons, preferably before being faced with them in practice. We present a practical approach to ethical issues in clinical practice. Our survey can also be used as a stimulus for further discussion and teaching.

Evidence-based medicine and the development of medical libraries in China.

PubMed

Huang, Michael Bailou; Cheng, Aijun; Ma, Lu

2009-07-01

This article elaborates on the opportunities and challenges that evidence-based medicine (EBM) has posed to the development of medical libraries and summarizes the research in the field of evidence-based medicine and achievements of EBM practice in Chinese medical libraries. Issues such as building collections of information resources, transformation of information services models, human resources management, and training of medical librarians, clinicians, and EBM users are addressed. In view of problems encountered in EBM research and practice, several suggestions are made about important roles medical libraries can play in the future development of EBM in China.

Lessons learned from the reimbursement profile of a mature private medical toxicology practice: office-based practice pays.

PubMed

Thompson, Trevonne M; Leikin, Jerrold B

2015-03-01

We previously reported the financial data for the first 5 years of one of the author's medical toxicology practice. The practice has matured; changes have been made. The practice is increasing its focus on office-based encounters and reducing hospital-based acute care encounters. We report the reimbursement rates and other financial metrics of the current practice. Financial records from October 2009 through September 2013 were reviewed. This is a period of 4 fiscal years and represents the currently available financial data. Charges, payments, and reimbursement rates were recorded according to the type and setting of the medical toxicology encounter: forensic consultations, outpatient clinic encounters, nonpsychiatric inpatient consultations, emergency department (ED) consultations, and inpatient psychiatric consultations. All patients were seen regardless of ability to pay or insurance status. The number of billed Current Procedural Terminology (CPT) codes for office-based encounters increased over the study period; the number of billed CPT codes for inpatient and ED consultations reduced. Office-based encounters demonstrate a higher reimbursement rate and higher payments. In the fiscal year (FY) of 2012, office-based revenue exceeded hospital-based acute care revenue by over $140,000 despite a higher number of billed CPT encounters in acute care settings, and outpatient payments were 2.39 times higher than inpatient, inpatient psychiatry, observation unit, and ED payments combined. The average payment per CPT code was higher for outpatient clinic encounters than inpatient encounters for each fiscal year studied. There was an overall reduction in CPT billing volume between FY 2010 and FY 2013. Despite this, there was an increase in total practice revenue. There was no change in payor mix, practice logistics, or billing/collection service company. In this medical toxicology practice, office-based encounters demonstrate higher reimbursement rates and overall payments compared to inpatient and ED consultations. While consistent with our previous studies, these differences have been accentuated. This study demonstrates the results of changes to the practice--reduced inpatient/ED consultations and increased outpatient encounters. These practice changes resulted in higher overall revenue despite a lower patient volume. In this analysis, the office-based practice of medical toxicology has higher reimbursement rates, nearly 2.5 times higher, when compared to hospital-based acute care consultations.

Situating beyond the social: understanding the role of materiality in Danish nursing education.

PubMed

Soffer, Ann Katrine B

2016-10-01

Situated learning serves as an analytical framework for learning in a community of practice and has been widely used to understand the learning process that is entailed in becoming a nurse. Yet in this paper, the difficulties encountered with the original notion of situated learning once it is applied to contemporary Danish nursing education are introduced. One issue that has arisen is the analytical requirement for an educational program to be a homogeneous, singular, and social phenomenon thereby discounting the varied and different sites and materialities found within nursing education. By using the materiality of the hospital bed as an empirical example of the way materiality also shapes practices, an alternative understanding of situated participation can emerge. This approach allows different sites and materialities to be conceptualized as equally genuine parts of the situated leaning framework. I suggest the notion of multi-configured learning, which captures the heterogeneity and materiality encountered during ethnographic fieldwork at a Danish nursing school.

North America Wound, Ostomy, and Continence and Enterostomal Therapy Nurses Current Ostomy Care Practice Related to Peristomal Skin Issues.

PubMed

Colwell, Janice C; McNichol, Laurie; Boarini, Joy

The purpose of this study was to describe the practice of 796 ostomy nurses in North America in 2014 related to peristomal skin issues. Descriptive study. Participants were 796 wound, ostomy, and continence (WOC) and enterostomal therapy (ET) nurses currently practicing in the United States or Canada and caring for patients with ostomies. The collection of data occurred in conjunction with an educational program on peristomal skin complications and practice issues and solicited the participant's perception on the incidence and frequency of peristomal skin issues as well as on practice patterns. Participants attended an educational program. They were also asked to anonymously respond to multiple-choice questions on ostomy care management via an audience response system followed by discussion of each item and their responses. This descriptive study reports on the answers to the questions as well as the pertinent discussion points. Participants estimated that approximately 77.70% of their patients developed peristomal skin issues. The most commonly encountered problem was irritant contact dermatitis (peristomal moisture-associated skin damage). Contributing factors were inappropriate use of a pouching system owing to lack of follow-up after hospital discharge. Reported interventions for the prevention and management of peristomal skin issues included preoperative stoma site marking, use of a convex pouching system, and barrier rings. However, subsequent discussion revealed that the frequency of use of these products varied considerably. Participants identified shortened hospital stays, absence of preoperative stoma marking, and limited outpatient follow-up as contributing to development of peristomal skin problems. WOC and ET nurses estimate that more than three-quarters of persons living with an ostomy develop peristomal skin problems. Multiple interventions for managing these problems were identified, but some variability in management approaches emerged.

Work-based learning in health and social care.

PubMed

Phillips, Sue

This article examines some of the issues encountered in helping to develop and facilitate work-based learning (WBL) in clinical areas from the author's perspective of APEL/WBL co-ordinator. The advantages of work-based learning to both organisations and practitioners are discussed, together with possible drawbacks. The article concludes by identifying the positive aspects, including that of practice development, but suggests caution in attempting to use work-based learning in all circumstances.

Certified nurse-midwife and physician collaborative practice. Piloting a survey on the Internet.

PubMed

Miller, S; King, T; Lurie, P; Choitz, P

1997-01-01

This pilot study was designed to describe the clinical areas of collaboration, financial structures, and sources of conflict for certified nurse-midwives (CNMs) involved in nurse-midwife and physician collaborative practice (CP). A questionnaire was posted on an electronic bulletin board maintained by the Community-Based Nurse Midwifery Education Program of the Frontier School of Nursing. The nonrandom, convenience sample consisted of 78 respondents. Their mean age was 42 years; they had been in practice for a mean of 10 years, and 56% had graduate degrees. Eighty-nine percent reported involvement in CP. Eighty-three percent co-managed higher-risk women, and 46% performed vacuum-assisted deliveries or were first assistants at cesarean sections. Forty-eight percent of CNMs did not bill in their own names, and only 12% had full hospital privileges. The most common sources of conflict in CPs were clinical practice issues (100% ever encountered), power inequities (92%), financial issues (66%), and gender relations (58%). Collaborative practice is a common form of practice for CNMs and suggests a model for collaboration in other sectors of the health care system. Future research should explore methods of reducing the potential for conflict between CNMs and physicians.

Using Interdisciplinary Workgroups to Educate Surgery Residents in Systems-Based Practice.

PubMed

Gillen, Jacob R; Ramirez, Adriana G; Farineau, Diane W; Hoke, Tracey R; Schirmer, Bruce D; Williams, Michael D; Lau, Christine L

Meaningful education of residents in systems-based practice is notoriously challenging, despite its recognition as 1 of the 6 Accreditation Council for Graduate Medical Education core competencies. To address this challenge, surgery residents and other members of the health care team were organized into interdisciplinary workgroups that were tasked with developing solutions to "systems issues" confronted on a daily basis. The project's goals included providing more meaningful, hands-on educational experience for residents in system-based practice, while also generating practical solutions to workflow issues through interprofessional collaboration. Project participants included all surgery residents at the University of Virginia in Charlottesville, VA, as well as surgical health care professionals across all disciplines. Participants were organized into workgroups. Over the course of 3 sessions, each of 1-hour, each workgroup identified commonly encountered systems issues, chose 1 issue to address, and determined an implementable solution for this issue. In total, 140 participants were divided among 13 workgroups. Workgroup topics ranged from improving paging etiquette to standardizing interdisciplinary communication. In total, 9 of the 13 proposals have been piloted or fully implemented as standard practice at our institution, either within a single unit or over the entire health system. This project demonstrates an innovative approach toward resident education in system-based practice, providing residents with a hands-on experience in problem solving from a systems perspective. These interdisciplinary workgroups generated effective solutions to issues that were meaningful to frontline health care providers. Interdisciplinary collaboration within the workgroups served as a valuable team-building exercise to improve relations between the disciplines. This project can serve as a model for other institutions desiring meaningful education in the Accreditation Council for Graduate Medical Education competency of systems-based practice. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Sanitation, Stress, and Life Stage: A Systematic Data Collection Study among Women in Odisha, India.

PubMed

Hulland, Kristyna R S; Chase, Rachel P; Caruso, Bethany A; Swain, Rojalin; Biswal, Bismita; Sahoo, Krushna Chandra; Panigrahi, Pinaki; Dreibelbis, Robert

2015-01-01

Emerging evidence demonstrates how inadequate access to water and sanitation is linked to psychosocial stress, especially among women, forcing them to navigate social and physical barriers during their daily sanitation routines. We examine sanitation-related psychosocial stress (SRPS) across women's reproductive lives in three distinct geographic sites (urban slums, rural villages, and rural tribal villages) in Odisha, India. We explored daily sanitation practices of adolescent, newly married, pregnant, and established adult women (n = 60) and identified stressors encountered during sanitation. Responding to structured data collection methods, women ranked seven sanitation activities (defecation, urination, menstruation, bathing, post-defecation cleaning, carrying water, and changing clothes) based on stress (high to low) and level of freedom (associated with greatest freedom to having the most restrictions). Women then identified common stressors they encountered when practicing sanitation and sorted stressors in constrained piles based on frequency and severity of each issue. The constellation of factors influencing SRPS varies by life stage and location. Overall, sanitation behaviors that were most restricted (i.e., menstruation) were the most stressful. Women in different sites encountered different stressors, and the level of perceived severity varied based on site and life stage. Understanding the influence of place and life stage on SRPS provides a nuanced understanding of sanitation, and may help identify areas for intervention.

Medication adherence monitoring: implications for patients and providers.

PubMed

Gheorghiu, Bobby; Nayani, Seema

2018-05-01

Non-adherence to medication is a key worldwide issue and can lead to adverse patient outcomes and increased health system costs. Would a process facilitating notification of non-adherence infringe upon the autonomy of individuals or breach expectations of privacy? In contrast, patients who are not taking their medication could unknowingly be putting themselves at risk and all the while prescribers are unaware and without the opportunity to intervene. With the advent of electronic methods of medication adherence monitoring, this ethical dilemma now involves a new layer of complexity. We present two scenarios encountered in clinical practice that reflect issues occurring regularly in the Canadian healthcare system.

Nutrition research in the military.

PubMed

Hill, Neil E; Fallowfield, J L; Delves, S K; Wilson, D R

2014-06-01

Military research performed in an operational environment involves mission-specific considerations. The Institute of Naval Medicine was tasked in 2008 by the Surgeon General to investigate the nutritional status of deployed British military personnel, and how this might affect body composition, physical fitness and operational capability. This paper briefly describes the logistic and technical issues specific to military research that were encountered by the study team, how these issues were overcome and how this research has influenced military practice. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Commentary: On the wisdom and challenges of culturally attuned treatments for Latinos.

PubMed

Falicov, Celia Jaes

2009-06-01

In this commentary, I outline the common and distinctive components in the cultural adaptation studies in this special issue and compare cultural adaptations with universalistic and culture-specific perspectives. The term cultural attunement may be more reflective than cultural adaptation insofar as the cultural additions in these studies make the treatments more accessible by adding language translation, cultural values, and contextual stressors. These additions most likely enhance the level of engagement and retention in therapy for Latino families. The work ahead requires a deeper examination of the cultural theories of psychological distress and the cultural theories of change in therapy. A final proposal is made in this commentary for considering the bicultural aspects of the cultural adaptation or attunement enterprise, insofar as the clinical research encounters with immigrants are bicultural encounters. These encounters can reach beyond the notion of cultural "adaptation" of mainstream evidence-based treatments to ethnic minorities and present a unique opportunity for mutually enriching bicultural integration of theory, research, and practice.

Complexities of Providing Dental Hygiene Services in Community Care Settings.

PubMed

Zarkowski, Pamela; Aksu, Mert N

2016-06-01

Direct access care provided by dental hygienists can reduce oral health disparities for the underserved, yet legal, regulatory, and ethical considerations create complexities and limits. Individual state dental practice acts regulate the scope of practice and level of supervision required when dental hygienists deliver care. Yet, inconsistent state practice act regulations contribute to ethical and legal limitations and dilemmas for practitioners. The dental hygienist is positioned to assume an increasingly larger role in the management of oral health disparities. However, there are several legal and ethical considerations that impact both dental hygienists and dentists providing care in complex community settings. This article informs dental hygienists and other related constituencies about conundrums that are encountered when providing care 'beyond the operatory.' An evidence-based view of ways in which dental hygienists are reducing oral health disparities illustrates the complex issues involved in providing such care. Potential scenarios that can occur during care provision in underserved settings provide the basis for a discussion of legal and other associated issues impacting dental hygiene practice. Copyright © 2016 Elsevier Inc. All rights reserved.

Implementing programs for chronic illness management: the case of hypertension services.

PubMed

Christianson, J B; Pietz, L; Taylor, R; Woolley, A; Knutson, D J

1997-11-01

This article describes the process by which HealthSystem Minnesota (a vertically integrated health care organization), functioning in a competitive managed care environment, has been implementing a hypertension services program. The program involves a team approach to care, with emphasis on patient participation in treatment; decentralized care delivery by nurse coordinators at primary care practice sites; ongoing training and education for patients and providers; and the continuous monitoring and evaluation of patient outcomes and satisfaction. JOB-LEVEL ISSUES: A variety of issues, such as the role and responsibilities of the nurse coordinator, became evident as the program moved towards operational status at four primary care practice sites, which prolonged the implementation period. PROCESS-LEVEL ISSUES: Issues relating to work process changes were more complicated to resolve and required, in some cases, changes in the proposed model. The most significant process-level issues related to educating physicians about the program to secure their participation and support. ORGANIZATION-LEVEL ISSUES: Such issues, which were the most difficult for program implementors to anticipate and resolve, included an organizational culture that emphasized decision making autonomy at primary practice sites. In part, the difficulty encountered in resolving organization-level issues reflected the implementors' lack of awareness of the strength or complexity of the environmental pressures facing the organization, as well as a lack of sensitivity to nuances relating to organizational culture. Two groups of hypertensive patients--at the implementation and comparison sites--will be compared with respect to satisfaction with care, clinical outcomes, and costs. Expansion of the model to patients with other chronic conditions is under consideration.

Genetic testing: medico-legal issues.

PubMed

Bird, Sara

2014-07-01

The availability and frequency of genetic testing is increasing. Genetic testing poses some unique ethical and legal issues for medical practitioners because of the potential to identify genetic variants that carry implications for the risk of disease in the future for the patient and their relatives. The regulatory framework within which genetic testing is provided in Australia is also changing. This article examines some medico-legal issues associated with genetic testing that general practitioners (GPs) are likely encounter in their practices. There is inevitable involvement of the GP in the long term care of a patient (and possibly their family) following genetic testing, regardless of whether or not the GP has ordered the testing. Cases are presented to illustrate some of the medico-legal issues that may arise from direct-to-consumer genetic testing, information disclosure to genetic relatives and requests for parentage testing.

A systematic review of religious beliefs about major end-of-life issues in the five major world religions.

PubMed

Chakraborty, Rajshekhar; El-Jawahri, Areej R; Litzow, Mark R; Syrjala, Karen L; Parnes, Aric D; Hashmi, Shahrukh K

2017-10-01

The objective of this study was to examine the religious/spiritual beliefs of followers of the five major world religions about frequently encountered medical situations at the end of life (EoL). This was a systematic review of observational studies on the religious aspects of commonly encountered EoL situations. The databases used for retrieving studies were: Ovid MEDLINE In-Process & Other Non-Indexed Citations, Ovid MEDLINE, Ovid EMBASE, Ovid PsycINFO, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus. Observational studies, including surveys from healthcare providers or the general population, and case studies were included for review. Articles written from a purely theoretical or philosophical perspective were excluded. Our search strategy generated 968 references, 40 of which were included for review, while 5 studies were added from reference lists. Whenever possible, we organized the results into five categories that would be clinically meaningful for palliative care practices at the EoL: advanced directives, euthanasia and physician-assisted suicide, physical requirements (artificial nutrition, hydration, and pain management), autopsy practices, and other EoL religious considerations. A wide degree of heterogeneity was observed within religions, depending on the country of origin, level of education, and degree of intrinsic religiosity. Our review describes the religious practices pertaining to major EoL issues and explains the variations in EoL decision making by clinicians and patients based on their religious teachings and beliefs. Prospective studies with validated tools for religiosity should be performed in the future to assess the impact of religion on EoL care.

Collaborative Software Development in Support of Fast Adaptive AeroSpace Tools (FAAST)

NASA Technical Reports Server (NTRS)

Kleb, William L.; Nielsen, Eric J.; Gnoffo, Peter A.; Park, Michael A.; Wood, William A.

2003-01-01

A collaborative software development approach is described. The software product is an adaptation of proven computational capabilities combined with new capabilities to form the Agency's next generation aerothermodynamic and aerodynamic analysis and design tools. To efficiently produce a cohesive, robust, and extensible software suite, the approach uses agile software development techniques; specifically, project retrospectives, the Scrum status meeting format, and a subset of Extreme Programming's coding practices are employed. Examples are provided which demonstrate the substantial benefits derived from employing these practices. Also included is a discussion of issues encountered when porting legacy Fortran 77 code to Fortran 95 and a Fortran 95 coding standard.

Chiropractic Observation and Analysis Study (COAST): providing an understanding of current chiropractic practice.

PubMed

French, Simon D; Charity, Melanie J; Forsdike, Kirsty; Gunn, Jane M; Polus, Barbara I; Walker, Bruce F; Chondros, Patty; Britt, Helena C

2013-11-18

COAST (Chiropractic Observation and Analysis Study) aimed to describe the clinical practices of chiropractors in Victoria, Australia. Cross-sectional study using the BEACH (Bettering the Evaluation and Care of Health) methods for general practice. 180 chiropractors in active clinical practice in Victoria were randomly selected from the list of 1298 chiropractors registered on Chiropractors Registration Board of Victoria. Twenty-four chiropractors were ineligible, 72 agreed to participate, and 52 completed the study. Each participating chiropractor documented encounters with up to 100 consecutive patients. For each chiropractor-patient encounter, information collected included patient health profile, patient reasons for encounter, problems and diagnoses, and chiropractic care. Data were collected on 4464 chiropractor-patient encounters from 52 chiropractors between 11 December 2010 and 28 September 2012. In most (71%) encounters, patients were aged 25-64 years; 1% of encounters were with infants (age < 1 year; 95% CI, 0.3%-3.2%). Musculoskeletal reasons for encounter were described by patients at a rate of 60 per 100 encounters (95% CI, 54-67 encounters) and maintenance and wellness or check-up reasons were described at a rate of 39 per 100 encounters (95% CI, 33-47 encounters). Back problems were managed at a rate of 62 per 100 encounters (95% CI, 55-71 encounters). The most frequent care provided by the chiropractors was spinal manipulative therapy and massage. A range of conditions are managed by chiropractors in Victoria, Australia, but most commonly these conditions are musculoskeletal-related. These results can be used by stakeholders of the chiropractic profession in workforce development, education and health care policy.

Surgical ethics: surgical virtue and more.

PubMed

Vercler, Christian J

2015-01-01

The encounter between a patient and her surgeon is unique for several reasons. The surgeon inflicts pain upon a patient for the patient's own good. An operative intervention is irreducibly personal, such that the decisions about and performance of operations are inseparable from the idiosyncrasies of the individual surgeon. Furthermore, there is a chasm of knowledge between the patient and surgeon that is difficult to cross. Hence, training in the discipline of surgery includes the inculcation of certain virtues and practices to safeguard against abuses of this relationship and to make sure that the best interests of the patient are prioritized. The stories in this issue are evidence that in contemporary practice this is not quite enough, as surgeons reflect on instances they felt were ethically challenging. Common themes include the difficulty in communicating surgical uncertainty, patient-surgeon relationships, ethical issues in surgical training, and the impact of the technological imperative on caring for dying patients.

Department of Homeland Security (DHS) Proficiency Testing on Small-Scale Safety and Thermal Testing of Improvised Explosives

NASA Astrophysics Data System (ADS)

Reynolds, John; Sandstrom, Mary; Brown, Geoffrey; Warner, Kirstin; Phillips, Jason; Shelley, Timothy; Reyes, Jose; Hsu, Peter

2013-06-01

One of the first steps in establishing safe handling procedures for explosives is small-scale safety and thermal (SSST) testing. To better understand the response of improvised materials or HMEs to SSST testing, 18 HME materials were compared to 3 standard military explosives in a proficiency-type round robin study among five laboratories--2 DoD and 3 DOE--sponsored by DHS. The testing matrix has been designed to address problems encountered with improvised materials--powder mixtures, liquid suspensions, partially wetted solids, immiscible liquids, and reactive materials. Over 30 issues have been identified that indicate standard test methods may require modification when applied to HMEs to derive accurate sensitivity assessments needed for development safe handling and storage practices. This presentation will discuss experimental difficulties encountered when testing these problematic samples, show inter-laboratory testing results, show some statistical interpretation of the results, and highlight some of the testing issues. Some of the work was performed under the auspices of the U.S. Department of Energy by Lawrence Livermore National Laboratory under Contract DE-AC52-07NA27344. LLNL-ABS-617519 (721812).

The Managed Care Backlash: Perceptions and Rhetoric in Health Care Policy and the Potential for Health Care Reform

PubMed Central

Mechanic, David

2001-01-01

The focus on managed care and the managed care backlash divert attention from more important national health issues, such as insurance coverage and quality of care. The ongoing public debate often does not accurately convey the key issues or the relevant evidence. Important perceptions of reduced encounter time with physicians, limitations on physicians' ability to communicate options to patients, and blocked access to inpatient care, among others, are either incorrect or exaggerated. The public backlash reflects a lack of trust resulting from cost constraints, explicit rationing, and media coverage. Inevitable errors are now readily attributed to managed care practices and organizations. Some procedural consumer protections may help restore the eroding trust and refocus public discussion on more central issues. PMID:11286094

Primary care health issues among men who have sex with men.

PubMed

Gee, Royal

2006-04-01

The purpose of the article is to examine "appropriate" health care for men who have sex with men (MSM), which is not to suggest "special" health care. As a group, MSM are at increased risk for sexually transmitted infections, anal cancer, and mental health disorders. Focus areas in this article will address health issues that the primary care nurse practitioner (NP) may encounter in clinical practice: anal carcinoma, sexually transmitted diseases (STDs), high-risk sexual practices, depression, and substance abuse were topics chosen for inclusion in this article. These topics were among those highlighted in the Healthy People 2010 Companion Document for LGBT Health, which served to examine the healthcare disparities and lack of access to needed services related to sexual orientation. Extensive literature review of research articles, journals, clinical practice guidelines, books, and public health department Internet Web sites. There are unique health disparities that exist for MSM related to social, emotional, and mental health factors, in addition to physical issues such as STDs. There is an increasing need for primary care providers to be aware of these disparities, as well as the factors that influence these disparities, in order to provide multidimensional care and health counseling that is unique to NP practice. Both the primary care NP and the patient should be aware of the unique healthcare issues among MSM that should be incorporated into the patient's routine health maintenance program. As primary care providers, it is within the standards of practice for NPs to provide culturally competent care, along with health promotion and disease prevention for MSM.

Service quality, trust, and patient satisfaction in interpersonal-based medical service encounters.

PubMed

Chang, Ching-Sheng; Chen, Su-Yueh; Lan, Yi-Ting

2013-01-16

Interaction between service provider and customer is the primary core of service businesses of different natures, and the influence of trust on service quality and customer satisfaction could not be ignored in interpersonal-based service encounters. However, lack of existing literature on the correlation between service quality, patient trust, and satisfaction from the prospect of interpersonal-based medical service encounters has created a research gap in previous studies. Therefore, this study attempts to bridge such a gap with an evidence-based practice study. We adopted a cross-sectional design using a questionnaire survey of outpatients in seven medical centers of Taiwan. Three hundred and fifty copies of questionnaire were distributed, and 285 valid copies were retrieved, with a valid response rate of 81.43%. The SPSS 14.0 and AMOS 14.0 (structural equation modeling) statistical software packages were used for analysis. Structural equation modeling clarifies the extent of relationships between variables as well as the chain of cause and effect. Restated, SEM results do not merely show empirical relationships between variables when defining the practical situation. For this reason, SEM was used to test the hypotheses. Perception of interpersonal-based medical service encounters positively influences service quality and patient satisfaction. Perception of service quality among patients positively influences their trust. Perception of trust among patients positively influences their satisfaction. According to the findings, as interpersonal-based medical service encounters will positively influence service quality and patient satisfaction, and the differences for patients' perceptions of the professional skill and communication attitude of personnel in interpersonal-based medical service encounters will influence patients' overall satisfaction in two ways: (A) interpersonal-based medical service encounter directly affects patient satisfaction, which represents a direct effect; and (B) service quality and patient trust are used as intervening variables to affect patient satisfaction, which represents an indirect effect. Due to differences in the scale, resources and costs among medical institutions of different levels, it is a most urgent and concerning issue of how to control customers' demands and preferences and adopt correct marketing concepts under the circumstances of intense competition in order to satisfy the public and build up a competitive edge for medical institutions.

Addressing Authorship Issues Prospectively: A Heuristic Approach.

PubMed

Roberts, Laura Weiss

2017-02-01

Collaborative writing in academic medicine gives rise to more richly informed scholarship, and yet challenging ethical issues surrounding authorship are commonly encountered. International guidelines on authorship help clarify whether individuals who have contributed to a completed scholarly work have been correctly included as authors, but these guidelines do not facilitate intentional and proactive authorship planning or decisions regarding authorship order.In this Commentary, the author presents a heuristic approach to help collaborators clarify, anticipate, and resolve practical and ethically important authorship issues as they engage in the process of developing manuscripts. As this approach illustrates, assignment of authorship should balance work effort and professional responsibility, reflecting the effort and intellectual contribution and the public accountability of the individuals who participate in the work. Using a heuristic approach for managing authorship issues prospectively can foster an ethical, collaborative writing process in which individuals are properly recognized for their contributions.

The influence of knowledge and sociodemographics on AIDS perception and sexual practices among secondary school students in Nigeria.

PubMed

Oyeyemi, Y A; Abdulkarim, A; Oyeyemi, B O

2011-08-01

Recent trends show a disproportionate increase in new incidences of HIV infection among teenagers compared to other population segments. This study assessed secondary school students' perception of AIDS epidemic, and the influence of sociodemographic variables and AIDS knowledge on their perception and sexual practices. Nigerian teenagers (N=1143) were surveyed using a questionnaire that elicited information on their demographics, AIDS knowledge, perceptions and previous encounter with survivors, and sexual practices. Although AIDS epidemic was not a serious issue of concern to a substantial number of the students, they were knowledgeable on AIDS, and their perceptions on AIDS epidemics influenced their sexual practices. Female teenagers were more knowledgeable and concerned, and more frequently reported inexperience with sexual intercourse compared to their male counterparts. AIDS education and campaigns that foster the internalization of the seriousness of AIDS epidemics and arouse concern about them could enhance safe sexual practices among the youths.

Encountering the Unexpected: Revelations of Trust, Vulnerability, and Embodied Ways of Knowing.

PubMed

Russell, Laura D

2018-05-31

Health communication scholars grapple with complex issues, many of which probe embodied sensibilities. This essay narrates a profound, unexpected moment that gives rise to notions of trust, vulnerability, and risks involved when conducting fieldwork. The author explains how embodied interactions bring forth latent constructs pertinent to health communication research, both for investigative practices and applied purposes. Furthermore, the author questions how symbolic acts demonstrated by research participants may illuminate powerful meanings yet simultaneously pose potential dangers for researchers.

Optimizing the management of elderly colorectal surgery patients.

PubMed

Tan, Kok-Yang; Konishi, Fumio; Tan, Lawrence; Chin, Wui-Kin; Ong, Hean-Yee; Tan, Phyllis

2010-11-01

With the ever increasing number of geriatric surgical patients, there is a need to develop efficient processes that address all of the potential issues faced by patients during the perioperative period. This article explores the physiological changes in elderly surgical patients and the outcomes achieved after major abdominal surgery. Perioperative management strategies for elderly surgical patients in line with the practices of the Geriatric Surgical Team of Alexandra Health, Singapore, are also presented. A coordinated transdisciplinary approach best tackles the complexities encountered in these patients.

Fever Management Practices of Neuroscience Nurses, Part II: Nurse, Patient, and Barriers

PubMed Central

Thompson, Hilaire J.; Kirkness, Catherine J.; Mitchell, Pamela H.

2008-01-01

Fever is frequently encountered by neuroscience nurses in patients with neurological insults and often results in worsened patient outcomes when compared with similar patients who do not have fever. Best practices in fever management are then essential to optimizing patient outcomes. Yet the topic of best nursing practices for fever management is largely ignored in the clinical and research literature, which can complicate the achievement of best practices. A national survey to gauge fever management practices and decision making by neuroscience nurses was administered to members of the American Association of Neuroscience Nurses. Results of the questionnaire portion of the survey were previously published. This report presents a content analysis of the responses of neuroscience nurses to the open–ended-question portion of the survey (n = 106), which revealed a dichotomous primary focus on nursing- or patient-related issues. In addition, respondents described barriers and issues in the provision of fever-management care to neuroscience patients. In order to advance national best practices for fever management in neurologically vulnerable patients, further work needs to be conducted, particularly with regard to necessary continuing education for staff, facilitation of interdisciplinary communication, and development of patient care protocols. Neuroscience nurses are in an excellent position to provide leadership in these areas. PMID:17847665

The existential dimension in general practice: identifying understandings and experiences of general practitioners in Denmark

PubMed Central

Assing Hvidt, Elisabeth; Søndergaard, Jens; Ammentorp, Jette; Bjerrum, Lars; Gilså Hansen, Dorte; Olesen, Frede; Pedersen, Susanne S.; Timm, Helle; Timmermann, Connie; Hvidt, Niels Christian

2016-01-01

Objective The objective of this study is to identify points of agreement and disagreements among general practitioners (GPs) in Denmark concerning how the existential dimension is understood, and when and how it is integrated in the GP–patient encounter. Design A qualitative methodology with semi-structured focus group interviews was employed. Setting General practice setting in Denmark. Subjects Thirty-one GPs from two Danish regions between 38 and 68 years of age participated in seven focus group interviews. Results Although understood to involve broad life conditions such as present and future being and identity, connectedness to a society and to other people, the existential dimension was primarily reported integrated in connection with life-threatening diseases and death. Furthermore, integration of the existential dimension was characterized as unsystematic and intuitive. Communication about religious or spiritual questions was mostly avoided by GPs due to shyness and perceived lack of expertise. GPs also reported infrequent referrals of patients to chaplains. Conclusion GPs integrate issues related to the existential dimension in implicit and non-standardized ways and are hindered by cultural barriers. As a way to enhance a practice culture in which GPs pay more explicit attention to the patients’ multidimensional concerns, opportunities for professional development could be offered (courses or seminars) that focus on mutual sharing of existential reflections, ideas and communication competencies. Key pointsAlthough integration of the existential dimension is recommended for patient care in general practice, little is known about GPs’ understanding and integration of this dimension in the GP–patient encounter.The existential dimension is understood to involve broad and universal life conditions having no explicit reference to spiritual or religious aspects.The integration of the existential dimension is delimited to patient cases where life-threatening diseases, life crises and unexplainable patient symptoms occur. Integration of the existential dimension happens in unsystematic and intuitive ways.Cultural barriers such as shyness and lack of existential self-awareness seem to hinder GPs in communicating about issues related to the existential dimension. Educational initiatives might be needed in order to lessen barriers and enhance a more natural integration of communication about existential issues. PMID:27804316

Sanitation, Stress, and Life Stage: A Systematic Data Collection Study among Women in Odisha, India

PubMed Central

Hulland, Kristyna R. S.; Chase, Rachel P.; Caruso, Bethany A.; Swain, Rojalin; Biswal, Bismita; Sahoo, Krushna Chandra; Panigrahi, Pinaki; Dreibelbis, Robert

2015-01-01

Emerging evidence demonstrates how inadequate access to water and sanitation is linked to psychosocial stress, especially among women, forcing them to navigate social and physical barriers during their daily sanitation routines. We examine sanitation-related psychosocial stress (SRPS) across women’s reproductive lives in three distinct geographic sites (urban slums, rural villages, and rural tribal villages) in Odisha, India. We explored daily sanitation practices of adolescent, newly married, pregnant, and established adult women (n = 60) and identified stressors encountered during sanitation. Responding to structured data collection methods, women ranked seven sanitation activities (defecation, urination, menstruation, bathing, post-defecation cleaning, carrying water, and changing clothes) based on stress (high to low) and level of freedom (associated with greatest freedom to having the most restrictions). Women then identified common stressors they encountered when practicing sanitation and sorted stressors in constrained piles based on frequency and severity of each issue. The constellation of factors influencing SRPS varies by life stage and location. Overall, sanitation behaviors that were most restricted (i.e., menstruation) were the most stressful. Women in different sites encountered different stressors, and the level of perceived severity varied based on site and life stage. Understanding the influence of place and life stage on SRPS provides a nuanced understanding of sanitation, and may help identify areas for intervention. PMID:26551866

Moral Dilemmas and Existential Issues Encountered Both in Psychotherapy and Philosophical Counseling Practices.

PubMed

Popescu, Beatrice A

2015-08-01

This paper stems from clinical observations and empirical data collected in the therapy room over six years. It investigates the relationship between psychotherapy and philosophical counseling, proposing an integrative model of counseling. During cognitive behavior therapy sessions with clients who turn to therapy in order to solve their clinical issues, the author noticed that behind most of the invalidating symptoms classified by the DSM-5 as depression, anxiety, hypochondriac and phobic complaints, usually lies a lack of existential meaning or existential scope and clients are also tormented by moral dilemmas. Following the anamnestic interview and the psychological evaluation, rarely the depression or anxiety diagnosed on Axis I is purely just a sum of invalidating symptoms, which may disappear if treated symptomatically. When applying the Sentence Completion Test, an 80 items test of psychodynamic origin and high-face validity, most of the clients report an entire plethora of conscious or unconscious motivations, distorted cognitions or irrational thinking but also grave existential themes such as scope or meaning of life, professional identity, fear of death, solitude and loneliness, freedom of choice and liberty. Same issues are approached in the philosophical counseling practice, but no systematic research has been done yet in the field. Future research and investigation is needed in order to assess the importance of moral dilemmas and existential issues in both practices.

Moral Dilemmas and Existential Issues Encountered Both in Psychotherapy and Philosophical Counseling Practices

PubMed Central

Popescu, Beatrice A.

2015-01-01

This paper stems from clinical observations and empirical data collected in the therapy room over six years. It investigates the relationship between psychotherapy and philosophical counseling, proposing an integrative model of counseling. During cognitive behavior therapy sessions with clients who turn to therapy in order to solve their clinical issues, the author noticed that behind most of the invalidating symptoms classified by the DSM-5 as depression, anxiety, hypochondriac and phobic complaints, usually lies a lack of existential meaning or existential scope and clients are also tormented by moral dilemmas. Following the anamnestic interview and the psychological evaluation, rarely the depression or anxiety diagnosed on Axis I is purely just a sum of invalidating symptoms, which may disappear if treated symptomatically. When applying the Sentence Completion Test, an 80 items test of psychodynamic origin and high-face validity, most of the clients report an entire plethora of conscious or unconscious motivations, distorted cognitions or irrational thinking but also grave existential themes such as scope or meaning of life, professional identity, fear of death, solitude and loneliness, freedom of choice and liberty. Same issues are approached in the philosophical counseling practice, but no systematic research has been done yet in the field. Future research and investigation is needed in order to assess the importance of moral dilemmas and existential issues in both practices. PMID:27247674

Knowledge and Adherence to the National Guidelines for Malaria Case Management in Pregnancy among Healthcare Providers and Drug Outlet Dispensers in Rural, Western Kenya

PubMed Central

Riley, Christina; Dellicour, Stephanie; Ouma, Peter; Kioko, Urbanus; ter Kuile, Feiko O.; Omar, Ahmeddin; Kariuki, Simon; Buff, Ann M.; Desai, Meghna; Gutman, Julie

2016-01-01

Background Although prompt, effective treatment is a cornerstone of malaria control, information on provider adherence to malaria in pregnancy (MIP) treatment guidelines is limited. Incorrect or sub-optimal treatment can adversely affect the mother and fetus. This study assessed provider knowledge of and adherence to national case management guidelines for uncomplicated MIP. Methods We conducted a cross-sectional study from September to November 2013, in 51 health facilities (HF) and a randomly-selected sample of 39 drug outlets (DO) in the KEMRI/CDC Health and Demographic Surveillance System area in western Kenya. Provider knowledge of national treatment guidelines was assessed with standardized questionnaires. Correct practice required adequate diagnosis, pregnancy assessment, and treatment with correct drug and dosage. In HF, we conducted exit interviews in all women of childbearing age assessed for fever. In DO, simulated clients posing as first trimester pregnant women or as relatives of third trimester pregnant women collected standardized information. Results Correct MIP case management knowledge and practice were observed in 45% and 31% of HF and 0% and 3% of DO encounters, respectively. The correct drug and dosage for pregnancy trimester was prescribed in 62% of HF and 42% of DO encounters; correct prescription occurred less often in first than in second/ third trimesters (HF: 24% vs. 65%, p<0.01; DO: 0% vs. 40%, p<0.01). Sulfadoxine-pyrimethamine, which is not recommended for malaria treatment, was prescribed in 3% of HF and 18% of DO encounters. Exposure to artemether-lumefantrine in first trimester, which is contraindicated, occurred in 29% and 49% of HF and DO encounters, respectively. Conclusion This study highlights knowledge inadequacies and incorrect prescribing practices in the treatment of MIP. Particularly concerning is the prescription of contraindicated medications in the first trimester. These issues should be addressed through comprehensive trainings and increased supportive supervision. Additional innovative means to improve care should be explored. PMID:26789638

Nurse managers' experience with ethical issues in six government hospitals in Malaysia: a cross-sectional study.

PubMed

Musa, Maizura binti; Harun-Or-Rashid, M D; Sakamoto, Junichi

2011-11-16

Nurse managers have the burden of experiencing frequent ethical issues related to both their managerial and nursing care duties, according to previous international studies. However, no such study was published in Malaysia. The purpose of this study was to explore nurse managers' experience with ethical issues in six government hospitals in Malaysia including learning about the way they dealt with the issues. A cross-sectional study was conducted in August-September, 2010 involving 417 (69.2%) of total 603 nurse managers in the six Malaysian government hospitals. Data were collected using three-part self-administered questionnaire. Part I was regarding participants' demographics. Part II was about the frequency and areas of management where ethical issues were experienced, and scoring of the importance of 11 pre-identified ethical issues. Part III asked how they dealt with ethical issues in general; ways to deal with the 11 pre-identified ethical issues, and perceived stress level. Data were analyzed using descriptive statistics, cross-tabulations and Pearson's Chi-square. A total of 397 (95.2%) participants experienced ethical issues and 47.2% experienced them on weekly to daily basis. Experiencing ethical issues were not associated with areas of practice. Top area of management where ethical issues were encountered was "staff management", but "patient care" related ethical issues were rated as most important. Majority would "discuss with other nurses" in dealing generally with the issues. For pre-identified ethical issues regarding "patient care", "discuss with doctors" was preferred. Only 18.1% referred issues to "ethics committees" and 53.0% to the code of ethics. Nurse managers, regardless of their areas of practice, frequently experienced ethical issues. For dealing with these, team-approach needs to be emphasized. Proper understanding of the code of ethics is needed to provide basis for reasoning.

North America Wound, Ostomy, and Continence and Enterostomal Therapy Nurses Current Ostomy Care Practice Related to Peristomal Skin Issues

PubMed Central

McNichol, Laurie; Boarini, Joy

2017-01-01

PURPOSE: The purpose of this study was to describe the practice of 796 ostomy nurses in North America in 2014 related to peristomal skin issues. DESIGN: Descriptive study. SUBJECTS AND SETTING: Participants were 796 wound, ostomy, and continence (WOC) and enterostomal therapy (ET) nurses currently practicing in the United States or Canada and caring for patients with ostomies. The collection of data occurred in conjunction with an educational program on peristomal skin complications and practice issues and solicited the participant's perception on the incidence and frequency of peristomal skin issues as well as on practice patterns. METHODS: Participants attended an educational program. They were also asked to anonymously respond to multiple-choice questions on ostomy care management via an audience response system followed by discussion of each item and their responses. This descriptive study reports on the answers to the questions as well as the pertinent discussion points. RESULTS: Participants estimated that approximately 77.70% of their patients developed peristomal skin issues. The most commonly encountered problem was irritant contact dermatitis (peristomal moisture-associated skin damage). Contributing factors were inappropriate use of a pouching system owing to lack of follow-up after hospital discharge. Reported interventions for the prevention and management of peristomal skin issues included preoperative stoma site marking, use of a convex pouching system, and barrier rings. However, subsequent discussion revealed that the frequency of use of these products varied considerably. Participants identified shortened hospital stays, absence of preoperative stoma marking, and limited outpatient follow-up as contributing to development of peristomal skin problems. CONCLUSION: WOC and ET nurses estimate that more than three-quarters of persons living with an ostomy develop peristomal skin problems. Multiple interventions for managing these problems were identified, but some variability in management approaches emerged. PMID:28362656

06. Facilitating Collection of Research and Quality Data in Integrative Medicine Clinical Settings: Views From Academic, Health System and Private Clinics

PubMed Central

Dolor, Rowena; Victorson, David; Amoils, Steve

2013-01-01

Focus Areas: Integrative Approaches to Care The purpose of this panel discussion is to share successful efforts from a practice-based research network (PBRN) including ten integrative medicine clinics. The BraveNet PBRN includes integrative medicine clinics with academic health centers, large health systems, and a stand-alone private practice clinic. While clinical care is prioritized across all of these centers, introducing research into clinical sites oriented to providing care poses challenges that vary by clinic environment. We will highlight some of the unique issues encountered when trying to standardize data collection in sites practicing a patient-centered, whole-systems approach to healing as well as the solutions used to overcome these issues. We will present some operational solutions and data collected from the PBRN's ongoing data registry, entitled PRIMIER. The panel will engage attendees in a dialogue centering on potential for future analyses of existing results, ideas for possible upcoming studies, and creative ways to expand the PBRN data registry to include additional sites that may have expertise and interest in participating.

Virtual rehabilitation: What are the practical barriers for home-based research?

PubMed Central

Threapleton, Kate; Drummond, Avril; Standen, Penny

2016-01-01

Virtual reality technologies are becoming increasingly accessible and affordable to deliver, and consequently the interest in applying virtual reality within rehabilitation is growing. This has resulted in the emergence of research exploring the utility of virtual reality and interactive video gaming interventions for home use by patients. The aim of this paper is to highlight the practical factors and difficulties that may be encountered in research in this area, and to make recommendations for addressing these. Whilst this paper focuses on examples drawn mainly from stroke rehabilitation research, many of the issues raised are relevant to other conditions where virtual reality approaches have the potential to be applied to home-based rehabilitation. PMID:29942551

A systematic review of religious beliefs about major end-of-life issues in the five major world religions

PubMed Central

CHAKRABORTY, RAJSHEKHAR; EL-JAWAHRI, AREEJ R.; LITZOW, MARK R.; SYRJALA, KAREN L; PARNES, ARIC D.; HASHMI, SHAHRUKH K.

2018-01-01

Objective The objective of this study was to examine the religious/spiritual beliefs of followers of the five major world religions about frequently encountered medical situations at the end of life (EoL). Method This was a systematic review of observational studies on the religious aspects of commonly encountered EoL situations. The databases used for retrieving studies were: Ovid MEDLINE In-Process & Other Non-Indexed Citations, Ovid MEDLINE, Ovid EMBASE, Ovid PsycINFO, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus. Observational studies, including surveys from healthcare providers or the general population, and case studies were included for review. Articles written from a purely theoretical or philosophical perspective were excluded. Results Our search strategy generated 968 references, 40 of which were included for review, while 5 studies were added from reference lists. Whenever possible, we organized the results into five categories that would be clinically meaningful for palliative care practices at the EoL: advanced directives, euthanasia and physician-assisted suicide, physical requirements (artificial nutrition, hydration, and pain management), autopsy practices, and other EoL religious considerations. A wide degree of heterogeneity was observed within religions, depending on the country of origin, level of education, and degree of intrinsic religiosity. Significance of results Our review describes the religious practices pertaining to major EoL issues and explains the variations in EoL decision making by clinicians and patients based on their religious teachings and beliefs. Prospective studies with validated tools for religiosity should be performed in the future to assess the impact of religion on EoL care. PMID:28901283

Hybridization of Practices in Teacher-Researcher Collaboration

ERIC Educational Resources Information Center

Hamza, Karim; Palm, Ola; Palmqvist, Jenny; Piqueras, Jesús; Wickman, Per-Olof

2018-01-01

In this paper we present experiences from a joint collaborative research project which may be described as an encounter between a school science teaching practice and a university science didactics research practice. We provide narratives which demonstrate how the encounter between these two communities of practice interacted to produce…

Religion, Spirituality, and Medicine: Psychiatrists’ and Other Physicians’ Differing Observations, Interpretations, and Clinical Approaches

PubMed Central

Curlin, Farr A.; Lawrence, Ryan E.; Odell, Shaun; Chin, Marshall H.; Lantos, John D.; Koenig, Harold G.; Meador, Keith G.

2010-01-01

Objective This study compared the ways in which psychiatrists and nonpsychiatrists interpret the relationship between religion/spirituality and health and address religion/spirituality issues in the clinical encounter. Method The authors mailed a survey to a stratified random sample of 2,000 practicing U.S. physicians, with an oversampling of psychiatrists. The authors asked the physicians about their beliefs and observations regarding the relationship between religion/spirituality and patient health and about the ways in which they address religion/spirituality in the clinical setting. Results A total of 1,144 physicians completed the survey. Psychiatrists generally endorse positive influences of religion/spirituality on health, but they are more likely than other physicians to note that religion/spirituality sometimes causes negative emotions that lead to increased patient suffering (82% versus 44%). Compared to other physicians, psychiatrists are more likely to encounter religion/spirituality issues in clinical settings (92% versus 74% report their patients sometimes or often mention religion/spirituality issues), and they are more open to addressing religion/spirituality issues with patients (93% versus 53% say that it is usually or always appropriate to inquire about religion/spirituality). Conclusions This study suggests that the vast majority of psychiatrists appreciate the importance of religion and/or spirituality at least at a functional level. Compared to other physicians, psychiatrists also appear to be more comfortable, and have more experience, addressing religion/spirituality concerns in the clinical setting. PMID:18056237

Potential Effects of the Electronic Health Record on the Small Physician Practice: A Delphi Study.

PubMed

Sines, Chad C; Griffin, Gerald R

2017-01-01

The Health Information Technology for Economic and Clinical Health (HITECH) Act established the requirement of all medical practices to have certified electronic health records (EHRs). Some primary concerns that have been delaying implementation are issues of cost, revenue impact, and the effect on the patient encounter. Small physician practices (one to four physicians) account for 46 percent of all physicians. The purpose of this qualitative study using a modified Delphi research design was to examine the potential effect of the adoption of the EHR on revenue, unintended costs or savings, and changes in the patient encounter. Fifteen expert panelists completed the three-round survey process. The expert panelists reached a consensus that EHRs would reduce the number of patients seen per day, thereby reducing their revenue. Although the panelists limited their discussion on the effect of patient outcomes, their most dominant concern was the loss of face-to-face time with the patient. They felt that the use of an EHR would reduce the focus on the patient and potentially cause physicians to miss medical conditions. The results of this study indicate an avenue for EHR vendors to develop educational avenues to teach physicians how to optimize the EHR as well as to share success stories that demonstrate improved financial impact.

Potential Effects of the Electronic Health Record on the Small Physician Practice: A Delphi Study

PubMed Central

Sines, Chad C.; Griffin, Gerald R.

2017-01-01

The Health Information Technology for Economic and Clinical Health (HITECH) Act established the requirement of all medical practices to have certified electronic health records (EHRs). Some primary concerns that have been delaying implementation are issues of cost, revenue impact, and the effect on the patient encounter. Small physician practices (one to four physicians) account for 46 percent of all physicians. The purpose of this qualitative study using a modified Delphi research design was to examine the potential effect of the adoption of the EHR on revenue, unintended costs or savings, and changes in the patient encounter. Fifteen expert panelists completed the three-round survey process. The expert panelists reached a consensus that EHRs would reduce the number of patients seen per day, thereby reducing their revenue. Although the panelists limited their discussion on the effect of patient outcomes, their most dominant concern was the loss of face-to-face time with the patient. They felt that the use of an EHR would reduce the focus on the patient and potentially cause physicians to miss medical conditions. The results of this study indicate an avenue for EHR vendors to develop educational avenues to teach physicians how to optimize the EHR as well as to share success stories that demonstrate improved financial impact. PMID:28566989

A reliable sewage quality abnormal event monitoring system.

PubMed

Li, Tianling; Winnel, Melissa; Lin, Hao; Panther, Jared; Liu, Chang; O'Halloran, Roger; Wang, Kewen; An, Taicheng; Wong, Po Keung; Zhang, Shanqing; Zhao, Huijun

2017-09-15

With closing water loop through purified recycled water, wastewater becomes a part of source water, requiring reliable wastewater quality monitoring system (WQMS) to manage wastewater source and mitigate potential health risks. However, the development of reliable WQMS is fatally constrained by severe contamination and biofouling of sensors due to the hostile analytical environment of wastewaters, especially raw sewages, that challenges the limit of existing sensing technologies. In this work, we report a technological solution to enable the development of WQMS for real-time abnormal event detection with high reliability and practicality. A vectored high flow hydrodynamic self-cleaning approach and a dual-sensor self-diagnostic concept are adopted for WQMS to effectively encounter vital sensor failing issues caused by contamination and biofouling and ensure the integrity of sensing data. The performance of the WQMS has been evaluated over a 3-year trial period at different sewage catchment sites across three Australian states. It has demonstrated that the developed WQMS is capable of continuously operating in raw sewage for a prolonged period up to 24 months without maintenance and failure, signifying the high reliability and practicality. The demonstrated WQMS capability to reliably acquire real-time wastewater quality information leaps forward the development of effective wastewater source management system. The reported self-cleaning and self-diagnostic concepts should be applicable to other online water quality monitoring systems, opening a new way to encounter the common reliability and stability issues caused by sensor contamination and biofouling. Copyright © 2017 Elsevier Ltd. All rights reserved.

Nurse's Awareness on Ethico-legal Aspects of Nursing Profession.

PubMed

Paudel Subedi, Krishna Kumari; Timalsina, Kalpana; Bhele, Raja Laxmi

2018-03-13

Nursing practice amicably includes practical efficacy and ethics. Now a days legal and ethical problems associated with client care are arising day by day. Therefore, nurses should have adequate understanding of basic legal concepts and issues relevant to nursing profession in order to protect the rights of the clients and the nurses. A cross sectional descriptive design was adopted for the study. 142 nurses were included by using purposive sampling technique. Data was collected with self-administered structured questionnaire. Descriptive statistics was used to reveal demographic information. Kruskal Wallis and Mann Whitney test were used to find out association of selected demographic variables and ethico legal aspects of nursing. Majority of participants were belonging to 20-29 years of age. More than half nurses had complete bachelor's degree and had less than 10 year's experiences. Majority of participants reported that they did not encounter any legal issues in their professional life till date. Similarly, majority of participants had average level knowledge and equate level of practice. Years of experiences and education level did not affect in knowledge level and existing practice related to ethico legal aspect of nursing. There was no significant relationship between level of knowledge and existing practice. Nurses have average knowledge and practice on ethico legal aspects. There is positive relationship between knowledge and practice though it is not statistically significant.

Morbidity and process of care in urban Malaysian general practice: the impact of payment system.

PubMed

Teng, C L; Aljunid, S M; Cheah, Molly; Leong, K C; Kwa, S K

2003-08-01

The majority of primary care consultations in Malaysia occur in the general practice clinics. To date, there is no comprehensive documentation of the morbidity and practice activities in this setting. We reported the reasons for encounter, diagnoses and process of care in urban general practice and the influence of payment system on the morbidity and practice activities. 115 clinics in Kuala Lumpur, Ipoh and Penang participated in this study. General practitioners in these clinics completed a 2-page questionnaire for each of the 30 consecutive patients. The questionnaire requested for the following information: demographic data, reasons for encounter, important physical findings, diagnoses, investigations ordered, outpatient procedures performed, medical certificate given, medication prescribed and referral made. The morbidity (reasons for encounter and diagnoses) was coded using ICPC-2 and the medication data was coded using MIMS Classification Index. During 3481 encounters, 5300 RFEs (152 RFEs per 100 encounters) and 3342 diagnoses (96 diagnoses per 100 encounters) were recorded. The majority of the RFEs and diagnoses are in the following ICPC Chapters: Respiratory, General and unspecified, Digestive, Neurological, Musculoskeletal and Skin. The frequencies of selected aspects of the process of care (rate per 100 encounters) were: laboratory investigations 14.7, outpatient procedures 2.4, sick certification 26.9, referral 2.4, and medication prescription 244. Consultation for chronic diseases and acute infections were influenced more by demographic variables (age, employment) rather than payment system. Cash-paying patients were more likely to receive laboratory investigations and injections. This study demonstrated the breadth of clinical care in the general practice. Relatively fewer patients consulted specifically for preventive care and treatment of chronic diseases. The frequencies of outpatient procedures and referrals appeared to be low. Payment system results in important differences in patient mix and influences some types of practice activities.

Discovering the nature of advanced nursing practice in high dependency care: a critical care nurse consultant's experience.

PubMed

Fairley, Debra

2005-06-01

This paper describes how a critical care nurse consultant's clinical role has evolved within a surgical high dependency unit (SHDU) in a large teaching hospitals trust. In order to provide some background to role development, an overview of the research exploring the nature of advanced nursing practice in the context of critical care will be presented. From the outset, advanced nursing practice was not perceived as the acquisition and application of technical procedures usually undertaken by doctors, but possibly an integration of medicine and nursing where holistic nursing assessment is combined with symptom-focused physical examination. A reflective account of practical problems encountered relating to role integration, professional autonomy, legal and consent issues, non-medical prescribing, and role evaluation will be presented. A model of working that can be applied to high dependency units, integrating the role of the advanced nurse practitioner within the clinical team, will be described.

[Software for illustrating a cost-quality balance carried out by clinical laboratory practice].

PubMed

Nishibori, Masahiro; Asayama, Hitoshi; Kimura, Satoshi; Takagi, Yasushi; Hagihara, Michio; Fujiwara, Mutsunori; Yoneyama, Akiko; Watanabe, Takashi

2010-09-01

We have no proper reference indicating the quality of clinical laboratory practice, which should clearly illustrates that better medical tests require more expenses. Japanese Society of Laboratory Medicine was concerned about recent difficult medical economy and issued a committee report proposing a guideline to evaluate the good laboratory practice. According to the guideline, we developed software that illustrate a cost-quality balance carried out by clinical laboratory practice. We encountered a number of controversial problems, for example, how to measure and weight each quality-related factor, how to calculate costs of a laboratory test and how to consider characteristics of a clinical laboratory. Consequently we finished only prototype software within the given period and the budget. In this paper, software implementation of the guideline and the above-mentioned problems are summarized. Aiming to stimulate these discussions, the operative software will be put on the Society's homepage for trial

Australian men's sexual practices in saunas, sex clubs and other male sex on premises venues.

PubMed

Lyons, Anthony; Smith, Anthony M A; Grierson, Jeffrey W; von Doussa, Henry

2010-06-01

Sex on premises venues (SOPVs) where men have sex with men have been implicated in the spread of sexually transmissible infections, but few studies have described men's sexual encounters in SOPVs, particularly the degree to which men from different backgrounds engage in risky sexual practices. Interviewer administered surveys were conducted with 186 Australian men who have sex with men (MSM) within 48 h of visiting an SOPV. They reported their sexual practices, the characteristics of their partners and other circumstances surrounding their sexual encounters. All analyses were based on the number of sexual encounters (n = 430). Oral sex was the most common practice, occurring in 74.9% of encounters, followed by massage, frottage or kissing (53.7%), solo or mutual masturbation (36.3%), and anal sex (32.1%). Multivariate analyses revealed age as a significant factor for having protected anal sex (P = 0.001), insertive anal sex (P = 0.004) and receptive anal sex (P < 0.001). These practices were more frequent in encounters among younger men, while masturbation (P = 0.03) was more frequent among older men. When men's sexual partners were affected by alcohol, encounters were less likely to involve unprotected anal intercourse (P = 0.006) and more likely to involve massage, frottage or kissing (P = 0.009). Men disclosed their HIV status in only 7.7% of encounters. With the likelihood of risky sexual practices varying according to background, results from this study should be used to guide interventions aiming to promote safer sex in SOPVs.

A recent U.S. patent process for a musical instrument

NASA Astrophysics Data System (ADS)

Baecker, James I.

2005-09-01

The ins and outs of going from a novel musical instrument concept to issuance of a U.S. patent. The technical work performed included the development of a musical instrument based on space-frame body construction and a definition of the instrument body's resonance characteristics. The result required a description of the invention and communication with the patent attorney and conveying a correct perception of the invention to the U.S. Patent Office. This presentation describes several technical, practical, legal, and commercial issues encountered during the patent process by the inventors and their business entity. On 7 September 2004, U.S. Patent No. 6,787,688 for a musical instrument was issued and assigned by the inventors to Harmos Music, Ltd.

Challenges for consent and community engagement in the conduct of cluster randomized trial among school children in low income settings: experiences from Kenya.

PubMed

Okello, George; Jones, Caroline; Bonareri, Maureen; Ndegwa, Sarah N; McHaro, Carlos; Kengo, Juddy; Kinyua, Kevin; Dubeck, Margaret M; Halliday, Katherine E; Jukes, Matthew C H; Molyneux, Sassy; Brooker, Simon J

2013-05-16

There are a number of practical and ethical issues raised in school-based health research, particularly those related to obtaining consent from parents and assent from children. One approach to developing, strengthening, and supporting appropriate consent and assent processes is through community engagement. To date, much of the literature on community engagement in biomedical research has concentrated on community- or hospital-based research, with little documentation, if any, of community engagement in school-based health research. In this paper we discuss our experiences of consent, assent and community engagement in implementing a large school-based cluster randomized trial in rural Kenya. Data collected as part of a qualitative study investigating the acceptability of the main trial, focus group discussions with field staff, observations of practice and authors' experiences are used to: 1) highlight the challenges faced in obtaining assent/consent; and 2) strategies taken to try to both protect participant rights (including to refuse and to withdraw) and ensure the success of the trial. Early meetings with national, district and local level stakeholders were important in establishing their co-operation and support for the project. Despite this support, both practical and ethical challenges were encountered during consenting and assenting procedures. Our strategy for addressing these challenges focused on improving communication and understanding of the trial, and maintaining dialogue with all the relevant stakeholders throughout the study period. A range of stakeholders within and beyond schools play a key role in school based health trials. Community entry and information dissemination strategies need careful planning from the outset, and with on-going consultation and feedback mechanisms established in order to identify and address concerns as they arise. We believe our experiences, and the ethical and practical issues and dilemmas encountered, will be of interest for others planning to conduct school-based research in Africa. National Institute of Health NCT00878007.

Challenges for consent and community engagement in the conduct of cluster randomized trial among school children in low income settings: experiences from Kenya

PubMed Central

2013-01-01

Background There are a number of practical and ethical issues raised in school-based health research, particularly those related to obtaining consent from parents and assent from children. One approach to developing, strengthening, and supporting appropriate consent and assent processes is through community engagement. To date, much of the literature on community engagement in biomedical research has concentrated on community- or hospital-based research, with little documentation, if any, of community engagement in school-based health research. In this paper we discuss our experiences of consent, assent and community engagement in implementing a large school-based cluster randomized trial in rural Kenya. Methods Data collected as part of a qualitative study investigating the acceptability of the main trial, focus group discussions with field staff, observations of practice and authors’ experiences are used to: 1) highlight the challenges faced in obtaining assent/consent; and 2) strategies taken to try to both protect participant rights (including to refuse and to withdraw) and ensure the success of the trial. Results Early meetings with national, district and local level stakeholders were important in establishing their co-operation and support for the project. Despite this support, both practical and ethical challenges were encountered during consenting and assenting procedures. Our strategy for addressing these challenges focused on improving communication and understanding of the trial, and maintaining dialogue with all the relevant stakeholders throughout the study period. Conclusions A range of stakeholders within and beyond schools play a key role in school based health trials. Community entry and information dissemination strategies need careful planning from the outset, and with on-going consultation and feedback mechanisms established in order to identify and address concerns as they arise. We believe our experiences, and the ethical and practical issues and dilemmas encountered, will be of interest for others planning to conduct school-based research in Africa. Trial registration National Institute of Health NCT00878007 PMID:23680181

Neonatal Hypoglycemia: A Continuing Debate in Definition and Management.

PubMed

Stomnaroska-Damcevski, Orhideja; Petkovska, Elizabeta; Jancevska, Snezana; Danilovski, Dragan

2015-01-01

Neonatal hypoglycemia (NH) is one of the most common abnormalities encountered in the newborn. Maintaining glucose homeostasis is one of the important physiological events during fetal-to-neonatal transition. Transient low blood glucose concentrations are frequently encountered in the majority of healthy newborns and are the reflections of normal metabolic adaptation processes. Nevertheless, there is a great concern that prolonged or recurrent low blood glucose levels may result in long-term neurological and developmental consequences. Strikingly, it was demonstrated that the incidence and timing of low glucose concentrations in the groups most at risk for asymptomatic neonatal hypoglycemia, did not find association between repetitive low glucose concentrations and poor neurodevelopmental outcomes. On the contrary, NH due to hyperinsulinism is strongly associated with brain injury. Fundamental issue of great professional controversy is concerning the best manner to manage asymptomatic newborns NH. Both, overtreating NH and undertreating NH are poles with significant potential disadvantages. Therefore, NH is one of the most important issues in the day-to-day practice. This article appraises the critical questions of definition (widely accepted blood glucose concentration: < 2.6 mmol/l or 47 mg/dl), follow-up ad management of NH.

Aircraft Survivability. Susceptibility Reduction. Fall 2010

DTIC Science & Technology

2010-01-01

limits flexibility when issues are encountered during development. Once a program enters Engineering, Manufacturing, and Development (EMD), the...using a flexible , efficient computational environment based on a credible set of components. Unfortunately, current survivability codes contain many...approach limits flexibility when issues are encountered during development. Once a program enters Engineering Manufacturing and Development (EMD), the

Administrative encounters in general practice: low value or hidden value care?

PubMed

Trevena, Lyndal J; Harrison, Christopher; Britt, Helena C

2018-02-19

To determine the frequency of general practice administrative encounters, and to determine whether they represent low value care. Secondary analysis of data from the Bettering Evaluation and Care of Health (BEACH) dataset. 1 568 100 GP-patient encounters in Australia, 2000-01 to 2015-16. An annual nationally representative random sample of about 1000 GPs, who each recorded the details of 100 consecutive encounters with patients. Proportions of general practice encounters that were potentially low value care encounters (among the patient's reasons for the encounter was at least one administrative, medication, or referral request) and potentially low value care only encounters (such reasons were the sole reason for the encounter). For 2015-16, we also examined other health care provided by GPs at these encounters. During 2015-16, 18.5% (95% CI, 17.7-19.3%) of 97 398 GP-patient encounters were potentially low value care request encounters; 7.4% (95% CI, 7.0-7.9%) were potentially low value care only encounters. Administrative work was requested at 3.8% (95% CI, 3.5-4.0%) of GP visits, 35.4% of which were for care planning and coordination, 33.5% for certification, and 31.2% for other reasons. Medication requests were made at 13.1% (95% CI, 12.4-13.7%) of encounters; other health care was provided at 57.9% of medication request encounters, counselling, advice or education at 23.4%, and pathology testing was ordered at 16.7%. Referrals were requested at 2.8% (95% CI, 1.7-3.0%) of visits, at 69.4% of which additional health care was provided. The problems managed most frequently at potentially low value care only encounters were chronic diseases. Most patients requested certificates, medications and referrals in the context of seeking help for other health needs. Additional health care, particularly for chronic diseases, was provided at most GP administrative encounters. The MBS Review should consider the hidden value of these encounters.

Challenges of Conducting Research With Young Offenders With Traumatic Brain Injury.

PubMed

OʼRourke, Conall; Templeton, Michelle; Cohen, Miriam H; Linden, Mark A

2018-05-31

The purpose of this commentary is to highlight the challenges encountered when conducting research with young offenders. This is drawn from the first-hand experience of 3 researchers working on separate projects within this environment. Young offenders present as a complex clinical population with high levels of illiteracy, substance abuse, and mental health issues. Significant planning is therefore required before working with this group. Consideration must be given to the heterogeneity of prison populations alongside the potential limitations of datacollection methods, in particular, reliance on self-report. The capacity of young offenders to comprehend and effectively engage with research is also of concern, posing issues of both a practical and ethical nature. The absence of a consistent "research culture" within prison environments poses further practical challenges, potentially also placing significant burden on both researchers and prison resources. The challenges discussed in this article may help inform future studies in the area and emphasize the need for greater critical reflection among researchers conducting work of this type.

[Problem-posing as a nutritional education strategy with obese teenagers].

PubMed

Rodrigues, Erika Marafon; Boog, Maria Cristina Faber

2006-05-01

Obesity is a public health issue with relevant social determinants in its etiology and where interventions with teenagers encounter complex biopsychological conditions. This study evaluated intervention in nutritional education through a problem-posing approach with 22 obese teenagers, treated collectively and individually for eight months. Speech acts were collected through the use of word cards, observer recording, and tape-recording. The study adopted a qualitative methodology, and the approach involved content analysis. Problem-posing facilitated changes in eating behavior, triggering reflections on nutritional practices, family circumstances, social stigma, interaction with health professionals, and religion. Teenagers under individual care posed problems more effectively in relation to eating, while those under collective care posed problems in relation to family and psychological issues, with effective qualitative eating changes in both groups. The intervention helped teenagers understand their life history and determinants of eating behaviors, spontaneously implementing eating changes and making them aware of possibilities for maintaining the new practices and autonomously exercising their role as protagonists in their own health care.

Preparing Nursing Students for Interprofessional Practice: The Interdisciplinary Curriculum for Oncology Palliative Care Education.

PubMed

Hermann, Carla P; Head, Barbara A; Black, Karen; Singleton, Karen

2016-01-01

Interprofessional educational experiences for baccalaureate nursing students are essential to prepare them for interprofessional communication, collaboration, and team work. Nurse educators are ideally positioned to develop and lead such initiatives. The purpose of this article is to describe the development and implementation of an interprofessional education (IPE) project involving students in nursing, medicine, social work, and chaplaincy. The Interdisciplinary Curriculum for Oncology Palliative Care Education project uses team-based palliative oncology education as the framework for teaching students interprofessional practice skills. The need for IPE is apparent, but there are very few comprehensive, successful projects for nurse educators to use as models. This article describes the development of the curriculum by the interprofessional faculty team. Issues encountered by nursing faculty members as they implemented the IPE experience are discussed. Solutions developed to address the issues and ongoing challenges are presented. This project can serve as a model of a successful IPE initiative involving nursing students. Copyright © 2016 Elsevier Inc. All rights reserved.

A beginner's guide to ethnographic observation in nursing research.

PubMed

Conroy, Tiffany

2017-03-22

Background Observation is mentioned in most ethnographic textbooks, but specific details about how it should be conducted and the practicalities to be considered in ethnographic nursing research are not always explicit. This paper explores the experiences of and challenges faced by a novice nurse researcher who used observation to collect data. Aim To provide a novice researcher's perspective of observation in ethnographic nursing research and to highlight the associated challenges. Discussion Challenges that arose in observation began with determining which perspective to take, followed by rehearsing observation, developing and maintaining a constructive relationship with the observation site, being aware of the influence of the observer, managing interactions between the observed and the observer, and responding to ethical issues. Conclusion Novice nurse researchers considering using observation to collect data should be aware of the potential challenges they might encounter. Implications for practice The information presented in this paper will enable novice researchers to anticipate these issues and develop strategies to prevent or address them.

Salbutamol in paediatrics: pharmacology, prescribing and controversies.

PubMed

Andrzejowski, Paul; Carroll, Will

2016-08-01

Salbutamol has become a key drug in respiratory medicine since it was first developed by Sir David Jack et al in 1968, 5000 years after the β agonist ephedrine was first used in its raw form, as the Ma Huang herb in Chinese medicine to treat asthma. It is one of the most commonly encountered medicines in paediatric practice and the authors have found that an understanding of its pharmacology in clinical practice is incredibly helpful. In this article, we discuss its pharmacology and pharmacodynamics, practical prescribing points and some unresolved issues surrounding its use, which should serve to provide an essential working knowledge for the busy paediatrician. 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/

Providing Competent and Affirming Services for Transgender and Gender Nonconforming Older Adults.

PubMed

Porter, Kristen E; Brennan-Ing, Mark; Chang, Sand C; Dickey, Lore M; Singh, Anneliese A; Bower, Kyle L; Witten, Tarynn M

2016-01-01

Despite the growing visibility and acceptance of transgender and gender nonconforming (TGNC) individuals, TGNC older adults experience many barriers in accessing competent and affirming health and social services due to anti-TGNC prejudice, discrimination, and lack of competent healthcare training on the part of healthcare workers. Clinical gerontologists and geriatricians will likely encounter TGNC adults in their practice given population aging and greater numbers of TGNC people who are living in their affirmed gender identities. The American Psychological Association recently published its Guidelines for Psychological Practice with Transgender and Gender Nonconforming People, which document the unique needs of TGNC individuals and outlines approaches for competent and affirming service provision (APA, 2015). We interpret these Guidelines using a gerontological lens to elucidate specific issues faced by the TGNC older adult along with the practice and policy implications for this population.

A review of the practices and results of the UTMB to South Pole teledermatology program over the past six years.

PubMed

Sun, Angel; Lanier, Russell; Diven, Dayna

2010-01-15

There is no place on earth more remote and inaccessible than Antarctica. In 2002, Raytheon Polar Services Co. (RPS) awarded The University of Texas Medical Branch (UTMB) at Galveston the contract to provide specialty medical services via telemedicine to the approximately 3,500 National Science Foundation (NSF) researchers and support personnel who rotate through Antarctica in a given year. We present the practices and results of the UTMB to the South Pole teledermatology program over the past six years, from 2003 to 2008. Issues encountered include logistics of sending out biopsies for pathologic diagnosis, limited bandwidth, and satellite availability for data transmission. The UTMB to the South Pole teledermatology program demonstrates the clinical practicality of telemedicine in providing dermatologic care to remote populations in extreme climate conditions.

Practical issues regarding implementing a randomized clinical trial in a homeless population: strategies and lessons learned.

PubMed

Ojo-Fati, Olamide; Joseph, Anne M; Ig-Izevbekhai, Jed; Thomas, Janet L; Everson-Rose, Susan A; Pratt, Rebekah; Raymond, Nancy; Cooney, Ned L; Luo, Xianghua; Okuyemi, Kolawole S

2017-07-05

There is a critical need for objective data to guide effective health promotion and care for homeless populations. However, many investigators exclude homeless populations from clinical trials due to practical concerns about conducting research with this population. This report is based on our experience and lessons learned while conducting two large NIH-funded randomized controlled trials targeting smoking cessation among persons who are homeless. The current report also addresses challenges when conducting clinical trials among homeless populations and offers potential solutions. Homeless individuals face several challenges including the need to negotiate daily access to food, clothing, and shelter. Some of the critical issues investigators encounter include recruitment and retention obstacles; cognitive impairment, mental health and substance abuse disorders; transportation and scheduling challenges; issues pertaining to adequate study compensation; the need for safety protocols for study staff; and issues related to protecting the wellbeing of these potentially vulnerable adults. Anticipating realistic conditions in which to conduct studies with participants who are homeless will help investigators to design efficient protocols and may improve the feasibility of conducting clinical trials involving homeless populations and the quality of the data collected by the researchers. ClinicalTrials.gov, ID: NCT00786149 . Registered on 5 November 2008; ClinicalTrials.gov, ID: NCT01932996 . Registered on 20 November 2014.

Ethical and Moral Courage is Distress among Professional Nurses: A Workplace Issue.

PubMed

Brown, Geraldine

2015-01-01

Ethics and moral issues do impact the manner in which professional nurses perform their major duties. Moral distress often conflict with an ethical appropriate course of action that is known, but cannot be implemented. This distress has been associated with job dissatisfaction, burnout, early retirement, withdrawal from the moral dimensions of direct patient care, and others just leaving the profession altogether. In the workplace, institutions must make an assertive effort in providing resources and addressing situations that cause personal anxiety and depression that adversely affects total patient care. The American Association of Critical Care Nurses (AACN) has addressed ethical issues and moral distress in practices that support nurses with moral courage, when encountering ethical conflicts. Ask, Affirm, Assess and Act are the 4 A's that AACN believes should be a part of an organization's strategic plan to create a healthy workplace environment.

Electronic tracking for people with dementia: an exploratory study of the ethical issues experienced by carers in making decisions about usage.

PubMed

White, Eleanor Bantry; Montgomery, Paul

2014-03-01

Electronic tracking through GPS (global positioning system) is being used to monitor and locate people with dementia who are vulnerable to becoming lost. Through a review of the literature and an original study, this article examined ethical issues associated with use in a domestic setting. The qualitative study consisted of in-depth interviews with 10 carers who were using electronic tracking. The study explored the values, beliefs and contextual factors that motivated carers to use electronic tracking. It examined the extent of involvement of the person with dementia in decision-making and it explored the various ethical dilemmas encountered by carers when introducing the tracking system. As an issue that emerged from the interviews, specific attention was paid to exploring covert usage. From the study findings, recommendations have been made for research and practice about the use of electronic tracking in dementia care.

Service quality, trust, and patient satisfaction in interpersonal-based medical service encounters

PubMed Central

2013-01-01

Background Interaction between service provider and customer is the primary core of service businesses of different natures, and the influence of trust on service quality and customer satisfaction could not be ignored in interpersonal-based service encounters. However, lack of existing literature on the correlation between service quality, patient trust, and satisfaction from the prospect of interpersonal-based medical service encounters has created a research gap in previous studies. Therefore, this study attempts to bridge such a gap with an evidence-based practice study. Methods We adopted a cross-sectional design using a questionnaire survey of outpatients in seven medical centers of Taiwan. Three hundred and fifty copies of questionnaire were distributed, and 285 valid copies were retrieved, with a valid response rate of 81.43%. The SPSS 14.0 and AMOS 14.0 (structural equation modeling) statistical software packages were used for analysis. Structural equation modeling clarifies the extent of relationships between variables as well as the chain of cause and effect. Restated, SEM results do not merely show empirical relationships between variables when defining the practical situation. For this reason, SEM was used to test the hypotheses. Results Perception of interpersonal-based medical service encounters positively influences service quality and patient satisfaction. Perception of service quality among patients positively influences their trust. Perception of trust among patients positively influences their satisfaction. Conclusions According to the findings, as interpersonal-based medical service encounters will positively influence service quality and patient satisfaction, and the differences for patients’ perceptions of the professional skill and communication attitude of personnel in interpersonal-based medical service encounters will influence patients’ overall satisfaction in two ways: (A) interpersonal-based medical service encounter directly affects patient satisfaction, which represents a direct effect; and (B) service quality and patient trust are used as intervening variables to affect patient satisfaction, which represents an indirect effect. Due to differences in the scale, resources and costs among medical institutions of different levels, it is a most urgent and concerning issue of how to control customers’ demands and preferences and adopt correct marketing concepts under the circumstances of intense competition in order to satisfy the public and build up a competitive edge for medical institutions. PMID:23320786

Beyond Compliance Checking: A Situated Approach to Visual Research Ethics.

PubMed

Lenette, Caroline; Botfield, Jessica R; Boydell, Katherine; Haire, Bridget; Newman, Christy E; Zwi, Anthony B

2018-03-19

Visual research methods like photography and digital storytelling are increasingly used in health and social sciences research as participatory approaches that benefit participants, researchers, and audiences. Visual methods involve a number of additional ethical considerations such as using identifiable content and ownership of creative outputs. As such, ethics committees should use different assessment frameworks to consider research protocols with visual methods. Here, we outline the limitations of ethics committees in assessing projects with a visual focus and highlight the sparse knowledge on how researchers respond when they encounter ethical challenges in the practice of visual research. We propose a situated approach in relation to visual methodologies that encompasses a negotiated, flexible approach, given that ethical issues usually emerge in relation to the specific contexts of individual research projects. Drawing on available literature and two case studies, we identify and reflect on nuanced ethical implications in visual research, like tensions between aesthetics and research validity. The case studies highlight strategies developed in-situ to address the challenges two researchers encountered when using visual research methods, illustrating that some practice implications are not necessarily addressed using established ethical clearance procedures. A situated approach can ensure that visual research remains ethical, engaging, and rigorous.

The Potential of the Internet for Alternative Caring Practices for Health

PubMed Central

Atkinson, Sarah; Ayers, Andrew

2013-01-01

The practices of health care in late modernity are informed by competing visions of the ideal human and the nature of care. Western societies typically characterise the ideal human as independent and self-reliant. The resultant welfare systems provide temporary havens away from the everyday, competitive spaces of capitalist societies, termed here the enclave model. Social scientists problematise this model on several grounds: the construction of pathologised and medicalised body forms; the neglect of caring practices that are gendered, invisible and primarily private; the de-politicisation of caring practices. Policy calls reject reference to care and its associations with dependency, make visible and value informal care work or invoke a caring citizenship as a policy goal not just a means. Into this field of contested notions of care enters a well-documented rise in access to, and consultation through, the internet in everyday lives for a vast range of issues. Health care encountered on-line reflects a similar range in form as that encountered off-line and much that is innovative, whilst clearly of benefit, does nothing to challenge the existing dominance of the enclave model of social care. However, certain groups of sites create spaces through which participants can both express and extract caring relationships that are otherwise unforthcoming. The paper argues that these sites afford potential to develop an alternative model of caring, to reframe questions of how to care about distant others and to demonstrate the centrality of caring relations to human life. PMID:20419518

The potential of the internet for alternative caring practices for health.

PubMed

Atkinson, Sarah; Ayers, Andrew

2010-04-01

The practices of health care in late modernity are informed by competing visions of the ideal human and the nature of care. Western societies typically characterise the ideal human as independent and self-reliant. The resultant welfare systems provide temporary havens away from the everyday, competitive spaces of capitalist societies, termed here the enclave model. Social scientists problematise this model on several grounds: the construction of pathologised and medicalised body forms; the neglect of caring practices that are gendered, invisible and primarily private; the de-politicisation of caring practices. Policy calls reject reference to care and its associations with dependency, make visible and value informal care work or invoke a caring citizenship as a policy goal not just a means. Into this field of contested notions of care enters a well-documented rise in access to, and consultation through, the internet in everyday lives for a vast range of issues. Health care encountered online reflects a similar range in form as that encountered offline and much that is innovative, whilst clearly of benefit, does nothing to challenge the existing dominance of the enclave model of social care. However, certain groups of sites create spaces through which participants can both express and extract caring relationships that are otherwise unforthcoming. The paper argues that these sites afford the potential to develop an alternative model of caring, to reframe questions of how to care about distant others and to demonstrate the centrality of caring relations to human life.

The work of nurses in Australian general practice: A national survey.

PubMed

Joyce, Catherine M; Piterman, Leon

2011-01-01

Following recent reforms to Australia's health system, nurses now comprise a significant and growing sector of the Australian primary care workforce, but there is little data describing the services they provide. This study aimed to describe the patient consultations of nurses in Australian general practice, including patient characteristics, reasons for the consultation, treatments provided and other actions taken. The study was a national cross-sectional survey, with each participating nurse collecting information about 50 nurse-patient encounters. General practice settings in all regions of Australia. 108 nurses volunteered in response to advertisements and 104 returned completed study materials. Participants included Registered (Division 1) and Enrolled (Division 2) nurses working in a general practice setting. Data were collected between May 2007 and May 2008 using a profile questionnaire and a series of encounter forms. Information was gathered on reasons for encounter, patient characteristics, and actions taken. Data were classified using the International Classification of Primary Care. The final data set included 5,253 nurse-patient encounters. 37.2% of patients (95% CI 33.3-41.2) were aged 65 and over, and 57.1% were female (95% CI 54.9-59.5). The majority of encounters (90.7%) were with existing patients of the practice (95% CI 89.1-92.7). The most common reasons for encounter were general and unspecified problems (35.4 per 100 encounters; 95% CI 31.8-39.1), followed by skin-related problems (20.0; 95% CI 17.3-22.8), and cardiovascular problems (11.0; 95% CI 8.7-13.3). Common management actions included medical examinations (20.7 per 100 encounters), immunisations (22.5), diagnostic tests (10.6), and dressings (15.8). Approximately 30% of encounters involved advice-giving. The findings confirm the generalist nature of the General Practice Nurse role, with a wide range of patient types and clinical conditions. There is a clear influence of current funding and organisational arrangements on work patterns, with tasks that have specific funding (including immunisations and wound care) featuring prominently in nurses' work. Whilst nurses' rates for presenting conditions were similar to doctors at a general level, specific actions taken and problems managed differed. New policy reforms in Australia are supporting greater flexibility in the General Practice Nurse role, maximising efficient use of nurses' skills in the primary health care context. Copyright © 2010 Elsevier Ltd. All rights reserved.

Lack of Impact of Direct-to-Consumer Advertising on the Physician-Patient Encounter in Primary Care: A SNOCAP Report

PubMed Central

Parnes, Bennett; Smith, Peter C.; Gilroy, Christine; Quintela, Javan; Emsermann, Caroline B.; Dickinson, L. Miriam; Westfall, John M.

2009-01-01

PURPOSE Direct-to-consumer advertising (DTCA) has increased tremendously during the past decade. Recent changes in the DTCA environment may have affected its impact on clinical encounters. Our objective was to determine the rate of patient medication inquiries and their influence on clinical encounters in primary care. METHODS Our methods consisted of a cross-sectional survey in the State Networks of Colorado Ambulatory Practices and Partners, a collaboration of 3 practice-based research networks. Clinicians completed a short patient encounter form after consecutive patient encounter for one-half or 1 full day. The main outcomes were the rate of inquiries, independent predictors of inquiries, and overall impact on clinical encounters. RESULTS One hundred sixty-eight clinicians in 22 practices completed forms after 1,647 patient encounters. In 58 encounters (3.5%), the patient inquired about a specific new prescription medication. Community health center patients made fewer inquiries than private practice patients (1.7% vs 7.2%, P<.001). Predictors of inquiries included taking 3 or more chronic medications and the clinician being female. Most clinicians reported the requested medication was not their first choice for treatment (62%), but it was prescribed in 53% of the cases. Physicians interpreted the overall impact on the visit as positive in 24% of visits, neutral in 66%, and negative in 10%. CONCLUSIONS Patient requests for prescription medication were uncommon overall, and even more so among patients in lower income groups. These requests were rarely perceived by clinicians as having a negative impact on the encounter. Future mixed methods studies should explore specific socioeconomic groups and reasons for clinicians’ willingness to prescribe these medications. PMID:19139448

Lack of impact of direct-to-consumer advertising on the physician-patient encounter in primary care: a SNOCAP report.

PubMed

Parnes, Bennett; Smith, Peter C; Gilroy, Christine; Quintela, Javan; Emsermann, Caroline B; Dickinson, L Miriam; Westfall, John M

2009-01-01

Direct-to-consumer advertising (DTCA) has increased tremendously during the past decade. Recent changes in the DTCA environment may have affected its impact on clinical encounters. Our objective was to determine the rate of patient medication inquiries and their influence on clinical encounters in primary care. Our methods consisted of a cross-sectional survey in the State Networks of Colorado Ambulatory Practices and Partners, a collaboration of 3 practice-based research networks. Clinicians completed a short patient encounter form after consecutive patient encounter for one-half or 1 full day. The main outcomes were the rate of inquiries, independent predictors of inquiries, and overall impact on clinical encounters. One hundred sixty-eight clinicians in 22 practices completed forms after 1,647 patient encounters. In 58 encounters (3.5%), the patient inquired about a specific new prescription medication. Community health center patients made fewer inquiries than private practice patients (1.7% vs 7.2%, P<.001). Predictors of inquiries included taking 3 or more chronic medications and the clinician being female. Most clinicians reported the requested medication was not their first choice for treatment (62%), but it was prescribed in 53% of the cases. Physicians interpreted the overall impact on the visit as positive in 24% of visits, neutral in 66%, and negative in 10%. Patient requests for prescription medication were uncommon overall, and even more so among patients in lower income groups. These requests were rarely perceived by clinicians as having a negative impact on the encounter. Future mixed methods studies should explore specific socioeconomic groups and reasons for clinicians' willingness to prescribe these medications.

The ethical junior: a typology of ethical problems faced by house officers

PubMed Central

McDougall, Rosalind; Sokol, Daniel K

2008-01-01

Although many studies have explored the experiences of doctors in their first postgraduate year, few have focused on the ethical issues encountered by this group. Based on an extensive literature review of research involving house officers, we argue that these doctors encounter a broad range of ‘everyday’ ethical challenges, from truth-telling to working in non-ideal conditions. We propose a typology of house officers' ethical issues and advocate prioritizing these issues in undergraduate medical ethics and law curricula. PMID:18299625

The National Long Term Care Demonstration: operational issues encountered in developing the research design.

PubMed

Carcagno, G J; Kemper, P

1983-01-01

This paper describes the design of the National Long Term Care Demonstration and its evaluation and discusses a number of operational issues encountered in the design process: simultaneous design of research and operations, identification of the target population, randomization, collection of comparable data, development of an assessment instrument, potential changes in existing programs, and termination planning.

Toward Successful Implementation of Speech Recognition Technology: A Survey of SRT Utilization Issues in Healthcare Settings.

PubMed

Clarke, Martina A; King, Joshua L; Kim, Min Soon

2015-07-01

To evaluate physician utilization of speech recognition technology (SRT) for medical documentation in two hospitals. A quantitative survey was used to collect data in the areas of practice, electronic equipment used for documentation, documentation created after providing care, and overall thoughts about and satisfaction with the SRT. The survey sample was from one rural and one urban facility in central Missouri. In addition, qualitative interviews were conducted with a chief medical officer and a physician champion regarding implementation issues, training, choice of SRT, and outcomes from their perspective. Seventy-one (60%) of the anticipated 125 surveys were returned. A total of 16 (23%) participants were practicing in internal medicine and 9 (13%) were practicing in family medicine. Fifty-six (79%) participants used a desktop and 14 (20%) used a laptop (2%) computer. SRT products from Nuance were the dominant SRT used by 59 participants (83%). Windows operating systems (Microsoft, Redmond, WA) was used by more than 58 (82%) of the survey respondents. With regard to user experience, 42 (59%) participants experienced spelling and grammatical errors, 15 (21%) encountered clinical inaccuracy, 9 (13%) experienced word substitution, and 4 (6%) experienced misleading medical information. This study shows critical issues of inconsistency, unreliability, and dissatisfaction in the functionality and usability of SRT. This merits further attention to improve the functionality and usability of SRT for better adoption within varying healthcare settings.

The human resource crisis in neuro-ophthalmology.

PubMed

Frohman, Larry P

2008-09-01

Neuro-ophthalmology is facing a serious human resource issue. Few are entering the subspecialty, which is perceived as being poorly compensated compared with other subspecialties of ophthalmology. The low compensation comes from the fact that 1) non-procedural encounters remain undervalued, 2) efforts that benefit other medical specialists are not counted, and 3) the relatively low expenses of neuro-ophthalmologists are not factored into compensation formulas. Mission-based budgeting, which forces academic departments to be financially accountable without the expectation of fiscal relief from medical schools or practice plans, has exacerbated the compensation issue. Solutions must come from within neuro-ophthalmology, academic departments, medical schools, and medical practice plans. They include 1) providing educational resources so that neuro-ophthalmologists need not spend so much time teaching the basics, 2) factoring into compensation the impact of neuro-ophthalmologists in teaching and on revenue generation by procedure-based specialists, 3) improving the efficiency of neuro-ophthalmologists in their consultative practices by providing ample clerical support and other measures, 4) providing contractual salary compensation by departments such as neurosurgery to recognize the contributions made by neuro-ophthalmologists, and 5) reorganizing the academic clinical effort as multidisciplinary rather than departmental.

The patient who believes and the analyst who does not (1).

PubMed

Lijtmaer, Ruth M

2009-01-01

A patient's religious beliefs and practices challenge the clinical experience and self-knowledge of the analyst owing to a great complexity of factors, and often take the form of the analyst's resistances and countertransference reactions to spiritual and religious issues. The analyst's feelings about the patient's encounters with religion and other forms of healing experiences may result in impasses and communication breakdown for a variety of reasons. These reasons include the analyst's own unresolved issues around her role as a psychoanalyst-which incorporates in some way psychoanalysis's views of religious belief-and these old conflicts may be irritated by the religious themes expressed by the patient. Vignettes from the treatments of two patients provide examples of the analyst's countertransference conflicts, particularly envy in the case of a therapist who is an atheist.

Ethical issues in nanomedicine: Tempest in a teapot?

PubMed

Allon, Irit; Ben-Yehudah, Ahmi; Dekel, Raz; Solbakk, Jan-Helge; Weltring, Klaus-Michael; Siegal, Gil

2017-03-01

Nanomedicine offers remarkable options for new therapeutic avenues. As methods in nanomedicine advance, ethical questions conjunctly arise. Nanomedicine is an exceptional niche in several aspects as it reflects risks and uncertainties not encountered in other areas of medical research or practice. Nanomedicine partially overlaps, partially interlocks and partially exceeds other medical disciplines. Some interpreters agree that advances in nanotechnology may pose varied ethical challenges, whilst others argue that these challenges are not new and that nanotechnology basically echoes recurrent bioethical dilemmas. The purpose of this article is to discuss some of the ethical issues related to nanomedicine and to reflect on the question whether nanomedicine generates ethical challenges of new and unique nature. Such a determination should have implications on regulatory processes and professional conducts and protocols in the future.

A conceptual framework of organizational stressors in sport performers.

PubMed

Fletcher, D; Hanton, S; Mellalieu, S D; Neil, R

2012-08-01

In the study reported here, 12 sport performers (six elite and six non-elite) were interviewed with regard to organizational-related issues they had experienced in preparation for competition. Grounded theory procedures facilitated the development of a conceptual framework of organizational stressors consisting of five general dimensions: factors intrinsic to the sport, roles in the sport organization, sport relationships and interpersonal demands, athletic career and performance development issues, and organizational structure and climate of the sport. The data indicate that the stressors were encountered proportionately more by elite performers (#EPOS=315) than non-elite performers (#NPOS=228) with some demands being in common and some unique to each group. The results are discussed in relation to previous research and regarding their implications for professional practice. © 2010 John Wiley & Sons A/S.

Problems and Processes in Medical Encounters: The CASES method of dialogue analysis

PubMed Central

Laws, M. Barton; Taubin, Tatiana; Bezreh, Tanya; Lee, Yoojin; Beach, Mary Catherine; Wilson, Ira B.

2013-01-01

Objective To develop methods to reliably capture structural and dynamic temporal features of clinical interactions. Methods Observational study of 50 audio-recorded routine outpatient visits to HIV specialty clinics, using innovative analytic methods. The Comprehensive Analysis of the Structure of Encounters System (CASES) uses transcripts coded for speech acts, then imposes larger-scale structural elements: threads – the problems or issues addressed; and processes within threads –basic tasks of clinical care labeled Presentation, Information, Resolution (decision making) and Engagement (interpersonal exchange). Threads are also coded for the nature of resolution. Results 61% of utterances are in presentation processes. Provider verbal dominance is greatest in information and resolution processes, which also contain a high proportion of provider directives. About half of threads result in no action or decision. Information flows predominantly from patient to provider in presentation processes, and from provider to patient in information processes. Engagement is rare. Conclusions In this data, resolution is provider centered; more time for patient participation in resolution, or interpersonal engagement, would have to come from presentation. Practice Implications Awareness of the use of time in clinical encounters, and the interaction processes associated with various tasks, may help make clinical communication more efficient and effective. PMID:23391684

Challenges of Combining Perspectives.

PubMed

Sundvall, Maria; Titelman, David; Bäärnhielm, Sofie

2018-02-23

Asylum seekers have increased risk of suicide and suicidal behavior, with differences related to origin, gender, and age. There are barriers to communication in clinical encounters between asylum seekers and clinicians. There is insufficient knowledge about how communication in the clinical encounter affects the suicide risk in female asylum seekers. To explore the documented communication between female asylum-seeking suicide attempters and clinicians and how it affects treatment. The medical records of 18 asylum-seeking women who had attempted suicide were analyzed with content analysis. Communication between patients and clinicians was affected by: the unbearable realities of the women; difficulties for clinicians in decoding languages of distress, and understanding trauma and subjective meanings of suicide; challenges of combining patients' and clinicians' perspectives; and a sense of shared powerlessness. The medical records did not give direct access to the patient's experience, only to the patient as documented by the clinician. The results suggest that clinicians working with asylum seekers who have attempted suicide need to develop an understanding of social and cultural factors and of trauma issues. A question for further study is how an enhanced integration of context and subjectivity in psychiatric practice would equip clinicians for the specific challenges encountered.

Nurse managers' experience with ethical issues in six government hospitals in Malaysia: A cross-sectional study

PubMed Central

2011-01-01

Background Nurse managers have the burden of experiencing frequent ethical issues related to both their managerial and nursing care duties, according to previous international studies. However, no such study was published in Malaysia. The purpose of this study was to explore nurse managers' experience with ethical issues in six government hospitals in Malaysia including learning about the way they dealt with the issues. Methods A cross-sectional study was conducted in August-September, 2010 involving 417 (69.2%) of total 603 nurse managers in the six Malaysian government hospitals. Data were collected using three-part self-administered questionnaire. Part I was regarding participants' demographics. Part II was about the frequency and areas of management where ethical issues were experienced, and scoring of the importance of 11 pre-identified ethical issues. Part III asked how they dealt with ethical issues in general; ways to deal with the 11 pre-identified ethical issues, and perceived stress level. Data were analyzed using descriptive statistics, cross-tabulations and Pearson's Chi-square. Results A total of 397 (95.2%) participants experienced ethical issues and 47.2% experienced them on weekly to daily basis. Experiencing ethical issues were not associated with areas of practice. Top area of management where ethical issues were encountered was "staff management", but "patient care" related ethical issues were rated as most important. Majority would "discuss with other nurses" in dealing generally with the issues. For pre-identified ethical issues regarding "patient care", "discuss with doctors" was preferred. Only 18.1% referred issues to "ethics committees" and 53.0% to the code of ethics. Conclusions Nurse managers, regardless of their areas of practice, frequently experienced ethical issues. For dealing with these, team-approach needs to be emphasized. Proper understanding of the code of ethics is needed to provide basis for reasoning. PMID:22085735

Truth-telling, decision-making, and ethics among cancer patients in nursing practice in China.

PubMed

Ling, Dong-Lan; Yu, Hong-Jing; Guo, Hui-Ling

2017-01-01

Truth-telling toward terminally ill patients is a challenging ethical issue in healthcare practice. However, there are no existing ethical guidelines or frameworks provided for Chinese nurses in relation to decision-making on truth-telling of terminal illness and the role of nurses thus is not explicit when encountering this issue. The intention of this paper is to provide ethical guidelines or strategies with regards to decision-making on truth-telling of terminal illness for Chinese nurses. This paper initially present a case scenario and then critically discuss the ethical issue in association with ethical principles and philosophical theories. Instead of focusing on attitudes toward truth disclosure, it aims to provide strategies regarding this issue for nurses. It highlights and discusses some of the relevant ethical assumptions around the perceived role of nurses in healthcare settings by focusing on nursing ethical virtues, nursing codes of ethics, and philosophical perspectives. And Confucian culture is discussed to explicate that deontology does not consider family-oriented care in China. Treating each family individually to explore the family's beliefs and values on this issue is essential in healthcare practice and nurses should tailor their own approach to individual needs regarding truth-telling in different situations. Moreover, the Chinese Code of Ethics should be modified to be more specific and applicable. Finally, a narrative ethics approach should be applied and teamwork between nurses, physicians and families should be established to support cancer patients and to ensure their autonomy and hope. Ethical considerations: This paper was approved by the Ethics Committee of The Second Affiliated Hospital of Guangzhou Medical University. The authors have obtained consent to use the case study and it has been anonymised to preserve the patient's confidentiality.

Self-Presentation, Desired Partner Characteristics, and Sexual Behavior Preferences in Online Personal Advertisements of Men Seeking Non-Gay-Identified Men.

PubMed

Downing, Martin J; Schrimshaw, Eric W

2014-03-14

Despite attention to the sexual behaviors of non-gay-identified (NGI) men who have same-sex encounters, virtually no research has focused on issues of partner desirability and selection. Limited evidence suggests that a subgroup of men who have sex with men (MSM) advertise online for sexual encounters with NGI men. Exchange theory provided a framework to investigate this seeking of NGI men, based on the content of Internet personal advertisements for same-sex encounters. Researchers analyzed 282 ads posted to an online bulletin board. Ads by men who explicitly desired encounters with NGI men were compared with those by men who did not indicate this preference in potential partners. Multivariate analyses revealed that NGI-seeking men had significantly increased odds of identifying as discreet (Adjusted odds ratio [ AOR ] = 2.82), seeking a discreet encounter ( AOR = 4.68), seeking a masculine partner ( AOR = 2.18), being willing to host ( AOR = 2.77), as well as seeking oral-receptive sex ( AOR = 2.69), unprotected oral sex ( AOR = 6.76), and anal-receptive sex ( AOR = 2.18). Further, NGI-seeking ads were more likely to not mention condom use or safer sex practices ( AOR = 4.13) and were less likely to indicate a desire for oral-insertive sex ( AOR = 0.34) and rimming ( AOR = 0.21). Findings suggest that some men may deliberately present themselves in ways that they perceive as being attractive to NGI men, and have research implications for NGI MSM, their partners, and the risk outcomes of these online ads.

Self-Presentation, Desired Partner Characteristics, and Sexual Behavior Preferences in Online Personal Advertisements of Men Seeking Non-Gay-Identified Men

PubMed Central

Schrimshaw, Eric W.

2015-01-01

Despite attention to the sexual behaviors of non-gay-identified (NGI) men who have same-sex encounters, virtually no research has focused on issues of partner desirability and selection. Limited evidence suggests that a subgroup of men who have sex with men (MSM) advertise online for sexual encounters with NGI men. Exchange theory provided a framework to investigate this seeking of NGI men, based on the content of Internet personal advertisements for same-sex encounters. Researchers analyzed 282 ads posted to an online bulletin board. Ads by men who explicitly desired encounters with NGI men were compared with those by men who did not indicate this preference in potential partners. Multivariate analyses revealed that NGI-seeking men had significantly increased odds of identifying as discreet (Adjusted odds ratio [AOR] = 2.82), seeking a discreet encounter (AOR = 4.68), seeking a masculine partner (AOR = 2.18), being willing to host (AOR = 2.77), as well as seeking oral-receptive sex (AOR = 2.69), unprotected oral sex (AOR = 6.76), and anal-receptive sex (AOR = 2.18). Further, NGI-seeking ads were more likely to not mention condom use or safer sex practices (AOR = 4.13) and were less likely to indicate a desire for oral-insertive sex (AOR = 0.34) and rimming (AOR = 0.21). Findings suggest that some men may deliberately present themselves in ways that they perceive as being attractive to NGI men, and have research implications for NGI MSM, their partners, and the risk outcomes of these online ads. PMID:25750927

The theory-practice gap and skill acquisition: an issue for nursing education.

PubMed

Scully, Natashia Josephine

2011-01-01

Matching textbook descriptions of clinical situations with the reality of practice is an ongoing problem faced by members of the nursing profession and is commonly referred to as the "theory-practice gap". This ubiquitous gap is inevitably encountered by all nurses at various times; yet it is widely agreed that it is student nurses--given their novice, rule governed status--who find themselves in the midst of the theory-practice void. This paper will discuss the nature of the theory-practice gap and skill acquisition, in relation to a personal experience of mine as an undergraduate nursing student, and its significance in relation to student anxiety levels, nurse education (specifically the roles of the classroom teacher and clinical educators), teaching methods and the responsibility of the student to become accountable for their own education. I intend to communicate how my personal situation was dealt with and evaluate that experience in relation to current nursing literature. Ultimately, this discussion will demonstrate the value of reflection underpinning the development of competency in nursing and its role in bridging the theory-practice gap.

Developing a general practice library: a collaborative project between a GP and librarian.

PubMed

Pearson, D; Rossall, H

2001-12-01

The authors report on a self-completed questionnaire study from a North Yorkshire based general practice regarding the information needs of its clinicians. The work was carried out with a particular focus on the practice library, and the findings identified that a new approach to maintaining and developing the library was needed. The literature regarding the information needs of primary care clinicians and the role of practice libraries is considered, and compared to those of the clinicians at the practice. Discussion follows on how a collaborative project was set up between the practice and a librarian based at the local NHS Trust library in order to improve the existing practice library. Difficulties encountered and issues unique to the project are explored, including training implications presented by the implementation of electronic resources. Marketing activities implemented are discussed, how the library will operate in its new capacity, and how ongoing support and maintenance of the library will be carried out. It is concluded that although scepticism still exists regarding librarian involvement in practice libraries, collaboration between clinicians and librarians is an effective approach to the successful development and maintenance of a practice library, and recommendations are therefore made for similar collaborative work.

Reflection-Based Learning for Professional Ethical Formation.

PubMed

Branch, William T; George, Maura

2017-04-01

One way practitioners learn ethics is by reflecting on experience. They may reflect in the moment (reflection-in-action) or afterwards (reflection-on-action). We illustrate how a teaching clinician may transform relationships with patients and teach person-centered care through reflective learning. We discuss reflective learning pedagogies and present two case examples of our preferred method, guided group reflection using narratives. This method fosters moral development alongside professional identity formation in students and advanced learners. Our method for reflective learning addresses and enables processing of the most pressing ethical issues that learners encounter in practice. © 2017 American Medical Association. All Rights Reserved.

Chinese guidelines for treatment of adult primary immune thrombocytopenia.

PubMed

Liu, Xin-Guang; Bai, Xiao-Chuan; Chen, Fang-Ping; Cheng, Yun-Feng; Dai, Ke-Sheng; Fang, Mei-Yun; Feng, Jian-Ming; Gong, Yu-Ping; Guo, Tao; Guo, Xin-Hong; Han, Yue; Hong, Luo-Jia; Hu, Yu; Hua, Bao-Lai; Huang, Rui-Bing; Li, Yan; Peng, Jun; Shu, Mi-Mi; Sun, Jing; Sun, Pei-Yan; Sun, Yu-Qian; Wang, Chun-Sen; Wang, Shu-Jie; Wang, Xiao-Min; Wu, Cong-Ming; Wu, Wen-Man; Yan, Zhen-Yu; Yang, Feng-E; Yang, Lin-Hua; Yang, Ren-Chi; Yang, Tong-Hua; Ye, Xu; Zhang, Guang-Sen; Zhang, Lei; Zheng, Chang-Cheng; Zhou, Hu; Zhou, Min; Zhou, Rong-Fu; Zhou, Ze-Ping; Zhu, Hong-Li; Zhu, Tie-Nan; Hou, Ming

2018-06-01

Primary immune thrombocytopenia (ITP) is a bleeding disorder commonly encountered in clinical practice. The International Working Group (IWG) on ITP has published several landmark papers on terminology, definitions, outcome criteria, bleeding assessment, diagnosis, and management of ITP. The Chinese consensus reports for diagnosis and management of adult ITP have been updated to the 4th edition. Based on current consensus positions and new emerging clinical evidence, the thrombosis and hemostasis group of the Chinese Society of Hematology issued Chinese guidelines for management of adult ITP, which aim to provide evidence-based recommendations for clinical decision making.

Evaluation of patient and doctor perception toward the use of telemedicine in Apollo Tele Health Services, India.

PubMed

Acharya, Rajesh V; Rai, Jasuma J

2016-01-01

Telemedicine incorporates electronic information and medical technology. It connects healthcare through vast distances which would benefit both patients and doctors. The aim of this questionnaire study was to evaluate the effects of telemedicine on patients and medical specialists. A cross-sectional study was conducted among 122 participants (71 patients and 51 doctors) on satisfaction in quality of service, cost-effectiveness, and problems encountered in healthcare provided by the telemedicine in Apollo Tele Health Services, Hyderabad, Telangana, India. The data for each group were calculated and compared. About 80% patients and all the doctors reported their satisfaction on the quality of treatment given through telemedicine. Approximately, 90% of the participants found telemedicine cost-effective and 61% of the doctors found an increase in patient's inflow apart for their regular practice. Problems encountered in telemedicine were 47% in technical issues and 39% in time scheduling by doctors and 31% of patients were uncomfortable to face the camera, and 24% had technical issues. The results of the present study showed that telemedicine in healthcare could prove to be useful to patients in distant regions and to rural doctors in India. In the near future, telemedicine can be considered as an alternate to face to face patient care.

Exploring ethics in practice: creating moral community in healthcare one place at a time.

PubMed

Scott, Sandra L; Marck, Patricia; Barton, Sylvia

2011-01-01

Examining everyday ethical situations in clinical practice is a vital but often overlooked activity for nursing leaders and practitioners, as well as most other healthcare professionals. In this paper, we share how a series of practitioner-led Ethics in Practice sessions (EIPs), which originated within a busy urban teaching hospital, were adapted and translated, first into home care and more recently, into an EIP session for public health nurses. The success of EIP sessions rests with their focus on issues that are selected by practitioners. The aims of EIPs are to foster ethical leadership within communities of practice, create safe places to share concerns, use relevant research evidence and other literature to support informed discussion, and generate stories that deepen our understanding of the ethical situations we encounter in our work. We hope our experience inspires nursing leaders, nursing colleagues and fellow healthcare professionals to consider using the EIP approach to build moral community and the idea of moral imagination with their clinical colleagues, one place at a time.

Nature and frequency of exchanges on medications during primary care encounters.

PubMed

Richard, Claude; Lussier, Marie-Thérèse

2006-12-01

To describe the exchanges, related to discussion of all medications during primary care medical consultations. Descriptive study of audio recordings of 422 medical encounters. Coding was done with MEDICODE, a validated instrument developed to analyse verbal exchanges on medications. The unit of analysis is the medication. An average of 3.9 medications (S.D.=2.8; range 1-21) are discussed per interview and 4.2 themes are broached for each drug (S.D.=2.6; range 1-17). "Active Discussed", "Represcribed" and "Newly Prescribed" drugs account for 43.1, 16.3 and 10.6%, respectively of all medications discussed. Themes most often discussed are Name, Instructions, Observed Main Effect, Class, Reasons for Taking the Drug, General Use of the Medication, Expected Effect on Symptoms, Form of the Medication, Indications Another Consultation Needed, and Alternative Medication. The least often discussed themes include clinically significant ones such as Possible Adverse Effects, Observed Adverse Effects, Expression of Attitudes and Emotions with regard to the medication, Compliance and Warnings. The average number of themes discussed differed between medications that were prescribed during the encounter, either New prescriptions or Represcribed drugs, compared to medications that were only discussed during the encounter. Our results show that medication discussions are heterogeneous and vary with the status of the medication and the theme. Also, the nature and extent of the discussions about medications do not support the shared-decision making model. Though it is too soon to make specific recommendations about discussions on medications, it seems clear that information-sharing about medications during medical encounters is a process that extends beyond any single encounter. Although communication skills are now part of most medical curriculums, there is an obvious need to put forth the concept of patient medication knowledge-building over multiple physician-patient encounters and to better prepare physicians to use the specific content and process skills necessary to revisit issues related to medications that seem necessary to support their patients' medication-taking practices.

Nurses' use of qualitative research approaches to investigate tobacco use and control.

PubMed

Schultz, Annette S H; Bottorff, Joan L; McKeown, Stephanie Barclay

2009-01-01

Qualitative research methods are increasingly used by nurse scientists to explore a wide variety of topics relevant to practice and/or health policy issues. The purpose of this chapter is to review the contributions of nurse scientists to the field of tobacco control through the use of qualitative research methods. A systematic literature search strategy was used to identify 51 articles published between 1980 and 2008. The majority (84%) of reviewed articles were authored by North American nurse scientists. Cessation was the most commonly (85%) studied aspect of tobacco control. Six qualitative research approaches were used: qualitative descriptive (55%), narrative analysis (8%), phenomenology (6%), grounded theory (14%), ethnography (12%), and case study (6%). Qualitative descriptive methods were primarily one-off studies to address practical problems or issues encountered in practice, and often validated current understandings related to tobacco. Researchers who used other types of qualitative methods and who conducted qualitative studies as part of programs of research were more likely to make more substantive contributions to the evolving field of tobacco control. These contributions related to how smoking intertwines with personal and social identities, the influence of social context on tobacco use, and nurses' involvement in tobacco control (both of their own tobacco use and in assisting others). Nurse scientists interested in exploring tobacco-related issues are encouraged to consider the full range of qualitative research approaches. Qualitative research methods contribute to our understanding of tobacco use arising from nursing practice, health care and policy, along with the field of tobacco control in general.

Evidence-based use of electronic clinical tracking systems in advanced practice registered nurse education: an integrative review.

PubMed

Branstetter, M Laurie; Smith, Lynette S; Brooks, Andrea F

2014-07-01

Over the past decade, the federal government has mandated healthcare providers to incorporate electronic health records into practice by 2015. This technological update in healthcare documentation has generated a need for advanced practice RN programs to incorporate information technology into education. The National Organization of Nurse Practitioner Faculties created core competencies to guide program standards for advanced practice RN education. One core competency is Technology and Information Literacy. Educational programs are moving toward the utilization of electronic clinical tracking systems to capture students' clinical encounter data. The purpose of this integrative review was to evaluate current research on advanced practice RN students' documentation of clinical encounters utilizing electronic clinical tracking systems to meet advanced practice RN curriculum outcome goals in information technology as defined by the National Organization of Nurse Practitioner Faculties. The state of the science depicts student' and faculty attitudes, preferences, opinions, and data collections of students' clinical encounters. Although electronic clinical tracking systems were utilized to track students' clinical encounters, these systems have not been evaluated for meeting information technology core competency standards. Educational programs are utilizing electronic clinical tracking systems with limited evidence-based literature evaluating the ability of these systems to meet the core competencies in advanced practice RN programs.

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.

Ecological Knowledge Among Communities, Managers and Scientists: Bridging Divergent Perspectives to Improve Forest Management Outcomes

NASA Astrophysics Data System (ADS)

Rist, Lucy; Shackleton, Charlie; Gadamus, Lily; Chapin, F. Stuart; Gowda, C. Made; Setty, Siddappa; Kannan, Ramesh; Shaanker, R. Uma

2016-04-01

Multiple actors are typically involved in forest management, namely communities, managers and researchers. In such cases, suboptimal management outcomes may, in addition to other factors, be symptomatic of a divergence in perspectives among these actors driven by fundamental differences in ecological knowledge. We examine the degree of congruence between the understandings of actors surrounding key issues of management concern in three case studies from tropical, subtropical and boreal forests. We identify commonly encountered points of divergence in ecological knowledge relating to key management processes and issues. We use these to formulate seven hypotheses about differences in the bodies of knowledge that frequently underlie communication and learning failures in forest management contexts where multiple actors are involved and outcomes are judged to be suboptimal. Finally, we present a set of propositions to acknowledge and narrow these differences. A more complete recognition of the full triangulation between all actors involved, and of the influence that fundamental differences in ecological knowledge can exert, may help lead to a more fruitful integration between local knowledge and practice, manager knowledge and practice, and contemporary science in forest management.

Post Launch Monitoring of food products: what can be learned from pharmacovigilance.

PubMed

van Puijenbroek, E P; Hepburn, P A; Herd, T M; van Grootheest, A C

2007-03-01

Post Launch Monitoring (PLM) is one of the new approaches that are used in assessing the safety of novel foods or ingredients. It shares a close resemblance with procedures applied in the field of medicines, where Post Marketing Surveillance (PMS) has been carried out since the beginning of the 1960s. For this reason, Unilever and the Netherlands Pharmacovigilance Centre Lareb, maintaining the national reporting scheme in the Netherlands for adverse drug reactions, have been working together to optimize the Unilever's Post Launch Monitoring service. As a result of this cooperation a practical model for conducting PLM for food products has been developed. This model is also applicable for consumer products in general. The system allows for coding and assessing reports and the early detection of 'signals' of unintended health reactions. The methodological issues surrounding reporting of possible health reactions and practical issues surrounding coding and assessment of the reports that were encountered in the first period of this partnership are discussed. In addition, similarities and differences concerning PMS and PLM are described.

Ethical Issues in Addressing Social Media Posts About Suicidal Intentions During an Online Study Among Youth: Case Study.

PubMed

Young, Sean D; Garett, Renee

2018-05-03

Due to the popularity of social media, researchers are increasingly conducting studies that monitor and analyze people's health-related social media conversations. Because social media users can post about any topic at any time, no known best ethical practices exist as to whether and how to monitor participants' posts for safety-related issues that might be unrelated to the study, such as expressions of suicidal intentions. This is a case study during a social media-based study on sleep and activity among freshman undergraduate students, where we by chance noticed that a student was using social media to express suicidal intentions. Although we connected the student to student psychological services in order to receive treatment, we encountered a number of barriers that initially prevented this from occurring, such as institutional review board and regulatory practices related to lack of experience with these newer types of studies. We discuss the implications of this experience for future research. ©Sean D Young, Renee Garett. Originally published in JMIR Mental Health (http://mental.jmir.org), 03.05.2018.

Facilities removal working group

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

NONE

This working group`s first objective is to identify major economic, technical, and regulatory constraints on operator practices and decisions relevant to offshore facilities removal. Then, the group will try to make recommendations as to regulatory and policy adjustments, additional research, or process improvements and/or technological advances, that may be needed to improve the efficiency and effectiveness of the removal process. The working group will focus primarily on issues dealing with Gulf of Mexico platform abandonments. In order to make the working group sessions as productive as possible, the Facilities Removal Working Group will focus on three topics that address amore » majority of the concerns and/or constraints relevant to facilities removal. The three areas are: (1) Explosive Severing and its Impact on Marine Life, (2) Pile and Conductor Severing, and (3) Deep Water Abandonments This paper will outline the current state of practice in the offshore industry, identifying current regulations and specific issues encountered when addressing each of the three main topics above. The intent of the paper is to highlight potential issues for panel discussion, not to provide a detailed review of all data relevant to the topic. Before each panel discussion, key speakers will review data and information to facilitate development and discussion of the main issues of each topic. Please refer to the attached agenda for the workshop format, key speakers, presentation topics, and panel participants. The goal of the panel discussions is to identify key issues for each of the three topics above. The working group will also make recommendations on how to proceed on these key issues.« less

Encountering Pedagogy through Relational Art Practices

ERIC Educational Resources Information Center

Irwin, Rita L.; O'Donoghue, Donal

2012-01-01

Two artists involved in "socially engaged art" practice were invited to work with art education teacher candidates and instructors in an effort to rethink notions of teaching, learning and art. We initiated this residency, which we called "The Summerhill Residency", to examine how learning encounters might create environments…

The Fate of Progressive Language Policies and Practices.

ERIC Educational Resources Information Center

Dudley-Marling, Curt, Ed.; Edelsky, Carole, Ed.

Noting that progressive language policies have encountered and will always encounter fierce resistance, this book presents a collection of essays by progressive language educators, theorists, and policymakers that reflect on the fate of progressive language practices and policies. Part 1 comprises three contextualizing chapters that provide a…

Fabricated Childhoods: Uncanny Encounters with the More-than-Human

ERIC Educational Resources Information Center

Blaise, Mindy

2016-01-01

This article is based on uncanny encounters with Julia deVille's exhibit, "Phantasmagoria". Inspired by Deleuzian-informed research practices, the author experiments with provoking practices to defy dominant developmental notions of childhood. This article reworks a humanist ontology by bringing together the discursive, the material, the…

Describing knowledge encounters in healthcare: a mixed studies systematic review and development of a classification.

PubMed

Hurst, Dominic; Mickan, Sharon

2017-03-14

Implementation science seeks to promote the uptake of research and other evidence-based findings into practice, but for healthcare professionals, this is complex as practice draws on, in addition to scientific principles, rules of thumb and a store of practical wisdom acquired from a range of informational and experiential sources. The aims of this review were to identify sources of information and professional experiences encountered by healthcare workers and from this to build a classification system, for use in future observational studies, that describes influences on how healthcare professionals acquire and use information in their clinical practice. This was a mixed studies systematic review of observational studies. OVID MEDLINE and Embase and Google Scholar were searched using terms around information, knowledge or evidence and sharing, searching and utilisation combined with terms relating to healthcare groups. Studies were eligible if one of the intentions was to identify information or experiential encounters by healthcare workers. Data was extracted by one author after piloting with another. Studies were assessed using the Mixed Methods Appraisal Tool (MMAT). The primary outcome extracted was the information source or professional experience encounter. Similar encounters were grouped together as single constructs. Our synthesis involved a mixed approach using the top-down logic of the Bliss Bibliographic Classification System (BC2) to generate classification categories and a bottom-up approach to develop descriptive codes (or "facets") for each category, from the data. The generic terms of BC2 were customised by an iterative process of thematic content analysis. Facets were developed by using available theory and keeping in mind the pragmatic end use of the classification. Eighty studies were included from which 178 discreet knowledge encounters were extracted. Six classification categories were developed: what information or experience was encountered; how was the information or experience encountered; what was the mode of encounter; from whom did the information originate or with whom was the experience; how many participants were there; and where did the encounter take place. For each of these categories, relevant descriptive facets were identified. We have sought to identify and classify all knowledge encounters, and we have developed a faceted description of key categories which will support richer descriptions and interrogations of knowledge encounters in healthcare research.

Temenos regained: reflections on the absence of the analyst.

PubMed

Abramovitch, Henry

2002-10-01

The importance of the temenos as a metaphor to conceptualize therapeutic containment is discussed. Jung drew the analogy between the consulting room and the temenos, at the centre of the Greek Temple as a sacred and inviolate place where the analysand might encounter the Self. Although Jung believed that whether called or not, the gods would appear, under certain conditions, patients may experience 'temenos lost', the loss of the holding function of the analytic space. Two cases are presented in which temenos issues played a central role. In one case, an unorthodox method was used to preserve the analytic container during the absence of the analyst and in the other, the impact of an extra-analytical encounter had a dramatic effect on the holding function of the temenos. A discussion is presented of the appropriate circumstances in which analysts may deviate from traditional analytic practice in order to preserve the temenos and transform a 'temenos lost' into a 'temenos regained'.

Antiservice Within the Medical Service Encounter: Lessons for Radiologists Beyond Service Recovery.

PubMed

Hill, Paul Armstrong; Hill, Ronald Paul

2015-12-01

Recent modifications in the metrics for reimbursement have reinforced the importance of radiology service-delivery experiences of patients. Evaluating current radiology practices calls for reflection on the various touch points with patients, as well as their overall satisfaction. If problems occur during encounters, service failure, or lack of satisfactory medical experiences can be transformed through service recovery, whereby patients-as-customers are given chances to voice their concerns, and health care providers across the spectrum can work together to resolve problematic issues. This paper takes a systemic view of the patient experience as embedded in the care continuum, recognizing that different beliefs, attitudes, and behaviors of members of the health care team can negatively affect or sabotage patient satisfaction. Although radiologists are only one of many roles in the care continuum, recommendations are discussed for how they can integrate service satisfaction as a pervasive communal goal among all health care team members. Copyright © 2015 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Motion/visual cueing requirements for vortex encounters during simulated transport visual approach and landing

NASA Technical Reports Server (NTRS)

Parrish, R. V.; Bowles, R. L.

1983-01-01

This paper addresses the issues of motion/visual cueing fidelity requirements for vortex encounters during simulated transport visual approaches and landings. Four simulator configurations were utilized to provide objective performance measures during simulated vortex penetrations, and subjective comments from pilots were collected. The configurations used were as follows: fixed base with visual degradation (delay), fixed base with no visual degradation, moving base with visual degradation (delay), and moving base with no visual degradation. The statistical comparisons of the objective measures and the subjective pilot opinions indicated that although both minimum visual delay and motion cueing are recommended for the vortex penetration task, the visual-scene delay characteristics were not as significant a fidelity factor as was the presence of motion cues. However, this indication was applicable to a restricted task, and to transport aircraft. Although they were statistically significant, the effects of visual delay and motion cueing on the touchdown-related measures were considered to be of no practical consequence.

Representing energy efficiency diagnosis strategies in cognitive work analysis.

PubMed

Hilliard, Antony; Jamieson, Greg A

2017-03-01

This article describes challenges encountered in applying Jens Rasmussen's Cognitive Work Analysis (CWA) framework to the practice of energy efficiency Monitoring & Targeting (M&T). Eight theoretic issues encountered in the analysis are described with respect to Rasmussen's work and the modeling solutions we adopted. We grappled with how to usefully apply Work Domain Analysis (WDA) to analyze categories of domains with secondary purposes and no ideal grain of decomposition. This difficulty encouraged us to pursue Control Task (ConTA) and Strategies (StrA) analysis, which are under-explored as bases for interface design. In ConTA we found M&T was best represented by two interlinked work functions; one controlling energy, the other maintaining knowledge representations. From StrA, we identified a popular representation-dependent strategy and inferred information required to diagnose faults in system performance and knowledge representation. This article presents and discusses excerpts from our analysis, and outlines their application to diagnosis support tools. Copyright © 2015 Elsevier Ltd. All rights reserved.

The impact of brief team communication, leadership and team behavior training on ad hoc team performance in trauma care settings.

PubMed

Roberts, Nicole K; Williams, Reed G; Schwind, Cathy J; Sutyak, John A; McDowell, Christopher; Griffen, David; Wall, Jarrod; Sanfey, Hilary; Chestnut, Audra; Meier, Andreas H; Wohltmann, Christopher; Clark, Ted R; Wetter, Nathan

2014-02-01

Communication breakdowns and care coordination problems often cause preventable adverse patient care events, which can be especially acute in the trauma setting, in which ad hoc teams have little time for advanced planning. Existing teamwork curricula do not address the particular issues associated with ad hoc emergency teams providing trauma care. Ad hoc trauma teams completed a preinstruction simulated trauma encounter and were provided with instruction on appropriate team behaviors and team communication. Teams completed a postinstruction simulated trauma encounter immediately afterward and 3 weeks later, then completed a questionnaire. Blinded raters rated videotapes of the simulations. Participants expressed high levels of satisfaction and intent to change practice after the intervention. Participants changed teamwork and communication behavior on the posttest, and changes were sustained after a 3-week interval, though there was some loss of retention. Brief training exercises can change teamwork and communication behaviors on ad hoc trauma teams. Copyright © 2014 Elsevier Inc. All rights reserved.

Insurance-related and financial challenges reported by managed care enrollees with breast cancer.

PubMed

Klimmek, Rachel; Snow, Denise; Wenzel, Jennifer

2010-10-01

Cancer survivors in the United States often encounter significant challenges in obtaining and paying for medical care. Multiple research studies have examined these issues in Medicare and Medicaid populations and the underinsured, but very little is known about insurance-related challenges encountered by cancer survivors enrolled in private insurance programs such as managed care. This secondary analysis of data explored the insurance-related and financial challenges reported by women enrolled in a managed care organization during cancer treatment and early follow-up. The researchers reviewed semistructured interviews with 14 women with breast cancer near the time of diagnosis, midway through treatment, and after treatment completion. Most women reported considerable stress related to performance of insurance-related tasks during or immediately after treatment, which resulted in negative emotional and psychological experiences. This article presents recommendations for how oncology nurses can intervene to assess and address these challenges and their effects. Future research should examine best practices related to nursing management of insurance-related and financial challenges during cancer.

Multiple myeloma: Diagnosis and management issues in patients with pre-existing chronic kidney disease.

PubMed

Vadlamudi, Srilatha; Annapareddy, Siva Nagendra Reddy

2016-01-01

Multiple myeloma is one of the most common malignancies encountered in clinical practice. Renal involvement in myeloma is a well-recognized entity. Although rare, another special situation that a nephrologist can encounter is myeloma occurring in a patient with preexisting chronic kidney disease (CKD) due to other etiologies. Anemia, bone pains and hypercalcemia, which commonly indicate the diagnosis of myeloma in the general population, are not useful in the presence of CKD. The sensitivity and specificity of serum free light chain assay is decreased in the presence of renal failure. Chemotherapy-related adverse effects are high compared with that in patients without CKD; this is attributed to the decreased clearance of drugs and the additive effect of chemotherapy-related adverse effects to the complications of CKD. Autologous and allogenic bone marrow transplantation can be attempted in this group of patients with non-myeloablative-conditioning regimens. Combined bone marrow and renal transplantation remains a viable option in this group of patients to increase life expectancy and quality of life.

Medical and surgical tourism: the new world of health care globalization and what it means for the practicing surgeon.

PubMed

Unti, James A

2009-04-01

In this issue of the Bulletin, the leadership of the American College of Surgeons has published a Statement on Medical and Surgical Tourism (see page 26). The statement addresses a number of concerns about this new industry and some of the safety and quality issues that patients may encounter if they seek health care services outside of the U.S. On June 16, 2008, the American Medical Association adopted its own first set of guidelines on medical tourism to help ensure the safety of patients who are considering traveling abroad for medical care. The American College of Surgeons' statement and the American Medical Association's guidelines together provide an important set of principles for consideration by patients, employers, insurers, and other third-party groups responsible for coordinating such travel outside of the country.

An adaptive robust controller for time delay maglev transportation systems

NASA Astrophysics Data System (ADS)

Milani, Reza Hamidi; Zarabadipour, Hassan; Shahnazi, Reza

2012-12-01

For engineering systems, uncertainties and time delays are two important issues that must be considered in control design. Uncertainties are often encountered in various dynamical systems due to modeling errors, measurement noises, linearization and approximations. Time delays have always been among the most difficult problems encountered in process control. In practical applications of feedback control, time delay arises frequently and can severely degrade closed-loop system performance and in some cases, drives the system to instability. Therefore, stability analysis and controller synthesis for uncertain nonlinear time-delay systems are important both in theory and in practice and many analytical techniques have been developed using delay-dependent Lyapunov function. In the past decade the magnetic and levitation (maglev) transportation system as a new system with high functionality has been the focus of numerous studies. However, maglev transportation systems are highly nonlinear and thus designing controller for those are challenging. The main topic of this paper is to design an adaptive robust controller for maglev transportation systems with time-delay, parametric uncertainties and external disturbances. In this paper, an adaptive robust control (ARC) is designed for this purpose. It should be noted that the adaptive gain is derived from Lyapunov-Krasovskii synthesis method, therefore asymptotic stability is guaranteed.

Challenges in conducting qualitative research in health: A conceptual paper.

PubMed

Khankeh, Hamidreza; Ranjbar, Maryam; Khorasani-Zavareh, Davoud; Zargham-Boroujeni, Ali; Johansson, Eva

2015-01-01

Qualitative research focuses on social world and provides the tools to study health phenomena from the perspective of those experiencing them. Identifying the problem, forming the question, and selecting an appropriate methodology and design are some of the initial challenges that researchers encounter in the early stages of any research project. These problems are particularly common for novices. This article describes the practical challenges of using qualitative inquiry in the field of health and the challenges of performing an interpretive research based on professional experience as a qualitative researcher and on available literature. One of the main topics discussed is the nature of qualitative research, its inherent challenges, and how to overcome them. Some of those highlighted here include: identification of the research problem, formation of the research question/aim, and selecting an appropriate methodology and research design, which are the main concerns of qualitative researchers and need to be handled properly. Insights from real-life experiences in conducting qualitative research in health reveal these issues. The paper provides personal comments on the experiences of a researcher in conducting pure qualitative research in the field of health. It offers insights into the practical difficulties encountered when performing qualitative studies and offers solutions and alternatives applied by these authors, which may be of use to others.

The global Filipino nurse: An integrative review of Filipino nurses' work experiences.

PubMed

Montayre, Jed; Montayre, Jasmine; Holroyd, Eleanor

2018-05-01

To understand the work-related experiences of Philippine-trained nurses working globally. The Philippines is a major source country of foreign-trained nurses located globally. However, there is paucity of research on professional factors and career related issues affecting foreign-trained nurses' work experiences. An integrative review through a comprehensive search of literature was undertaken from November 2015 and was repeated in August 2016. Seven articles satisfied the selection criteria. Filipino nurses experienced differences in the practice of nursing in terms of work process, roles and autonomy. Moreover, they encountered challenges such as work-related discrimination and technical difficulties within the organisation. A clear understanding of Filipino nurses' work experiences and the challenges they have encountered suggests identification of important constructs influencing effective translation of nursing practice across cultures and health systems, which then form the basis for support strategies. It is critical to recognize foreign-trained nurses' experience of work-related differences and challenges as these foster favorable conditions for the management team to plan and continually evaluate policies around recruitment, retention and support offered to these nurses. Furthermore, findings suggest internationalization of nursing framework and standards integrating a transcultural paradigm among staff members within a work organisation. © 2017 John Wiley & Sons Ltd.

Good Chemical Measurements, Good Public Policies

NASA Astrophysics Data System (ADS)

Faulkner, Larry R.

2005-02-01

At every turn now, one encounters sharply debated issues and important public policies that rest on chemical information. This is true in practically any arena where public interest intersects with the material world: health care practice and public health; energy; quality of air, water, and food; manufacturing standards and product liability; criminal justice; national and international security, including the defense against terrorism. The scale can be truly global, as in the case of the current debate over climate change, which extends into international efforts to regulate gaseous emissions. Sometimes the relevant chemical measurements and applicable theory are sound and their scope is appropriate to the policy; often they are inadequate and a policy or debate overreaches the analytical capability needed to support it. In the decades ahead, the issues with us today will become even more pressing and will drive a still greater reliance on analytical chemistry. This presentation will have four parts covering (a) illustrations of the impact of analytical chemistry on public debate and public policy, including instances where analytical capabilities actually gave rise to new issues and policies, (b) the manner in which chemical information is handled and understood in public debates, (c) areas of analytical chemistry that will be critical to sound public policy in the future, and (d) implications for the education of leaders and general citizens of modern societies.

Integration of a Computer-Based Consultant into the Clinical Setting*

PubMed Central

Bischoff, Miriam B.; Shortliffe, Edward H.

1983-01-01

Studies of the attitudes of medical personnel regarding computer-based clinical consultation systems have shown that successful programs must be designed not only to satisfy a need for expert level advice but also to fit smoothly into the dally routine of physician/users. Planning for system use should accordingly be emphasized in all aspects of the system design. ONCOCIN is an oncology protocol management system that assists physicians with the management of outpatients enrolled in experimental cancer chemotherapy protocols. ONCOCIN was designed for initial implementation in the Stanford Oncology Day Care Center, where it has been in limited use since May of 1981. The clinic's physicians currently use the system dally in the management of patients with Hodgkin's and non-Hodgkin's lymphoma. This work has allowed us to study physician-computer interaction and to explore artificial intelligence research issues. This paper discusses the practical issues to consider when designing a consultation system for physicians and the logistical issues to address when integrating such a system into a clinic setting. We describe how ONCOCIN has addressed these issues, the problems encountered, their resolution, and the lessons learned.

Chronic hand eczema: perception and knowledge in non-affected individuals from general and dermatological practice.

PubMed

Letulé, Valerie; Herzinger, Thomas; Schirner, Astrid; Hertrich, Frank; Lange, Dirk; Ruzicka, Thomas; Molin, Sonja

2014-11-01

Misunderstanding and stigmatisation are common problems encountered by patients with hand eczema. Various misconceptions about the disease circulate in the general population. Although hand eczema has gained more attention in dermatology during the past years, information on public perception of the disease is still lacking. The aim of our study was to investigate perception of and level of knowledge on the subject hand eczema. There were 624 patients included from 2 general medicine practices and 2 dermatological practices. A self-administered questionnaire was filled out by the participants, covering issues on history of hand eczema, level of knowledge and attitude towards a clinical photograph of hand eczema. We found that a larger proportion of individuals from dermatological practice were more familiar with hand eczema as a disease than those from general medical practice. Women knew significantly more about and had a more positive perception of the disease than men. Our results imply that the level of knowledge on hand eczema in the general public is rather low and influenced by prejudice.

Fieldwork in nursing research: positionality, practicalities and predicaments.

PubMed

Borbasi, Sally; Jackson, Debra; Wilkes, Lesley

2005-09-01

This paper draws on the literature to explore some of the issues of concern to nurses undertaking fieldwork in contemporary healthcare settings. The emergence of poststructuralist and postmodern perspectives has raised questions about ethnographic approaches, and problematized the role of researchers in the construction of plausible and credible ethnographic accounts. As a practice discipline, nursing needs to negotiate a thorny path between methodological purity and practical application, with nurse researchers required to take account of both philosophical and pragmatic concerns. There is general agreement that researching with an individual or group rather than researching on an individual or group is the more effective way to approach fieldwork. Feminist writers appear to have dealt with this issue best, advocating intimacy, self-disclosure, and reciprocity in encounters with research participants. The duality of the nurse researcher role; power and politics and the moral implications of fieldwork are acknowledged as factors influencing nurses in the planning and conduct of fieldwork. Nurses as researchers may be better equipped than other social researchers to deal with contingencies in the field. Laying the epistemological ground for the participant observer role during fieldwork and understanding its impact on the resultant ethnographic account is essential to methodological rigour in field research. Consideration of some of the practicalities and predicaments experienced by nurses as researchers when conducting fieldwork prior to going out into the field is an important research strategy and will facilitate methodological potency.

"Being flexible and creative": a qualitative study on maternity care assistants' experiences with non-Western immigrant women.

PubMed

Boerleider, Agatha W; Francke, Anneke L; van de Reep, Merle; Manniën, Judith; Wiegers, Therese A; Devillé, Walter L J M

2014-01-01

Several studies conducted in developed countries have explored postnatal care professionals' experiences with non-western women. These studies reported different cultural practices, lack of knowledge of the maternity care system, communication difficulties, and the important role of the baby's grandmother as care-giver in the postnatal period. However, not much attention has been paid in existing literature to postnatal care professionals' approaches to these issues. Our main objective was to gain insight into how Dutch postnatal care providers--'maternity care assistants' (MCA)--address issues encountered when providing care for non-western women. A generic qualitative research approach was used. Two researchers interviewed fifteen MCAs individually, analysing the interview material separately and then comparing and discussing their results. Analytical codes were organised into main themes and subthemes. MCAs perceive caring for non-western women as interesting and challenging, but sometimes difficult too. To guarantee the health and safety of mother and baby, they have adopted flexible and creative approaches to address issues concerning traditional practices, socioeconomic status and communication. Furthermore, they employ several other strategies to establish relationships with non-western clients and their families, improve women's knowledge of the maternity care system and give health education. Provision of postnatal care to non-western clients may require special skills and measures. The quality of care for non-western clients might be improved by including these skills in education and retraining programmes for postnatal care providers on top of factual knowledge about traditional practices.

Changes in Payer Mix and Physician Reimbursement After the Affordable Care Act and Medicaid Expansion.

PubMed

Jones, Christine D; Scott, Serena J; Anoff, Debra L; Pierce, Read G; Glasheen, Jeffrey J

2015-01-01

Although uncompensated care for hospital-based care has fallen dramatically since the implementation of the Affordable Care Act and Medicaid expansion, the changes in hospital physician reimbursement are not known. We evaluated if payer mix and physician reimbursement by encounter changed between 2013 and 2014 in an academic hospitalist practice in a Medicaid expansion state. This was a retrospective cohort study of all general medicine inpatient admissions to an academic hospitalist group in 2013 and 2014. The proportion of encounters by payer and reimbursement/inpatient encounter were compared in 2013 versus 2014. A sensitivity analysis determined the relative contribution of different factors to the change in reimbursement/encounter. Among 37 540 and 40 397 general medicine inpatient encounters in 2013 and 2014, respectively, Medicaid encounters increased (17.3% to 30.0%, P < .001), uninsured encounters decreased (18.4% to 6.3%, P < 0.001), and private payer encounters also decreased (14.1% to 13.3%, P = .001). The median reimbursement/encounter increased 4.2% from $79.98/encounter in 2013 to $83.36/encounter in 2014 (P < .001). In a sensitivity analysis, changes in length of stay, proportions in encounter type by payer, payer mix, and reimbursement for encounter type by payer accounted for -0.7%, 0.8%, 2.0%, and 2.3% of the reimbursement change, respectively. From 2013 to 2014, Medicaid encounters increased, and uninsured and private payer encounters decreased within our hospitalist practice. Reimbursement/encounter also increased, much of which could be attributed to a change in payer mix. Further analyses of physician reimbursement in Medicaid expansion and non-expansion states would further delineate reimbursement changes that are directly attributable to Medicaid expansion. © The Author(s) 2015.

Changes in Payer Mix and Physician Reimbursement After the Affordable Care Act and Medicaid Expansion

PubMed Central

Jones, Christine D.; Scott, Serena J.; Anoff, Debra L.; Pierce, Read G.; Glasheen, Jeffrey J.

2015-01-01

Although uncompensated care for hospital-based care has fallen dramatically since the implementation of the Affordable Care Act and Medicaid expansion, the changes in hospital physician reimbursement are not known. We evaluated if payer mix and physician reimbursement by encounter changed between 2013 and 2014 in an academic hospitalist practice in a Medicaid expansion state. This was a retrospective cohort study of all general medicine inpatient admissions to an academic hospitalist group in 2013 and 2014. The proportion of encounters by payer and reimbursement/inpatient encounter were compared in 2013 versus 2014. A sensitivity analysis determined the relative contribution of different factors to the change in reimbursement/encounter. Among 37 540 and 40 397 general medicine inpatient encounters in 2013 and 2014, respectively, Medicaid encounters increased (17.3% to 30.0%, P < .001), uninsured encounters decreased (18.4% to 6.3%, P < 0.001), and private payer encounters also decreased (14.1% to 13.3%, P = .001). The median reimbursement/encounter increased 4.2% from $79.98/encounter in 2013 to $83.36/encounter in 2014 (P < .001). In a sensitivity analysis, changes in length of stay, proportions in encounter type by payer, payer mix, and reimbursement for encounter type by payer accounted for −0.7%, 0.8%, 2.0%, and 2.3% of the reimbursement change, respectively. From 2013 to 2014, Medicaid encounters increased, and uninsured and private payer encounters decreased within our hospitalist practice. Reimbursement/encounter also increased, much of which could be attributed to a change in payer mix. Further analyses of physician reimbursement in Medicaid expansion and non-expansion states would further delineate reimbursement changes that are directly attributable to Medicaid expansion. PMID:26310500

Family medicine outpatient encounters are more complex than those of cardiology and psychiatry.

PubMed

Katerndahl, David; Wood, Robert; Jaén, Carlos Roberto

2011-01-01

comparison studies suggest that the guideline-concordant care provided for specific medical conditions is less optimal in primary care compared with cardiology and psychiatry settings. The purpose of this study is to estimate the relative complexity of patient encounters in general/family practice, cardiology, and psychiatry settings. secondary analysis of the 2000 National Ambulatory Medical Care Survey data for ambulatory patients seen in general/family practice, cardiology, and psychiatry settings was performed. The complexity for each variable was estimated as the quantity weighted by variability and diversity. there is minimal difference in the unadjusted input and total encounter complexity of general/family practice and cardiology; psychiatry's input is less complex. Cardiology encounters involved more input quantitatively, but the diversity of general/family practice input eliminated the difference. Cardiology also involved more complex output. However, when the duration of visit is factored in, the complexity of care provided per hour in general/family practice is 33% more relative to cardiology and 5 times more relative to psychiatry. care during family physician visits is more complex per hour than the care during visits to cardiologists or psychiatrists. This may account for a lower rate of completion of process items measured for quality of care.

A Pilot Quality Improvement Collaborative to Improve Safety Net Dental Access for Pregnant Women and Young Children.

PubMed

Vander Schaaf, Emily B; Quinonez, Rocio B; Cornett, Amanda C; Randolph, Greg D; Boggess, Kim; Flower, Kori B

2018-02-01

Objectives To determine acceptability and feasibility of a quality improvement (QI) collaborative in safety net dental practices, and evaluate its effects on financial stability, access, efficiency, and care for pregnant women and young children. Methods Five safety net dental practices participated in a 15-month learning collaborative utilizing business assessments, QI training, early childhood oral health training, and prenatal oral health training. Practices collected monthly data on: net revenue, no-show rates, total encounters, and number of encounters for young children and pregnant women. We analyzed quantitative data using paired t-tests before and after the collaborative and collected supplemental qualitative feedback from clinic staff through focus groups and directed email. Results All mean measures improved, including: higher monthly revenue ($28,380-$33,102, p = 0.37), decreased no-show rate (17.7-14.3%, p = 0.11), higher monthly dental health encounters (283-328, p = 0.08), and higher monthly encounters for young children (8.8-10.5, p = 0.65), and pregnant women (2.8-9.7, p = 0.29). Results varied by practice, with some demonstrating largest increases in encounters for young children and others pregnant women. Focus group participants reported that the collaborative improved access for pregnant women and young children, and that QI methods were often new and difficult. Conclusion for practice Participation by safety net dental practices in a QI collaborative is feasible and acceptable. Individual sites saw greater improvements in different outcomes areas, based on their own structures and needs. Future efforts should focus on specific needs of each dental practice and should offer additional QI training.

State of family medicine practice in Lebanon

PubMed Central

Helou, Mariana; Rizk, Grace Abi

2016-01-01

Background: Many difficulties are encountered in family medicine practice and were subject to multinational studies. To date, no study was conducted in Lebanon to assess the challenges that family physicians face. This study aims to evaluate the family medicine practice in Lebanon stressing on the difficulties encountered by Lebanese family physicians. Materials and Methods: A questionnaire was sent to all 96 family medicine physicians practicing in Lebanon. Participants answered questions about characteristics of family medicine practice, evaluation of the quality of work, identification of obstacles, and their effect on the medical practice. Results: The response rate was 59%, and the average number of years of practice was 10.7 years. Physicians complain mainly of heavy load at work, too many bureaucratic tasks, demanding patients, and being undervalued by the specialists. Most physicians are able to adapt between their professional and private life. Conclusion: Despite all the obstacles encountered, Lebanese family physicians have a moderate satisfaction toward their practice. They remain positive and enthusiastic about their profession. Until the ministry of public health revises its current health system, the primary care profession in Lebanon will remain fragile as a profession. PMID:27453843

State of family medicine practice in Lebanon.

PubMed

Helou, Mariana; Rizk, Grace Abi

2016-01-01

Many difficulties are encountered in family medicine practice and were subject to multinational studies. To date, no study was conducted in Lebanon to assess the challenges that family physicians face. This study aims to evaluate the family medicine practice in Lebanon stressing on the difficulties encountered by Lebanese family physicians. A questionnaire was sent to all 96 family medicine physicians practicing in Lebanon. Participants answered questions about characteristics of family medicine practice, evaluation of the quality of work, identification of obstacles, and their effect on the medical practice. The response rate was 59%, and the average number of years of practice was 10.7 years. Physicians complain mainly of heavy load at work, too many bureaucratic tasks, demanding patients, and being undervalued by the specialists. Most physicians are able to adapt between their professional and private life. Despite all the obstacles encountered, Lebanese family physicians have a moderate satisfaction toward their practice. They remain positive and enthusiastic about their profession. Until the ministry of public health revises its current health system, the primary care profession in Lebanon will remain fragile as a profession.

Private pharmacy staff in Hanoi dispensing steroids - theory and practice

PubMed Central

Larsson, Mattias; Binh, Nguyen Thanh; Tomson, Göran; Chuc, Nguyen TK; Falkenberg, Torkel

Objective To investigate self reported practice and actual practice of private pharmacy staff in relation to drug regulations and provision of prednisolone (a prescription-only corticosteroid) on request to treat lower back pain. Method Sixty private pharmacies in Hanoi were randomly selected. Self reported practice was assessed through interviews with pharmacy staff using a questionnaire; actual practice was assessed with the Simulated Client Method with 5 encounters in each pharmacy (a total of 295 encounters). Results Sixty percent of the pharmacy staff interviewed said that they would not dispense corticosteroids without prescription and 60% could mention some adverse effects. In practice all but one pharmacy dispensed corticosteroids without prescription in 76 % of all the encounters. Questions and advice given to the clients were associated with significantly lower dispensing of corticosteroids. Conclusion The low compliance with prescription regulations and the discrepancy between stated practice and actual practice raises concerns. This study indicates that commercial pressures exceed the deterrent effect of current drug regulations and their implementation and hence enforcement of regulations needs to be improved. PMID:25247001

Monitoring Reasons for Encounter via an Electronic Patient Record System: the Case of a Rural Practice Initiative

PubMed Central

Klinis, Spyridon; Markaki, Adelais; Kounalakis, Dimitrios; Symvoulakis, Emmanouil K.

2012-01-01

The objective of this brief communication was to tabulate common reasons for encounter in a Greek rural general practice, as result of a recently adopted electronic patient record (EPR) application. Twenty encounter reasons accounted for 3,797 visits (61% of all patient encounters), whereas 565 other reasons accounted for the remaining 2,429 visits (39%). Number one reason for encounter was health maintenance or disease prevention seeking services, including screening examinations for malignancies, immunization and provision of medical opinion reports. Hypertension, lipid disorder and ischemic heart disease without angina were among the most common reasons for seeking care. A strengths/weaknesses/opportunities/threats (SWOT) analysis on the key role of an EPR system in collecting data from rural and remote primary health care settings is also presented. PMID:23091407

Interkulturelles Lernen — Zur Grundlegung eines didaktischen Prinzips interkultureller Begegnungen

NASA Astrophysics Data System (ADS)

Sandhaas, Bernd

1988-12-01

In the Federal Republic of Germany there have in recent years been many varied encounters between Germans and representatives of other cultures, particularly those from Third World countries. These have increasingly been organized with an awareness of global interdependence and have as a result opened the door to the influence of foreign cultures and to an unmistakeable movement in the direction of a multicultural society. An intercultural pedagogical approach and didactic theory are faced with the task of resolving the consequent problems related to education and training. The author firstly attempts to systematize as a typology the practice of learning as it occurs in intercultural encounters in so far as this relates to the Federal Republic of Germany. He suggests that `intercultural learning' should be seen as the didactic principle underlying the organization of learning in such encounters. Through a detailed discussion of his central concepts of `culture' and `learning' and of the issue of `interculturalism', and by sketching a theoretical model of the stages and goals of the learning taking place, he then makes plain the necessary enlargement of the German concept of `Kultur' and the process of differentiation which the concept of learning will have to engage in if it is to be applicable to educational activity in international or intercultural contexts.

Dialogue as skill: training a health professions workforce that can talk about race and racism.

PubMed

Murray-García, Jann L; Harrell, Steven; García, Jorge A; Gizzi, Elio; Simms-Mackey, Pamela

2014-09-01

Efforts in the field of multicultural education for the health professions have focused on increasing trainees' knowledge base and awareness of other cultures, and on teaching technical communication skills in cross-cultural encounters. Yet to be adequately addressed in training are profound issues of racial bias and the often awkward challenge of cross-racial dialogue, both of which likely play some part in well-documented racial disparities in health care encounters. We seek to establish the need for the skill of dialoguing explicitly with patients, colleagues, and others about race and racism and its implications for patient well-being, for clinical practice, and for the ongoing personal and professional development of health care professionals. We present evidence establishing the need to go beyond training in interview skills that efficiently "extract" relevant cultural and clinical information from patients. This evidence includes concepts from social psychology that include implicit bias, explicit bias, and aversive racism. Aiming to connect the dots of diverse literatures, we believe health professions educators and institutional leaders can play a pivotal role in reducing racial disparities in health care encounters by actively promoting, nurturing, and participating in this dialogue, modeling its value as an indispensable skill and institutional priority.

Quagmires for clinical psychology and executive coaching? Ethical considerations and practice challenges.

PubMed

Gebhardt, Judith Ann

2016-04-01

As the coaching field burgeons, both the mental health and coaching professionals, and their respective professions, face a myriad of potential quagmires, especially if the unique challenges encountered are ignored. After a short introduction and presentation on ethics and morals related to executive coaching and clinical therapy, a discussion follows on the lengthy and intimate relationship between executive coaching and psychology. Next are definitions and comparisons and 6 areas that are potential quagmires. This includes roles, skill sets/core competencies, education/training, licensing/credentialing-certification, governing bodies and confidentiality, and fees/reimbursement. Each section includes a discussion and several questions to highlight potentially problematic areas, practice challenges, and/or ethical issues, followed with brief responses. This paper concludes with the inquiry, "Where do we go from here?" (c) 2016 APA, all rights reserved).

Promoting Resilience in New Perioperative Nurses.

PubMed

Stephens, Teresa M; Smith, Pamela; Cherry, Caitlin

2017-03-01

New nursing graduates experience many challenges when transitioning from the academic environment to the practice setting. For many, the period of transition from student to employee is less than optimal, with many still experiencing reality shock, cognitive dissonance, and theory-practice gaps. The Stephens Model of Nursing Student Resilience addresses the unique issues faced by new graduate nurses to assist them in developing healthy coping strategies and to promote resilience. This model forms the basis of the RN Personal Resilience Enhancement Plan, a supplemental onboarding program created to assist new nurses in confidently facing challenges encountered during orientation and successfully moving forward as nursing professionals. This article describes the concept of resilience and explains how to link the RN Personal Resilience Enhancement Plan to the onboarding process in the perioperative setting. Copyright © 2017 AORN, Inc. Published by Elsevier Inc. All rights reserved.

Improvising in the Vulnerable Encounter: Using Improvised Participatory Theatre in Change for Healthcare Practice

ERIC Educational Resources Information Center

Larsen, Henry; Friis, Preben; Heape, Chris

2018-01-01

Healthcare practitioners are often presented with vulnerable encounters where their professional experience is insufficient when dealing with patients who suffer from illnesses such as chronic pain. How can one otherwise understand chronic pain and develop practices whereby medical healthcare practitioners can experience alternative ways of doing…

Social workers and delivery of evidence-based psychosocial treatments for substance use disorders.

PubMed

Wells, Elizabeth A; Kristman-Valente, Allison N; Peavy, K Michelle; Jackson, T Ron

2013-01-01

Social workers encounter individuals with substance use disorders (SUDs) in a variety of settings. With changes in health care policy and a movement toward integration of health and behavioral health services, social workers will play an increased role vis-á-vis SUD. As direct service providers, administrators, care managers, and policy makers, they will select, deliver, or advocate for delivery of evidence-based SUD treatment practices. This article provides an overview of effective psychosocial SUD treatment approaches. In addition to describing the treatments, the article discusses empirical support, populations for whom the treatments are known to be efficacious, and implementation issues.

A Bayesian Framework for Estimating the Concordance Correlation Coefficient Using Skew-elliptical Distributions.

PubMed

Feng, Dai; Baumgartner, Richard; Svetnik, Vladimir

2018-04-05

The concordance correlation coefficient (CCC) is a widely used scaled index in the study of agreement. In this article, we propose estimating the CCC by a unified Bayesian framework that can (1) accommodate symmetric or asymmetric and light- or heavy-tailed data; (2) select model from several candidates; and (3) address other issues frequently encountered in practice such as confounding covariates and missing data. The performance of the proposal was studied and demonstrated using simulated as well as real-life biomarker data from a clinical study of an insomnia drug. The implementation of the proposal is accessible through a package in the Comprehensive R Archive Network.

Martial arts sports medicine: current issues and competition event coverage.

PubMed

Nishime, Robert S

2007-06-01

More sports medicine professionals are becoming actively involved in the care of the martial arts athlete. Although there are many different forms of martial arts practiced worldwide, certain styles have shown a potential for increased participation in competitive-type events. Further research is needed to better understand the prevalence and profiles of injuries sustained in martial arts full-contact competitive events. Breaking down the martial art techniques into basic concepts of striking, grappling, and submission maneuvers, including choking and joint locking, may facilitate better understanding and management of injuries. This article outlines this approach and reviews the commonly encountered injuries and problems during martial arts full-contact competitions.

Developing a new hybrid revascularization program: a road map for hospital managers and physician leaders.

PubMed

Harjai, Kishore J; Samy, Sanjay; Pennypacker, Barbara; Onofre, Bonnie; Stanfield, Pamela; Yaeger, Lynne; Stapleton, Dwight; Esrig, Barry C

2012-12-01

Hybrid coronary revascularization, which involves minimally invasive direct coronary artery bypass surgery using the left internal mammary artery to left anterior descending and percutaneous coronary intervention using drug-eluting stents for the remaining diseased coronary vessels, is an innovative approach to decrease the morbidity of conventional surgery. Little information is available to guide hospital managers and physician leaders in implementing a hybrid revascularization program. In this article, we describe the people-process-technology issues that managers and leaders are likely to encounter as they develop a hybrid revascularization program in their practice. ©2012, Wiley Periodicals, Inc.

Delivery of Clinical Preventive Services in Family Medicine Offices

PubMed Central

Crabtree, Benjamin F.; Miller, William L.; Tallia, Alfred F.; Cohen, Deborah J.; DiCicco-Bloom, Barbara; McIlvain, Helen E.; Aita, Virginia A.; Scott, John G.; Gregory, Patrice B.; Stange, Kurt C.; McDaniel, Reuben R.

2005-01-01

BACKGROUND This study aimed to elucidate how clinical preventive services are delivered in family practices and how this information might inform improvement efforts. METHODS We used a comparative case study design to observe clinical preventive service delivery in 18 purposefully selected Midwestern family medicine offices from 1997 to 1999. Medical records, observation of outpatient encounters, and patient exit cards were used to calculate practice-level rates of delivery of clinical preventive services. Field notes from direct observation of clinical encounters and prolonged observation of the practice and transcripts from in-depth interviews of practice staff and physicians were systematically examined to identify approaches to delivering clinical preventive services recommended by the US Preventive Services Task Force. RESULTS Practices developed individualized approaches for delivering clinical preventive services, with no one approach being successful across practices. Clinicians acknowledged a 3-fold mission of providing acute care, managing chronic problems, and prevention, but only some made prevention a priority. The clinical encounter was a central focus for preventive service delivery in all practices. Preventive services delivery rates often appeared to be influenced by competing demands within the clinical encounter (including between different preventive services), having a physician champion who prioritized prevention, and economic concerns. CONCLUSIONS Practice quality improvement efforts that assume there is an optimal approach for delivering clinical preventive services fail to account for practices’ propensity to optimize care processes to meet local contexts. Interventions to enhance clinical preventive service delivery should be tailored to meet the local needs of practices and their patient populations. PMID:16189059

The Third National Telemedicine & Telehealth Service Provider Showcase Conference: Advancing Telehealth Partnerships.

PubMed

Alverson, Dale C; Krupinski, Elizabeth A; Erps, Kristine A; Rowe, Nancy S; Weinstein, Ronald S

2018-05-31

As telemedicine and telehealth services are experiencing increasing rates of adoption, industry leaders and healthcare service providers are becoming increasingly focused on human resource issues encountered in the delivery of a broad range of telehealth services. To create a forum for the discussion of many interrelated elements of telehealth service industry, a national conference entitled "Telemedicine & Telehealth Service Provider Showcase" (SPS) Conference was established in 2014, and repeated in 2016 and 2017, in Arizona. These SPS Conferences include thought leaders, telehealth service providers, government administrators, and academicians from leading programs addressing service provider workforce issues. This report summarizes the content of SPS 2017 conference, held in Phoenix, AZ, October 2-3, 2017. The topics covered at SPS 2017 include using telehealth services as a strategic asset; development of appropriate effective partnerships; direct-to-consumer initiatives; important reimbursement, legislative, and regulatory issues (i.e., Centers for Medicare & Medicaid Services [CMS] approaches, financial models, and return on investment [ROI]); marketing; evaluation and applied metrics; remote monitoring and sensors; integration with electronic health records; and overall lessons learned. The content of SPS 2017 is summarized in the body of this report. The SPS 2017 program evaluators included attendees, speakers, and exhibitors. The knowledge attendees gained at SPS 2017 was characterized, by all three groups, as forward-looking and practical. SPS 2017 succeeded in identifying, and focusing on, solutions for issues, challenges, and barriers impacting the rapidly expanding telehealth service segment of the healthcare industry. The growing interest in this annual SPS Conference series apparently reflects, in part, the program committee's successes in identifying practical issues and their potential solutions.

Challenging Operations: An Ethical Framework to Assist Humanitarian Aid Workers in their Decision-making Processes.

PubMed

Clarinval, Caroline; Biller-Andorno, Nikola

2014-06-23

This paper aims to raise awareness regarding ethical issues in the context of humanitarian action, and to offer a framework for systematically and effectively addressing such issues. Several cases highlight ethical issues that humanitarian aid workers are confronted with at different levels over the course of their deployments. The first case discusses a situation at a macro-level concerning decisions being made at the headquarters of a humanitarian organization. The second case looks at meso-level issues that need to be solved at a country or regional level. The third case proposes an ethical dilemma at the micro-level of the individual patient-provider relationship. These real-life cases have been selected to illustrate the ethical dimension of conflicts within the context of humanitarian action that might remain unrecognized in everyday practice. In addition, we propose an ethical framework to assist humanitarian aid workers in their decision-making process. The framework draws on the principles and values that guide humanitarian action and public health ethics more generally. Beyond identifying substantive core values, the framework also includes a ten-step process modelled on tools used in the clinical setting that promotes a transparent and clear decision-making process and improves the monitoring and evaluation of aid interventions. Finally, we recommend organizational measures to implement the framework effectively. This paper uses a combination of public health/clinical ethics concepts and practices and applies them to the decision-making challenges encountered in relief operations in the humanitarian aid context.

Ethical Issues in Integrated Health Care: Implications for Social Workers.

PubMed

Reamer, Frederic G

2018-05-01

Integrated health care has come of age. What began modestly in the 1930s has evolved into a mature model of health care that is quickly becoming the standard of care. Social workers are now employed in a wide range of comprehensive integrated health care organizations. Some of these settings were designed as integrated health care delivery systems from their beginning. Others evolved over time, some incorporating behavioral health into existing primary care centers and others incorporating primary care into existing behavioral health agencies. In all of these contexts, social workers are encountering complex, sometimes unprecedented, ethical challenges. This article identifies and discusses ethical issues facing social workers in integrated health care settings, especially related to informed consent, privacy, confidentiality, boundaries, dual relationships, and conflicts of interest. The author includes practical resources that social workers can use to develop state-of-the-art ethics policies and protocols.

Video Analysis and Remote Digital Ethnography: Approaches to understanding user perspectives and processes involving healthcare information technology.

PubMed

Kushniruk, Andre W; Borycki, Elizabeth M

2015-01-01

Innovations in healthcare information systems promise to revolutionize and streamline healthcare processes worldwide. However, the complexity of these systems and the need to better understand issues related to human-computer interaction have slowed progress in this area. In this chapter the authors describe their work in using methods adapted from usability engineering, video ethnography and analysis of digital log files for improving our understanding of complex real-world healthcare interactions between humans and technology. The approaches taken are cost-effective and practical and can provide detailed ethnographic data on issues health professionals and consumers encounter while using systems as well as potential safety problems. The work is important in that it can be used in techno-anthropology to characterize complex user interactions with technologies and also to provide feedback into redesign and optimization of improved healthcare information systems.

Recommendations for toxicological investigation of drug-impaired driving and motor vehicle fatalities.

PubMed

Logan, Barry K; Lowrie, Kayla J; Turri, Jennifer L; Yeakel, Jillian K; Limoges, Jennifer F; Miles, Amy K; Scarneo, Colleen E; Kerrigan, Sarah; Farrell, Laurel J

2013-10-01

This report describes the review and update of a set of minimum recommendations for the toxicological investigation of suspected alcohol and drug-impaired driving cases and motor vehicle fatalities involving drugs or alcohol. The recommendations have the goal of ensuring that a consistent set of data regarding the most frequently encountered drugs linked to driving impairment is collected for practical application in the investigation of these cases and to allow epidemiological monitoring and the development of evidence-based public policy on this important public safety issue. The recommendations are based on a survey of practices in US laboratories performing this kind of analysis, consideration of existing epidemiological crash and arrest data and practical considerations of widely available technology platforms in laboratories performing this work. The final recommendations were derived from a consensus meeting of experts recruited from survey respondents and the membership of the National Safety Council's Alcohol, Drug and Impairment Division (formerly known as the Committee on Alcohol and Other Drugs, CAOD).

Professional issues related to obstacles to midwifery practice in the Americas: a pilot survey.

PubMed

McCool, William; Guidera, Mamie; Reale, Barbara; Smith, Andrea; Koucoi, Jaclyn

2013-08-01

the WHO (2011) estimates that 350,000 newly trained midwives are needed internationally to meet Goal 5-- Improve Maternal Health--of the 8 Millennium Development Goals established by the United Nations in 2000. Recognizing the challenges in accomplishing this goal, it is also imperative to retain trained midwives in the profession. Little to date has been investigated regarding the factors that lead to experienced midwives leaving the profession prematurely, particularly in low resource countries. in an effort to initiate identification of barriers that limit midwives' ability to continue in practice, a pilot study was conducted with a convenience sample of 58 midwife attendees, representing 12 countries, at the International Confederation of Midwives - Americas Triennial Regional Meeting in 2010. A survey was distributed to midwife respondents to explore potential influences on work retention, including: encounters of adverse outcomes in practice; empowerment to make change in the work setting; and migration. sixty per cent of respondents reported encountering a maternal or newborn death or injury, and 10% had considered leaving the profession. Over 50% of the midwives listed three potential results that could occur after experiencing an adverse outcome in practice. These included: (a) an investigation by a governmental agency; (b) complaints about the midwife via available media; and (c) involvement in a lawsuit. The consequence most frequently cited for not enacting evidence-based changes in the workplace was resistance from obstetrical colleagues. while there are limitations to gathering data from attendees at a professional meeting, this is the first known international survey of midwives regarding factors that may contribute to their leaving the profession at a time when there is an increasing global awareness of the need for a skilled birth attendant at every birth. Copyright © 2012 Elsevier Ltd. All rights reserved.

Primary care access for mental illness in Australia: Patterns of access to general practice from 2006 to 2016.

PubMed

Farrer, Louise M; Walker, Jennie; Harrison, Christopher; Banfield, Michelle

2018-01-01

General practice has an important role within the Australian healthcare system to provide access to care and effective management of chronic health conditions. However, people with serious mental illness experience challenges associated with service access. The current paper seeks to examine drivers of access to general practice for people with common and serious mental disorders, compared with people who access care for type II diabetes, a common physical health problem managed in general practice. The Bettering the Evaluation and Care of Health (BEACH) programme provides the most comprehensive and objective measurement of general practitioner activity in Australia. Using BEACH data, this study compared general practice encounters for depression, anxiety, bipolar disorder, schizophrenia, and type II diabetes during a 10-year period between 2006 and 2016. Analysis revealed more frequent encounters for depression compared to anxiety, and a higher representation of women in encounters for bipolar disorder compared to men. The relationship between number of encounters and patient age was strongly associated with the life course and mortality characteristics associated with each disorder. The findings highlight specific challenges associated with access to primary care for people with serious mental illness, and suggest areas of focus to improve the ability of these patients to access and navigate the health system.

Emergency mental health nursing for self-harming refugees and asylum seekers.

PubMed

Procter, Nicholas G

2005-09-01

This article describes the structure and function of emergency mental health nursing practice for self-harming refugees and asylum seekers on Temporary Protection Visas. Emergency nurses working in accident and emergency departments or as part of crisis intervention teams will see self-harming refugees and asylum seekers at the very point of their distress. This clinical paper is intended to support nurses in their practice should they encounter an adult asylum seeker needing emergency mental health care. Practical strategies are highlighted to help mental health nurses assess, care, and comfort refugees and asylum seekers in this predicament. Mental health nurses should, where possible, work closely with asylum seekers, their support workers, and accredited interpreters and translators to ensure the appropriate use of language when dealing with mental and emotional health issues without further isolating the asylum seeker from appropriate services. To help strengthen continuity and integration of mental health supports for refugees and asylum seekers, well-resourced care must be experienced as coherent and connected. A coherent, interdisciplinary and team-orientated approach will synthesize different viewpoints to shape clinical practice and create workable solutions in local situations.

Empathy in general practice-the gap between wishes and reality: comparing the views of patients and physicians.

PubMed

Derksen, F A W M; Olde Hartman, Tim; Bensing, Jozien; Lagro-Janssen, Antoine

2018-03-27

Empathy is regarded by patients and general practitioners (GPs) as fundamental in patient-GP communication. Patients do not always experience empathy and GPs encounter circumstances which hamper applying it. To explore why receiving and offering empathy during the encounter in general practice does not always meet the wishes of both patients and GPs. A qualitative research method, based on focus group interviews with patients and in-depth interviews with GPs, was carried out. Within the research process, iterative data collection and analysis were applied. Both patients and GPs perceive a gap between what they wish for with regard to empathy, and what they actually encounter in general practice. Patients report on circumstances which hamper receiving empathy and GPs on circumstances offering it. Various obstacles were mentioned: (i) circumstances related to practice organization, (ii) circumstances related to patient-GP communication or connectedness, (iii) differences between the patient's and the GP's expectations, (iv) time pressure and its causes and (v) the GP's individual capability to offer empathy. When patients do not receive empathy from their GP or practice staff, they feel frustrated. This causes a gap between their expectations on the one hand and their actual experiences on the other. GPs generally want to incorporate empathy; the GP's private, professional and psychological well-being appears to be an important contributing factor in practicing empathy in daily practice. But they encounter various obstacles to offer this. It is up to GPs to take responsibility for showing practice members the importance of an appropriate empathical behaviour towards patients.

Ability of Social Work Students to Determine the Appropriateness of Solutions to Problems Encountered in Social Work Practice.

ERIC Educational Resources Information Center

Sturges, Jack; Yarbrough, Roy D.

The purpose of this study was to determine whether there was an association between the amount of formal social work education completed and ability of students to judge the degree of appropriateness of proposed solutions to problems frequently encountered in social work practice, and secondarily to determine whether students' judgments of problem…

Mothers' Perceptions of Citizenship, Practices for Developing Citizenship Conscience of Their Children and Problems They Encountered

ERIC Educational Resources Information Center

Ersoy, A. Figen

2012-01-01

Family plays an important role in the development of citizenship awareness of children. The purpose of the present study is to figure out the citizenship perceptions of mothers, their practices for developing citizenship conscience of their children and to explore the problems they have encountered. In this study, critical case sampling method has…

Moving Beyond the Theoretical: Medical Students' Desire for Practical, Role-Specific Ethics Training.

PubMed

Stites, Shana D; Clapp, Justin; Gallagher, Stefanie; Fiester, Autumn

2018-05-04

Background It has been widely reported that medical trainees experience situations with profound ethical implications during their clinical rotations. To address this most U.S. medical schools include ethics curricula in their undergraduate programs. However, the content of these curricula vary substantially. Our pilot study aimed to discover, from the students' perspective, how ethics pedagogy prepares medical students for clerkship and what gaps might remain. This qualitative study organized focus groups of third- and fourth-year medical students. Participants recounted ethical concerns encountered during clerkship rotations and reflected on how their medical school ethics curriculum informed their responses to these scenarios. Transcripts of the focus group sessions were analyzed using a grounded theory approach to identify common themes that characterized the students' experiences. While students' accounts demonstrated a solid grasp of ethical theory and attunement to ethical concerns presented in the clinic, they also consistently evinced an inability to act on these issues given clerks' particular position in a complex learning hierarchy. Students felt they received too little training in the role-specific application of medical ethics as clinical trainees. We found a desire among trainees for enhanced practical ethics training in preparation for the clerkship phase of medical education. We recommend several strategies that can begin to address these findings. The use of roleplaying with standardized patients can enable students to practice engagement with ethical issues. Conventional ethics courses can focus more on action-based pedagogy and instruction in conflict management techniques. Finally, clear structures for reporting and seeking advice and support for addressing ethical issues can lessen students' apprehension to act on ethical concerns.

“Being Flexible and Creative”: A Qualitative Study on Maternity Care Assistants' Experiences with Non-Western Immigrant Women

PubMed Central

Boerleider, Agatha W.; Francke, Anneke L.; van de Reep, Merle; Manniën, Judith; Wiegers, Therese A.; Devillé, Walter L. J. M.

2014-01-01

Background Several studies conducted in developed countries have explored postnatal care professionals' experiences with non-western women. These studies reported different cultural practices, lack of knowledge of the maternity care system, communication difficulties, and the important role of the baby's grandmother as care-giver in the postnatal period. However, not much attention has been paid in existing literature to postnatal care professionals' approaches to these issues. Our main objective was to gain insight into how Dutch postnatal care providers - ‘maternity care assistants’ (MCA) - address issues encountered when providing care for non-western women. Methods A generic qualitative research approach was used. Two researchers interviewed fifteen MCAs individually, analysing the interview material separately and then comparing and discussing their results. Analytical codes were organised into main themes and subthemes. Results MCAs perceive caring for non-western women as interesting and challenging, but sometimes difficult too. To guarantee the health and safety of mother and baby, they have adopted flexible and creative approaches to address issues concerning traditional practices, socioeconomic status and communication. Furthermore, they employ several other strategies to establish relationships with non-western clients and their families, improve women's knowledge of the maternity care system and give health education. Conclusion Provision of postnatal care to non-western clients may require special skills and measures. The quality of care for non-western clients might be improved by including these skills in education and retraining programmes for postnatal care providers on top of factual knowledge about traditional practices. PMID:24622576

Developing prehospital clinical practice guidelines for resource limited settings: why re-invent the wheel?

PubMed

McCaul, Michael; de Waal, Ben; Hodkinson, Peter; Pigoga, Jennifer L; Young, Taryn; Wallis, Lee A

2018-02-05

Methods on developing new (de novo) clinical practice guidelines (CPGs) have received substantial attention. However, the volume of literature is not matched by research into alternative methods of CPG development using existing CPG documents-a specific issue for guideline development groups in low- and middle-income countries. We report on how we developed a context specific prehospital CPG using an alternative guideline development method. Difficulties experienced and lessons learnt in applying existing global guidelines' recommendations to a national context are highlighted. The project produced the first emergency care CPG for prehospital providers in Africa. It included > 270 CPGs and produced over 1000 recommendations for prehospital emergency care. We encountered various difficulties, including (1) applicability issues: few pre-hospital CPGs applicable to Africa, (2) evidence synthesis: heterogeneous levels of evidence classifications and (3) guideline quality. Learning points included (1) focusing on key CPGs and evidence mapping, (2) searching other resources for CPGs, (3) broad representation on CPG advisory boards and (4) transparency and knowledge translation. Re-inventing the wheel to produce CPGs is not always feasible. We hope this paper will encourage further projects to use existing CPGs in developing guidance to improve patient care in resource-limited settings.

The charismatic journey of mastery learning.

PubMed

Inui, Thomas S

2015-11-01

A collection of articles in this issue examine the concept of mastery learning, underscoring that our journey is from a 19th-century construct for assuring skill development (i.e., completing a schedule of rotations driven by the calendar) to a 21st-century sequence of learning opportunities focused on acquiring mastery of special key competencies within clerkships or other activities. Mastery learning processes and standards have the potential to clarify learning goals and competency measurement issues in medical education. Although mastery learning methods originally focused on developing learners' competency with skillful procedures, the author of this Commentary posits that mastery learning methods may be usefully applied more extensively to broader domains of skillful practice, especially those practices that can be linked to outcomes of care. The transition to mastery-focused criteria for educational advancement is laudatory, but challenges will be encountered in the journey to mastery education. The author examines several of these potential challenges, including expansion of mastery learning approaches to effective but relational clinician advice-giving and counseling behaviors, developing criteria for choosing critical competencies that can be linked to outcomes, avoiding a excessively fragmented approach to mastery measurement, and dealing with "educational comorbidity."

Everyday ethics in internal medicine resident clinic: an opportunity to teach.

PubMed

Carrese, Joseph A; McDonald, Erin L; Moon, Margaret; Taylor, Holly A; Khaira, Kiran; Catherine Beach, Mary; Hughes, Mark T

2011-07-01

Being a good doctor requires competency in ethics. Accordingly, ethics education during residency training is important. We studied the everyday ethics-related issues (i.e. ordinary ethics issues commonly faced) that internal medical residents encounter in their out-patient clinic and determined whether teaching about these issues occurred during faculty preceptor-resident interactions. This study involved a multi-method qualitative research design combining observation of preceptor-resident discussions with preceptor interviews. The study was conducted in two different internal medicine training programme clinics over a 2-week period in June 2007. Fifty-three residents and 19 preceptors were observed, and 10 preceptors were interviewed. Transcripts of observer field notes and faculty interviews were carefully analysed. The analysis identified several themes of everyday ethics issues and determined whether preceptors identified and taught about these issues. Everyday ethics content was considered present in 109 (81%) of the 135 observed case presentations. Three major thematic domains and associated sub-themes related to everyday ethics issues were identified, concerning: (i) the Doctor-Patient Interaction (relationships; communication; shared decision making); (ii) the Resident as Learner (developmental issues; challenges and conflicts associated with training; relationships with colleagues and mentors; interactions with the preceptor), and; (iii) the Doctor-System Interaction (financial issues; doctor-system issues; external influences; doctor frustration related to system issues). Everyday ethics issues were explicitly identified by preceptors (without teaching) in 18 of 109 cases (17%); explicit identification and teaching occurred in only 13 cases (12%). In this study a variety of everyday ethics issues were frequently encountered as residents cared for patients. Yet, faculty preceptors infrequently explicitly identified or taught these issues during their interactions with residents. Ethics education is important and residents may regard teaching about the ethics-related issues they actually encounter to be highly relevant. A better understanding of the barriers to teaching is needed in order to promote education about everyday ethics in the out-patient setting. © Blackwell Publishing Ltd 2011.

Everyday ethics in internal medicine resident clinic: an opportunity to teach

PubMed Central

Carrese, Joseph A; McDonald, Erin L; Moon, Margaret; Taylor, Holly A; Khaira, Kiran; Beach, Mary Catherine; Hughes, Mark T

2011-01-01

OBJECTIVES Being a good doctor requires competency in ethics. Accordingly, ethics education during residency training is important. We studied the everyday ethics-related issues (i.e. ordinary ethics issues commonly faced) that internal medical residents encounter in their out-patient clinic and determined whether teaching about these issues occurred during faculty preceptor–resident interactions. METHODS This study involved a multi-method qualitative research design combining observation of preceptor-resident discussions with preceptor interviews. The study was conducted in two different internal medicine training programme clinics over a 2-week period in June 2007. Fifty-three residents and 19 preceptors were observed, and 10 preceptors were interviewed. Transcripts of observer field notes and faculty interviews were carefully analysed. The analysis identified several themes of everyday ethics issues and determined whether preceptors identified and taught about these issues. RESULTS Everyday ethics content was considered present in 109 (81%) of the 135 observed case presentations. Three major thematic domains and associated sub-themes related to everyday ethics issues were identified, concerning: (i) the Doctor–Patient Interaction (relationships; communication; shared decision making); (ii) the Resident as Learner (developmental issues; challenges and conflicts associated with training; relationships with colleagues and mentors; interactions with the preceptor), and; (iii) the Doctor–System Interaction (financial issues; doctor–system issues; external influences; doctor frustration related to system issues). Everyday ethics issues were explicitly identified by preceptors (without teaching) in 18 of 109 cases (17%); explicit identification and teaching occurred in only 13 cases (12%). CONCLUSIONS In this study a variety of everyday ethics issues were frequently encountered as residents cared for patients. Yet, faculty preceptors infrequently explicitly identified or taught these issues during their interactions with residents. Ethics education is important and residents may regard teaching about the ethics-related issues they actually encounter to be highly relevant. A better understanding of the barriers to teaching is needed in order to promote education about everyday ethics in the out-patient setting. PMID:21649704

Knowledge management and informatics considerations for comparative effectiveness research: a case-driven exploration.

PubMed

Embi, Peter J; Hebert, Courtney; Gordillo, Gayle; Kelleher, Kelly; Payne, Philip R O

2013-08-01

As clinical data are increasingly collected and stored electronically, their potential use for comparative effectiveness research (CER) grows. Despite this promise, challenges face those wishing to leverage such data. In this paper we aim to enumerate some of the knowledge management and informatics issues common to such data reuse. After reviewing the current state of knowledge regarding biomedical informatics challenges and best practices related to CER, we then present 2 research projects at our institution. We analyze these and highlight several common themes and challenges related to the conduct of CER studies. Finally, we represent these emergent themes. The informatics challenges commonly encountered by those conducting CER studies include issues related to data information and knowledge management (eg, data reuse, data preparation) as well as those related to people and organizational issues (eg, sociotechnical factors and organizational factors). Examples of these are described in further detail and a formal framework for describing these findings is presented. Significant challenges face researchers attempting to use often diverse and heterogeneous datasets for CER. These challenges must be understood in order to be dealt with successfully and can often be overcome with the appropriate use of informatics best practices. Many research and policy questions remain to be answered in order to realize the full potential of the increasingly electronic clinical data available for such research.

Challenges in conducting qualitative research in health: A conceptual paper

PubMed Central

Khankeh, Hamidreza; Ranjbar, Maryam; Khorasani-Zavareh, Davoud; Zargham-Boroujeni, Ali; Johansson, Eva

2015-01-01

Background: Qualitative research focuses on social world and provides the tools to study health phenomena from the perspective of those experiencing them. Identifying the problem, forming the question, and selecting an appropriate methodology and design are some of the initial challenges that researchers encounter in the early stages of any research project. These problems are particularly common for novices. Materials and Methods: This article describes the practical challenges of using qualitative inquiry in the field of health and the challenges of performing an interpretive research based on professional experience as a qualitative researcher and on available literature. Results: One of the main topics discussed is the nature of qualitative research, its inherent challenges, and how to overcome them. Some of those highlighted here include: identification of the research problem, formation of the research question/aim, and selecting an appropriate methodology and research design, which are the main concerns of qualitative researchers and need to be handled properly. Insights from real-life experiences in conducting qualitative research in health reveal these issues. Conclusions: The paper provides personal comments on the experiences of a researcher in conducting pure qualitative research in the field of health. It offers insights into the practical difficulties encountered when performing qualitative studies and offers solutions and alternatives applied by these authors, which may be of use to others. PMID:26793245

Understanding patients in multicultural settings: a personal reflection on ethnicity and culture in clinical practice.

PubMed

Hickling, Frederick W

2012-01-01

To identify and discourse on the complexities of ethnicity and culture, their role in the social and psychological functioning of patients and their potential impact on clinical assessment and treatment of these patients in diverse cultural contexts. Description of aspects of the cultural competence required by clinicians in mental health service provisions in therapeutic interactions involving the therapist and patient and also in the encounter between practitioners. The four-decade clinical experience of the author, an African Jamaican psychiatrist, encompasses clinical experience in the Caribbean, North America, Europe and New Zealand. From this wealth of multicultural clinical practice the author uses personal examples of four experiences with patients and professionals of African Caribbean, British and Maori ethnicities to discuss issues of ethnicity, ethnic identity and stereotyping, culture, cultural competency and alterity in the exchanges between the therapist and patient, and between therapists and the difficulties encountered in effective assessment and treatment of patients in multicultural settings. The author highlights the importance of historical experience in the psychological constitution of patients, which is the basis of a novel analytic model called psychohistoriography. This insight-oriented individual or group-focused intervention was created with the intention of attempting to heal the wounds of history; an aim that is absent from existing psychoanalytic treatment modalities. Psychohistoriography may be a viable therapeutic option in the negotiation of cross-cultural clinical interactions.

A novel critical skills curriculum for surgical interns incorporating simulation training improves readiness for acute inpatient care.

PubMed

Antonoff, Mara B; Shelstad, Ryan C; Schmitz, Connie; Chipman, Jeffrey; D'Cunha, Jonathan

2009-01-01

Surgical interns encounter complex, acute care situations often managed with limited supervision. Furthermore, medical school training does not adequately prepare students for special surgical considerations. Using simulation training, we implemented a course aimed at improving surgical intern readiness for responding to unique, life-threatening issues encountered in daily surgical care. Twenty University of Minnesota surgical interns participated in the 3-week course. The first session consisted of interactive didactics and simulation covering hypoxia, shock, and metabolic disturbances; the second session addressed cardiopulmonary emergencies, including ventricular assist device and pacemaker use. Electronic simulation scenarios comprised the third session, allowing learners to demonstrate learned/practiced skills. The outcomes were assessed objectively (pretest and posttest) and subjectively (standardized feedback evaluations). Fifteen learners completed the pretest and posttest. The mean absolute score increase was 14% with average relative score improvement of 43%. Twenty learners completed feedback evaluations using a standard 5-point Likert scale. Respondents scored the first 2 sessions on topic importance (5 = very important), giving the first session 4.90 (+/- 0.31) and the second session 4.45 (+/- 0.89). Respondents ranked their confidence in executing practiced skills on actual patients (5 = very confident) as 4.24 (+/- 0.71). There was uniform support for the value of the electronic simulation scenarios as enhanced learning tools. We developed a course for surgical interns incorporating didactics and simulation. Learners demonstrated objective improvement in testing and reported that the course topics were highly important. After course completion, learners provided feedback indicating a high level of confidence in executing practiced skills, suggesting improved preparation for acute surgical care.

Meso and micro level workforce challenges in psychiatric rehabilitation.

PubMed

Reifels, Lennart; Pirkis, Jane

2012-01-01

Results of an exploratory study are presented which examined workforce challenges in Australia's most established psychiatric rehabilitation sector. The study had the two-fold aim of investigating workforce challenges at an organizational ("meso") level and at the level of direct-service workers' daily practice ("micro"). Data from 23 key informant interviews conducted with service managers and long-serving staff were analyzed through basic descriptive and thematic analyses. Organizations faced significant annual staff turnover (25.6%), specific staff supply shortages, and challenges in recruiting staff with adequate experience and longevity to match the complexity of client issues. Workers equally encountered challenges in this increasingly complex and rapidly changing field of work. CONCLUSIONS & IMPLICATIONS FOR PRACTICE: Workforce strategies designed to attract/retain experienced staff can improve workforce cohesiveness and sustainability, as can training and support activities aimed at equipping staff to reflect on and operate in dynamic and changing work environments.

A clinician's understanding of ethics in palliative care: an American perspective.

PubMed

Cimino, James E

2003-04-01

I believe the standard for making ethical decisions should be the same for all patients: appropriate medical interventions, carefully weighing their benefits and burdens, and trying to honor the wishes of the patients. When cure is not possible, the balance between benefits and burdens should shift to greater consideration of the burden side of the equation. The ascendancy of autonomy over other medical ethical principles is the center for most of the ethical dilemmas encountered in palliative care. This paper discusses the issues of autonomy, informed consent, patient capacity, advance directives, futility, "do-not-resuscitate" orders, withholding or withdrawing interventions, euthanasia, and sedation therapy. After 41 years of my personally caring for over 4000 terminally ill patients, primarily at Calvary Hospital, the most practical approach has been to establish trust with patients and families, determining their goals, and diligently applying the principles of beneficence (benefits) and nonmaleficence (burdens) in everyday practice.

Towards agreement on best practice for publishing raw clinical trial data.

PubMed

Hrynaszkiewicz, Iain; Altman, Douglas G

2009-03-18

Many research-funding agencies now require open access to the results of research they have funded, and some also require that researchers make available the raw data generated from that research. Similarly, the journal Trials aims to address inadequate reporting in randomised controlled trials, and in order to fulfil this objective, the journal is working with the scientific and publishing communities to try to establish best practice for publishing raw data from clinical trials in peer-reviewed biomedical journals. Common issues encountered when considering raw data for publication include patient privacy - unless explicit consent for publication is obtained - and ownership, but agreed-upon policies for tackling these concerns do not appear to be addressed in the guidance or mandates currently established. Potential next steps for journal editors and publishers, ethics committees, research-funding agencies, and researchers are proposed, and alternatives to journal publication, such as restricted access repositories, are outlined.

Documenting the doable and doing the documented: bridging strategies at the UK Stem Cell Bank.

PubMed

Stephens, Neil; Atkinson, Paul; Glasner, Peter

2011-12-01

We explore the local negotiation of regulatory practice at the UK Stem Cell Bank, the first Bank of its type in the world. Basing our empirical work on a detailed analysis of one aspect of the Bank's regulatory commitment--the completion of the Cell Line Information form--we make visible the necessary judgements and labour involved in interpreting and operationalizing externally imposed regulation. The discussion opens by detailing the problems encountered when the Bank completes the form: reconciling a bureaucratic system of accountability with craft-like laboratory skills involving multiple kinds of tacit knowledge. We follow this by explicating the emergent 'bridging strategies' pursued by the Bank to address these issues, highlighting their reliance upon the formation of trust and social networks. The closing discussion emphasizes the contingent assembly of regulatory practices that emerge in the local setting.

Baccalaureate Minority Nursing Students Perceived Barriers and Facilitators to Clinical Education Practices: An Integrative Review.

PubMed

Graham, Crystal L; Phillips, Shannon M; Newman, Susan D; Atz, Teresa W

2016-01-01

This integrative review synthesized baccalaureate minority nursing students' perceptions of their clinical experiences. The diversity of the nursing workforce does not mirror the United States population. Attrition rates of minority nursing students remain higher than rates for White students. Literature examining facilitators and barriers to minority student success predominantly focuses on academic factors, excluding those relevant to clinical education. An integrative review using literature from nursing and education. Three common perceived barriers were identified: discrimination from faculty, peers, nursing staff, and patients; bias in faculty grading practices; and isolation. Although little is known about the relationship between clinical failures and overall attrition, this review provides evidence that minority students encounter significant barriers in clinical education. To increase the diversity of the nursing workforce, faculty must address these issues and make modifications to ensure an equal opportunity at a quality education for all students.

[The scope of forensic psychiatry: ethical responsibilities and conflicts of values].

PubMed

Arboleda-Flórez, Julio; Weisstub, David N

2006-01-01

To write about ethics in specialties that straddle the lines of multiple systems cannot be done without discussing values and decisional rules that underlie each one of those systems. By virtue of its multiple associations, forensic psychiatry is an archetype of such specialties ; it works within a set of values that might be viewed as antithetical, even irreconcilable, with other aspects of psychiatry. The extensive scope of action of forensic psychiatry compels its practitioners to hold alternate world views and to apply decisional rules that may clash with the classical values and ethical considerations of medicine (Weisstub, 1980). In this article, following an historical précis, the authors review the scope of action of forensic psychiatry as the basis for the definition of this subspecialty. The concepts, themes and controversies pertaining to the ethical practice of this specialty will be reflected upon in the light of issues encountered in actual practice.

Aspects of sleep disorders in children and adolescents

PubMed Central

Stores, Gregory

2009-01-01

Sleep disorders in children and adolescents is a topic that has been, and remains, neglected in both public health education and professional training. Although much knowledge has been accumulated in recent times, it has been poorly disseminated and, therefore, relatively little is put into practice. Only some general issues can be discussed in this article. The aspects chosen relate mainly to clinical practice, but they also have relevance for research. They concern various differences between sleep disorders in children and those in adults, the occurrence of such disorders in young people, their effects on psychological and physical development, the essential (but often ignored) distinction between sleep problems and their underlying causes (ie, sleep disorders), types of sleep disturbance encountered at different ages during development, and the differential diagnosis of certain parasomnias that are at particular risk of being confused with each other. PMID:19432390

A Protocol for Collecting Human Cardiac Tissue for Research.

PubMed

Blair, Cheavar A; Haynes, Premi; Campbell, Stuart G; Chung, Charles; Mitov, Mihail I; Dennis, Donna; Bonnell, Mark R; Hoopes, Charles W; Guglin, Maya; Campbell, Kenneth S

2016-01-01

This manuscript describes a protocol at the University of Kentucky that allows a translational research team to collect human myocardium that can be used for biological research. We have gained a great deal of practical experience since we started this protocol in 2008, and we hope that other groups might be able to learn from our endeavors. To date, we have procured ~4000 samples from ~230 patients. The tissue that we collect comes from organ donors and from patients who are receiving a heart transplant or a ventricular assist device because they have heart failure. We begin our manuscript by describing the importance of human samples in cardiac research. Subsequently, we describe the process for obtaining consent from patients, the cost of running the protocol, and some of the issues and practical difficulties that we have encountered. We conclude with some suggestions for other researchers who may be considering starting a similar protocol.

A Protocol for Collecting Human Cardiac Tissue for Research

PubMed Central

Blair, Cheavar A.; Haynes, Premi; Campbell, Stuart G.; Chung, Charles; Mitov, Mihail I.; Dennis, Donna; Bonnell, Mark R.; Hoopes, Charles W.; Guglin, Maya; Campbell, Kenneth S.

2016-01-01

This manuscript describes a protocol at the University of Kentucky that allows a translational research team to collect human myocardium that can be used for biological research. We have gained a great deal of practical experience since we started this protocol in 2008, and we hope that other groups might be able to learn from our endeavors. To date, we have procured ~4000 samples from ~230 patients. The tissue that we collect comes from organ donors and from patients who are receiving a heart transplant or a ventricular assist device because they have heart failure. We begin our manuscript by describing the importance of human samples in cardiac research. Subsequently, we describe the process for obtaining consent from patients, the cost of running the protocol, and some of the issues and practical difficulties that we have encountered. We conclude with some suggestions for other researchers who may be considering starting a similar protocol. PMID:28042604

Practical Tips for Working as an Expedition Doctor on High-Altitude Expeditions.

PubMed

Brants, Anne; Metcalfe, Tracee

2017-09-01

Brants, Anne, and Tracee Metcalfe. Practical tips for working as an expedition doctor on high-altitude expeditions. High Alt Med Biol. 18:193-198, 2017.-With the explosion of adventure travel over the past decade, there has been a concurrent increase in mountaineering expeditions to extreme elevations, including many of the 8000-m peaks. This trend has created an increased demand for qualified expedition doctors to provide specialized medical advice and care to climbers and expedition staff. This review is intended to help physicians prepare for work on such expeditions. The authors rely heavily on their own experience and discuss the types of work available on high-altitude expeditions; how to identify a safe and reputable guiding company; personal and medical preparation; priorities in selecting or building an appropriate medical kit; and medical conditions commonly encountered on expeditions. The review concludes by considering ethical dilemmas and other difficult issues unique to this work.

Cyber security: a critical examination of information sharing versus data sensitivity issues for organisations at risk of cyber attack.

PubMed

Mallinder, Jason; Drabwell, Peter

Cyber threats are growing and evolving at an unprecedented rate.Consequently, it is becoming vitally important that organisations share information internally and externally before, during and after incidents they encounter so that lessons can be learned, good practice identified and new cyber resilience capabilities developed. Many organisations are reluctant to share such information for fear of divulging sensitive information or because it may be vague or incomplete. This provides organisations with a complex dilemma: how to share information as openly as possibly about cyber incidents, while protecting their confidentiality and focusing on service recovery from such incidents. This paper explores the dilemma of information sharing versus sensitivity and provides a practical overview of considerations every business continuity plan should address to plan effectively for information sharing in the event of a cyber incident.

Barriers to diagnosing and managing hypertension - a qualitative study in Australian general practice.

PubMed

Howes, Faline; Hansen, Emily; Williams, Danielle; Nelson, Mark

2010-07-01

Elevated blood pressure (BP) is a major modifiable risk factor. However hypertension still remains underdiagnosed, untreated or suboptimally treated. This study aimed to identify and explore barriers to initiating medication and treating elevated BP to target levels in the general practice setting. Six focus groups involving 30 clinicians were audio recorded, transcribed in full and analysed for common emerging themes using an iterative thematic analysis. After making the decision to commence treatment, medication initiation was relatively straightforward. Clinical uncertainty about true underlying BP, distrust of measurement technology, and distrust of the evidence underpinning hypertension management were expressed. Patient age, gender and comorbidity influenced treatment strategy. Related themes included perceived patient attitude, clinical inertia, and patient centred care. Systems issues included lack of resources and lack of time. The management of an asymptomatic chronic disease within a patient centred, encounter based primary care context can be challenging.

Determining the hydraulic properties of saturated, low-permeability geological materials in the laboratory: Advances in theory and practice

USGS Publications Warehouse

Zhang, M.; Takahashi, M.; Morin, R.H.; Endo, H.; Esaki, T.; ,

2002-01-01

The accurate hydraulic characterization of low-permeability subsurface environments has important practical significance. In order to examine this issue from the perspective of laboratory-based approaches, we review some recent advancements in the theoretical analyses of three different laboratory techniques specifically applied to low-permeability geologic materials: constant-head, constant flow-rate and transient-pulse permeability tests. Some potential strategies for effectively decreasing the time required to confidently estimate the permeability of these materials are presented. In addition, a new and versatile laboratory system is introduced that can implement any of these three test methods while simultaneously subjecting a specimen to high confining pressures and pore pressures, thereby simulating in situ conditions at great depths. The capabilities and advantages of this innovative system are demonstrated using experimental data derived from Shirahama sandstone and Inada granite, two rock types widely encountered in Japan.

Using Issues-Based Art Education to Facilitate Middle School Students' Learning in Racial Issues

ERIC Educational Resources Information Center

Li, Dan

2018-01-01

Issues-based art education encourages students to express their perspectives on different social issues through art making. In this article, the author discusses racial issues with middle school students through contemporary artwork discussion and hands-on poster making. The difficulties that students encounter in their poster making session will…

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.

District nurses' involvement in mental health: an exploratory survey.

PubMed

Lee, Soo; Knight, Denise

2006-04-01

This article reports on a survey of district nurses' involvement in mental health interventions in one county. Seventy-nine questionnaires were sent and 46 were returned. Descriptive analysis was carried out using statistical software. The DNs reported encountering a wide range of mental health issues and interventions in practice: dementia, anxiety and depression featured highly. Over half (55%) of the respondents reported involvement in bereavement counselling, and 28% and 23% of respondents reported encountering anxiety management, and problem solving and alcohol advice respectively. A large proportion, however, reported no involvement in mental health interventions. Among the psychiatric professionals, district nurses tended to have most frequent contacts with social workers. GPs were the most likely person to whom DNs made referrals, followed by community psychiatric nurses. Despite the apparent awareness of the values of psychosocial interventions, DNs were equally influenced by the medical model of treatment. In order to realize the potential contribution of district nurses in mental health interventions, there is a need for primary care teams to foster a closer working relationship with mental health specialist services.

An investigation of how university sports team athletic therapists and physical therapists experience ethical issues.

PubMed

Riendeau, Catherine; Parent-Houle, Valérie; Lebel-Gabriel, Marie Eve; Gauvin, Patrick; Liu, Le Yu; Pearson, Isabelle; Hunt, Matthew R

2015-03-01

Qualitative study using interpretive description methodology. The purpose of this study was to better understand how ethical issues are experienced by university sports team athletic therapists and physical therapists. In clinical practice, sports teams are associated with a range of ethical issues. Issues commonly reported in the literature include confidentiality, return-to-play decisions, conflicts of interest, advertising, doping, and use of local anesthetic. To date, there has been limited examination of how athletic therapists and physical therapists involved with sports teams experience these ethical issues, and limited exploration of how these ethical issues, when encountered, are shaped by therapists' professional roles and responsibilities. Semi-structured interviews were conducted with 11 athletic or physical therapists working with sports teams in 5 Canadian provinces. The data were analyzed inductively, using a recursive approach and constant comparative techniques. Four key themes were developed relating to the participants' experiences of ethical issues: establishing and maintaining professional boundaries, striving for respectful and effective collaboration, seeking answers to ethical concerns, and living with the repercussions of challenging decisions. While many ethical issues reported by participants resemble those faced by sports medicine physicians, they are experienced in distinctive ways, due to differences in professional roles and identities. Issues concerning professional boundaries were also more prominent for the study participants than the literature has reported them to be for sports medicine physicians. Effective communication and enhanced collaboration appear to be key elements in managing these ethical challenges.

A social-ecological framework: A model for addressing ethical practice in nursing.

PubMed

Davidson, Patricia; Rushton, Cynda Hylton; Kurtz, Melissa; Wise, Brian; Jackson, Debra; Beaman, Adam; Broome, Marion

2018-03-01

To develop a framework to enable discussion, debate and the formulation of interventions to address ethical issues in nursing practice. Social, cultural, political and economic drivers are rapidly changing the landscape of health care in our local environments but also in a global context. Increasingly, nurses are faced with a range of ethical dilemmas in their work. This requires investigation into the culture of healthcare systems and organisations to identify the root causes and address the barriers and enablers of ethical practice. The increased medicalisation of health care; pressures for systemisation; efficiency and cost reduction; and an ageing population contribute to this complexity. Often, ethical issues in nursing are considered within the abstract and philosophical realm until a dilemma is encountered. Such an approach limits the capacity to tangibly embrace ethical values and frameworks as pathways to equitable, accessible, safe and quality health care and as a foundation for strengthening a supportive and enabling workplace for nurses and other healthcare workers. Conceptual framework development. A comprehensive literature review was undertaken using the social-ecological framework as an organising construct. This framework views ethical practice as the outcome of interaction among a range of factors at eight levels: individual factors (patients and families); individual factors (nurses); relationships between healthcare professionals; relationships between patients and nurses; organisational healthcare context; professional and education regulation and standards; community; and social, political and economic. Considering these elements as discrete, yet interactive and intertwined forces can be useful in developing interventions to promote ethical practice. We consider this framework to have utility in policy, practice, education and research. Nurses face ethical challenges on a daily basis, considering these within a social-ecological framework can assist in developing strategies and resolutions. © 2017 John Wiley & Sons Ltd.

Pharmacy users’ expectations of pharmacy encounters: a Q‐methodological study

PubMed Central

Renberg, Tobias; Wichman Törnqvist, Kristina; Kälvemark Sporrong, Sofia; Kettis Lindblad, Åsa; Tully, Mary P.

2010-01-01

Abstract Background  Pharmacy practice is evolving according to general health‐care trends such as increased patient involvement and public health initiatives. In addition, pharmacists strive to find new professional roles. Clients’ expectations of service encounters at pharmacies is an under‐explored topic but crucial to understanding how pharmacy practice can evolve efficiently. Objective  To identify and describe different normative expectations of the pharmacy encounter among pharmacy clients. Methods  Q methodology, an approach to systematically explore subjectivity that retains complete patterns of responses and organizes these into factors of operant subjectivity. Setting and participants  Eighty‐five regular prescription medication users recruited at Swedish community pharmacies and by snowballing. Results  Seven factors of operant subjectivity were identified, and organized into two groups. Factors that emphasized the physical drug product as the central object of the pharmacy encounter were labelled as independent drug shopping; logistics of drug distribution; and supply of individual’s own drugs. Factors that emphasized personal support as desirable were labelled competence as individual support; individualist professional relations, just take care of me; and practical health‐care and lifestyle support. Discussion and conclusions  The systematic Q‐methodological approach yielded valuable insights into how pharmacy clients construct their expectations for service encounters. They hold differentiating normative expectations for pharmacy services. Understanding these varying viewpoints may be important for developing and prioritizing among efficient pharmacy services. Clients’ expectations do not correspond with trends that guide current pharmacy practice development. This might be a challenge for promoting or implementing services based on such trends. PMID:21199199

Pharmacy users' expectations of pharmacy encounters: a Q-methodological study.

PubMed

Renberg, Tobias; Wichman Törnqvist, Kristina; Kälvemark Sporrong, Sofia; Kettis Lindblad, Asa; Tully, Mary P

2011-12-01

Pharmacy practice is evolving according to general health-care trends such as increased patient involvement and public health initiatives. In addition, pharmacists strive to find new professional roles. Clients' expectations of service encounters at pharmacies is an under-explored topic but crucial to understanding how pharmacy practice can evolve efficiently. To identify and describe different normative expectations of the pharmacy encounter among pharmacy clients. Q methodology, an approach to systematically explore subjectivity that retains complete patterns of responses and organizes these into factors of operant subjectivity. Eighty-five regular prescription medication users recruited at Swedish community pharmacies and by snowballing. Seven factors of operant subjectivity were identified, and organized into two groups. Factors that emphasized the physical drug product as the central object of the pharmacy encounter were labelled as independent drug shopping; logistics of drug distribution; and supply of individual's own drugs. Factors that emphasized personal support as desirable were labelled competence as individual support; individualist professional relations, just take care of me; and practical health-care and lifestyle support. The systematic Q-methodological approach yielded valuable insights into how pharmacy clients construct their expectations for service encounters. They hold differentiating normative expectations for pharmacy services. Understanding these varying viewpoints may be important for developing and prioritizing among efficient pharmacy services. Clients' expectations do not correspond with trends that guide current pharmacy practice development. This might be a challenge for promoting or implementing services based on such trends. © 2010 Blackwell Publishing Ltd.

Psychosocial diagnoses occurring after patients present with fatigue.

PubMed

MacKean, Peter Reagh; Stewart, Moira; Maddocks, Heather L

2016-08-01

To discover the frequency of psychosocial and other diagnoses occurring at the end of a visit when patients present to their FPs with concerns about fatigue. Cross-sectional study of patient-FP encounters for fatigue. Ten FP practices in southwestern Ontario. A total of 259 encounters involving 167 patients presenting to their FPs between March 1, 2006, and June 30, 2010, with concerns about fatigue. The frequency of psychological and social diagnoses made at the end of visits, and whether diagnoses were made by FPs at the end of the visits versus whether the code for fatigue remained. The associations between patient age, sex, fatigue presenting with other symptoms, or the presence of previous chronic conditions and the outcomes was tested. Psychosocial diagnoses were made 23.9% of the time. Among psychosocial diagnoses made, depressive disorder and anxiety disorder or anxiety state were diagnosed more often in women (P = .048). Slightly less than 30% of the time, the cause of patients' fatigue remained undiagnosed at the end of the encounter. A diagnosis was made more often in men. Causes of fatigue frequently remain undiagnosed; however, when there is a diagnosis, psychosocial diagnoses are common. Therefore, it would be appropriate for FPs to screen for psychosocial issues when their patients present with fatigue, unless some other diagnosis is evident. Depression and anxiety could be considered particularly among female patients with fatigue. Copyright© the College of Family Physicians of Canada.

Communicating about ocean health: theoretical and practical considerations

PubMed Central

McComas, Katherine A.; Byrne, Sahara E.

2016-01-01

As anthropogenic stressors threaten the health of marine ecosystems, there is a need to better understand how the public processes and responds to information about ocean health. Recent studies of public perceptions about ocean issues report high concern but limited knowledge, prompting calls for information campaigns to mobilize public support for ocean restoration policy. Drawing on the literature from communication, psychology and related social science disciplines, we consider a set of social-cognitive challenges that researchers and advocates are likely to encounter when communicating with the public about ocean health and emerging marine diseases—namely, the psychological distance at which ocean issues are construed, the unfamiliarity of aquatic systems to many members of the public and the potential for marine health issues to be interpreted through politicized schemas that encourage motivated reasoning over the dispassionate consideration of scientific evidence. We offer theory-based strategies to help public outreach efforts address these challenges and present data from a recent experiment exploring the role of message framing (emphasizing the public health or environmental consequences of marine disease) in shaping public support for environmental policy. PMID:26880833

Communicating about ocean health: theoretical and practical considerations.

PubMed

Schuldt, Jonathon P; McComas, Katherine A; Byrne, Sahara E

2016-03-05

As anthropogenic stressors threaten the health of marine ecosystems, there is a need to better understand how the public processes and responds to information about ocean health. Recent studies of public perceptions about ocean issues report high concern but limited knowledge, prompting calls for information campaigns to mobilize public support for ocean restoration policy. Drawing on the literature from communication, psychology and related social science disciplines, we consider a set of social-cognitive challenges that researchers and advocates are likely to encounter when communicating with the public about ocean health and emerging marine diseases--namely, the psychological distance at which ocean issues are construed, the unfamiliarity of aquatic systems to many members of the public and the potential for marine health issues to be interpreted through politicized schemas that encourage motivated reasoning over the dispassionate consideration of scientific evidence. We offer theory-based strategies to help public outreach efforts address these challenges and present data from a recent experiment exploring the role of message framing (emphasizing the public health or environmental consequences of marine disease) in shaping public support for environmental policy. © 2016 The Author(s).

Viable Options for Fertility Preservation in Breast Cancer Patients: A Focus on Latin America.

PubMed

Lambertini, Matteo; Goldrat, Oranite; Barragan-Carrillo, Regina; Viglietti, Giulia; Demeestere, Isabelle; Villarreal-Garza, Cynthia

2017-01-01

Thanks to the improved survival outcomes observed in recent years, a growing attention has been given to the quality of life issues faced by young women with breast cancer such as fertility preservation and concerns related to future pregnancies. However, several challenges remain for young women with breast cancer considering undergoing fertility preservation strategies. Further specific issues on this regard should be taken into account in Latin America, where patients and physicians face particular barriers that hinder the routine adoption of this practice. Hence, further efforts are needed to overcome these deficiencies and improve the correct referral of breast cancer patients to fertility preservation strategies. The aim of the present review is to focus on the risk of anticancer treatment-related premature ovarian failure and infertility in young breast cancer patients, to summarize the current knowledge on the available options for fertility preservation, and to discuss the safety issues of pregnancy in breast cancer survivors. Furthermore, this review aims to highlight the specific clinical challenges in this field encountered by healthcare providers and young breast cancer patients from Latin American countries.

Mine to market: The legal issues

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

Not Available

1985-01-01

The movement of mineral products from mine to market is the fundamental objective of every mining enterprise. However, the difficult and recurring legal problems encountered in these activities have been overlooked by legal scholars, and little literature is available. The manual from the Foundation's Special Institute on Mine to Market: The Legal Issues is intended to help cure this deficiency, and will be invaluable to individuals involved in any phase of the production and sale or purchase of minerals - from negotiating an initial lease to preparing an agreement for the purchase or sale of a refined product. Included inmore » the manual are discussions of: the mining process - from severance to saleable product; marketing strategy and the lawyer - methods of selling and hedging used in the mining industry; metal markets and pricing mechanisms; the impact of the uniform commercial code on contracts for the sale of minerals and other goods; contracts for the international sale of minerals; countertrade - commercial practices, legal issues, and policy dilemmas; commercial impracticability in mineral transactions; price and payment terms in mineral agreements; and mineral sales and processing agreements.« less

Ethical issues recognized by critical care nurses in the intensive care units of a tertiary hospital during two separate periods.

PubMed

Park, Dong Won; Moon, Jae Young; Ku, Eun Yong; Kim, Sun Jong; Koo, Young-Mo; Kim, Ock-Joo; Lee, Soon Haeng; Jo, Min-Woo; Lim, Chae-Man; Armstrong, John David; Koh, Younsuck

2015-04-01

This research aimed to investigate the changes in ethical issues in everyday clinical practice recognized by critical care nurses during two observation periods. We conducted a retrospective analysis of data obtained by prospective questionnaire surveys of nurses in the intensive care units (ICU) of a tertiary university-affiliated hospital in Seoul, Korea. Data were collected prospectively during two different periods, February 2002-January 2003 (Period 1) and August 2011-July 2012 (Period 2). Significantly fewer cases with ethical issues were reported in Period 2 than in Period 1 (89 cases [2.1%] of 4,291 ICU admissions vs. 51 [0.5%] of 9,302 ICU admissions, respectively; P < 0.001). The highest incidence of cases with identified ethical issues in both Periods occurred in MICU. The major source of ethical issues in Periods 1 and 2 was behavior-related. Among behaviorrelated issues, inappropriate healthcare professional behavior was predominant in both periods and mainly involved resident physicians. Ethical issue numbers regarding end-oflife (EOL) care significantly decreased in the proportion with respect to ethical issues during Period 2 (P = 0.044). In conclusion, the decreased incidence of cases with identified ethical issues in Period 2 might be associated with ethical enhancement related with EOL and improvements in the ICU care environment of the studied hospital. However, behaviorrelated issues involving resident physicians represent a considerable proportion of ethical issues encountered by critical care nurses. A systemic approach to solve behavior-related issues of resident physicians seems to be required to enhance an ethical environment in the studied ICU.

Automated recognition of microcalcification clusters in mammograms

NASA Astrophysics Data System (ADS)

Bankman, Isaac N.; Christens-Barry, William A.; Kim, Dong W.; Weinberg, Irving N.; Gatewood, Olga B.; Brody, William R.

1993-07-01

The widespread and increasing use of mammographic screening for early breast cancer detection is placing a significant strain on clinical radiologists. Large numbers of radiographic films have to be visually interpreted in fine detail to determine the subtle hallmarks of cancer that may be present. We developed an algorithm for detecting microcalcification clusters, the most common and useful signs of early, potentially curable breast cancer. We describe this algorithm, which utilizes contour map representations of digitized mammographic films, and discuss its benefits in overcoming difficulties often encountered in algorithmic approaches to radiographic image processing. We present experimental analyses of mammographic films employing this contour-based algorithm and discuss practical issues relevant to its use in an automated film interpretation instrument.

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

Brown, Carrie; LaRue, Anna; Pigman, Margaret

As more and more zero net energy (ZNE) buildings are built and monitored, we can learn from both careful case studies of individual projects as well as a broader perspective of trends over time. In a forum sponsored by Pacific Gas and Electric Company (PG&E), eight expert speakers discussed: results and lessons from monitoring occupied ZNE buildings; best practices for setting performance targets and getting actionable performance information, and; things that have surprised them about monitored ZNE buildings. This paper distills the content of the forum by laying out the most common hurdles that are encountered in setting up monitoringmore » projects, frequent performance issues that the monitoring uncovers, and lessons learned that can be applied to future projects.« less

Health care encounters in Danish chiropractic practice from a consumer perspectives - a mixed methods investigation.

PubMed

Myburgh, Corrie; Boyle, Eleanor; Larsen, Johanne Brinch; Christensen, Henrik Wulff

2016-01-01

Perceived value is the key ingredient to carving and maintaining a competitive business niche. The opportunities to interact with consumers to understand and enhance perceived value are termed 'touch points'. Due to the out-of-pocket expense incurred by patients, Danish chiropractors are subject to consumer trends and behaviors. The purpose of this investigation was to explore and describe consumer touch points relevant to perceived value through healthcare journeys in chiropractic practices. We designed a convergent parallel, mixed methods study. Our purposive sampling framework identified 11 chiropractic clinics from which we collected observational field notes, video recordings and face-to-face interviews. Data was collected between April 14(th) and June 26(th) 2014. We described the exteriors and interiors of all participant clinics, interviewed 32 staff members, 12 new patients and 36 follow-up patients and finally video recorded 11 new and 24 follow-up consultations. Categorization and analysis led to the emergence six consumer touch point themes: 'the internet', 'the physical environment', 'practice models', 'administrative staff', 'the consultation sequence and timing' and 'a consultation that adds value'. The Internet functions as a tool when choosing/confirming a clinic as appropriate, developing and initial image and managing appointments. The administrative hub appears integral to the shaping of positive consumer experiences outside of the consultation. Clinic location, practice model and interior design may contribute to context effects and thus may influence value perception during the clinical encounter. The duration of hands-on treatment received from the chiropractor is not an apparent consumer focus point. Rather, through a seven stage clinical procedure patients value consultations with clinicians who demonstrate professional competence by effective communication diagnosis/management and facilitating satisfactory treatment outcomes. At least six consumer touch points add/detract from value-related experiences in chiropractic practices. The duration of hands-on treatment per se does not appear to be a particular focus point. More research is required to explore this issue.

Challenging Operations: An Ethical Framework to Assist Humanitarian Aid Workers in their Decision-making Processes

PubMed Central

Clarinval, Caroline; Biller-Andorno, Nikola

2014-01-01

Introduction: This paper aims to raise awareness regarding ethical issues in the context of humanitarian action, and to offer a framework for systematically and effectively addressing such issues. Methods: Several cases highlight ethical issues that humanitarian aid workers are confronted with at different levels over the course of their deployments. The first case discusses a situation at a macro-level concerning decisions being made at the headquarters of a humanitarian organization. The second case looks at meso-level issues that need to be solved at a country or regional level. The third case proposes an ethical dilemma at the micro-level of the individual patient-provider relationship. Discussion: These real-life cases have been selected to illustrate the ethical dimension of conflicts within the context of humanitarian action that might remain unrecognized in everyday practice. In addition, we propose an ethical framework to assist humanitarian aid workers in their decision-making process. The framework draws on the principles and values that guide humanitarian action and public health ethics more generally. Beyond identifying substantive core values, the framework also includes a ten-step process modelled on tools used in the clinical setting that promotes a transparent and clear decision-making process and improves the monitoring and evaluation of aid interventions. Finally, we recommend organizational measures to implement the framework effectively. Conclusion: This paper uses a combination of public health/clinical ethics concepts and practices and applies them to the decision-making challenges encountered in relief operations in the humanitarian aid context. PMID:24987575

Casebooks in Early Modern England:

PubMed Central

Kassell, Lauren

2014-01-01

summary Casebooks are the richest sources that we have for encounters between early modern medical practitioners and their patients. This article compares astrological and medical records across two centuries, focused on England, and charts developments in the ways in which practitioners kept records and reflected on their practices. Astrologers had a long history of working from particular moments, stellar configurations, and events to general rules. These practices required systematic notation. Physicians increasingly modeled themselves on Hippocrates, recording details of cases as the basis for reasoned expositions of the histories of disease. Medical records, as other scholars have demonstrated, shaped the production of medical knowledge. Instead, this article focuses on the nature of casebooks as artifacts of the medical encounter. It establishes that casebooks were serial records of practice, akin to diaries, testimonials, and registers; identifies extant English casebooks and the practices that led to their production and preservation; and concludes that the processes of writing, ordering, and preserving medical records are as important for understanding the medical encounter as the records themselves. PMID:25557513

Casebooks in early modern England: medicine, astrology, and written records.

PubMed

Kassell, Lauren

2014-01-01

Casebooks are the richest sources that we have for encounters between early modern medical practitioners and their patients. This article compares astrological and medical records across two centuries, focused on England, and charts developments in the ways in which practitioners kept records and reflected on their practices. Astrologers had a long history of working from particular moments, stellar configurations, and events to general rules. These practices required systematic notation. Physicians increasingly modeled themselves on Hippocrates, recording details of cases as the basis for reasoned expositions of the histories of disease. Medical records, as other scholars have demonstrated, shaped the production of medical knowledge. Instead, this article focuses on the nature of casebooks as artifacts of the medical encounter. It establishes that casebooks were serial records of practice, akin to diaries, testimonials, and registers; identifies extant English casebooks and the practices that led to their production and preservation; and concludes that the processes of writing, ordering, and preserving medical records are as important for understanding the medical encounter as the records themselves.

The Major Environmentally-Based Land Use Issues on the Urban Fringe.

ERIC Educational Resources Information Center

Hordon, Robert M.

Types of land-use issues which form current problems in urban areas are discussed in this paper. The majority of these environmentally based issues revolve around the management of water. The five most often encountered water-oriented issues are denoted in rank order of importance. First, an ample water supply which is free from contamination must…

Using continuous sedation until death for cancer patients: A qualitative interview study of physicians’ and nurses’ practice in three European countries

PubMed Central

Rietjens, Judith; Bruinsma, Sophie; Deliens, Luc; Sterckx, Sigrid; Mortier, Freddy; Brown, Jayne; Mathers, Nigel; van der Heide, Agnes

2015-01-01

Background: Extensive debate surrounds the practice of continuous sedation until death to control refractory symptoms in terminal cancer care. We examined reported practice of United Kingdom, Belgian and Dutch physicians and nurses. Methods: Qualitative case studies using interviews. Setting: Hospitals, the domestic home and hospices or palliative care units. Participants: In all, 57 Physicians and 73 nurses involved in the care of 84 cancer patients. Results: UK respondents reported a continuum of practice from the provision of low doses of sedatives to control terminal restlessness to rarely encountered deep sedation. In contrast, Belgian respondents predominantly described the use of deep sedation, emphasizing the importance of responding to the patient’s request. Dutch respondents emphasized making an official medical decision informed by the patient’s wish and establishing that a refractory symptom was present. Respondents employed rationales that showed different stances towards four key issues: the preservation of consciousness, concerns about the potential hastening of death, whether they perceived continuous sedation until death as an ‘alternative’ to euthanasia and whether they sought to follow guidelines or frameworks for practice. Conclusion: This qualitative analysis suggests that there is systematic variation in end-of-life care sedation practice and its conceptualization in the United Kingdom, Belgium and the Netherlands. PMID:25062816

Methodological, technical, and ethical issues of a computerized data system.

PubMed

Rice, C A; Godkin, M A; Catlin, R J

1980-06-01

This report examines some methodological, technical, and ethical issues which need to be addressed in designing and implementing a valid and reliable computerized clinical data base. The report focuses on the data collection system used by four residency based family health centers, affiliated with the University of Massachusetts Medical Center. It is suggested that data reliability and validity can be maximized by: (1) standardizing encounter forms at affiliated health centers to eliminate recording biases and ensure data comparability; (2) using forms with a diagnosis checklist to reduce coding errors and increase the number of diagnoses recorded per encounter; (3) developing uniform diagnostic criteria; (4) identifying sources of error, including discrepancies of clinical data as recorded in medical records, encounter forms, and the computer; and (5) improving provider cooperation in recording data by distributing data summaries which reinforce the data's applicability to service provision. Potential applications of the data for research purposes are restricted by personnel and computer costs, confidentiality considerations, programming related issues, and, most importantly, health center priorities, largely focused on patient care, not research.

Virginia Department of Transportation public-private procurement : issues and accomplishments and interim report

DOT National Transportation Integrated Search

1997-01-01

This paper documents the contracting and procurement issues and opportunities encountered by VDOT in developing what was their first public-private partnership agreement for an Intelligent Transportation System (ITS).

Balloon-assisted tracking: a must-know technique to overcome difficult anatomy during transradial approach.

PubMed

Patel, Tejas; Shah, Sanjay; Pancholy, Samir; Rao, Sunil; Bertrand, Olivier F; Kwan, Tak

2014-02-01

To examine the use and outcomes of balloon-assisted tracking (BAT) technique for dealing with complexities of arm and chest vasculature during transradial approach (TRA) at a single high volume radial center. TRA has been used for coronary angiography and percutaneous coronary interventions (PCI) around the world. Different techniques have been described to address the anatomical issues and tortuosities for successful completion of coronary angiography and PCI. This study describes the use of BAT technique and associated outcomes during real world clinical practice. Subjects comprised 63 patients, (out of total 8,245 patients between January 2011 and December 2012) in whom we encountered significantly complex anatomical course in radial, brachial, or subclavian region, leading to difficult advancement of a diagnostic or a guide catheter despite trying all standard maneuvers. In all of them BAT technique was used and they were retrospectively analyzed for the purpose of this study. About 63 (0.76%) of 8,245 patients met the study criteria. Twenty-five (39.7%) patients had very small RA. Twenty-two (34.9%) had severe RA tortuosity. Four (6.3%) had complex RA loops. Six (9.5%) had severe RA spasm and six (9.5%) had severe subclavian tortuosity and/or stenosis. We encountered technical failure in three (4.8%) patients (two had very small RA and one had 360 degree RA loop). BAT technique was useful to address the anatomical issues and tortuosities of radial, brachial, and subclavian vasculature during TRA. Copyright © 2013 Wiley Periodicals, Inc.

Sensitivity Training and Group Encounter, an Introduction.

ERIC Educational Resources Information Center

Siroka, Robert W., Ed.; And Others

"Sensitivity Training and Group Encounter" attempts to explore group interaction on many levels--verbal, sensory, and physical. It can be utilized as a model for dealing with various forms of interpersonal relations, from ongoing social issues to the isolation, alienation, and distrust felt by the members of a group. Presented as a guide to this…

Spaces of Spiritual Citizenship: Children's Relational and Emotional Encounters with the Everyday School Environment

ERIC Educational Resources Information Center

Hemming, Peter J.

2013-01-01

This article addresses the issue of children's spiritual, relational and emotional encounters with the primary school environment, with reference to concepts and theories from both education studies and human geography. Drawing on mixed-method qualitative research in two case study institutions, the article examines pupils' photographed "special…

The State of The Environment 1972-1982.

ERIC Educational Resources Information Center

United Nations Environment Programme, Nairobi (Kenya).

This report focuses on the changes (positive or negative) that occurred in the state of the world environment in the decade following the United Nations Conference on the Human Environment convened at Stockholm in June 1972. It also brings into focus the major environmental issues encountered or likely to be encountered. The first section focuses…

Helping Students Navigate Faith Challenges in the Biblical Studies Classroom

ERIC Educational Resources Information Center

Sharp, Carolyn J.; Clark-Soles, Jaime

2012-01-01

What happens when students encounter the academic study of the Bible in the seminary or undergraduate classroom? Does a teacher have a responsibility to help students navigate challenges to Christian faith that might arise? What pedagogical problems and opportunities does this encounter present? How does this issue manifest differently in…

The Methodological Benefits of Social Media: "Studying Up" in Brazil in the Facebook Age

ERIC Educational Resources Information Center

Straubhaar, Rolf

2015-01-01

While conducting research on the organizational cultures of elite nonprofit organizations in Rio de Janeiro, the author encountered many access issues identified in the current literature: in particular, difficulty in encountering research subjects due to the transitional nature of educational nonprofits and the role of secretaries and…

Do general practice patients with and without appointment differ? Cross-sectional study.

PubMed

Riedl, Bernhard; Kehrer, Simon; Werner, Christoph U; Schneider, Antonius; Linde, Klaus

2018-06-23

Even in practices with a comprehensive appointment system a minority of patients walks in without prior notice, sometimes causing problems for practice service quality. We aimed to explore differences between patients consulting primary care practices with and without appointment. Consecutive patients visiting five primary care practices without an appointment and following patients with an appointment were asked to fill in a four-page questionnaire addressing socio-demographic characteristics, the reason for encounter, urgency of seeing a physician, depressive, somatic and anxiety symptoms, personality traits, and satisfaction with the practice. Physicians also documented the reason for encounter and assessed the urgency. Data were analyzed using univariate and multivariate methods. Two hundred fifty-one patients without and 250 patients with appointment participated. Patients without appointment were significantly younger (mean age 44 vs. 50 years) and reported less often chronic diseases (29% vs. 45%). Also, reasons for encounter differed (e.g., 27% vs. 16% with a respiratory problem). Patients' ratings of urgency did not differ between groups (p = 0.46), but physicians rated urgency higher among patients without appointment (p < 0.001). In logistic regression analyses younger age, male gender, absence of chronic disease, positive screening for at least one mental disorder, low values on the personality trait openness for experience, a high urgency rating by the physician, and a respiratory or musculoskeletal problem as reason for encounter were significantly associated with a higher likelihood of being a patient without appointment. In this study, younger age and a high urgency rating by physicians were the variables most consistently associated with the likelihood of being a patient without appointment. Overall, differences between patients seeking general practices with a comprehensive appointment system without prior notice and patients with appointments were relatively minor.

Rational prescribing in paediatrics in a resource-limited setting.

PubMed

Risk, Rachel; Naismith, Hamish; Burnett, Alexander; Moore, Sophie E; Cham, Mamady; Unger, Stefan

2013-07-01

There is evidence of inappropriate medication use, causing unnecessary costs for health systems, particularly those with limited resources. Overprescription is commonly reported and can lead to antibiotic resistance. Prescribing patterns differ between countries; little is known about paediatric prescribing practices in Africa. To investigate prescribing practices in children in The Gambia, West Africa. A retrospective survey of prescribing practices in children under 5 years of age based on WHO protocol DAP/93.1 was conducted. Twenty government-run health centres across all six regions in The Gambia were assessed. The first 10 encounters each month in 2010 were recorded. For each encounter, patient demographics, diagnoses and medications were recorded as per protocol. Two thousand and four hundred patient encounters were included. The mean number of medications per encounter was 2.2 (median 2.0, IQR 2.0-3.0). Across different geographical regions within The Gambia antibiotics were prescribed in 63.4% (IQR 62.8-65.8%) and micronutrients in 21.7% (IQR 15.3-27.1%) of patient encounters. There was evidence of high antibiotic prescription in children with cough and coryzal symptoms (54.5%; IQR 35.8-59.0%) and simple diarrhoea without dehydration (44.8%; IQR 36.7-61.3%). 74.8% (IQR 71.8-76.1%) of medications were prescribed generically. The study showed an overprescription of antibiotics and substantial usage of micronutrients despite a lack of international evidence-based guidelines. Cost-effective interventions to improve prescribing practices are called for and more studies with a focus on rational prescribing in paediatrics in low-income settings are urgently required to fill the gap in current knowledge.

The organisational stressors encountered by athletes with a disability.

PubMed

Arnold, Rachel; Wagstaff, Christopher R D; Steadman, Lauren; Pratt, Yasmin

2017-06-01

Organisational stressors have been found to be prevalent and problematic for sport performers, with research identifying demographic differences in the stressors encountered. Nevertheless, extant sport psychology research on the topic of stress has generally focused on able-bodied athletes; whilst that which has been conducted on performers with a disability has typically recruited relatively small samples to explore a narrow selection of organisational stressors, or examined other components of the stress process. The purpose of the present study was to explore the various organisational stressors that athletes with a disability encounter. The sample comprised 18 elite athletes with a disability (10 male, 8 female) who had a classified disability and experience of competing at a major championships in their sport (e.g., Paralympic Games, World Championships). Participants took part in a semi-structured interview which was analysed by drawing from grounded theory procedures. A total of 316 organisational stressors were identified, which were abstracted into 31 concepts and four, previously conceptualised, exploratory schemes: leadership and personnel issues, cultural and team issues, logistical and environmental issues, and performance and personal issues. This study not only provides the first illustration of the prevalence of organisational stressors for athletes with a disability, but also significantly points to salient similarities and distinct differences between the stress experiences of performers with and without a disability.

Tracking Patient Encounters and Clinical Skills to Determine Competency in Ambulatory Care Advanced Pharmacy Practice Experiences

PubMed Central

Pereira, Chrystian R.; Harris, Ila M.; Moon, Jean Y.; Westberg, Sarah M.; Kolar, Claire

2016-01-01

Objective. To determine if the amount of exposure to patient encounters and clinical skills correlates to student clinical competency on ambulatory care advanced pharmacy practice experiences (APPEs). Design. Students in ambulatory care APPEs tracked the number of patients encountered by medical condition and the number of patient care skills performed. At the end of the APPE, preceptors evaluated students’ competency for each medical condition and skill, referencing the Dreyfus model for skill acquisition. Assessment. Data was collected from September 2012 through August 2014. Forty-six responses from a student tracking tool were matched to preceptor ratings. Students rated as competent saw more patients and performed more skills overall. Preceptors noted minimal impact on workload. Conclusions. Increased exposure to patient encounters and skills performed had a positive association with higher Dreyfus stage, which may represent a starting point in the conversation for more thoughtful design of ambulatory care APPEs. PMID:26941440

Importance of direct patient care in advanced pharmacy practice experiences.

PubMed

Rathbun, R Chris; Hester, E Kelly; Arnold, Lindsay M; Chung, Allison M; Dunn, Steven P; Harinstein, Lisa M; Leber, Molly; Murphy, Julie A; Schonder, Kristine S; Wilhelm, Sheila M; Smilie, Kristine B

2012-04-01

The Accreditation Council for Pharmacy Education issued revised standards (Standards 2007) for professional programs leading to the Doctor of Pharmacy degree in July 2007. The new standards require colleges and schools of pharmacy to provide pharmacy practice experiences that include direct interaction with diverse patient populations. These experiences are to take place in multiple practice environments (e.g., community, ambulatory care, acute care medicine, specialized practice areas) and must include face-to-face interactions between students and patients, and students and health care providers. In 2009, the American College of Clinical Pharmacy (ACCP) identified concerns among their members that training for some students during the fourth year of pharmacy curriculums are essentially observational experiences rather than encounters where students actively participate in direct patient care activities. These ACCP members also stated that there is a need to identify effective mechanisms for preceptors to balance patient care responsibilities with students' educational needs in order to fully prepare graduates for contemporary, patient-centered practice. The 2010 ACCP Educational Affairs Committee was charged to provide recommendations to more effectively foster the integration of pharmacy students into direct patient care activities during advanced pharmacy practice experiences (APPEs). In this commentary, the benefits to key stakeholders (pharmacy students, APPE preceptors, clerkship sites, health care institutions, academic pharmacy programs) of this approach are reviewed. Recommendations for implementation of direct patient care experiences are also provided, together with discussion of the practical issues associated with delivery of effective APPE. Examples of ambulatory care and acute care APPE models that successfully integrate pharmacy students into the delivery of direct patient care are described. Enabling students to engage in high-quality patient care experiences and to assume responsibility for drug therapy outcomes is achievable in a variety of practice settings. In our opinion, such an approach is mandatory if contemporary pharmacy education is to be successful in producing a skilled workforce capable of affecting drug therapy outcomes. © 2012 Pharmacotherapy Publications, Inc.

On-Board Sound Intensity (OBSI) study, phase 2 : [summary].

DOT National Transportation Integrated Search

2014-05-01

To many people, environmental issues might : suggest air pollution, water pollution, or similar : ideas. But an environmental issue of growing : concern is noise pollution, which many cities : in Florida are encountering as they grow, and : nei...

Rural medical education: five medical students spend a year in rural Port Lincoln, Australia.

PubMed

Baillie, Sue; Matena, Jenni; Yerxa, John; Newbury, Jonathan

2007-01-01

The University of Adelaide and the University of South Australia established the Spencer Gulf Rural Health School (SGRHS) as a joint venture to facilitate rural health professional education and research. Annually a cohort of medical students from the University of Adelaide volunteer and are placed in various SGRHS 'learning centres' throughout rural South Australia for the 5th year of their medical training. This article addresses the issues encountered in one of these 'learning centres' in Port Lincoln, rural South Australia. The challenge was to integrate five students into a general medical practice and the local hospital and to provide high quality medical education for the academic year. Medical practice, student and university requirements were identified and a range of strategies implemented to address these. To date, four groups of medical students have successfully completed their rural academic year in Port Lincoln since 2003. The local systems have evolved to allow five students to integrate into the practice and hospital using a range of teaching and learning methods and resources.

Diagnosis and management of endometriosis: the role of the advanced practice nurse in primary care.

PubMed

Mao, Alexandra J; Anastasi, Joyce K

2010-02-01

To discuss the etiology, clinical presentation, diagnosis, and management of endometriosis for the advanced practice nurse (APN) in primary care. Selected research, clinical studies, clinical practice guidelines, and review articles. Commonly encountered by the APN in primary care, endometriosis is a chronic, progressive inflammatory disease characterized by endometrial lesions, cysts, fibrosis, or adhesions in the pelvic cavity, causing chronic pelvic pain and infertility in women of reproductive age. Because of its frequently normal physical examination findings, variable clinical presentations, and nonspecific, overlapping symptoms with other conditions, endometriosis can be difficult to diagnose. As there currently are no accurate noninvasive diagnostic tests specific for endometriosis, it is imperative for the APN to become knowledgeable about the etiology, clinical presentation, diagnosis, and current treatment options of this disease. The APN in primary care plays an essential role in health promotion through disease management and infertility prevention by providing support and much needed information to the patient with endometriosis. APNs can also facilitate quality of care and manage treatments effectively to improve quality of life, reduce pain, and prevent further progression of disease. Practice recommendations include timely diagnosis, pain management, infertility counseling, patient education, and support for quality of life issues.

The Global Online Sexuality Survey (GOSS): male homosexuality among Arabic-speaking internet users in the Middle East--2010.

PubMed

Shaeer, Osama; Shaeer, Kamal

2014-10-01

The prevalence of male homosexuality is difficult to elicit considering the sensitivity of one's sexual orientation. The Global Online Sexuality Survey (GOSS) is an online epidemiologic study of male and female sexuality. The online nature of GOSS allows more confidentiality and wider geographic reach, particularly important in investigating sexual issues within the more conservative societies. This study aims to determine the prevalence of male homosexuality among Internet users in the Arabic-speaking Middle East and the unique characteristics of this subset of the population. Prevalence of male homosexuality. In the year 2010, GOSS was offered to Arabic-speaking web surfers above 18 years of age in the Middle East. Potential participants were invited via advertising on Facebook®. Invitations were dispatched randomly with the exception of geographic region and age, regardless web surfing preferences. GOSS relied in part on validated questionnaires such as the International Index of Erectile Function, as well on other nonvalidated questions. 17.1% reported desire toward the same sex, of whom 5.6% had homosexual encounters, mostly in the form of external stimulation rather than intercourse, and exclusively undercover. An overwhelming majority was ego-dystonic (78.2%). This is--to our knowledge--the first online survey to address the prevalence of homosexual orientation and practice in the Middle East, discriminating desire from practice, ego-syntonic from ego-dystonic, and investigating the pattern of practice. Homosexual desire is present in the Middle East as it is around the world, and homosexual encounters are as prevalent. Yet, the undercover and ego-dystonic states prevail. © 2014 International Society for Sexual Medicine.

The role of maternal emotion regulation in overreactive and lax discipline.

PubMed

Lorber, Michael F

2012-08-01

The roles of cognitive reappraisal and expressive suppression as intentional methods mothers use to regulate their own emotion were investigated in relation to mothers' experience and expression of negative emotion and their overreactive and lax discipline practices. Eighty-two mothers of toddlers completed questionnaires that measured these constructs. Emotion regulation strategies were more consistently associated with overreactive than with lax discipline. More suppression in discipline encounters was associated with less overreactivity, an association partially mediated by expressed negative emotion. Reappraisal, both globally and in the context of discipline encounters, was inversely associated with overreactive discipline. The association of global reappraisal and overreactivity was mediated in parallel by experienced and expressed negative emotion. Surprisingly, global reappraisal, relative to reappraisal in discipline encounters, appears to have more consistent implications for mothers' emotion and parenting practices in discipline encounters. A reconceptualization of the nature of reappraisal in discipline encounters is suggested. The study is the first to systematically apply methods and concepts from the better-developed basic research literature on adults' emotion regulation to the domain of parenting. PsycINFO Database Record (c) 2012 APA, all rights reserved.

Outpatient prescription practices in rural township health centers in Sichuan Province, China

PubMed Central

2012-01-01

Background Sichuan Province is an agricultural and economically developing province in western China. To understand practices of prescribing medications for outpatients in rural township health centers is important for the development of the rural medical and health services in this province and western China. Methods This is an observational study based on data from the 4th National Health Services Survey of China. A total of 3,059 prescriptions from 30 township health centers in Sichuan Province were collected and analyzed. Seven indicators were employed in the analyses to characterize the prescription practices. They are disease distribution, average cost per encounter, number of medications per encounter, percentage of encounters with antibiotics, percentage of encounters with glucocorticoids, percentage of encounters with combined glucocorticoids and antibiotics, and percentage of encounters with injections. Results The average medication cost per encounter was 16.30 Yuan ($2.59). About 60% of the prescriptions contained Chinese patent medicine (CPM), and almost all prescriptions (98.07%) contained western medicine. 85.18% of the prescriptions contained antibiotics, of which, 24.98% contained two or more types of antibiotics; the percentage of prescriptions with glucocorticoids was 19.99%; the percentage of prescriptions with both glucocorticoids and antibiotics was 16.67%; 51.40% of the prescriptions included injections, of which, 39.90% included two or more injections. Conclusions The findings from this study demonstrated irrational medication uses of antibiotics, glucocorticoids and injections prescribed for outpatients in the rural township health centers in Sichuan Province. The reasons for irrational medication uses are not only solely due to the pursuit of maximizing benefits in the township health centers, but also more likely attributable to the lack of medical knowledge of rational medication uses among rural doctors and the lack of medical devices for disease diagnosis in those township health centers. The policy implication from this study is to enhance professional training in rational medication uses for rural doctors, improve hardware facilities for township health centers, promote health education to rural residents and establish a public reporting system to monitor prescription practices in rural township health centers, etc. PMID:22988946

'We can't get anything done because...': making sense of 'barriers' to Practice-based Commissioning.

PubMed

Checkland, Kath; Coleman, Anna; Harrison, Stephen; Hiroeh, Urara

2009-01-01

To investigate the issues raised by participants as 'barriers' to the development of Practice-based Commissioning (PBC) in 'early adopter' sites in England. Detailed case studies of five PBC consortia in three Primary Care Trusts (PCTs). Data collection included interviews with a wide range of respondents (46 in total), including general practitioners, PCT employees, Local Authority employees and patient representatives, observation of many different types of meetings (68 in total), and analysis of documents tabled at meetings and circulated at other times. It has been claimed that progress in developing PBC has been slow. Our respondents articulated a number of factors that they felt were holding them back, which could have been identified as 'barriers' preventing change. The issues raised were consistent across our sites (lack of time, resources and personnel, and difficult relationships with the PCT), but observation suggested that these issues arose out of very different organizational 'sensemaking', and as a result the apparent 'barriers' had different meanings in different organizational contexts. Weick's concept of 'organizational sensemaking' provides a useful framework within which to explore the problems encountered when implementing policy. Observational methods are a powerful tool in understanding sensemaking. The variations in sensemaking that we observed suggest that the use of 'barrier' metaphors in descriptions of implementation problems risks homogenizing the portrayal of situations that differ greatly in reality. This implies that top-down or centrally driven solutions to such situations will often be inappropriate.

Maintaining Sexual Health throughout Gynecologic Cancer Survivorship: A Comprehensive Review and Clinical Guide

PubMed Central

Huffman, Laura B.; Hartenbach, Ellen M.; Carter, Jeanne; Rash, Joanne K.; Kushner, David M.

2016-01-01

Objective The diagnosis and treatment of gynecologic cancer can cause short- and long-term negative effects on sexual health and quality of life (QoL). The aim of this article is to present a comprehensive overview of the sexual health concerns of gynecologic cancer survivors and discuss evidence-based treatment options for commonly encountered sexual health issues. Methods A comprehensive literature search of English language studies on sexual health in gynecologic cancer survivors and the treatment of sexual dysfunction was conducted in MEDLINE databases. Relevant data are presented in this review. Additionally, personal and institutional practices are incorporated where relevant. Results Sexual dysfunction is prevalent among gynecologic cancer survivors as a result of surgery, radiation, and chemotherapy--negatively impacting QoL. Many patients expect their healthcare providers to address sexual health concerns, but most have never discussed sex-related issues with their physician. Lubricants, moisturizers, and dilators are effective, simple, non-hormonal interventions that can alleviate the morbidity of vaginal atrophy, stenosis, and pain. Pelvic floor physical therapy can be an additional tool to address dyspareunia. Cognitive behavioral therapy has been shown to be beneficial to patients reporting problems with sexual interest, arousal, and orgasm. Conclusion Oncology providers can make a significant impact on the QoL of gynecologic cancer survivors by addressing sexual health concerns. Simple strategies can be implemented into clinical practice to discuss and treat many sexual issues. Referral to specialized sexual health providers may be needed to address more complex problems. PMID:26556768

Guidelines for the identification of unknown samples for laboratories performing forensic analyses for chemical terrorism.

PubMed

Magnuson, Matthew L; Satzger, R Duane; Alcaraz, Armando; Brewer, Jason; Fetterolf, Dean; Harper, Martin; Hrynchuk, Ronald; McNally, Mary F; Montgomery, Madeline; Nottingham, Eric; Peterson, James; Rickenbach, Michael; Seidel, Jimmy L; Wolnik, Karen

2012-05-01

Since the early 1990s, the FBI Laboratory has sponsored Scientific Working Groups to improve discipline practices and build consensus among the forensic community. The Scientific Working Group on the Forensic Analysis of Chemical, Biological, Radiological and Nuclear Terrorism developed guidance, contained in this document, on issues forensic laboratories encounter when accepting and analyzing unknown samples associated with chemical terrorism, including laboratory capabilities and analytical testing plans. In the context of forensic analysis of chemical terrorism, this guidance defines an unknown sample and addresses what constitutes definitive and tentative identification. Laboratory safety, reporting issues, and postreporting considerations are also discussed. Utilization of these guidelines, as part of planning for forensic analysis related to a chemical terrorism incident, may help avoid unfortunate consequences not only to the public but also to the laboratory personnel. 2011 American Academy of Forensic Sciences. Published 2011. This article is a U.S. Government work and is in the public domain in the U.S.A.

The attitudes of nursing students to euthanasia.

PubMed

Naseh, Ladan; Heidari, Mohammad

2017-01-01

One of the most common morally controversial issues in endof-life care is euthanasia. Examining the attitudes of nursing students to this issue is important because they may encounter situations related to euthanasia during their clinical courses. The aim of our study was to examine nursing students' attitudes to euthanasia in Shahrekord city in western Iran. This was done using the Euthanasia Attitude Scale. The scale is divided into four categories, ie ethical considerations, practical considerations, treasuring life and naturalistic beliefs. Of 132 nursing students, 120 participated in the study (response rate 93.1%). According to the study's findings, 52.5%, 2.5% and 45% of the students reported a negative, neutral and positive attitude to euthanasia, respectively. There was a significant correlation between the nursing students' attitudes to euthanasia and some demographic characteristics, including sex, age and religious beliefs. Iranian Muslim nursing students participating in the study had a negative attitude to euthanasia. Further studies are recommended among nursing students from different cultures and of different religious faiths.

Application of LAC-type processes and concepts to nonrecreation management issues in protected areas

Treesearch

Linda Merigliano; David N. Cole; David J. Parsons

1997-01-01

When Limits of Acceptable Change concepts are applied to nonrecreational issues, two primary problems are encountered: (1) developing zoning schemes which are compatible when multiple issues are addressed, and (2) defining the desired condition and establishing measurable standards for ecosystem attributes which change in unpredictable ways. Approaches to overcome...

Resistances Encountered in Starting a Group Therapy Program for Suicide Attempters in Varied Administrative Settings.

ERIC Educational Resources Information Center

Hackel, Jacqueline; Asimos, Chrisula T.

1980-01-01

Reports areas of difficulty (including funding issues, management and personal bias issues, and theoretical issues) which emerged in the development of five treatment groups of depressed and suicidal patients. Groups reflected efforts between the city-county mental health system and funding agencies. Strategies for overcoming difficulties are…

Virginia Department of Transportation public-private procurement : issues and accomplishments and interim report

DOT National Transportation Integrated Search

1999-01-01

This paper documents the contracting and procurement issues and opportunities encountered by the Virginia Department of Transportation (VDOT) in developing what was their first public-private partnership agreement for an Intelligent Transportation Sy...

A Study on the Application of Creative Problem Solving Teaching to Statistics Teaching

ERIC Educational Resources Information Center

Hu, Ridong; Xiaohui, Su; Shieh, Chich-Jen

2017-01-01

Everyone would encounter the life issue of solving complicated problems generated by economic behaviors among all activities for making a living. Various life problems encountered therefore could be generalized by economic statistics. In other words, a lot of important events in daily life are related to economic statistics. For this reason,…

A Decolonizing Encounter: Ward Churchill and Antonia Darder in Dialogue. Counterpoints: Studies in the Postmodern Theory of Education. Volume 430

ERIC Educational Resources Information Center

Orelus, Pierre W., Ed.

2012-01-01

"A Decolonizing Encounter" examines the effects of western colonialism on historically marginalized and colonized populations living both in the West and the "third world". Specifically, it explores crucial issues such as the decolonizing of schools and communities of color; the decentralization of power of the capitalist and…

Factors Affecting Student Persistence at a Selected Community College in the Stann Creek District, Belize, Central America

ERIC Educational Resources Information Center

Martinez, Karen Charlette

2011-01-01

Students encounter many issues that influence their persistence in college; some they come with, others they encounter while enrolled. Factors influencing students' success in college have taken on much interest in recent years. Students' persistence studies have been increasing; however, there is much to be learned about factors influencing…

The Role of Individualism/Collectivism in Critical Classroom Encounters: A Four Country Study

ERIC Educational Resources Information Center

Frankel, Robert; Swanson, Scott R.; Sagan, Mariusz

2005-01-01

Internationalization raises the issue of whether, and to what extent, the inherent culture of a country may have particular influence on the nature of service interactions, and on education (i.e., student-professor interactions) specifically. Thus the service encounter in the classroom becomes a subject of increasing importance and interest with…

The Problem-Based Learning Process: Reflections of Pre-Service Elementary School Teachers

ERIC Educational Resources Information Center

Baysal, Zeliha Nurdan

2017-01-01

This study aims to identify the benefits acquired by third-year pre-service elementary school teachers participating in a problem-based learning process in social studies education, the issues they encountered in that process and those they are likely to encounter, and their feelings about the process. Semi-structured interviews were used as one…

Testing vaccines in pediatric research subjects.

PubMed

Jacobson, Robert M; Ovsyannikova, Inna G; Poland, Gregory A

2009-05-26

Past difficulties encountered in pediatric vaccine research have positively influenced the development of modern regulations of human subjects' research. These regulations permit pediatric research but impose special restrictions on the types of studies to which children may participate, and these restrictions have important implications for modern vaccine trials. These ethical issues pose real but surmountable concerns. Considerations also include the use of placebos, critical for trial design but an impediment to parental permission. Recent pediatric vaccine studies illustrate practical alternatives to placebos that preserve allocation concealment and blinding yet obtain parental support. Vaccine researchers must consider the role parents play, not just in giving formal permission for their children's participation, but also for their roles in active recruitment, successful retention, and data acquisition. Studies of parents' attitudes do identify consistencies among motivating forces that drive parents to participate or refuse their children's participation. These studies should influence how we design and execute pediatric vaccine trials. Finally, ethical considerations and current regulations raise certain issues concerning the remuneration of the research volunteer when that volunteer is a child. The published literature illustrates wide variation in practice. Better understanding of the restrictions in pediatric research, the use of placebos, the attitude of parents, and the concerns with remuneration can better equip the vaccine researcher in pursuing successful studies in children.

Multiscale Phenomena in the Solid-Liquid Transition State of a Granular Material: Analysis and Modelling of Dense Granular Materials

DTIC Science & Technology

2011-09-26

most challenging to characterize and model of the gamut of granular behaviour encountered in practice. In particular, it exhibits self-organized...is intrinsically multiscale and is arguably one of, if not, the most challenging to characterize and model of the gamut of granular behaviour...the most challenging to characterize and model of the gamut of granular behaviour encountered in practice. In particular, it exhibits self-organized

Do internal medicine interns practice etiquette-based communication? A critical look at the inpatient encounter.

PubMed

Block, Lauren; Hutzler, Lindsey; Habicht, Robert; Wu, Albert W; Desai, Sanjay V; Novello Silva, Kathryn; Niessen, Timothy; Oliver, Nora; Feldman, Leonard

2013-11-01

Etiquette-based communication may improve the inpatient experience but is not universally practiced. We sought to determine the extent to which internal medicine interns practice behaviors that characterize etiquette-based medicine. Trained observers evaluated the use of 5 key communication strategies by internal medicine interns during inpatient clinical encounters: introducing one's self, explaining one's role in the patient's care, touching the patient, asking open-ended questions, and sitting down with the patient. Participants at 1 site then completed a survey estimating how frequently they performed each of the observed behaviors. A convenience sample of 29 interns was observed on a total of 732 patient encounters. Overall, interns introduced themselves 40% of the time and explained their role 37% of the time. Interns touched patients on 65% of visits, asked open-ended questions on 75% of visits, and sat down with patients during 9% of visits. Interns at 1 site estimated introducing themselves and their role and sitting with patients significantly more frequently than was observed (80% vs 40%, P < 0.01; 80% vs 37%, P < 0.01; and 58% vs 9%, P < 0.01, respectively). Resident physicians introduced themselves to patients, explained their role, and sat down with patients infrequently during observed inpatient encounters. Residents surveyed tended to overestimate their own practice of etiquette-based medicine. © 2013 Society of Hospital Medicine.

Gastrointestinal gas.

PubMed Central

Fardy, J; Sullivan, S

1988-01-01

Complaints related to gastrointestinal gas are commonly encountered in clinical practice. Various therapies have been proposed, yet none has appeared to be extremely effective. A review of the literature revealed little hard evidence to support the use of simethicone, pancreatic enzymes, anticholinergic agents or antibiotics. Evidence supporting the use of prokinetic agents has been the strongest, and there may be a pathophysiologic basis for the use of these agents if the complaints are related to abnormal intestinal motility. The use of activated charcoal for adsorbing intestinal gas has been effective in healthy subjects but has not been properly investigated in patients with gas complaints. Dietary modification may be beneficial in certain cases. Additional controlled trials are necessary to clarify the issues in the treatment of this common problem. PMID:3058280

Preparing supervisors to provide safeguarding supervision for healthcare staff.

PubMed

Smikle, Marcia

2017-11-28

This paper outlines why experienced supervisors at a London healthcare provider received skills training so they could offer safeguarding supervision to front-line colleagues with case management responsibilities for vulnerable children and young people. It examines how supervisors use the main functions of supervision and a cycle of reflection in clinical practice with supervisees. As well as the professional issues encountered by supervisors in relation to the benefits, the challenges of providing supervision and the action required to make safeguarding supervision a part of the organisational culture are also explored. ©2017 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

Toward a new paradigm in hospital-based pediatric education: the development of an onsite simulator program.

PubMed

Weinstock, Peter H; Kappus, Liana J; Kleinman, Monica E; Grenier, Barry; Hickey, Patricia; Burns, Jeffrey P

2005-11-01

The low incidence of crises in pediatrics, coupled with logistic issues and restricted work hours for trainees, hinders opportunities for frequent practice of crisis management and teamwork skills. We hypothesized that a dedicated simulator suite contiguous to the intensive care unit (ICU) would enhance the frequency and breadth of critical-incident training for a range of clinicians. Descriptive study. A tertiary-care pediatric teaching hospital. A realistic pediatric simulator suite was constructed 100 feet from the ICU, at a total base cost of $290,000. The simulation room is an exact replica of an ICU bed space, incorporating high-fidelity mannequin simulators. To capture an even wider audience, a portable unit was also created. Leaders from seven departments-critical care, cardiac intensive care, emergency medicine, transport medicine, anesthesia, respiratory care, and general pediatrics-completed instructor training to ensure effective debriefing techniques. Pediatric staff, including 100% of critical care fellows, 86% of nurses, 90% of respiratory therapists, and 74% of pediatric house staff, participated in >1500 learning encounters per year. All individuals were trained during their normal workday in the hospital. Courses in crisis resource management, skills acquisition, annual review, orientation, and trauma management (1,116, 98, 90, 60, and 60 encounters per year, respectively) were all designed by a multidisciplinary committee to ensure goal-directed education to a range of audiences. Annual costs were on par with those at other centers (approximately 44 dollars per trainee encounter). An onsite and comprehensive simulation program can significantly increase the opportunities for clinicians from multiple disciplines, in the course of their daily routines, to repetitively practice responses to pediatric medical crises. After an initial capital investment, the training appears to be cost-effective. Hospital-based simulator suites may point the way forward as a new paradigm for the effective education of today's busy clinicians.

General practitioners’ views on consultations with interpreters: A triad situation with complex issues

PubMed Central

Fatahi, Nabi; Hellström, Mikael; Skott, Carola; Mattsson, Bengt

2008-01-01

Objective To study a group of general practitioners’ (GPs) views on cross-cultural consultations through interpreters in primary healthcare in Sweden. Design Two group interviews and three personal interviews with experienced GPs regarding clinical consultation through interpreters were carried out. The interviews were transcribed and analysed and the text was categorized according to content analysis. Setting Primary healthcare. Subjects Eight GPs were interviewed. Main outcome measures The response and opinions of the GPs. Results In the analysis it appeared that an optimal clinical encounter demands an active role by all participants involved in the consultation. The interpreter has to strive after being a stable neutral information bridge, and has a balancing role between the GP and the patient. The GP has to be open to cultural inequalities and recognize consultation through an interpreter as a part of her/his job. The patient needs to be an active and visible participant, not hiding behind the interpreter. Common obstacles and imperfections to reach the best possible triad were discussed. Additionally, practical assets in the encounter were delineated. Accurate physical placing of the persons in the room, adequate length of consultation time, and using the same interpreter from one visit to another were mentioned as factors influencing the outcome of the consultation. Conclusion Barriers in cross-cultural communications could originate from all persons involved, the interpreter, the GP, and the patient, as well as from tangible factors. Ways to reduce misunderstandings in GP–patient encounters through interpreters are suggested. PMID:18297562

Are Behavioural Interventions Doomed to Fail? Challenges to Self-Management Support in Chronic Diseases.

PubMed

Vallis, Michael

2015-08-01

Self-management and self-management support are concepts very familiar to those of us in diabetes care. These concepts require openness to understanding the behaviours of persons with diabetes broadly, not only behaviours restricted to the biomedical perspective. Understanding the importance of health behaviour change and working within the Expanded Chronic Care Model define the context within which self-management support should occur. The purpose of this perspective is to identify a potential limitation in existing self-management support initiatives. This potential limitation reflects provider issues, not patient issues; that is, true self-management support might require changes by healthcare providers. Specifically, although behavioural interventions within the context of academic research studies are evidence based, behaviour change interventions implemented in general practice settings might prove less effective unless healthcare providers are able to shift from a practice based on the biomedical model to a practice based on the self-management support model. The purpose of this article is to facilitate effective self-management support by encouraging providers to switch from a model of care based on the expert clinician encountering the uninformed help seeker (the biomedical model) to one guided by collaboration grounded in the principles of description, prediction and choice. Key to understanding the value of making this shift are patient-centered communication principles and the tenets of complexity theory. Copyright © 2015 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.

History-Enriched Spaces for Shared Encounters

NASA Astrophysics Data System (ADS)

Konomi, Shin'ichi; Sezaki, Kaoru; Kitsuregawa, Masaru

We discuss "history-enriched spaces" that use historical data to support shared encounters. We first examine our experiences with DeaiExplorer, a social network display that uses RFID and a historical database to support social interactions at academic conferences. This leads to our discussions on three complementary approaches to addressing the issues of supporting social encounters: (1) embedding historical data in embodied interactions, (2) designing for weakly involved interactions such as social navigation, and (3) designing for privacy. Finally, we briefly describe a preliminary prototype of a proxemics-based awareness tool that considers these approaches.

Pattern of prescription drug use in Nigerian army hospitals.

PubMed

Adebayo, E T; Hussain, N A

2010-01-01

Most health expenditure of developing countries is on drugs and medical sundries but inappropriate use of such resources is common. To our knowledge, only few studies have been done in Africa on this issue , with inadequate consideration of the sociological context of the knowledge, attitude and practice of the prescribers especially doctors. This study presents the pooled data of the pattern of prescription drug use from three Nigerian Army hospitals using some WHO criteria, and the knowledge and attitude underlying doctors' prescribing practices in these hospitals. Retrospective cross-sectional survey of one year (March 2006-February 2007). Systematic random sample of general out patient case notes from three hospitals were collected using WHO criteria. The knowledge, attitude and practice survey of doctors at each study site towards the concept of rational drug use (RDU) were assessed using a self-administered questionnaire. Data collected from 660 case notes showed that average number of drugs per encounter was 2.8 while 49.3% of drugs were prescribed in the generic form. An average of 28.1% of patients encountered antibiotics. From the knowledge, attitude and practice survey, it is evident that 90.5% of 74 prescribers were aware of the existence of national essential drugs list but 58.1% of them did not use it as basis of prescriptions. In describing types of medicines preferred, 56.7% of prescribers claimed they prescribed a mixture of generic and branded drugs. Only 12.1% of prescribers could accurately detail the 5 steps of rational prescribing. The pattern of prescription drug use in Nigerian Army hospitals is unsatisfactory. It is characterised by high number of drugs per prescription, high rate of antibiotic usage and unscientific prescription by doctors. There is a need for further education and research on rational drug use among prescribers in Nigerian military health facilities.

Science Teachers Taking their First Steps toward Teaching Socioscientific Issues through Collaborative Action Research

NASA Astrophysics Data System (ADS)

Lee, Hyunju; Yang, Jung-eun

2017-06-01

This study presents two science teachers, Catherine and Jennifer, who took their first steps toward teaching socioscientific issues through collaborative action research. The teachers participated in the collaborative action research project because they wanted to address socioscientific issues but had limited experience in teaching them. The research questions included what kinds of challenges the teachers encountered when implementing socioscientific issues and to what extent they resolved the challenging issues as participating in collaborative action research. The primary data source consisted of audiotapes of regular group meetings containing information on the process of constructing and implementing lesson plans and reflecting on their teaching of socioscientific issues. We also collected classroom videotapes of the teachers' instruction and audiotapes of students' small group discussions and their worksheets. The findings indicated that when addressing socioscientific issues in the classes, the teachers encountered several challenging issues. We categorized them into four: (1) restructuring classroom dynamics and culture, (2) scaffolding students' engagement in socioscientific issues, (3) dealing with values, and (4) finding their niche in schools. However, this study showed that collaborative action research could be a framework for helping the teachers to overcome such challenges and have successful experiences of teaching socioscientific issues. These experiences became good motivation, to gradually develop their understanding of teaching socioscientific issues and instructional strategies for integrating the knowledge and skills that they had accumulated over the years.

Factors impacting on psychological wellbeing of international students in the health professions: A scoping review.

PubMed

McKenna, Lisa; Robinson, Eddie; Penman, Joy; Hills, Danny

2017-09-01

There are increasing numbers of international students undertaking health professional courses, particularly in Western countries. These courses not only expose students to the usual stresses and strains of academic learning, but also require students to undertake clinical placements and practice-based learning. While much is known about general issues facing international students, less is known about factors that impact on those studying in the health professions. To explore what is known about factors that influence the psychological wellbeing of international students in the health professions. A scoping review. A range of databases were searched, including CINAHL, Medline, Scopus, Proquest and ERIC, as well as grey literature, reference lists and Google Scholar. The review included qualitative or quantitative primary peer reviewed research studies that focused on international undergraduate or postgraduate students in the health professions. The core concept underpinning the review was psychological issues, with the outcome being psychological and/or social wellbeing. Thematic analysis across studies was used to identify key themes emerging. A total of 13 studies were included in the review, from the disciplines of nursing, medicine and speech-language pathology. Four key factor groups emerged from the review: negotiating structures and systems, communication and learning, quality of life and self-care, and facing discrimination and social isolation. International health professional students face similar issues to other international students. The nature of their courses, however, also requires negotiating different health care systems, and managing a range of clinical practice issues including with communication, and isolation and discrimination from clinical staff and patients. Further research is needed to specifically explore factors impacting on student well-being and how international students can be appropriately prepared and supported for their encounters. Copyright © 2017 Elsevier Ltd. All rights reserved.

Challenges, Not Barriers: The Work and Family Issues of Women Superintendents

ERIC Educational Resources Information Center

Reecks-Rodgers, Debra Ann

2013-01-01

Prior studies have indicated that qualified female administrators have not applied for superintendency positions because of possible work/family conflicts, but little research has been done on the work/family issues encountered by women in the superintendency or on the strategies they use to resolve these issues. In response, this study is an…

Preemptive financial strategies help IPAs avoid insolvency.

PubMed

Karling, J; Silberman, L

2000-11-01

The 1999 collapse in California of practice management giants FPA Medical Management, Inc. and MedPartners, Inc. has caused healthcare provider organizations, particularly independent practice associations (IPAs), to examine critical issues related to financial solvency. Problems such as declining membership, ineffective management, weak contracting, and lack of strategic vision frequently are encountered by troubled provider organizations. The common thread that runs through IPA failures is a combination of unreliable accounting data and inadequate reporting systems. This lack of satisfactory financial and reporting information impairs the ability of the provider group to maintain sufficient funds to cover expenses and pay physicians. Successful, financially stable provider networks use well-defined reporting procedures based on fundamental accounting and financial concepts, as well as a sound methodology for measuring and calculating claims liability estimates. In California, new regulations aimed at encouraging provider organizations to assume preemptive financial strategies are in the process of being adopted. IPAs in every state should consider reviewing these regulations as benchmarks by which to assess their financial procedures.

Stresses and satisfactions of the two-pharmacist relationship.

PubMed

Stanton, A L; Berger, B A

1987-12-01

Potential advantages and disadvantages of dual-career relationships are identified, and strategies for addressing common issues encountered by dual-career couples are presented. With regard to career issues, clarification of expectations and discussion between partners regarding career commitment, job selection and mobility, and maintenance of professional identity is emphasized. Benefits of dual-career relationships include shared occupational interests, financial rewards, and respect for each partner's professional expertise. Strategies for managing domestic responsibilities include modifying standards, setting priorities, and distributing tasks evenly among family members. Pharmacist couples who are parents have chosen several routes in managing child-care issues, including postponing childbearing until each adult's career is established, decreasing one partner's career involvement, and hiring community or in-home caretakers. Sharing equally in child care can help prevent an excessive workload for one parent. Progressive family-oriented employment practices may also aid dual-career couples with children. Striking a balance between career and family is identified as perhaps the most challenging task facing the dual-career couple; time distribution must be adjusted according to the couple's priorities. Identifying realistic priorities, negotiating honestly regarding attainment of mutual and individual goals, and maintaining flexibility are key in achieving success in the professional and private lives of two-pharmacist couples.

Exploring Digital Encounters in the Public Arena

NASA Astrophysics Data System (ADS)

Schieck, Ava Fatah Gen.; Kostakos, Vassilis; Penn, Alan

In this chapter, we explore the types of encounters that technology enables. We consider the differences between digital and nondigital encounters through two pilot studies carried out in the city of Bath, United Kingdom. We investigate how technology can be appropriated for shared interactions that support conscious (or unconscious) social encounters, and highlight the importance of space and the role of place in providing temporal and spatial mechanisms facilitating different types of shared encounters. Here, we apply a method based on intervention through "sensing and projecting" Bluetooth names and digital identity in the public arena, and describe initial observations about people's reaction toward the projection of their Bluetooth names in public. In particular, we note the significance of constructing socially meaningful relations between people mediated by these technologies. We discuss initial results and outline issues raised in detail before finally describing the ongoing work.

Issues and Knowledge Concerning the Use of Heads-Up Displays in Air Transports

DOT National Transportation Integrated Search

2003-03-01

This document provides a literature review of design issues encountered by the Federal Aviation Administration (FAA) during the : certification of head-up displays (HUDs) for use in air transports. This review extracts certification advice from the l...

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. Nursing faculties should assess the clinical environment prerequisites of the settings as a context of student experience before deciding on their accreditation. Moreover, the nursing faculty and nurse managers should also enhance competence with regard to discussing ethical issues with students among clinical nurses by identifying factors that hinder this learning opportunity in daily practice.

Assessing the Risk of Prehospital Administration of Naloxone with Subsequent Refusal of Care.

PubMed

Levine, Michael; Sanko, Stephen; Eckstein, Marc

2016-01-01

EMS providers frequently encounter opioid-toxic patients who receive naloxone and then refuse further medical care. Older studies revealed this practice to be safe. In light of the evolving patterns of opioid abuse, this study attempted to determine the safety of this practice. This is a retrospective review of all patient encounters by the Los Angeles Fire Department (LAFD) between July 1, 2011-December 31, 2013. All LAFD patient encounters are stored electronically. These electronic records were reviewed for subjects who received naloxone had a documented respiratory rate (RR) less than 12, and subsequently refused transport. Data abstracted included name, social security number (SSN), date of birth (DOB), date of EMS encounter, age, and treatment rendered. The names, SSN, and DOB, as available, were supplied to the coroner's office. The Coroner's records were reviewed to determine if a patient with the same or similar name (e.g., Jon vs. Jonathan) had died within 24 hours, 30 days, or 6 months of the initial EMS encounter. The abstractor was blinded to the study hypothesis. 205 subjects were identified; the median (IQR) age was 41 (29-53) years. 27 (13%) were female. One subject (0.49%) died within 24 hours of the initial EMS encounter. The cause of death (COD) was coronary artery disease and heroin use. Two additional subjects (1. %) died within 30 days. One of these subjects died 6 days later; the COD is unknown. The other subject died 20 days after the EMS encounter; the COD was cardiovascular disease and liver cirrhosis. No additional subjects were identified at the 6 month follow up. A third subject died of a heroin overdose 16 months after the initial EMS encounter, but was beyond the pre-defined follow up period. The practice of receiving pre-hospital naloxone by paramedics and subsequently refusing care is associated with an extremely low short- and intermediate-term mortality. Despite an evolving pattern of opioid abuse, the results of this study are consistent with previously reported studies.

Safety pharmacology investigations on the nervous system: An industry survey.

PubMed

Authier, Simon; Arezzo, Joseph; Delatte, Marcus S; Kallman, Mary-Jeanne; Markgraf, Carrie; Paquette, Dominique; Pugsley, Michael K; Ratcliffe, Sian; Redfern, William S; Stevens, Joanne; Valentin, Jean-Pierre; Vargas, Hugo M; Curtis, Michael J

2016-01-01

The Safety Pharmacology Society (SPS) conducted an industry survey in 2015 to identify industry practices as they relate to central, peripheral and autonomic nervous system ('CNS') drug safety testing. One hundred fifty-eight (158) participants from Asia (16%), Europe (20%) and North America (56%) responded to the survey. 52% of participants were from pharmaceutical companies (>1000 employees). Oncology (67%) and neurology/psychiatry (66%) were the most frequent target indications pursued by companies followed by inflammation (48%), cardiovascular (43%), metabolic (39%), infectious (37%), orphan (32%) and respiratory (29%) diseases. Seizures (67% of participants), gait abnormalities (67%), tremors (65%), emesis (56%), sedation (52%) and salivation (47%) were the most commonly encountered CNS issues in pre-clinical drug development while headache (65%), emesis/nausea (60%), fatigue (51%) and dizziness (49%) were the most frequent issues encountered in Phase I clinical trials. 54% of respondents reported that a standard battery of tests applied to screen drug candidates was the approach most commonly used to address non-clinical CNS safety testing. A minority (14% of all participants) reported using electroencephalography (EEG) screening prior to animal inclusion on toxicology studies. The most frequent group size was n=8 for functional observation battery (FOB), polysomnography and seizure liability studies. FOB evaluations were conducted in a dedicated room (78%) by blinded personnel (66%) with control for circadian cycle (55%) effects (e.g., dosing at a standardized time; balancing time of day across treatment groups). The rat was reported as the most common species used for seizure liability, nerve conduction and drug-abuse liability testing. Copyright © 2016 Elsevier Inc. All rights reserved.

Ritual and ceremony in intraoperative magnetic resonance imaging-assisted brain surgery.

PubMed

Gellert, Vance

2012-01-01

Previous photographic research into traditional and shamanic healing practices in Peru and Bolivia and a review of the literature suggested that all medical practices have cultural determined nonmedical activities as integral parts of the healing encounter. These include costume, ritual, ceremony, environment factors that were looked for in a western clinical encounter for this paper. A patient was followed through pre-op preparation and iMRI assisted brain surgery. All activities were photographed extensively and evaluated in a broader healing context. A number of activities were visually and metaphorically comparable with those seen in other practices. These are discussed as rituals of intention on the part of the caregivers to focus their skills on healing and also to mindfully engage the patient in the healing process. Artistic observation and analysis may be an effective way to identify these non quantifiable elements of the healing encounter and suggest directions for further research into the emotional components of the healing process. Copyright © 2012 Elsevier Inc. All rights reserved.

Minority students in the science classroom: Issues of language, class, race, culture and pedagogy

NASA Astrophysics Data System (ADS)

Sweeney, Aldrin Edward

A considerable proportion of the educationally at-risk students in the K-12 public education system is composed of minority students, either in terms of cultural background, linguistic background, and frequently, both. In particular, satisfactory levels of achievement in science are not being attained by these students. The concerns of this study center on examining and understanding the reasons underlying this situation, with a view to suggesting how these problems of underachievement in science might be addressed. Previous and ongoing educational research concerning these issues suggest that such underachievement may be due to current pedagogical practices which seem to actively discourage these students from achieving any significant measure of academic, educational or professional success. The purpose of this study is thus to explore the beliefs and pedagogical practices of science teachers as they relate to minority students, especially those minority students for whom English is not a first language and who have limited English proficiency (LEP). In the course of this study, the terminology 'minority students' will refer to and be inclusive of cultural and/or language minorities, i.e. those students who differ from the mainstream white American student in terms of cultural background and a native language other than English. Culturally derived usages of non-standard forms of English (e.g. Black English Vernacular) also will be subsumed within this definition of cultural and language minority students. Particular attention will be given to emergent issues relating to current pedagogical practices, also to the science teacher beliefs and epistemological rationales underlying such practices. In exploring these beliefs and pedagogical practices, the study also will seek to delineate and to understand the various problems which are being encountered in the teaching of science to minority students. As the result of exploring the beliefs and pedagogical practices of science teachers as they relate to minority students, it is intended that the completed study will contribute toward the development and elaboration of a substantive pedagogical content knowledge base for science teachers of cultural and language minority students. It is anticipated that the development of such a knowledge base will be of practical assistance to science teachers in their pedagogical decisions such that a greater inclusion of these students in the science discourse community may be attained.

A Method to Determine the Impact of Patient-Centered Care Interventions in Primary Care

PubMed Central

Daaleman, Timothy P.; Shea, Christopher M.; Halladay, Jacqueline; Reed, David

2014-01-01

INTRODUCTION The implementation of patient-centered care (PCC) innovations continues to be poorly understood. We used the implementation effectiveness framework to pilot a method for measuring the impact of a PCC innovation in primary care practices. METHODS We analyzed data from a prior study that assessed the implementation of an electronic geriatric quality-of-life (QOL) module in 3 primary care practices in central North Carolina in 2011–12. Patients responded to the items and the subsequent patient-provider encounter was coded using the Roter Interaction Analysis System (RIAS) system. We developed an implementation effectiveness measure specific to the QOL module (i.e., frequency of usage during the encounter) using RIAS and then tested if there were differences with RIAS codes using analysis of variance. RESULTS A total of 60 patient-provider encounters examined differences in the uptake of the QOL module (i.e., implementation-effectiveness measure) with the frequency of RIAS codes during the encounter (i.e., patient-centeredness measure). There was a significant association between the effectiveness measure and patient-centered RIAS codes. CONCLUSION The concept of implementation effectiveness provided a useful framework determine the impact of a PCC innovation. PRACTICE IMPLICATIONS A method that captures real-time interactions between patients and care staff over time can meaningfully evaluate PCC innovations. PMID:25269410

Using Option Grids: steps toward shared decision-making for neonatal circumcision.

PubMed

Fay, Mary; Grande, Stuart W; Donnelly, Kyla; Elwyn, Glyn

2016-02-01

To assess the impact, acceptability and feasibility of a short encounter tool designed to enhance the process of shared decision-making and parental engagement. We analyzed video-recordings of clinical encounters, half undertaken before and half after a brief intervention that trained four clinicians how to use Option Grids, using an observer-based measure of shared decision-making. We also analyzed semi-structured interviews conducted with the clinicians four weeks after their exposure to the intervention. Observer OPTION(5) scores were higher at post-intervention, with a mean of 33.9 (SD=23.5) compared to a mean of 16.1 (SD=7.1) for pre-intervention, a significant difference of 17.8 (95% CI: 2.4, 33.2). Prior to using the intervention, clinicians used a consent document to frame circumcision as a default practice. Encounters with the Option Grid conferred agency to both parents and clinicians, and facilitated shared decision-making. Clinician reported recognizing the tool's positive effect on their communication process. Tools such as Option Grids have the potential to make it easier for clinicians to achieve shared decision-making. Encounter tools have the potential to change practice. More research is needed to test their feasibility in routine practice. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

A Case Study of Professional Boundary Issues Experienced by Undergraduate Psychology Students in a Supervised Field Experience Course

ERIC Educational Resources Information Center

Sharp, Gwen; Yao, Richard; Cresiski, Robin; Hahn, Kate

2013-01-01

There has been little research on the types of boundary issues encountered in undergraduate psychology field experience courses, despite the increased popularity of such courses. This case study identifies the frequency and types of boundary issues faced by undergraduate psychology students enrolled in such a course, including the most common…

'To Trust or Not to Trust--Pupils' Ways of Judging Information Encountered in a Socio-Scientific Issue.

ERIC Educational Resources Information Center

Kolsto, Stein Dankert

2001-01-01

Describes a qualitative study in which 16-year-old Norwegian pupils dealt with a socio-scientific issue. Investigates aspects of students' decision-making concerning a local version of the well-known controversial issue of whether or not power transmission lines increase the risk for childhood leukemia. Some of the resolution strategies imply that…

Exploring healthcare communication models in private physiotherapy practice.

PubMed

Hiller, Amy; Guillemin, Marilys; Delany, Clare

2015-10-01

This project explored whether models of healthcare communication are evident within patient-physiotherapist communication in the private practice setting. Using qualitative ethnographic methods, fifty-two patient-physiotherapist treatment sessions were observed and interviews with nine physiotherapists were undertaken. Data were analyzed using thematic analysis. In these clinical encounters physiotherapists led the communication. The communication was structured and focussed on physical aspects of the patient's presentation. These features were mediated via casual conversation and the use of touch to respond to the individual patient. Physiotherapists did not explicitly link their therapeutic communication style to established communication models. However, they described a purposeful approach to how they communicated within the treatment encounter. The communication occurring in the private practice physiotherapy treatment encounter is predominantly representative of a 'practitioner-centred' model. However, the subtle use of touch and casual conversation implicitly communicate competence and care, representative of a patient-centred model. Physiotherapists do not explicitly draw from theories of communication to inform their practice. Physiotherapists may benefit from further education to achieve patient-centred communication. Equally, the incorporation of casual conversation and the use of touch into theory of physiotherapy patient-centred communication would highlight these specific skills that physiotherapists already utilize in practice. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Barriers to GPs' use of evidence-based medicine: a systematic review

PubMed Central

Zwolsman, Sandra; te Pas, Ellen; Hooft, Lotty; Waard, Margreet Wieringa-de; van Dijk, Nynke

2012-01-01

Background GPs report various barriers to the use and practice of evidence-based medicine (EBM). A review of research on these barriers may help solve problems regarding the uptake of evidence in clinical outpatient practice. Aim To determine the barriers encountered by GPs in the practice of EBM and to come up with solutions to the barriers identified. Design A systematic review of the literature. Method The following databases were searched: MEDLINE® (PubMed®), Embase, CINAHL®, ERIC, and the Cochrane Library, until February 2011. Primary studies (all methods, all languages) that explore the barriers that GPs encounter in the practice of EBM were included. Results A total of 14 700 articles were identified, of which 22 fulfilled all inclusion criteria. Of the latter, nine concerned qualitative, 12 concerned quantitative, and one concerned both qualitative and quantitative research methods. The barriers described in the articles cover the categories: evidence (including the accompanying EBM steps), the GP’s preferences (experience, expertise, education), and the patient’s preferences. The particular GP setting also has important barriers to the use of EBM. Barriers found in this review, among others, include lack of time, EBM skills, and available evidence; patient-related factors; and the attitude of the GP. Conclusion Various barriers are encountered when using EBM in GP practice. Interventions that help GPs to overcome these barriers are needed, both within EBM education and in clinical practice. PMID:22781999

Scientific authorship. Part 2. History, recurring issues, practices, and guidelines.

PubMed

Claxton, Larry D

2005-01-01

One challenge for most scientists is avoiding and resolving issues that center around authorship and the publishing of scientific manuscripts. While trying to place the research in proper context, impart new knowledge, follow proper guidelines, and publish in the most appropriate journal, the scientist often must deal with multi-collaborator issues like authorship allocation, trust and dependence, and resolution of publication conflicts. Most guidelines regarding publications, commentaries, and editorials have evolved from the ranks of editors in an effort to diminish the issues that faced them as editors. For example, the Ingelfinger rule attempts to prevent duplicate publications of the same study. This paper provides a historical overview of commonly encountered scientific authorship issues, a comparison of opinions on these issues, and the influence of various organizations and guidelines in regards to these issues. For example, a number of organizations provide guidelines for author allocation; however, a comparison shows that these guidelines differ on who should be an author, rules for ordering authors, and the level of responsibility for coauthors. Needs that emerge from this review are (a) a need for more controlled studies on authorship issues, (b) an increased awareness and a buy-in to consensus views by non-editor groups, e.g., managers, authors, reviewers, and scientific societies, and (c) a need for editors to express a greater understanding of authors' dilemmas and to exhibit greater flexibility. Also needed are occasions (e.g., an international congress) when editors and others (managers, authors, etc.) can directly exchange views, develop consensus approaches and solutions, and seek agreement on how to resolve authorship issues. Open dialogue is healthy, and it is essential for scientific integrity to be protected so that younger scientists can confidently follow the lead of their predecessors.

Clinical pharmacokinetics: perceptions of hospital pharmacists in Qatar about how it was taught and how it is applied.

PubMed

Kheir, Nadir; Awaisu, Ahmed; Gad, Hoda; Elazzazy, Shereen; Jibril, Farah; Gajam, Mawadda

2015-12-01

The application of clinical pharmacokinetics (PK) is essential when providing pharmaceutical care. Appropriate application of PK monitoring results in improved patient outcomes including decreased mortality, length of treatment, length of hospital stay, and adverse effects of drug therapy. Despite the well-documented evidence of benefits of clinical PK services, many pharmacists find it challenging to apply PK in clinical practice. To evaluate pharmacists' training backgrounds, attitude, practices, and perceived barriers pertaining to the application of PK in clinical practice in Qatar. All hospitals under Hamad Medical Corporation, the main healthcare provider in Qatar. This was a cross-sectional, descriptive study that was conducted between October 2012 and January 2013, using a self-administered web-based survey. Pharmacists were eligible to participate if they: (1) were working as full-time hospital pharmacists and; (2) have been in practice for at least 1 year. PK contents learned in undergraduate curriculum; perception towards the PK contents and instructions received in the undergraduate curriculum and; application of PK in current clinical practice. A total of 112 pharmacists responded to the questionnaire. The majority of the respondents (n = 91; 81.3 %) reported that they had received PK course(s) in their undergraduate curriculum. Similarly, the majority (70-80 %) of them agreed that the undergraduate PK courses or contents they received were important and relevant to their current practice. The pharmacists identified spending more time on dispensing and inventory issues rather than clinical practice, scarce resources, and manual rather than computerized PK calculations as some of the barriers they encountered in learning about PK and its application. The characteristics of the surveyed pharmacists such as gender, age, highest academic degree, and country of graduation did not influence the pharmacists' perception and attitudes towards PK teaching and application (p > 0.05). PK course contents were perceived to lack depth and relevance to practice, and pharmacist had no experiential training that included aspects of PK. These, and other issues, result in poor application of PK in practice.

Small-Group Standardized Patient Encounter Improves Athletic Training Students' Psychosocial Intervention and Referral Skills

ERIC Educational Resources Information Center

Walker, Stacy E.; Weidner, Thomas G.; Thrasher, Ashley B.

2016-01-01

Context: Athletic trainers provide psychological support, counseling, intervention, and referral to patients during clinical practice. However, students are rarely exposed to real-life opportunities to develop these skills. Objective: To determine if a small-group standardized patient (SP) encounter improved athletic training students'…

Issues Affecting Cross-Cultural Adaptation of International Graduate Students

ERIC Educational Resources Information Center

Hartshorne, Richard; Baucom, Jennifer

2007-01-01

The purpose of this study was to identify and analyze the adjustment problems encountered by international graduate students enrolled in American universities. Issues of interest included motives for attending graduate school, factors involved in facilitating and constraining the graduate school experience, personality traits that contribute to…

Burn Survivors' Perceptions regarding Relevant Sexual Education Strategies

ERIC Educational Resources Information Center

Parrott, Yolan; Esmail, Shaniff

2010-01-01

Purpose: This paper aims to investigate the unique issues childhood burn survivors experience in relation to sex education and sexual development. Design/methodology/approach: Using a phenomenological approach, participants described their lived experiences with regards to sex education and the sexuality issues they encountered as child burn…

Is EIA part of the wind power planning problem?

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

Smart, Duncan Ewan; Stojanovic, Timothy A., E-mail: tas21@st-andrews.ac.uk; Warren, Charles R.

2014-11-15

This research evaluates the importance and effectiveness of Environmental Impact Assessment (EIA) within wind farm planning debates, drawing on insights from case studies in Scotland. Despite general public support for renewable energy on the grounds that it is needed to tackle climate change and implement sustainable development, many proposed wind farms encounter significant resistance. The importance of planning issues and (EIA) processes has arguably been overlooked within recent wind farm social acceptability discourse. Through semi-structured interviews with key stakeholders and textual analysis of EIA documents, the characteristics of EIA are assessed in terms of its perceived purpose and performance. Themore » data show that whilst respondents perceive EIA to be important, they express concerns about bias and about the inability of EIA to address climate change and wind farm decommissioning issues adequately. Furthermore, the research identifies key issues which impede the effectiveness of EIA, and reveals differences between theoretical and practical framings of EIA. The paper questions the assumption that EIA is a universally applicable tool, and argues that its effectiveness should be analysed in the context of specific development sectors. The article concludes by reviewing whether the recently amended EIA Directive (2014/52/EU) could resolve identified problems within national EIA practice. - Highlights: • Evaluation of EIA for onshore wind farm planning in Scotland. • EIA is important for multiple aspects of onshore wind farm planning. • Multiple substantive deficiencies of relevance to wind farm planning exist in EIA. • Further research into EIA effectiveness for specific development types is required. • Directive 2014/52/EU may improve EIA effectiveness within wind farm planning.« less

Official Positions for FRAX® Bone Mineral Density and FRAX® simplification from Joint Official Positions Development Conference of the International Society for Clinical Densitometry and International Osteoporosis Foundation on FRAX®.

PubMed

Lewiecki, E Michael; Compston, Juliet E; Miller, Paul D; Adachi, Jonathan D; Adams, Judith E; Leslie, William D; Kanis, John A; Moayyeri, Alireza; Adler, Robert A; Hans, Didier B; Kendler, David L; Diez-Perez, Adolfo; Krieg, Marc-Antoine; Masri, Basel K; Lorenc, Roman R; Bauer, Douglas C; Blake, Glen M; Josse, Robert G; Clark, Patricia; Khan, Aliya A

2011-01-01

Tools to predict fracture risk are useful for selecting patients for pharmacological therapy in order to reduce fracture risk and redirect limited healthcare resources to those who are most likely to benefit. FRAX® is a World Health Organization fracture risk assessment algorithm for estimating the 10-year probability of hip fracture and major osteoporotic fracture. Effective application of FRAX® in clinical practice requires a thorough understanding of its limitations as well as its utility. For some patients, FRAX® may underestimate or overestimate fracture risk. In order to address some of the common issues encountered with the use of FRAX® for individual patients, the International Society for Clinical Densitometry (ISCD) and International Osteoporosis Foundation (IOF) assigned task forces to review the medical evidence and make recommendations for optimal use of FRAX® in clinical practice. Among the issues addressed were the use of bone mineral density (BMD) measurements at skeletal sites other than the femoral neck, the use of technologies other than dual-energy X-ray absorptiometry, the use of FRAX® without BMD input, the use of FRAX® to monitor treatment, and the addition of the rate of bone loss as a clinical risk factor for FRAX®. The evidence and recommendations were presented to a panel of experts at the Joint ISCD-IOF FRAX® Position Development Conference, resulting in the development of Joint ISCD-IOF Official Positions addressing FRAX®-related issues. Copyright © 2011 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.

Intimacy, intercourse and adjustments: Experiences of sexual life of a group of people with physical disabilities in South Africa.

PubMed

Hunt, Xanthe; Braathen, Stine Hellum; Swartz, Leslie; Carew, Mark Thomas; Rohleder, Poul

2018-02-01

There is a growing recognition of the sexual and reproductive rights of people with disabilities, and since the World Health Organisation's World Report on Disability, increased international attention has been given to these issues. Past research, however, suggests that this group encounter barriers to sexual and reproductive rights, which are both physical and attitudinal. Against this backdrop, this article employs a sequential mixed qualitative methodology to explore the practical and subjective experiences of 13 people with physical disabilities in South Africa, with regard to their sexual lives and experiences of sexuality. These experiences were marked by concerns about their 'fitness' as sexual beings and indicated that social forces were key in shaping their expectations for their own sexual life.

Organic synthesis: march of the machines.

PubMed

Ley, Steven V; Fitzpatrick, Daniel E; Ingham, Richard J; Myers, Rebecca M

2015-03-09

Organic synthesis is changing; in a world where budgets are constrained and the environmental impacts of practice are scrutinized, it is increasingly recognized that the efficient use of human resource is just as important as material use. New technologies and machines have found use as methods for transforming the way we work, addressing these issues encountered in research laboratories by enabling chemists to adopt a more holistic systems approach in their work. Modern developments in this area promote a multi-disciplinary approach and work is more efficient as a result. This Review focuses on the concepts, procedures and methods that have far-reaching implications in the chemistry world. Technologies have been grouped as topics of opportunity and their recent applications in innovative research laboratories are described. © 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Health Research Ethics: Between Ethics Codes and Culture.

PubMed

Gheondea-Eladi, Alexandra

2017-10-01

This article is meant to describe and analyze some of the ethical difficulties encountered in a pilot research on treatment decisions of patients with chronic viral hepatitis C infection in Romania. It departs from an overview of the main ethics codes, and it shows that social health research on patients falls in between institutional codes of ethics. Furthermore, the article moves on to analyze so-called "important moments" of empirical research, such as the implementation of the ethical protocol, dealing with informal payments and with information on shady actions, as well as requests of information from interviewed patients and deciding when and if to breach confidentiality. In an attempt to evaluate the ad hoc solutions found in the field, the concluding remarks discuss these issues at the threshold of theory and practice.

The Hispanic family and male-female relationships: an overview.

PubMed

Galanti, Geri-Ann

2003-07-01

An overview of the traditional Hispanic family and male-female relationships is presented, with an emphasis on issues relevant to providing health care to Hispanic populations. Aspects of the family presented include visitation, decision making, self-care, and emotional problems. Male-female relationships stem from traditional gender roles. Machismo and patriarchal authority characterize the male role; the roles of a traditional woman are housewife and mother. Women are expected to defer to the authority of their husbands. The negative aspects of machismo can result in heavy drinking and the pursuit of high-risk activities, leading to domestic violence and HIV/AIDS. These health risks are exacerbated by such cultural factors as male dominance, female modesty, and the practice of keeping problems within the family. The importance of personalism in patient-provider encounters is emphasized.

Anonymity and live-donor transplantation: an ELPAT view.

PubMed

Mamode, Nizam; Lennerling, Annette; Citterio, Franco; Massey, Emma; Van Assche, Kristof; Sterckx, Sigrid; Frunza, Mihaela; Jung, Harald; Pascalev, Assya; Zuidema, Willij; Johnson, Rachel; Loven, Charlotte; Weimar, Willem; Dor, Frank J M F; Dor, Frank

2013-02-27

Anonymity of donors or recipients in living-donor transplantation is a complex issue and practice varies widely. There are compelling arguments for maintaining anonymity of both parties before unspecified donor transplantation and specified indirect transplantation. After transplantation, there are still good reasons to avoid disclosure of identities. Although anonymity could be lifted if both parties explicitly request it, there are significant, potentially negative consequences of such an approach. Both donor and recipient should be counseled regarding these, and transplant teams should consider the considerable financial and psychosocial costs if problems are encountered as a result of contact. Given the recent rise in the number of unspecified living-donor transplants and through paired exchange schemes, it is vital that data are collected regarding the effects of maintaining or revoking anonymity after transplantation.

Pre-operative patient teaching in an acute care ward in Hong Kong: a case study.

PubMed

Lee, David S; Chien, W T

2002-10-01

Many nurses have acknowledged that adequate pre-operative teaching can alleviate patients' anxiety, increase patient participation in their own care, and minimize post-operative complications. However, the organization and degree to which pre-operative patient teachingfeatured in nurses' practice varies in different acute care settings. A case study design was used to explore the practice of pre-operative teaching in a surgical ward of an acute general hospital in Hong Kong. Seventeen registered nurses working on the ward were interviewed and observed in order to explore how they conduct a pre-operative teaching program and the difficulties encountered by them in carrying out pre-operative teaching on this acute care setting. Thefindings of this study indicate that pre-operative teaching workshops are organized and conducted by nursesfrom the operating theatre, in the day surgery center. Ward nurses were not actively involved in this pre-operative teaching. The results of this study present some similarities to a study with the similar design in Australia. There are also issues unique to the Hong Kong context. This case study was to review Hong Kong nurses' current practices of pre-operative teaching and to understand the cultural, conceptual and managementfactors influencing the practice in pre-operative teaching.

The clinical application of research utilization: amphotericin B.

PubMed

Reedy, A M; Shivnan, J C; Hanson, J L; Haisfield, M E; Gregory, R E

1994-05-01

To describe the first application of the research utilization process by clinical nurses using the Stetler-Marram Model of Research Utilization to the practice of amphotericin B administration; to share the findings; and to discuss issues encountered in the process and their solutions. Published articles identified through computerized literature searches, published abstracts and books, personal communication with one author, and an informal survey of other cancer centers' amphotericin B infusion practices; research articles were selected for review if studies included settings and patient populations similar to those of the authors and if they used experimental designs. Studies were reviewed for scientific merit and clinical applicability according to the Stetler-Marram model; findings were used to develop a specific nursing protocol for infusion times of amphotericin B based on clinical criteria. The Stetler-Marram model helped staff nurses decide how to apply research findings to practice, although using it was difficult and required mentorship. A research base exists for amphotericin B administration time but not for test doses or premedications to prevent or minimize side effects. Staff nurses can use the Stetler-Marram model but need resources and support from individuals, committees, and administration. A specific protocol representing a practice change was implemented and may be applicable to other settings.

A competency-based approach to nurses' continuing education for clinical reasoning and leadership through reflective practice in a care situation.

PubMed

Goudreau, Johanne; Pepin, Jacinthe; Larue, Caroline; Dubois, Sylvie; Descôteaux, Renée; Lavoie, Patrick; Dumont, Katia

2015-11-01

Newly graduated nurses need to demonstrate high levels of competencies when they enter the workplace. A competency-based approach to their education is recommended to ensure patients' needs are met. A continuing education intervention consistent with the competency-based approach to education was designed and implemented in eight care units in two teaching hospitals. It consists of a series of 30-min reflective practice groups on clinical events that newly graduated nurses encountered in their practice. It was evaluated using a descriptive longitudinal evaluative research design, combining individual and group interviews with stakeholders, the analysis of facilitators' journal entries, and a research assistant's field notes. The results suggest that issues associated with the implementation of the continuing education intervention revolved around leadership for managers, flexibility for nursing staff, and role shifting for the facilitators. Newly graduated nurses who participated in the study noted that the reflective practice sessions contributed to the development of both clinical reasoning and leadership. Nursing managers stated the advantages of the intervention on nurses' professional development and for the quality and safety of care. Following the end of the study, participants from two units managed to pursue the activity during their work time. Copyright © 2015 Elsevier Ltd. All rights reserved.

Abuse of family physicians by patients seeking controlled substances.

PubMed

Saveland, Christine; Hawker, Leisha; Miedema, Baukje; Macdougall, Peter

2014-02-01

To examine family physicians' career prevalence and monthly incidence of workplace abuse by controlled substance prescription seekers. A 4-page cross-sectional survey. A family medicine continuing medical education event in Halifax, NS. The survey was distributed to 316 family physicians attending the continuing medical education event. Career prevalence and monthly incidence of workplace abuse related to the act of prescribing controlled substances. Fifty-six percent (n = 178) of the 316 surveys were returned completed. Half the study participants were men (49%). Most study participants were in private practice and lived in Nova Scotia, and approximately half (51%) practised in urban settings. On average, the study participants had 20 years of practice experience. The career prevalence of abusive encounters related to controlled substance prescribing was divided into "minor," "major," and "severe" incidents. Overall, 95% of study participants reported having experienced at least 1 incident of minor abuse; 48% had experienced at least 1 incident of major abuse; and 17% had experienced at least 1 incident of severe abuse during their careers. Further, 30% reported having been abused in the past month; among those, the average number of abusive encounters was 3. Most (82%) of the abusers were male with a history of addiction (85%) and mental illness (39%). Opioids were the most frequently sought controlled substance. Abuse of family physicians by patients seeking controlled substances is substantial. Family physicians who prescribe controlled substances are at risk of being subjected to minor, major, or even severe abuse. Opioids were the most often sought controlled substance. A national discussion to deal with this issue is needed.

Creating a foundation for implementing an electronic health records (EHR)-integrated Social Knowledge Networking (SKN) system on medication reconciliation.

PubMed

Rangachari, P; Dellsperger, K C; Fallaw, D; Davis, I; Sumner, M; Ray, W; Fiedler, S; Nguyen, T; Rethemeyer, R

2018-04-01

In fall 2016, Augusta University received a two-year grant from AHRQ, to implement a Social Knowledge Networking (SKN) system for enabling its health system, AU-Health, to progress from "limited use" of EHR Medication Reconciliation (MedRec) Technology, to "meaningful use." Phase 1 sought to identify a comprehensive set of issues related to EHR MedRec encountered by practitioners at AU-Health. These efforts helped develop a Reporting Tool , which, along with a Discussion Tool , was incorporated into the AU-Health EHR, at the end of Phase 1. Phase 2 (currently underway), comprises a 52-week pilot of the EHR-integrated SKN system in outpatient and inpatient medicine units. The purpose of this paper is to describe the methods and results of Phase 1. Phase 1 utilized an exploratory mixed-method approach, involving two rounds of data collection. This included 15 individual interviews followed by a survey of 200 practitioners, i.e., physicians, nurses, and pharmacists, based in the outpatient and inpatient medicine service at AU Health. Thematic analysis of interviews identified 55 issue-items related to EHR MedRec under 9 issue-categories. The survey sought practitioners' importance-rating of all issue-items identified from interviews. A total of 127 (63%) survey responses were received. Factor analysis served to validate the following 6 of the 9 issue-categories, all of which, were rated "Important" or higher (on average), by over 70% of all respondents: 1) Care-Coordination (CCI); 2) Patient-Education (PEI); 3) Ownership-and-Accountability (OAI); 4) Processes-of-Care (PCI); 5) IT-Related (ITRI); and 6) Workforce-Training (WTI). Significance-testing of importance-rating by professional affiliation revealed no statistically significant differences for CCI and PEI; and some statistically significant differences for OAI, PCI, ITRI, and WTI. There were two key gleanings from the issues related to EHR MedRec unearthed by this study: 1) there was an absence of shared understanding among practitioners, of the value of EHR MedRec in promoting patient safety, which contributed to workarounds, and suboptimal use of the EHR MedRec system; and 2) there was a socio-technical dimension to many of the issues, creating an added layer of complexity. These gleanings in turn, provide insights into best practices for managing both clinical transitions-of-care in the EHR MedRec process; and socio-technical challenges encountered in EHR MedRec implementation.

Creating a foundation for implementing an electronic health records (EHR)-integrated Social Knowledge Networking (SKN) system on medication reconciliation

PubMed Central

Rangachari, P.; Dellsperger, K.C; Fallaw, D.; Davis, I.; Sumner, M.; Ray, W.; Fiedler, S.; Nguyen, T.; Rethemeyer, R.

2018-01-01

Background In fall 2016, Augusta University received a two-year grant from AHRQ, to implement a Social Knowledge Networking (SKN) system for enabling its health system, AU-Health, to progress from “limited use” of EHR Medication Reconciliation (MedRec) Technology, to “meaningful use.” Phase 1 sought to identify a comprehensive set of issues related to EHR MedRec encountered by practitioners at AU-Health. These efforts helped develop a Reporting Tool, which, along with a Discussion Tool, was incorporated into the AU-Health EHR, at the end of Phase 1. Phase 2 (currently underway), comprises a 52-week pilot of the EHR-integrated SKN system in outpatient and inpatient medicine units. The purpose of this paper is to describe the methods and results of Phase 1. Methods Phase 1 utilized an exploratory mixed-method approach, involving two rounds of data collection. This included 15 individual interviews followed by a survey of 200 practitioners, i.e., physicians, nurses, and pharmacists, based in the outpatient and inpatient medicine service at AU Health. Results Thematic analysis of interviews identified 55 issue-items related to EHR MedRec under 9 issue-categories. The survey sought practitioners’ importance-rating of all issue-items identified from interviews. A total of 127 (63%) survey responses were received. Factor analysis served to validate the following 6 of the 9 issue-categories, all of which, were rated “Important” or higher (on average), by over 70% of all respondents: 1) Care-Coordination (CCI); 2) Patient-Education (PEI); 3) Ownership-and-Accountability (OAI); 4) Processes-of-Care (PCI); 5) IT-Related (ITRI); and 6) Workforce-Training (WTI). Significance-testing of importance-rating by professional affiliation revealed no statistically significant differences for CCI and PEI; and some statistically significant differences for OAI, PCI, ITRI, and WTI. Conclusion There were two key gleanings from the issues related to EHR MedRec unearthed by this study: 1) there was an absence of shared understanding among practitioners, of the value of EHR MedRec in promoting patient safety, which contributed to workarounds, and suboptimal use of the EHR MedRec system; and 2) there was a socio-technical dimension to many of the issues, creating an added layer of complexity. These gleanings in turn, provide insights into best practices for managing both clinical transitions-of-care in the EHR MedRec process; and socio-technical challenges encountered in EHR MedRec implementation. PMID:29682132

Beyond Googling: The Ethics of Using Patients' Electronic Footprints in Psychiatric Practice.

PubMed

Fisher, Carl E; Appelbaum, Paul S

Electronic communications are an increasingly important part of people's lives, and much information is accessible through such means. Anecdotal clinical reports indicate that mental health professionals are beginning to use information from their patients' electronic activities in treatment and that their data-gathering practices have gone far beyond simply searching for patients online. Both academic and private sector researchers are developing mental health applications to collect patient information for clinical purposes. Professional societies and commentators have provided minimal guidance, however, about best practices for obtaining or using information from electronic communications or other online activities. This article reviews the clinical and ethical issues regarding use of patients' electronic activities, primarily focusing on situations in which patients share information with clinicians voluntarily. We discuss the potential uses of mental health patients' electronic footprints for therapeutic purposes, and consider both the potential benefits and the drawbacks and risks. Whether clinicians decide to use such information in treating any particular patient-and if so, the nature and scope of its use-requires case-by-case analysis. But it is reasonable to assume that clinicians, depending on their circumstances and goals, will encounter circumstances in which patients' electronic activities will be relevant to, and useful in, treatment.

MEASUREMENT ISSUES IN HOME-VISITING RESEARCH WITHIN TRIBAL COMMUNITIES: CHALLENGES AND STRATEGIES.

PubMed

Whitesell, Nancy Rumbaugh; Bolan, Marc; Chomos, Julianna C; Heath, Debra; Miles, Jon; Salvador, Melina; Whitmore, Corrie; Barlow, Allison

2018-05-04

In this article, Tribal Maternal, Infant, and Early Childhood Home Visiting (MIECHV) grantees share strategies they have developed and adopted to address the most common barriers to effective measurement (and thus to effective evaluation) encountered in the course of implementation and evaluation of their home-visiting programs. We identify key challenges in measuring outcomes in Tribal MIECHV Programs and provide practical examples of various strategies used to address these challenges within diverse American Indian and Alaska Native cultural and contextual settings. Notably, high-quality community engagement is a consistent thread throughout these strategies and fundamental to successful measurement in these communities. These strategies and practices reflect the experiences and innovative solutions of practitioners working on the ground to deliver and evaluate intervention programs to tribal communities. They may serve as models for getting high-quality data to inform intervention while working within the constraints and requirements of program funding. The utility of these practical solutions extends beyond the Tribal MIECHV grantees and offers the potential to inform a broad array of intervention evaluation efforts in tribal and other community contexts. © 2018 Michigan Association for Infant Mental Health.

Training and experience of nurses in responding to alcohol misuse in rural communities.

PubMed

Kennedy, Alison J; Mellor, David; McCabe, Marita P; Ricciardelli, Lina A; Brumby, Susan A; Head, Alexandra; Mercer-Grant, Catherine

2013-07-01

Alcohol misuse by farmers continues to challenge rural nurses. This article reports on the experiences of Australian nurses participating in the Alcohol Intervention Training Program (AITP). Qualitative interviews of 15 rural and remote nurses. Semi-structured phone interviews were utilized to assess the response to and implementation of the AITP-an intervention designed to build nurses' knowledge, confidence and skills when responding to alcohol misuse. It comprises practical and theoretical components and was designed for rural and remote settings where nurses encounter alcohol misuse. Nurses found the training provided new-or built on existing-knowledge of alcohol misuse and offered practical hands-on "real life" skills. A range of workplace and personal situations where the content of the training was now being utilized were identified, and future use anticipated. Barriers to using the new knowledge and skills included both rural and generic issues. Constructive feedback to increasingly target the training to rural settings was recommended. The AITP is an effective training program. It can be further tailored to meet common needs of rural and remote nurses working with farmers who misuse alcohol, while recognizing diversity in rural practice. © 2013 Wiley Periodicals, Inc.

Children with Cancer: School Related Issues

ERIC Educational Resources Information Center

Gartin, Barbara C.; Murdick, Nikki L.

2009-01-01

School gives purpose to a student's life. Today, students with cancer and cancer survivors are encouraged to continue their educational experiences to maintain a sense of normalcy. This manuscript discusses the research findings on medical, physical, and cognitive issues that students with cancer and cancer survivors may encounter in their…

Road Signs in Ethical Quicksand.

ERIC Educational Resources Information Center

Jerrell, S. Lee; Jerrell, Jeanette M.

1985-01-01

Some of the major moral and ethical dilemmas illustrated by authors in this special journal issue are highlighted. From an ethical viewpoint, the complexity of evaluation activities is likened to "quicksand" terrain in which directional or warning signs should be erected to aid personal choices when such issues are encountered.…

Teachers Teaching Teachers (T3)[TM]. Volume 5, Number 3

ERIC Educational Resources Information Center

Crow, Tracy, Ed.

2009-01-01

"Teachers Teaching Teachers" ("T3") focuses on coaches' roles in the professional development of teachers. Each issue also explores the challenges and rewards that teacher leaders encounter. This issue includes: (1) Building Bridges: Data Help Instructional Coach Make Vital Connections with Teachers (Theresa Long); (2) NSDC Tool: Instructional…

Learning as discourse change: A sociocultural mechanism

NASA Astrophysics Data System (ADS)

Wickman, Per-Olof; Östman, Leif

2002-09-01

This paper deals with a theoretical mechanism for learning and a methodological approach for analyzing meaning making in classroom talk and action. It examines the potential of the approach for illuminating learning on a discursive level, i.e., how discourses change and how individuals become participants of new practices. Our approach involves a high-resolution analysis of how meaningful relations are built in encounters between individuals and between individuals and the world. The approach is based mainly on the work of the later Wittgenstein, but also on pragmatism and sociocultural research. To demonstrate how our approach can be used, we analyze what university students learn during a practical on insects. We specifically demonstrate how the encounters with physical pinned insects contribute to the meaning students make and how these encounters interact with other experiences during laboratory work.

Understanding the primary care paradigm: an experiential learning focus of the early veterinary graduate.

PubMed

Dixon, William H R; Kinnison, Tierney; May, Stephen A

2017-11-01

At a time where high levels of stress are reported in the veterinary profession, this study explores the challenges that veterinary graduates encounter when they enter general (first opinion) practice. Participants had written reflective accounts of their 'Most Puzzling Cases' for the postgraduate Professional Key Skills module of the Certificate in Advanced Veterinary Practice, offered by the Royal Veterinary College. Reasons that a case was puzzling, or became challenging, were thematically analysed. Fifteen summaries were analysed. Three core themes were identified: 'clinical reasoning', centred on the limitations of pattern recognition and the methods used to overcome this; the 'veterinary healthcare system', focusing on the need for continuity of care, time pressure and support in the transition to practice; and the 'owner', looking at the broader clinical skills needed to succeed in general practice. Clinical reasoning was raised as an issue; discussion of when pattern recognition is not appropriate and what to do in these cases was common. A lack of experience in general practice case types, and how to best operate in the resource-constrained environment in which they present, is the likely cause of this, suggesting that a greater focus on the primary care paradigm is needed within veterinary education. © British Veterinary Association (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

The Library and Human Memory. Final Report on Mechanized Information Services in the University Library, Phase I - Planning. Part 13.

ERIC Educational Resources Information Center

Norman, Donald A.

This paper discusses the differences between the storage problems encountered in a large library and those encountered in the human memory. Some of the properties of the human memory system and some of the major issues which affect the interaction between human users and the existing library systems are outlined. The problem of browsing is used as…

Knowledge, attitudes and practice of healthcare ethics and law among doctors and nurses in Barbados.

PubMed

Hariharan, Seetharaman; Jonnalagadda, Ramesh; Walrond, Errol; Moseley, Harley

2006-06-09

The aim of the study is to assess the knowledge, attitudes and practices among healthcare professionals in Barbados in relation to healthcare ethics and law in an attempt to assist in guiding their professional conduct and aid in curriculum development. A self-administered structured questionnaire about knowledge of healthcare ethics, law and the role of an Ethics Committee in the healthcare system was devised, tested and distributed to all levels of staff at the Queen Elizabeth Hospital in Barbados (a tertiary care teaching hospital) during April and May 2003. The paper analyses 159 responses from doctors and nurses comprising junior doctors, consultants, staff nurses and sisters-in-charge. The frequency with which the respondents encountered ethical or legal problems varied widely from 'daily' to 'yearly'. 52% of senior medical staff and 20% of senior nursing staff knew little of the law pertinent to their work. 11% of the doctors did not know the contents of the Hippocratic Oath whilst a quarter of nurses did not know the Nurses Code. Nuremberg Code and Helsinki Code were known only to a few individuals. 29% of doctors and 37% of nurses had no knowledge of an existing hospital ethics committee. Physicians had a stronger opinion than nurses regarding practice of ethics such as adherence to patients' wishes, confidentiality, paternalism, consent for procedures and treating violent/non-compliant patients (p = 0.01) CONCLUSION: The study highlights the need to identify professionals in the workforce who appear to be indifferent to ethical and legal issues, to devise means to sensitize them to these issues and appropriately training them.

Impact of patients' religious and spiritual beliefs in pharmacy: from the perspective of the pharmacist.

PubMed

Daher, Moustafa; Chaar, Betty; Saini, Bandana

2015-01-01

Socio-cultural perspectives including religious and spiritual beliefs affect medicine use and adherence. Increasingly communities that pharmacists serve are diverse and pharmacists need to counsel medicine use issues with ethical and cultural sensitivity as well as pharmaceutical competence. There is very little research in this social aspect of pharmacy practice, and certainly none conducted in Australia, an increasingly multicultural, diverse population. The purpose of this study was to explore, from a pharmacy practitioner's viewpoint, the frequency and nature of cases where patients' articulated religious/spiritual belief affect medicine use; and pharmacist perspectives on handling these issues. Qualitative method employing semi-structured interviews with pharmacy practitioners, constructed around an interview guide. Pharmacist participants were recruited purposively from areas of linguistic diversity in Sydney, New South Wales, Australia. Verbatim transcription and thematic analyses were performed on the data. Thematic analyses of 21 semi-structured interviews depicted that scenarios where religious and spiritual belief and medication use intersect were frequently encountered by pharmacists. Patient concerns with excipients of animal origin and medication use while observing religious fasts were the main issues reported. Participants displayed scientific competence; however, aspects of ethical sensitivity in handling such issues could be improved. This novel study highlights the urgent need for more research, training and resource development for practitioners serving patients in multi-faith areas. Copyright © 2015 Elsevier Inc. All rights reserved.

Concentrated Language Encounter Approach in Practice for Global Teaching of Literacy: Lighthouse Strategy Implementation

ERIC Educational Resources Information Center

Rattanavich, Saowalak

2015-01-01

This article presents the lighthouse literacy strategies model using the concentrated language encounter (CLE) approach that has been successfully replicated in many countries in different languages and cultures. A review of CLE research studies and the project implementation in Thailand showed highly significant results in students' literacy…

Fading Correction To Be Used In Clinical Thermoluminescence Dosimetry

NASA Astrophysics Data System (ADS)

Furetta, C.; Azorin, J.; Rivera, T.

2004-09-01

This paper presents some useful expressions for fading correction, which can be used in practical situations as they can be encountered in clinical dosimetry. The situations took into consideration can be encountered in hospital environments during and after radiotherapeutic treatments of patients as well as for radiation protection procedures concerning staff members.

Logic of Accounting: The Case of Reporting Previous Options in Norwegian Activation Encounters

ERIC Educational Resources Information Center

Solberg, Janne

2017-01-01

The article deals with the enactment of client resistance in Norwegian vocational rehabilitation encounters. More specific, a practice here called "reporting previous options" is analyzed by using the resources of ethnomethodological conversation analysis (CA) in five instances as doing some sort of accounting. In response to the…

Implementing standard setting into the Conjoint MAFP/FRACGP Part 1 examination - Process and issues.

PubMed

Chan, S C; Mohd Amin, S; Lee, T W

2016-01-01

The College of General Practitioners of Malaysia and the Royal Australian College of General Practitioners held the first Conjoint Member of the College of General Practitioners (MCGP)/Fellow of Royal Australian College of General Practitioners (FRACGP) examination in 1982, later renamed the Conjoint MAFP/FRACGP examinations. The examination assesses competency for safe independent general practice and as family medicine specialists in Malaysia. Therefore, a defensible standard set pass mark is imperative to separate the competent from the incompetent. This paper discusses the process and issues encountered in implementing standard setting to the Conjoint Part 1 examination. Critical to success in standard setting were judges' understanding of the process of the modified Angoff method, defining the borderline candidate's characteristics and the composition of judges. These were overcome by repeated hands-on training, provision of detailed guidelines and careful selection of judges. In December 2013, 16 judges successfully standard set the Part 1 Conjoint examinations, with high inter-rater reliability: Cronbach's alpha coefficient 0.926 (Applied Knowledge Test), 0.921 (Key Feature Problems).

Values Guide Us in Times of Uncertainty: DACA and Graduate Medical Education.

PubMed

Poll-Hunter, Norma I; Young, Geoffrey H; Shick, Matthew

2017-11-01

With a new administration and Congress, there is uncertainty surrounding the future of the Deferred Action for Childhood Arrivals (DACA) program. In light of this uncertainty, medical schools have tried to better understand how they can support trainees with DACA. In their article in this issue, Nakae and colleagues describe the issues often encountered by medical students with DACA as they prepare for residency and by the program directors who receive their applications. They offer recommendations for best practices to support these trainees. The authors of this Invited Commentary expand on these important considerations, based on their experiences at a national level. They argue that the core values in academic medicine should drive decision making, the student voice is critical, teamwork is essential, and wellness deserves attention. Academic medicine is part of a larger movement with partners across the health professions and higher education focused on advancing the values of access and opportunity for all. The authors of this Invited Commentary argue that remaining steadfast and committed to the core values in medicine will allow the academic medicine community to successfully navigate these uncertain times.

Pharmacists on Facebook: online social networking and the profession.

PubMed

Mattingly, T Joseph; Cain, Jeff; Fink, Joseph L

2010-01-01

To provide a brief history of Facebook and online social networking and discuss how it has contributed and can contribute in the future to a paradigm change in social communications. When student pharmacists complete school and enter practice, they encounter enhanced expectations to act appropriately and professionally. Facebook expands the dilemma of separating private and public life--a challenge for individuals in all professions. From the standpoint of a professional association, Facebook provides a tremendous opportunity to reach out to members in an unprecedented way. Pharmacy organizations are beginning to use these new tools to increase communication and dissemination of information. The popularity of Facebook has brought the issue of online social networking to the forefront of professional and organizational discussions. The issues of privacy, identity protection, and e-professionalism are likely to reappear as pharmacists and student pharmacists continue to communicate via online networks. The potential exists for organizations to harness this organizational and communication power for their own interests. Further study is needed regarding the interaction between online social networking applications and the profession of pharmacy.

Patients' approaches to students' learning at a clinical education ward--an ethnographic study.

PubMed

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

2014-07-02

It is well known that patients' involvement in health care students' learning is essential and gives students opportunities to experience clinical reasoning and practice clinical skills when interacting with patients. Students encounter patients in different contexts throughout their education. However, looking across the research providing evidence about learning related to patient-student encounters reveals a lack of knowledge about the actual learning process that occurs in encounters between patients and students. The aim of this study was to explore patient-student encounters in relation to students' learning in a patient-centered health-care setting. An ethnographic approach was used to study the encounters between patients and students. The setting was a clinical education ward for nursing students at a university hospital with eight beds. The study included 10 observations with 11 students and 10 patients. The observer followed one or two students taking care of one patient. During the fieldwork observational and reflective notes were taken. After each observation follow-up interviews were conducted with each patient and student separately. Data were analyzed using an ethnographic approach. The most striking results showed that patients took different approaches in the encounters with students. When the students managed to create a good atmosphere and a mutual relationship, the patients were active participants in the students' learning. If the students did not manage to create a good atmosphere, the relationship became one-way and the patients were passive participants, letting the students practice on their bodies but without engaging in a dialogue with the students. Patient-student encounters, at a clinical education ward with a patient-centred pedagogical framework, can develop into either a learning relationship or an attending relationship. A learning relationship is based on a mutual relationship between patients and students resulting in patients actively participating in students' learning and they both experience it as a joint action. An attending relationship is based on a one-way relationship between patients and students resulting in patients passively participating by letting students to practice on their bodies but without engaging in a learning dialogue with the students.

Customer Service: Implications for Reference Practice.

ERIC Educational Resources Information Center

Whitlatch, Jo Bell

1995-01-01

The past decade has seen an increasing emphasis on customer service in business research and management. Two concepts in understanding business customer service practices are discussed: the service encounter and total quality management. Highlights include customer service research and practices in business; implications for library reference…

'A good fit?' Bringing the sociology of footwear to the clinical encounter in podiatry services: a narrative review.

PubMed

Nicholls, Emily; Robinson, Victoria; Farndon, Lisa; Vernon, Wesley

2018-01-01

This narrative review explores the ways in which drawing on theories and methods used in sociological work on footwear and identity can contribute to healthcare research with podiatrists and their patients, highlighting recent research in this field, implications for practice and potential areas for future development.Traditionally, research within Podiatry Services has tended to adopt a quantitative, positivist focus, developing separately from a growing body of sociological work exploring the importance of shoes in constructing identity and self-image. Bringing qualitative research drawing on sociological theory and methods to the clinical encounter has real potential to increase our understanding of patient values, motivations and - crucially - any barriers to adopting 'healthier' footwear that they may encounter. Such work can help practitioners to understand why patients may resist making changes to their footwear practices, and help us to devise new ways for practitioners to explore and ultimately break down individual barriers to change (including their own preconceptions as practitioners). This, in turn, may lead to long-term, sustainable changes to footwear practices and improvements in foot health for those with complex health conditions and the wider population. A recognition of the complex links between shoes and identity is opening up space for discussion of patient resistance to footwear changes, and paving the way for future research in this field beyond the temporary 'moment' of the clinical encounter.

Public policies, private choices: Consumer desire and the practice of energy efficiency

NASA Astrophysics Data System (ADS)

Deumling, Reuben Alexander

Refrigerator energy consumption has been the subject of regulatory attention in the US for some thirty years. Federal product standards, energy labels, and a variety of programs to get consumers to discard their existing refrigerators sooner and buy new, more energy efficient ones have transformed the refrigerator landscape and changed how many of us think about refrigerators. The results of these policies are celebrated as a successful model for how to combine regulatory objectives and consumer preferences in pursuit of environmental outcomes where everyone wins. Yet per capita refrigerator energy consumption today remains (much) higher in the US than anywhere else, in part because energy efficiency overlooks the ways behavior, habit, emulation, social norms, advertising, and energy efficiency policies themselves shape energy consumption patterns. To understand these dynamics I investigate how people replacing their refrigerators through a state-sponsored energy efficiency program make sense of the choices facing them, and how various types of information designed to aid in this process (Consumer Reports tests, Energy Guide labels, rebate programs) frame the issue of responsible refrigerator consumption. Using interviews and archival research I examine how this information is used to script the choice of a refrigerator, whose priorities shape the form and content of these cues, and what the social meanings generated by and through encounters with refrigerators and energy efficiency are. I also helped build a model for estimating historic refrigerator energy consumption in the US, to measure the repercussions of refrigerator energy inefficiency. My focus in this dissertation is on the ways the pursuit of energy efficiency improvements for domestic refrigerators intersects with and sometimes reinforces escalating demand for energy. My research suggests that the practice of pursuing energy efficiency improvements in refrigerators subordinates the issue of refrigerator energy consumption---what factors influence it, how and why it fluctuated historically, how to take it seriously---in pursuit of increased sales. The a priori assumption that consumers desire certain styles of refrigerator has become a compulsion to trade up. In evaluating the results of energy policies celebrating technical achievements without paying attention to the social dynamics which these regulations encounter is insufficient.

Opening the black-box of person-centred care: An arts-informed narrative inquiry into mental health education and practice.

PubMed

Schwind, Jasna K; Lindsay, Gail M; Coffey, Sue; Morrison, Debbie; Mildon, Barb

2014-08-01

Nursing education has a history of encouraging students to know their patients and to negotiate the in-between of art/science, person/profession, and intuition/evidence. Nurse-teachers know that students may abandon some values and practices when they encounter practice environments that are complex and have competing agendas. We are concerned that nursing knowledge is black-boxed, invisible and taken-for-granted, in healthcare settings. Our research explores how nursing students and nurses are constructing and enacting person-centred care in mental health education and practice. We want to understand the nursing standpoint on this significant ontological issue and to make nursing knowledge construction and utilization visible; illuminating how person-centred theory emerges from practice. The process involved four 3-hour group meetings and an individual follow-up telephone conversation. Students and nurses met at a tertiary-care mental health organization. Fourteen nurses (Registered Nurses and Registered Practical Nurses) and nursing students (Bachelor of Science in Nursing and Practical Nursing) participated in our inquiry. We used arts-informed narrative inquiry to explore experience through the arts such as metaphor, collage, poems, letters, and group conversations. The black-box is opened as the inquiry reveals how nursing knowledge is constructed, assumptions are challenged and new practices emerge. Our research is significant for education and for practice and is transferable to other populations and settings. Nurses are affirmed in person-centred values and practices that include partnership with those in their care, role modeling for colleagues and mentoring students and new nurses. Students participate in transferring their learning from school to practice, in the company of experienced colleagues; together they open the black-box to show how nurses conceptualize and enact person-centred care. Copyright © 2014 Elsevier Ltd. All rights reserved.

Enveloped Lives: Practicing Health and Care in Lithuania.

PubMed

Praspaliauskiene, Rima

2016-12-01

This article analyzes informal medical payments that the majority of Lithuanians give or feel compelled to give to doctors before or after treatment. It focuses on how patients and their caretakers encounter, practice, and enact informal payments in health care and how these payments create a reality of health care that is not limited to an economic rationality. Within such a frame, rather than being considered a gift or bribe, it conceptualizes these little white envelopes as a practice of health and care. The article shows how an envelope of money given to a doctor transcends the material patient-doctor transaction and emerges as a productive force for coping with illness, medical encounters, and misfortunes. © 2016 by the American Anthropological Association.

Collaborating across services to advance evidence-based nursing practice.

PubMed

Kenny, Deborah J; Richard, Maggie L; Ceniceros, Xochitl; Blaize, Kelli

2010-01-01

Military medical treatment facilities offer a unique environment in which to develop a culture of evidence-based practice (EBP). Distinctive issues arise in the context of changed patient care demographics because of a war-injured population. These issues offer an opportunity to enhance the quality of care through the use and adaptation of research findings in this special nursing environment. In addition, the colocation of two military medical centers offers the prospect of collaborative efforts to create a regional culture for nursing EBP. The purposes of this study were to describe the processes of a collaborative project to train nurses in EBP and to share resources in developing and implementing evidence-based clinical nursing guidelines in two large military medical centers in the Northeastern United States and to discuss the collective efforts of nurse researchers, leadership, advanced practice nurses, and staff nurses in each hospital to facilitate the EBP process. A description of the organizational structure and the climate for EBP of each facility is provided followed by discussion of training efforts and the inculcation of an organizational culture for EBP. Contextual barriers and facilitators were encountered throughout the project. The two nurse researchers leading the projects were able to overcome the barriers and capitalize on opportunities to promote EBP. Three evidence-based clinical practice guidelines were developed at each facility and are currently in various stages of implementation. Despite the barriers, EBP continues to be at the forefront of military nursing practice in the U.S. National Capital Region. Clear communication and regular meetings were essential to the success of the collaborative project within and between the two military hospitals. Military-specific barriers to EBP included high team attrition and turnover because of the war mission and the usual high staff turnover at military hospitals. Military facilitators included a common mission of providing high-quality care for war-injured service members. Lessons learned from this project can be generalized to civilian facilities.

Ethical Issues in the Assessment and Treatment of a Rational Suicidal Client.

ERIC Educational Resources Information Center

Snipe, Rosetta M.

1988-01-01

Notes that rational client's decision to commit suicide may present complex ethical issues for therapist. Presents and discusses three-month account of therapy with client, from perspective of ethical values and principles upon which assessment and treatment decisions were made, and complex ethical dilemmas encountered as therapist juxtaposed…

Doctoral Supervision in a Cross-Cultural Context: Issues Affecting Supervisors and Candidates

ERIC Educational Resources Information Center

Winchester-Seeto, Theresa; Homewood, Judi; Thogersen, Jane; Jacenyik-Trawoger, Christa; Manathunga, Catherine; Reid, Anna; Holbrook, Allyson

2014-01-01

This article presents an analysis of rich data, gathered from interviews with 46 candidates and 38 supervisors from three Australian universities, about experiences of doctoral supervision in cross-cultural situations. Our analysis shows that many of the issues reported by international candidates are the same as those encountered by domestic…

Teachers Teaching Teachers (T3)[TM]. Volume 4, Number 7

ERIC Educational Resources Information Center

von Frank, Valerie, Ed.

2009-01-01

"Teachers Teaching Teachers" ("T3") focuses on coaches' roles in the professional development of teachers. Each issue also explores the challenges and rewards that teacher leaders encounter. This issue includes: (1) Learning Cycle Spins Individuals into a Team (Valerie von Frank); (2) NSDC Tool: The Professional Teaching and Learning Cycle; (3)…

Family Home Childcare Providers: A Comparison of Subsidized and Non-Subsidized Working Environments and Employee Issues

ERIC Educational Resources Information Center

Shriner, Michael; Schlee, Bethanne M.; Mullis, Ronald L.; Cornille, Thomas A.; Mullis, Ann K.

2008-01-01

Federal and State Governments provide childcare subsidies for low-income working families. This study compares the encountered issues and working environments of family home providers of subsidized and non-subsidized childcare. Questionnaires were distributed throughout a southeastern state in the United States to 548 family home childcare…

Teachers Teaching Teachers (T3)[TM]. Volume 4, Number 8

ERIC Educational Resources Information Center

von Frank, Valerie, Ed.

2009-01-01

"Teachers Teaching Teachers" ("T3") focuses on coaches' roles in the professional development of teachers. Each issue also explores the challenges and rewards that teacher leaders encounter. This issue includes: (1) Tackling Behavior from All Sides (Valerie von Frank); (2) Tools: Effective Behavior Support Self-Assessment Survey; (3) Lessons from…

Teachers Teaching Teachers (T3)[TM]. Volume 4, Number 6

ERIC Educational Resources Information Center

von Frank, Valerie, Ed.

2009-01-01

"Teachers Teaching Teachers" ("T3") focuses on coaches' roles in the professional development of teachers. Each issue also explores the challenges and rewards that teacher leaders encounter. This issue includes: (1) Values and Clarity Build Classroom Language (Valerie von Frank); (2) Tools: Identifying and Clarifying Beliefs about Learning; (3)…

A Case Study Approach to Ethics in Career Development, Second Edition. Monograph Series

ERIC Educational Resources Information Center

Makela, Julia Panke; Perlus, Jessamyn G.

2017-01-01

This second edition tackles some of the most vexing questions that career development professionals encounter today. Using a case study design, it offers a hands-on experience with ethical terminology, resources, and issues. Each dilemma presented includes detailed, guided discussion of key issues and recommendations, with direct connections to…

The inpatient psychiatric unit as both a safe and unsafe place: implications for absconding.

PubMed

Muir-Cochrane, Eimear; Oster, Candice; Grotto, Jessica; Gerace, Adam; Jones, Julia

2013-08-01

Absconding from acute psychiatric inpatient units is a significant issue with serious social, economic, and emotional costs. A qualitative study was undertaken to explore the experiences of people (n = 12) who had been held involuntarily under the local mental health act in an Australian inpatient psychiatric unit, and who had absconded (or attempted to abscond) during this time. The aim of the study was to explore why people abscond from psychiatric inpatient units, drawing on published work from health geography on the significance of the person-place encounter, and in particular the concept of 'therapeutic landscapes'. The findings show that the inpatient unit is perceived as a safe or unsafe place, dependent on the dialectical relationship between the physical, individual, social, and symbolic aspects of the unit. Consumers absconded when the unit was perceived as unsafe. Forming a therapeutic relationship with staff, familiarity with the unit, a comfortable environment, and positive experiences with other consumers all supported perceptions that the unit was safe, decreasing the likelihood of absconding. Findings extend existing work on the person-place encounter within psychiatric inpatient units, and bring new knowledge about the reasons why consumers abscond. Implications for practice are discussed. © 2012 The Authors; International Journal of Mental Health Nursing © 2012 Australian College of Mental Health Nurses Inc.

Teaching biotechnology in NSW schools

NASA Astrophysics Data System (ADS)

Steele, Frances A.

Agriculture, industry and medicine are being altered by new biological technologies. Today's students are the citizens who will make decisions about associated ethical issues. They need to have the knowledge that will enable them to make informed choices. Hence biotechnology has an important place in science education. The aims of the research were to: 1. describe the state of biotechnology teaching in NSW; 2. determine whether teachers in NSW do not teach biotechnology because they do not have the necessary knowledge and experience; 3. identify other reasons why NSW teachers choose not to teach biotechnology; 4. describe problems encountered in teaching biotechnology in NSW; 5. suggest ways in which the problems encountered in the teaching of biotechnology can be overcome. Quantitative and qualitative methods were used in a complementary way to investigate these aims. In a sample of teachers surveyed, many reported that they chose not to teach biotechnology because they did not have adequate knowledge and experience. Other obstacles were identified. These were: 1. the difficulty of the subject matter; 2. the lack of practical work; 3. lack of a program for biotechnology in junior science. The results of this trial suggested that a biotechnology unit should be developed in collaboration with the teacher and that time needs to be made available for school based program development.

Is the Lack of Specific Lesbian, Gay, Bisexual, Transgender and Queer/Questioning (LGBTQ) Health Care Education in Medical School a Cause for Concern? Evidence From a Survey of Knowledge and Practice Among UK Medical Students.

PubMed

Parameshwaran, Vishnu; Cockbain, Beatrice C; Hillyard, Miriam; Price, Jonathan R

2017-01-01

Lesbian, gay, bisexual, transgender and queer/questioning (LGBTQ) people frequently report negative health care encounters. Medical professionals may inadequately manage LGBTQ persons' health if they have not received training in this area. An anonymous survey measuring efficacy in health situations among LGBTQ persons was answered by 166 medical students across all years of a UK university. Results show that 84.9% of participants reported a lack of LGBTQ health care education, with deficits in confidence clarifying unfamiliar sexual and gender terms, deciding the ward in which to nurse transgender patients, finding support resources, and discussing domestic abuse with LGBTQ patients. Most participants reported that they would not clarify gender pronouns or ask about gender or sexual identity in mental health or reproductive health settings. Participants reported infrequently observing doctors making similar inquiries. Participants held positive attitudes toward LGBTQ patients, with attitude scores positively correlating with LGBTQ terminology knowledge scores (r s  = 0.5052, p < .01). Addressing gender identity and sexuality issues within medical curricula may remove barriers to accessing health care and improve encounters for LGBTQ patients.

Numerical Study of a Convective Turbulence Encounter

NASA Technical Reports Server (NTRS)

Proctor, Fred H.; Hamilton, David W.; Bowles, Roland L.

2002-01-01

A numerical simulation of a convective turbulence event is investigated and compared with observational data. The specific case was encountered during one of NASA's flight tests and was characterized by severe turbulence. The event was associated with overshooting convective turrets that contained low to moderate radar reflectivity. Model comparisons with observations are quite favorable. Turbulence hazard metrics are proposed and applied to the numerical data set. Issues such as adequate grid size are examined.

(ETHNO-)MEDICAL ETHICS IN GLOBALIZING CHINA: TRACING LOCAL KNOWLEDGE AND ADAPTATION OF BIOMEDICINE.

PubMed

Micollier, Evelyne

2015-12-01

Encounters between several bodies of therapeutic knowledge have led to a restructuring of the entire health system, including a transformation in medical ethics. Defining "new ethics" with both Chinese and international characteristics, is part of the ongoing knowledge production process: plural health ideas, practices and medical sciences develop within the broader framework of social and economic transition. Such transition simultaneously reveals and encourages China's influence and position in an era of globalization including in the technical and knowledge production domains. Re-alignments in medical ethics in Reform China (post-1979) highlight a rather under-explored aspect of medical plurality enabling these ethics to be used as an analytical lens to provide information about social and political issues. In this article, two sets of ethical principles, one from Late Imperial China (Late Ming Era), the other from post-Mao China (1980s), are detailed and analysed. They were selected as case-studies mainly because they reflected at the time of their emergence an on-going radical change in society in the realm of health and medicine. Therefore both sets unveil the process of legitimizing a "Chinese medicine" in a context of epistemological shift: such a process takes various conceptual and practicalforms framed along the lines of the current dominant ideological system and constrained by socio-economic and political factors. Finally, issues relative to research ethics, bioethics and the New Health Reform guidelines raised in the 2000s, which represents also a significant historical turn for China, are discussed. Drawn from the overall discussion throughout the text, several concluding remarks contribute to advocate for "win-win" encounters--from the East to the West and from the South to the South, and for more implementable transnational/global ethics designing.

The evolving definition of essential tremor: What are we dealing with?

PubMed

Louis, Elan D

2018-01-01

Although essential tremor (ET) is commonly encountered in clinical practice, historically, there has been considerable disagreement as how to best define it, and now with a growing sense of its clinical complexity, how to best encapsulate it. Here, I draw attention to five issues of current uncertainty. A PubMed search conducted on June 19, 2017 crossed "essential tremor" with 9 second search terms (e.g., definition, diagnosis). There are several major issues of clinical and diagnostic uncertainty. Underlying each issue is a larger question about the nature of the underlying pathophysiology of ET. Does age of onset of ET matter? How much dystonia is acceptable in ET? How much in the way of "cerebellar signs" are acceptable? Are non-motor features due to the underlying disease or merely secondary to the clinical features? Is ET a single disease entity or something else? We are learning more about ET and, as a by-product of these efforts, are struggling with its definition. Further understanding the nature of the underlying disease pathogenesis as well as the role the cerebellum and cerebellar relays play in this process will likely provide important clues to enable us to bring order to areas of uncertainty. Copyright © 2017 Elsevier Ltd. All rights reserved.

A qualitative description of service providers' experiences of ethical issues in HIV care.

PubMed

Sabone, Motshedisi B; Mogobe, Keitshokile Dintle; Matshediso, Ellah; Shaibu, Sheila; Ntsayagae, Esther I; Corless, Inge B; Cuca, Yvette P; Holzemer, William L; Dawson-Rose, Carol; Baez, Solymar S Soliz; Rivero-Mendz, Marta; Webel, Allison R; Eller, Lucille Sanzero; Reid, Paula; Johnson, Mallory O; Kemppainen, Jeanne; Reyes, Darcel; Nokes, Kathleen; Wantland, Dean; Nicholas, Patrice K; Lingren, Teri; Portillo, Carmen J; Sefcik, Elizabeth; Long-Middleton, Ellen

2018-01-01

Managing HIV treatment is a complex multi-dimensional task because of a combination of factors such as stigma and discrimination of some populations who frequently get infected with HIV. In addition, patient-provider encounters have become increasingly multicultural, making effective communication and provision of ethically sound care a challenge. This article explores ethical issues that health service providers in the United States and Botswana encountered in their interaction with patients in HIV care. A descriptive qualitative design was used to collect data from health service providers and patients using focused group discussions. This article is based on responses from health service providers only. Participants and context: This article is based on 11 focused group discussions with a total sample of 71 service providers in seven US sites and one Botswana site. Ethical considerations: Ethical review boards at all the study sites reviewed the study protocol and approved it. Ethical review boards of the study's coordinating centers, Rutgers University and the University of California at San Francisco, also approved it. The study participants provided a written informed consent to participate. HIV service providers encountered ethical challenges in all the four Beauchamp and Childress' biomedical ethics of respect for patients' autonomy, beneficence, justice, and nonmaleficence. The finding that HIV service providers encounter ethical challenges in their interaction with patients is supported by prior studies. The ethical challenges are particularly prominent in multicultural care and resource-constrained care environments. Provision of HIV care is fraught with ethical challenges that tend to pose different issues depending on a given care environment. It is important that strong partnerships are developed among key stakeholders in HIV care. In addition, health service providers need to be provided with resources so they can provide quality and ethically sound care.

Describing the content of primary care: limitations of Canadian billing data.

PubMed

Katz, Alan; Halas, Gayle; Dillon, Michael; Sloshower, Jordan

2012-02-15

Primary health care systems are designed to provide comprehensive patient care. However, the ICD 9 coding system used for billing purposes in Canada neither characterizes nor captures the scope of clinical practice or complexity of physician-patient interactions. This study aims to describe the content of primary care clinical encounters and examine the limitations of using administrative data to capture the content of these visits. Although a number of U.S studies have described the content of primary care encounters, this is the first Canadian study to do so. Study-specific data collection forms were completed by 16 primary care physicians in community health and family practice clinics in Winnipeg, Manitoba, Canada. The data collection forms were completed immediately following the patient encounter and included patient and visit characteristics, such as primary reason for visit, topics discussed, actions taken, degree of complexity as well as diagnosis and ICD-9 codes. Data was collected for 760 patient encounters. The diagnostic codes often did not reflect the dominant topic of the visit or the topic requiring the most amount of time. Physicians often address multiple problems and provide numerous services thus increasing the complexity of care. This is one of the first Canadian studies to critically analyze the content of primary care clinical encounters. The data allowed a greater understanding of primary care clinical encounters and attests to the deficiencies of singular ICD-9 coding which fails to capture the comprehensiveness and complexity of the primary care encounter. As primary care reform initiatives in the U.S and Canada attempt to transform the way family physicians deliver care, it becomes increasingly important that other tools for structuring primary care data are considered in order to help physicians, researchers and policy makers understand the breadth and complexity of primary care.

Pedagogical encounters between nurses and patients in a medical ward--a field study.

PubMed

Friberg, F; Andersson, E Pilhammar; Bengtsson, J

2007-05-01

Patient teaching is regarded as an important aspect of nursing care as well as an essential part of the nursing profession. In nursing practice, a distinction can be made between formal (planned) and informal (spontaneous) patient teaching. The major part of patient teaching research is within the area of formal teaching. In spite of the fact that spontaneous teaching occurs in everyday nursing practice, there is a lack of knowledge in this area. The aim was to illuminate pedagogical dimensions in nursing situations and informal teaching. The study is a fieldwork study within the frames of a life-world phenomenological tradition. Fifteen registered nurses in a general medical ward of a university hospital in Sweden were followed in their daily work with patients. Twelve patients suffering from various chronic diseases were interviewed. The observations comprised a total of 173 h on 34 separate occasions. Informal dialogues with nurses were carried through. Further, formal interviews were conducted with 12 of the observed patients. The data were analysed by means of a life-world phenomenological approach. Two different pedagogical encounters are presented: "Players in different field pedagogical encounters", in which there is a breakdown in the pedagogical dialogue, and "Players in same field pedagogical encounters", in which the pedagogical dialogue develops. Patients' experiences of seeking and acquiring knowledge within these two types of encounter are characterised as "worry" versus "preparedness". Patients' dignity is either threatened or supported, depending on the type of encounter. Health care organisations have to create a pedagogical climate where "Same field pedagogical encounters" can be created. The nurse has to view the patient as a learning person in order to help the patient to achieve "preparedness". "Preparedness" is described as a cognitive-emotive-existential state and emphasised as an important goal of patient teaching.

Monitoring InBaskets With Feedback to Providers Enhances the Timeliness of Patient Care.

PubMed

Trant, Amelia A; Strait, Michael; Kaplan, Rory; Dest, Vanna; Roshka, Adam; Lyons, Catherine A; Vest, Kevin A; Steffen, Tessa; Chiang, Anne; Adelson, Kerin B

2018-05-01

Electronic health records have changed providers' workflow. Epic's InBasket supplants traditional communication and is a central hub for clinical information. Failure to promptly complete records impairs communication and revenue collection. By tracking providers' InBasket activities and offering feedback, we hoped to improve InBasket management and interdisciplinary communication. We created a report to track 273 providers' InBasket activities, including ambulatory transcriptions, chart cosignatures, order cosignatures, patient calls, results, and billable encounters. The report showed how often and for how long each activity was delinquent. We completed three Plan-Do-Study-Act cycles. During cycle 1 (November to December 2015), we sent all providers automated e-mails with their monthly results. During cycle 2 (January to April 2016), we focused solely on billable encounter closure and sent targeted e-mails to providers with > 50 delinquent encounters. The e-mails stated that providers had 30 days to complete encounters or their practices would be closed to new patients; at 30 days, noncompliant providers had 60 days before practice suspension. During cycle 3 (May to September 2016), we continued to monitor and send targeted e-mails to providers who accumulated > 50 encounters. We modeled the financial impact of the intervention using net closure data, the report's aging function, and billing logs. InBasket monitoring with structured feedback decreased open encounters by 53.43%. We did not see improvements in the other metrics that the report tracked. We estimate that $231,724 was saved as a result of the intervention and $349,179 was lost to filing deadlines. Automated e-mails did not reduce open encounters; targeted e-mails to providers improved InBasket management.

Investigation of fatigue by Australian general practice registrars: a cross-sectional study.

PubMed

Morgan, Simon; Henderson, Kim M; Tapley, Amanda; Thomson, Allison; Wilson, Jessica; Scott, John; Spike, Neil A; McArthur, Lawrie; van Driel, Mieke L; Magin, Parker J

2015-06-01

Fatigue is the most common undifferentiated problem presenting in general practice. Previous studies have shown that this presentation leads to multiple investigations. There is no published literature describing the management of patients with fatigue by general practice (GP) registrars. To document the investigation-ordering behaviour of GP registrars in managing patients with a new diagnosis of unexplained fatigue. This was a cross-sectional analysis of data from Registrar Clinical Encounters in Training (ReCEnT), an ongoing cohort study of GP registrars' consultations. We established the prevalence of new diagnoses of unexplained fatigue and associations with that diagnosis, the rate of test ordering and the number and types of investigations ordered. 644 registrars contributed data from 68 986 encounters. In 0.78% of patient encounters, a new diagnosis of unexplained fatigue was made. Pathology was ordered in 78.4% of these problems (versus 18.1% in non-fatigue problems), at a rate of 488 tests per 100 new fatigue problems. Our study suggests that unexplained fatigue elicits a non-rational approach to test ordering by registrars. These findings contribute to the understanding of GP registrar management of fatigue, and undifferentiated presentations more broadly, and suggest educational approaches to improve practice, including dealing with uncertainty.

The impact of an evolving profession on the frequency and perceived difficulty of ethical encounters among physical therapists in the clinic.

PubMed

Berg-Poppe, Patti; MacCabe, Angela; Karges, Joy

2018-05-14

Ethical decision making is situated within dynamic contexts specific to practice standards and environments, contemporary policy, and responsive educational systems. Reflecting on an evolving profession lends insight into the role of ethical codes of conduct. The purpose of this study was to gather information about the frequency and perceived difficulty physical therapists (PTs) experience with common ethical situations within contemporary clinical practice. PTs within the United States were invited to participate in an online questionnaire replicating a 1980 study. Subjects were 336 PTs from a variety of practice environments. Just 1 item was reported as moderately/extremely difficult by contemporary respondents, compared to 16 items in the 1980 study. The number of items meeting moderate/high encounter frequency was similar between the two groups (2015 = 16/19; 1980 = 15/19). While today's PTs report that they encounter ethical situations at a frequency similar to PTs in 1980, these same PTs report these ethical challenges as minimally difficult when compared to PTs responding to the 1980 survey. It is proposed that a move toward autonomous practice, the elevation of the entry level professional degree, and changing health care policy and environments have been influential in shaping these changes over time.

A valuable approach to the use of electronic medical data in primary care research: Panning for gold.

PubMed

Barnett, Stephen; Henderson, Joan; Hodgkins, Adam; Harrison, Christopher; Ghosh, Abhijeet; Dijkmans-Hadley, Bridget; Britt, Helena; Bonney, Andrew

2017-05-01

Electronic medical data (EMD) from electronic health records of general practice computer systems have enormous research potential, yet many variables are unreliable. The aim of this study was to compare selected data variables from general practice EMD with a reliable, representative national dataset (Bettering the Evaluation and Care of Health (BEACH)) in order to validate their use for primary care research. EMD variables were compared with encounter data from the nationally representative BEACH program using χ 2 tests and robust 95% confidence intervals to test their validity (measure what they reportedly measure). The variables focused on for this study were patient age, sex, smoking status and medications prescribed at the visit. The EMD sample from six general practices in the Illawarra region of New South Wales, Australia, yielded data on 196,515 patient encounters. Details of 90,553 encounters were recorded in the 2013 BEACH dataset from 924 general practitioners. No significant differences in patient age ( p = 0.36) or sex ( p = 0.39) were found. EMD had a lower rate of current smokers and higher average scripts per visit, but similar prescribing distribution patterns. Validating EMD variables offers avenues for improving primary care delivery and measuring outcomes of care to inform clinical practice and health policy.

Learning Clinical Skills during Bedside Teaching Encounters in General Practice: A Video-Observational Study with Insights from Activity Theory

ERIC Educational Resources Information Center

Ajjawi, Rola; Rees, Charlotte; Monrouxe, Lynn V.

2015-01-01

Purpose: This paper aims to explore how opportunities for learning clinical skills are negotiated within bedside teaching encounters (BTEs). Bedside teaching, within the medical workplace, is considered essential for helping students develop their clinical skills. Design/methodology/approach: An audio and/or video observational study examining…

Private Perceptions, Public Reflections: Aesthetic Encounters as Vehicles for Shared Meaning Making

ERIC Educational Resources Information Center

White, Boyd

2011-01-01

This paper begins with a brief discussion of aesthetic theory, especially as it relates to art education. Then, to see how theory may apply to practice, it describes an investigation into the manner in which encounters with artworks unfold, how meanings are constructed and values articulated, based on the study of four volunteers' interactions…

Communicative Language Teaching: A Practical Scenario in the Context of Bangladesh

ERIC Educational Resources Information Center

Ahmed, Md. Kawser

2016-01-01

Communicative Language Teaching, popularly known as CLT, has become a newly adopted methodology in the teaching and learning context of Bangladesh. This methodology, since the initiation, has encountered and is still encountering a number of hurdles that need to be dealt with best care and feasible strategy. Of all methods, most of the educational…

Practical Knowledge Storage among Preservice, Novice, and Experienced Educators of Students Who Are Deaf and Hard-of-Hearing.

ERIC Educational Resources Information Center

Marlatt, Edward A.

2004-01-01

Surveys of 163 preservice, novice, and experienced teachers of students who are deaf and hard-of-hearing addressed practical knowledge and adherence to classroom rules of practice (brief statements of how to behave in frequently encountered teaching situations) and practical principles (general constructs about expectations of students). No…

Integrating surveillance data on water-related diseases and drinking-water quality; action-research in a Brazilian municipality.

PubMed

Queiroz, Ana Carolina Lanza; Cardoso, Laís Santos de Magalhães; Heller, Léo; Cairncross, Sandy

2015-12-01

The Brazilian Ministry of Health proposed a research study involving municipal professional staff conducting both epidemiological and water quality surveillance to facilitate the integration of the data which they collected. It aimed to improve the intersectoral collaboration and health promotion activities in the municipalities, especially regarding drinking-water quality. We then conducted a study using the action-research approach. At its evaluation phase, a technique which we called 'the tree analogy' was applied in order to identify both possibilities and challenges related to the proposed interlinkage. Results showed that integrating the two data collection systems cannot be attained without prior institutional adjustments. It suggests therefore the necessity to unravel issues that go beyond the selection and the interrelation of indicators and compatibility of software, to include political, administrative and personal matters. The evaluation process led those involved to re-think their practice by sharing experiences encountered in everyday practice, and formulating constructive criticisms. All this inevitably unleashes a process of empowerment. From this perspective, we have certainly gathered some fruit from the Tree, but not necessarily the most visible.

Educating the humanitarian engineer.

PubMed

Passino, Kevin M

2009-12-01

The creation of new technologies that serve humanity holds the potential to help end global poverty. Unfortunately, relatively little is done in engineering education to support engineers' humanitarian efforts. Here, various strategies are introduced to augment the teaching of engineering ethics with the goal of encouraging engineers to serve as effective volunteers for community service. First, codes of ethics, moral frameworks, and comparative analysis of professional service standards lay the foundation for expectations for voluntary service in the engineering profession. Second, standard coverage of global issues in engineering ethics educates humanitarian engineers about aspects of the community that influence technical design constraints encountered in practice. Sample assignments on volunteerism are provided, including a prototypical design problem that integrates community constraints into a technical design problem in a novel way. Third, it is shown how extracurricular engineering organizations can provide a theory-practice approach to education in volunteerism. Sample completed projects are described for both undergraduates and graduate students. The student organization approach is contrasted with the service-learning approach. Finally, long-term goals for establishing better infrastructure are identified for educating the humanitarian engineer in the university, and supporting life-long activities of humanitarian engineers.

From Narcissism to Face Work: Two Views on the Self in Social Interaction.

PubMed

Peräkylä, Anssi

2015-09-01

Through the analysis of conversational interaction and clinical notes, this article develops conceptual linkages between the Goffmanian concept of face and the psychoanalytic and psychiatric understandings of narcissism. Self-cathexis--the investment of libidinal emotion to the image of self--is a key issue both for Goffman and in psychoanalytic studies of narcissism. For Goffman, the self and its cathexis are inherently fragile interactional achievements, whereas for psychoanalysts such as Kernberg and Kohut, they are relatively stable intrapsychic structures. An application of Goffman's theory to narcissistic personality disorders suggests that pathological narcissism involves the isolation of the person's self-image from interactional. practices and a consequent inability to benefit from face work in ordinary social encounters. Clinical experience suggests revisions to the theory of face work: there is a biographical continuity in a person's experience of face, and successful participation in face work is made possible by the psychic capacity of playful orientation to one's own and others' narcissistic illusions. Such playful orientation is manifested through the interactional practices of role distancing.

ISBI Practice Guidelines for Burn Care.

PubMed

2016-08-01

Practice guidelines (PGs) are recommendations for diagnosis and treatment of diseases and injuries, and are designed to define optimal evaluation and management. The first PGs for burn care addressed the issues encountered in developed countries, lacking consideration for circumstances in resource-limited settings (RLS). Thus, the mission of the 2014-2016 committee established by the International Society for Burn Injury (ISBI) was to create PGs for burn care to improve the care of burn patients in both RLS and resource-abundant settings. An important component of this effort is to communicate a consensus opinion on recommendations for burn care for different aspects of burn management. An additional goal is to reduce costs by outlining effective and efficient recommendations for management of medical problems specific to burn care. These recommendations are supported by the best research evidence, as well as by expert opinion. Although our vision was the creation of clinical guidelines that could be applicable in RLS, the ISBI PGs for Burn Care have been written to address the needs of burn specialists everywhere in the world. Copyright © 2016. Published by Elsevier Ltd.

The New Racism in Education.

ERIC Educational Resources Information Center

Pressman, Harvey; Gartner, Alan

1986-01-01

Discusses the current practice in the U.S. of standardized testing of teachers as a response to the perceived failures of public schools. Focuses on the position that this practice reduces the already low percentage of minority teachers in the schools. Reviews testing practices in various states and the consequences encountered. (SA)

Interactions between sleep disorders and oral diseases.

PubMed

Huynh, N T; Emami, E; Helman, J I; Chervin, R D

2014-04-01

Dental sleep medicine is a rapidly growing field that is in close and direct interaction with sleep medicine and comprises many aspects of human health. As a result, dentists who encounter sleep health and sleep disorders may work with clinicians from many other disciplines and specialties. The main sleep and oral health issues that are covered in this review are obstructive sleep apnea, chronic mouth breathing, sleep-related gastroesophageal reflux, and sleep bruxism. In addition, edentulism and its impact on sleep disorders are discussed. Improving sleep quality and sleep characteristics, oral health, and oral function involves both pathophysiology and disease management. The multiple interactions between oral health and sleep underscore the need for an interdisciplinary clinical team to manage oral health-related sleep disorders that are commonly seen in dental practice. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Patenting nature or protecting culture? Ethnopharmacology and indigenous intellectual property rights

PubMed Central

McGonigle, Ian Vincent

2016-01-01

Ethnopharmacologists are scientists and anthropologists that study indigenous medicines and healing practices, and who often develop new therapies and medicines for wider use. Ethnopharmacologists do fieldwork with indigenous peoples in traditional societies, where they encounter a wide range of cultural values and varying ideas about the nature of property relations. This poses difficulties for protecting indigenous intellectual property and for making just trade agreements. This Note reviews the legal issues relevant to the protection of indigenous resources in ethnopharmacology trade agreements, and suggests that recent developments in anthropology and the social study of science could be instructive in furthering the legal discourse and in providing policy directions. Specifically, the Note introduces the concepts of ‘ontological pluralism’ and ‘epistemic subsidiarity’, which could help lawmakers write sui generis trade agreements to better protect indigenous knowledge and resources. PMID:27774245

Patenting nature or protecting culture? Ethnopharmacology and indigenous intellectual property rights.

PubMed

McGonigle, Ian Vincent

2016-04-01

Ethnopharmacologists are scientists and anthropologists that study indigenous medicines and healing practices, and who often develop new therapies and medicines for wider use. Ethnopharmacologists do fieldwork with indigenous peoples in traditional societies, where they encounter a wide range of cultural values and varying ideas about the nature of property relations. This poses difficulties for protecting indigenous intellectual property and for making just trade agreements. This Note reviews the legal issues relevant to the protection of indigenous resources in ethnopharmacology trade agreements, and suggests that recent developments in anthropology and the social study of science could be instructive in furthering the legal discourse and in providing policy directions. Specifically, the Note introduces the concepts of 'ontological pluralism' and 'epistemic subsidiarity', which could help lawmakers write sui generis trade agreements to better protect indigenous knowledge and resources.

Ethical analysis in public health.

PubMed

Roberts, Marc J; Reich, Michael R

2002-03-23

Public-health regularly encounters serious ethical dilemmas, such as rationing scarce resources, influencing individuals to change their behaviour, and limiting freedom to diminish disease transmission. Yet unlike medical ethics, there is no agreed-upon framework for analysing these difficulties. We offer such a framework. It distinguishes three philosophical views, often invoked in public-health discourse: positions based on outcomes (utilitarianism), positions focused on rights and opportunities (liberalism), and views that emphasise character and virtue (communitarianism). We explore critical variations within each approach, and identify practical problems that arise in addressing the ethical dimensions of health policy. We conclude by examining challenges posed by the feminist argument of ethics-of-care and by postmodern views about the nature of ethics. Health professionals need enhanced skills in applied philosophy to improve the coherence, transparency, and quality of public deliberations over ethical issues inherent in health policy.

An Analysis of Whistle-Blowers and Their Impact on Marketing Practices.

ERIC Educational Resources Information Center

Montgomery, D. Cameron; Starkey, Paul L.

1999-01-01

Describes types of ethical situations in the workplace and types of whistleblowing in which employees might engage. Urges business educators to prepare their students for encounters with illegal or unethical employer practices. (SK)

Conducting international nursing research: challenges and opportunities.

PubMed

Opollo, Jackline Gloria; Opollo, Diana Alaka; Gray, Jennifer; Spies, Lori

2014-11-01

To describe practical experiences before, during and after gaining entry into research fields in Kenya and Uganda. Planning, conducting and implementing international research can be an arduous task. Novice researchers need practical guides to accessing international fields and mitigating challenges met in the field. The researchers conducted three different studies in two developing nations. This paper reviews challenges encountered when conducting international research. Solutions used to overcome these challenges are discussed. Establishing and maintaining effective partnerships is critical to the success of international research efforts. Researchers must be tactful, flexible and creative when handling methodological, ethical and logistical challenges encountered in settings poor in resources. International research provides opportunities for increasing dedication, building cross-cultural competence and advancing health professional practice globally. This paper contributes to nursing scholarship by highlighting the practical challenges of conducting international research. Illustrations aimed at lending insight and encouraging others to expand their dedication to conducting international research are offered.

Finding a path through the health unit: practical experience of Ugandan patients.

PubMed

Mogensen, Hanne O

2005-01-01

Finding one's way through a health facility is not necessarily an easy task for Ugandan patients. Our understanding of how people succeed in doing so, and of the obstacles they encounter on their way, is incomplete if we focus only on the cognitive level of the clinical encounter. Much research in public health and medical anthropology implicitly works with the notion that agency is located in the mind and that cognitive understanding is a precondition for practice. Based on material from eastern Uganda, this article explores the practical experience of Ugandan patients and their relatives and reflects upon the ways in which this notion of agency has often caused us to confuse the spectator's point of view with the actor's point of view. Thus, as Pierre Bourdieu has argued, we are made to look for answers to "questions that practice never asks because it has no need to ask them."

A researcher's journey: Exploring a sensitive topic with vulnerable women.

PubMed

Marsh, Christine A; Browne, Jenny; Taylor, Jan; Davis, Deborah

2017-02-01

The conduct of research regardless of the subject or methods employed brings responsibilities and challenges. These are greater when dealing with sensitive topics and vulnerable groups and therefore researchers must navigate a range of complex issues and make choices in relation to practical, ethical and philosophical concerns. While literature dealing with research methodologies and research design may assist to some degree, it cannot provide a clear pathway or template as each research project must respond to a unique set of circumstances. We can however, also learn from sharing our stories and critical reflections on our research processes. The purpose of this article is to highlight the practical and methodological issues arising from researching a sensitive topic with vulnerable women experiencing an Assumption of Care. Research involving topics that are deeply personal and private combined with a vulnerable population can be complex and challenging for the researcher. Although some issues were anticipated from the literature, others encountered in this study were unexpected. Special considerations and prerequisites were necessary to build mutual trust and share power with women who had experienced an Assumption of Care at birth. Narrative Inquiry was a good methodological fit for this study as it privileged the voices of women and insisted that their experiences be considered within the context of their lives. Although Narrative Inquiry is a suitable choice for researching sensitive topics with vulnerable women specific considerations are still required to ensure the benefits of this research for both participants and researchers. Family and Community Service (FACS) have now replaced the formerly known Department of Community Services (DoCS) and in consideration of the timing of this study this article uses the terminology as DoCS. Copyright © 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

The rate of epinephrine administration associated with allergy skin testing in a suburban allergy practice from 1997 to 2010.

PubMed

Swender, David A; Chernin, Leah R; Mitchell, Chris; Sher, Theodore; Hostoffer, Robert; Tcheurekdjian, Haig

2012-01-01

Allergy skin testing is considered a safe method for testing for IgE-mediated allergic responses although anaphylactic events can occur. Reported rates of anaphylaxis per patient are not consistent and range from 0.008 to 4%. The aim of this study was to determine the rate of epinephrine use associated with allergy skin-prick testing (SPT) and intradermal testing (IDT) in a suburban practice over 13 years. This retrospective chart review used billing and procedure coding records during the time period from January 1997 to June 2010 to identify encounters where epinephrine was administered after SPT or IDT. Patient encounters with procedure codes for skin testing plus either parenteral epinephrine, corticosteroid, antihistamine, or i.v. fluid administration were identified. These patient charts were reviewed to determine if epinephrine was administered, whether systemic reactions developed, and rates of epinephrine administration were calculated. There were 28,907 patient encounters for SPT and 18,212 for IDT. Epinephrine was administered in six patient encounters (0.02%) where SPT was performed; no IDT encounters led to epinephrine administration. There were no fatalities. Allergy skin testing to a variety of allergens, when administered by well-trained personnel, is a safe procedure. This study, involving the largest population to date, showed a rate of systemic reactions requiring epinephrine of 20 per 100,000 SPT visits. No epinephrine was given after IDT.

The rate of epinephrine administration associated with allergy skin testing in a suburban allergy practice from 1997 to 2010

PubMed Central

Chernin, Leah R.; Mitchell, Chris; Sher, Theodore; Hostoffer, Robert; Tcheurekdjian, Haig

2012-01-01

Allergy skin testing is considered a safe method for testing for IgE-mediated allergic responses although anaphylactic events can occur. Reported rates of anaphylaxis per patient are not consistent and range from 0.008 to 4%. The aim of this study was to determine the rate of epinephrine use associated with allergy skin-prick testing (SPT) and intradermal testing (IDT) in a suburban practice over 13 years. This retrospective chart review used billing and procedure coding records during the time period from January 1997 to June 2010 to identify encounters where epinephrine was administered after SPT or IDT. Patient encounters with procedure codes for skin testing plus either parenteral epinephrine, corticosteroid, antihistamine, or i.v. fluid administration were identified. These patient charts were reviewed to determine if epinephrine was administered, whether systemic reactions developed, and rates of epinephrine administration were calculated. There were 28,907 patient encounters for SPT and 18,212 for IDT. Epinephrine was administered in six patient encounters (0.02%) where SPT was performed; no IDT encounters led to epinephrine administration. There were no fatalities. Allergy skin testing to a variety of allergens, when administered by well-trained personnel, is a safe procedure. This study, involving the largest population to date, showed a rate of systemic reactions requiring epinephrine of 20 per 100,000 SPT visits. No epinephrine was given after IDT. PMID:23342290

Reasons for encounter and disease patterns in Danish primary care: changes over 16 years.

PubMed

Moth, Grete; Olesen, Frede; Vedsted, Peter

2012-06-01

Approximately 98% of Danish citizens are listed with a general practice which they consult for medical advice. Although 85% of the population contact their general practitioner (GP) every year, little is known about these contacts. The aim of the present paper is to gain updated knowledge about patients' reasons for encounter and the GP activities and to make comparisons with a similar study from 1993. All GPs in the Central Denmark Region were invited to register all contacts during one randomly chosen day within a year. The registration included questions about patients' reasons for encounter, the types and contents of the contacts, referrals, and distribution between new episodes and follow-up contacts. Aggregated data were compared with the results from 1993. A total of 404 (46%) GPs participated. The number of contacts per 1000 inhabitants had risen by 19.7%. The reasons for encounter and final diagnoses resembled those in 1993. Musculoskeletal, psychological, and respiratory problems were the most common reasons for encounter, psychological problems being the only type to increase over the period. Interestingly, the proportion of diagnoses within the ICPC 'A' chapter rose from 13.5 to 19.7%. The referral rate rose by 2% (relative: 18.7%) from 10.7% to 12.7% and the share of follow-up contacts rose from 45.9% to 50.4% (relative: 8.7%). Quite small changes were seen in the patterns of reasons for encounter and diagnoses from 1993 to 2009. However, an increase was found in contacts with general practice and referrals and in the proportion of follow-ups.

The Off-Campus Center: Extending the Reach of Higher Education. Organizational Issues.

ERIC Educational Resources Information Center

Gabor, Stanley C.; Heggan, Jon P.

Based on a study of basic organizational issues typically encountered in opening, managing, and closing an off-campus center (OCC), this monograph is designed for colleges and universities wishing to explore the possibility of creating or expanding an OCC for adult students. The definition of an OCC is provided. After a brief statistical overview…

An Analysis of Technological Issues Emanating from Faculty Transition to a New Learning Management System

ERIC Educational Resources Information Center

Sanga, Mapopa William

2016-01-01

This case study investigated the process 119 faculty members underwent as they transitioned from using Desire to Learn (D2L) learning management system (LMS), to using Canvas LMS. Other than analyzing technological issues faculty members encountered while navigating various aspects of the Canvas interface, the study also analyzed technological…

Friending, IMing, and Hanging out Face-to-Face: Overlap in Adolescents' Online and Offline Social Networks

ERIC Educational Resources Information Center

Reich, Stephanie M.; Subrahmanyam, Kaveri; Espinoza, Guadalupe

2012-01-01

Many new and important developmental issues are encountered during adolescence, which is also a time when Internet use becomes increasingly popular. Studies have shown that adolescents are using these online spaces to address developmental issues, especially needs for intimacy and connection to others. Online communication with its potential for…

Identity Crisis in Cormac McCarthy's "All the Pretty Horses"

ERIC Educational Resources Information Center

Gebreen, Hayder A. K.

2016-01-01

The issue of identity is one of the main issues that encounters man in each culture. Identity is a set of behaviors, emotions, and thought patterns which are unique to every individual that define him as a member of a certain group. Identity is shaped by race, ethnicity, religious beliefs, language, physical features, childhood experiences, sexual…

Desperate Shadows of "Belonging": Revealing Pedagogical Issues with Teaching Prescribed English Texts in the NSW Higher School Certificate (HSC)

ERIC Educational Resources Information Center

Jogie, Melissa R.

2015-01-01

As New South Wales (NSW) bids farewell to the 2009-2014 Area of Study concept "Belonging", this article summarises some critical reflections from English teachers on the main pedagogical issues encountered when using prescribed texts to teach "Belonging" to both the Standard and Advanced English courses in contemporary…

Live Scale Active Shooter Exercise: Lessons Learned

ERIC Educational Resources Information Center

Ervin, Randy

2008-01-01

On October 23, 2007, the Lake Land College Public Safety Department conducted a full-scale live exercise that simulated an active shooter and barricaded hostage. In this article, the author will emphasize what they learned, and how they intend to benefit from it. He will list the law enforcement issues and general issues they encountered, and then…

Moving from Good Ideas in Educational Systems Change to Sustainable Program Implementation: Coming to Terms with Some of the Realities

ERIC Educational Resources Information Center

Noell, George H.; Gansle, Kristin A.

2009-01-01

Proponents of systemic changes in education commonly encounter ethical, theoretical, and pragmatic challenges in moving from possibility to implementation of their vision of change. Although ethical and theoretical issues are critically important to a successful change initiative, pragmatic issues relevant to assuring program implementation have…

'There's the record, closed and final': Rough for Theatre II as Psychiatric Encounter.

PubMed

Heron, Jonathan; Broome, Matthew

2016-06-01

A co-authored collaboration between a theatre practitioner and a clinical psychiatrist, this paper will examine Rough for Theatre II (RFTII) and Beckett's demonstration of the way records are used to understand the human subject. Using Beckett's play to explore interdisciplinary issues of embodiment and diagnosis, the authors will present a dialogue that makes use of the 'best sources' in precisely the same manner as the play's protagonists. One of those sources will be Beckett himself, as Heron will locate the play in its theatrical context through reflections upon his own practice (with Fail Better Productions, UK) as well as recent studies such as Beckett, Technology and the Body (Maude 2009) and Performing Embodiment in Samuel Beckett's Drama (McMullan 2010); another source will be the philosopher Wilhelm Windleband, whose 1901 History of Philosophy was read and noted upon by Beckett in the 1930s, as Broome will introduce a philosophical and psychiatric context to the exchange. Windelband is now a neglected figure in philosophy; but as one of the key figures of Neo-Kantianism in the late 19(th) century, his work was an important impetus to that of Rickert, Weber and Heidegger. Specifically, Windelband gives us the distinction between idiographic and nomothetic understanding of individuals, an approach that is of relevance to the psychiatric encounter. This academic dialogue will consider tensions between subjectivity and objectivity in clinical and performance practice, while examining Beckett's analysis of the use of case notes and relating them back to Windelband's ideas on the understanding of others. The dialogue took place in 2011 at the University of Warwick, and has since been edited by the authors.

Challenges in sharing knowledge: reflections from the perspective of an expatriate nurse working in a South Sudanese hospital.

PubMed

Tjoflåt, I; Karlsen, B

2012-12-01

This account, based on the experience of the first author, aims to describe an example of practice from a hospital in South Sudan. The example illustrates a cross-cultural encounter and the challenges that a Sudanese nurse and an expatriate nurse face in sharing knowledge when providing patient care. The constructed practical example between nurses with different knowledge bases and experiences was characterized by the expatriate nurse giving her instructions and not allowing the Sudanese nurse to respond to them. This 'one-way' communication demonstrated that the expatriate nurse considered herself to have the better knowledge of nursing care. These aspects of the encounter formed the basis for the following discussion, which sheds light on how the expatriate nurse ideally could have worked by using a dialogue instead of one-way communication. The importance of having knowledge and understanding of the context in cross-cultural encounters was also emphasized. The discussion of this practical example can provide insight for other nurses when working in cultures other than their own into the importance of using a dialogue when sharing knowledge in a cross-cultural encounter. In addition, expatriates can be made aware of the importance of acquiring knowledge about the context for 'the other' when working cross culturally. Finally, it should be noted that the description and discussion of the experience reflect only the perspective of the expatriate nurse. © 2012 The Authors. International Nursing Review © 2012 International Council of Nurses.

Learning to be Seen: The Depiction of Encounters Between Israeli and Newcomer Children in Children's Literature

ERIC Educational Resources Information Center

Golden, Deborah; Drubetskoy, Tatyana

2005-01-01

Books written for and about children may serve to convey central cultural tenets to new members of society. This paper looks at the depiction of encounters between newcomer and locally born children in contemporary Hebrew literature aimed at teenage readers and presents the major resources and practices by means of which the newcomer protagonists…

Into the Cracks: A Geology of Encounters with Addiction as Disease and Moral Failing

ERIC Educational Resources Information Center

McCoy, Kate

2010-01-01

The author is thinking with Deleuze's ethical practice of "being on the lookout" for encounters with the cracks. Drawing on research in the USA on access to health care for people who use illicit drugs, the author works with Deleuze and Guattari, Deleuze and Foucault in a geological and genealogical mode of inquiry to investigate the preoccupation…

Issues encountered in a qualitative secondary analysis of help-seeking in the prodrome to psychosis.

PubMed

Gladstone, Brenda M; Volpe, Tiziana; Boydell, Katherine M

2007-10-01

Primary data are rarely used explicitly as a source of data outside of the original research purpose for which they were collected. As a result, qualitative secondary analysis (QSA) has been described as an "invisible enterprise" for which there is a "notable silence" amongst the qualitative research community. In this paper, we report on the methodological implications of conducting a secondary analysis of qualitative data focusing on parents' narratives of help-seeking activities in the prodrome to psychosis. We review the literature on QSA, highlighting the main characteristics of the approach, and discuss issues and challenges encountered in conducting a secondary analysis. We conclude with some thoughts on the implications for conducting a QSA in children's mental health services and research.

Emergency nurses' perceptions of the role of confidence, self-efficacy and reflexivity in managing the cognitively impaired older person in pain.

PubMed

Fry, Margaret; MacGregor, Casimir; Hyland, Simone; Payne, Barbara; Chenoweth, Lynn

2015-06-01

The study aimed to explore the practice of care among emergency nurses caring for older persons with cognitive impairment and who presented in pain from a long bone fracture, to highlight nurse confidence and self-efficacy in practice. Cognitive impairment is an issue increasingly facing emergency departments. Older persons with cognitive impairment have complex care needs, requiring effective clinical decision-making and provision of care. Nurse confidence and self-efficacy are critical to meeting the necessary standards of care for this vulnerable patient group. A multi-centre study. The study was undertaken across four emergency departments in Sydney, Australia. Sixteen focus group discussions were conducted with 80 emergency departments of nurses. Four main themes emerged: confidence and self-efficacy through experience; confidence and self-efficacy as a balancing act; confidence and self-efficacy as practice; and confidence and self-efficacy and interpersonal relations. Our findings demonstrate that confidence, self-efficacy and reflexivity enabled the delivery of appropriate, timely and compassionate care. Further, confidence and self-efficacy within nursing praxis relied on clinical experience and reflective learning and was crucial to skill and knowledge acquisition. Our research suggests that confidence, self-efficacy and reflexivity need to be developed and valued in nurses' careers to better meet the needs of complex older persons encountered within everyday practice. © 2015 John Wiley & Sons Ltd.

[Analysis of the knowledge and practices of health care workers in Emergency Departments regarding the protection and preservation of evidence in forensic cases].

PubMed

Ilçe, Arzu; Yıldız, Dilek; Baysal, Gonca; Ozdoğan, Fatma; Taş, Fatma

2010-11-01

The frequency of violent incidents is increasing. This increase has made the role of Emergency Department (ED) staff more important in the collection, recording, protection, and storage of the evidence until the arrival of the responsible people concerned with the issue. Therefore, this study was designed to analyze the knowledge and practices of the nursing staff working in the EDs with respect to the protection and preservation of the evidence in forensic cases. This research, which was designed to be descriptive, was conducted with 44 health care workers in the hospitals with Emergency Departments in the center of Bolu province between October 2008 and January 2009. It was observed that 90.9% of the health care workers encountered forensic cases, 65.9% of them had not attended any training on forensic cases, and 22.7% of them did not use care when removing and storing the clothes of the patient. It was considered that 90.9% of the health care workers duly carry out their duties and responsibilities in forensic cases; however, 18.2% of them do not have sufficient knowledge or practical experience in the preservation and protection of evidence in forensic cases. It was observed that most health care workers do not have sufficient knowledge or practical experience in the preservation and protection of evidence in forensic cases.

"(Dis)Empowered by What We See … ": Exploring the Use of Video-Stimulated Reflection in Physical Education Pedagogy and Practice

ERIC Educational Resources Information Center

Mooney, Amanda; Hickey, Chris

2017-01-01

Reflexive accounts of physical education (PE) pedagogy and practice offer potential to reveal much about the intended and unintended learning, for both students and teachers, that can result from certain pedagogic encounters. Despite the promotion of reflective practice/s as a possible "panacea" for improved teaching and learning, there…

Ad Hoc Supervision of General Practice Registrars as a "Community of Practice": Analysis, Interpretation and Re-Presentation

ERIC Educational Resources Information Center

Clement, T.; Brown, J.; Morrison, J.; Nestel, D.

2016-01-01

General practice registrars in Australia undertake most of their vocational training in accredited general practices. They typically see patients alone from the start of their community-based training and are expected to seek timely ad hoc support from their supervisor. Such ad hoc encounters are a mechanism for ensuring patient safety, but also…

Quality considerations in midwifery pre-service education: exemplars from Africa.

PubMed

Fullerton, Judith T; Johnson, Peter G; Thompson, Joyce B; Vivio, Donna

2011-06-01

This paper uses comparisons and contrasts identified during an assessment of pre-service education for midwives in three countries in sub-Saharan Africa. The purpose of the paper is to stimulate discussion about issues that must be carefully considered in the context of midwifery educational programming and the expansion of the midwifery workforce. A mixed qualitative and quantitative participatory assessment was conducted in Ethiopia, Ghana and Malawi, in the context of a final review of outcomes of a USAID-funded global project (ACCESS). Quantitative surveys were distributed. Individual and focus group interviews were conducted. Participants included key informants at donor, government and policy-making levels, representatives of collaborating and supporting agencies, midwives and students in education programmes, and midwives in clinical practice. Information is presented concerning the challenges encountered by those responsible for midwifery pre-service education related to issues in programming including: pathways to midwifery, student recruitment and admission, midwifery curricula, preparation of faculty to engage in academic teaching and clinical mentorship, modes of curriculum dissemination and teaching/learning strategies, programme accreditation, qualifications for entry-into practice and the assessment of continued competence. Quality issues must be carefully considered when designing and implementing midwifery pre-service education programmes, and planning for the integration of new graduates into the health workforce. These issues, such as the availability of qualified tutors and clinical teachers, and measures for the implementation of competency-based teaching and learner-assessment strategies, are particularly relevant in countries that experience health manpower shortages. This review highlights important strategic choices that can be made to enhance the quality of pre-service midwifery education. The deployment, appropriate utilisation and increased number of highly qualified midwifery graduates can improve the quality of maternal and newborn health-care service, and reduce maternal and newborn mortality. Copyright © 2010 Elsevier Ltd. All rights reserved.

Challenges faced in implementation of a telehealth enabled chronic wound care system.

PubMed

Barrett, M; Larson, A; Carville, K; Ellis, I

2009-01-01

In the rural Midwest region of Western Australia (WA), wound care is a major burden on the healthcare system. Optimal wound care was found to be impeded by issues that included the involvement of multiple healthcare providers, incomplete and inconsistent documentation, and limited access to expert review. A telehealth solution was trailed in 2007. To describe the systemic barriers encountered in implementing a telehealth program in rural WA and to provide recommendations for future telehealth initiatives. This study trialled the use of a shared electronic wound imaging and reporting system in combination with an expert remote wound consultation service for the management of patients with chronic wounds in the Midwest of WA. The trial sites included rural hospital out-patient clinics, a private domiciliary nursing service, residential aged care facilities, general practices and a podiatry clinic. The implementation conformed to accepted best practice in introducing telehealth initiatives. During the trial 12 sites had the relevant software installed and were able to access a central server. Although a total of 41 patients with chronic wounds were enrolled, four sites did not enroll any patients and only two sites successfully incorporated the system into regular practice. Major obstacles were workforce issues and significant delays in installing the software at some sites. Only 47% of the healthcare providers trained to use the software at the beginning of the trial were still employed when the trial ended. Prolonged periods of vacant positions at one remote clinic and an aged care facility made it impossible for the remaining providers to allocate time for using the wound care software. The disease burden of the patient group, funding models and workforce shortages frustrated the successful adoption of an evidence based strategy that was known to improve health outcomes.

Engaging Musical Practices: A Sourcebook for Middle School General Music

ERIC Educational Resources Information Center

Burton, Suzanne L., Ed.

2012-01-01

Middle school general music may be a student's last encounter with school music. A practical book with accessible pedagogical resources on middle school general music is needed for methods courses and music practitioners' use. The book "Engaging Musical Practices: A Sourcebook for Middle School General Music" presents numerous ways to engage…

A Pilot Study of Problems and Practices in the Induction of Beginning Teachers.

ERIC Educational Resources Information Center

Bouchard, John B.; Hull, Ronald E.

A pilot study was designed to test the practicality of gathering data through interviews and to provide tentative information on induction problems and practices encountered by beginning teachers in the Cattaraugus-Chautauqua County area of New York. Fifty-three elementary self-contained classroom teachers and secondary academic subject-matter…

Life Story Reflection in Social Work Education: A Practical Model

ERIC Educational Resources Information Center

Spector-Mersel, Gabriela

2017-01-01

Drawing from the practice-oriented conception of reflection in social work, its applications in social work education typically focus on students' encounters with the field. Recognizing the value of practice-oriented reflection yet aware of its limitations, complementing it with life story reflection (LSR) is urged. The importance of LSR in social…

Synthetic Report of Research and Development of Professional Knowledge Practices

ERIC Educational Resources Information Center

Toiviainen, Hanna; Hoynalanmaa, Mikko; Lallimo, Jiri; Moen, Anne; Smordal, Ole; Morch, Anders; Toikka, Seppo

2006-01-01

This deliverable has been produced in the context of the Knowledge-Practice Laboratory (KP-Lab) project, which is aimed at facilitating innovative practices of working with knowledge in higher education, teacher training, and professional networks. This deliverable is a synopsis of the first experiences encountered during the first 6 months of the…

Cultural transition of international medical graduate residents into family practice in Canada.

PubMed

Triscott, Jean A C; Szafran, Olga; Waugh, Earle H; Torti, Jacqueline M I; Barton, Martina

2016-05-04

To identify the perceived strengths that international medical graduate (IMG) family medicine residents possess and the challenges they are perceived to encounter in integrating into Canadian family practice. This was a qualitative, exploratory study employing focus groups and interviews with 27 participants - 10 family physicians, 13 health care professionals, and 4 family medicine residents. Focus group/interview questions addressed the strengths that IMGs possess and the challenges they face in becoming culturally competent within the Canadian medico-cultural context. Qualitative data were audiotaped, transcribed, and analyzed thematically. Participants identified that IMG residents brought multiple strengths to Canadian practice including strong clinical knowledge and experience, high education level, the richness of varied cultural perspectives, and positive personal strengths. At the same time, IMG residents appeared to experience challenges in the areas of: (1) communication skills (language nuances, unfamiliar accents, speech volume/tone, eye contact, directness of communication); (2) clinical practice (uncommon diagnoses, lack of familiarity with care of the opposite sex and mental health conditions); (3) learning challenges (limited knowledge of Canada's health care system, patient-centered care and ethical principles, unfamiliarity with self-directed learning, unease with receiving feedback); (4) cultural differences (gender roles, gender equality, personal space, boundary issues; and (5) personal struggles. Residency programs must recognize the challenges that can occur during the cultural transition to Canadian family practice and incorporate medico-cultural education into the curriculum. IMG residents also need to be aware of cultural differences and be open to different perspectives and new learning.

Considerations for choosing an electronic medical record for an ophthalmology practice.

PubMed

DeBry, P W

2001-04-01

To give a brief overview of issues pertinent to selecting an ophthalmic electronic medical record (EMR) program and to outline the company demographics and software capabilities of the major vendors in this area. Software companies shipping an EMR package were contacted to obtain information on their software and company demographics. The focus was on companies selectively marketing to ophthalmology practices, and, therefore, most were selected based on their representation at the 1998 and/or 1999 American Academy of Ophthalmology meeting. Software companies that responded to repeated inquiries in a timely fashion were included. Sixteen companies were evaluated. Electronic medical records packages ranged from $3000 to $80 000 (mean, approximately $30 000). Company demographics revealed a range from 1 to 1600 employees (mean, 204). Most of these companies have been in business for 6 years or less (range, 1-15 years; mean, 6 years). My opinions concerning various aspects of the EMR are presented. There is a wide range of EMR products available for the ophthalmology practice. Computer technology has matured to a point at which the graphical demands of the ophthalmology EMR can be satisfied. Weaknesses do exist in the inherent difficulty of recording an ophthalmology encounter, the relative adolescence of software companies, and the lack of standards in the industry.

Effects of Long-Term Dharma-Chan Meditation on Cardiorespiratory Synchronization and Heart Rate Variability Behavior

PubMed Central

Chang, Chih-Hao

2013-01-01

Abstract Remarkable changes in cardiorespiratory interactions are frequently experienced by Chan meditation practitioners following years of practice. This study compares the results of our study on cardiorespiratory interactions for novice (control group) and experienced (experimental group) Chan meditation practitioners. The effectual co-action between the cardiac and respiratory systems was evaluated by the degree of cardiorespiratory phase synchronization (CRPS). In addition, an adaptive-frequency-range (AFR) scheme to reliably quantify heart rate variability (HRV) was developed for assessing the regulation of sympathetic–parasympathetic activity and the efficiency of pulmonary gas exchange. The enhanced HRV method, named HRVAFR, can resolve the issue of overestimating HRV under the condition of slow respiration rates, which is frequently encountered in studies on Chan meditation practitioners. In the comparison of the three data sets collected from the two groups, our findings resulted in innovative hypotheses to interpret the extraordinary process of the rejuvenation of cardiorespiratory functions through long-term Dharma-Chan meditation practice. Particularly, advanced practitioners exhibit a continuously high degree of cardiorespiratory phase synchronization, even during rapid breathing. Based on our post-experimental interview with advanced practitioners, the activation of inner Chakra energy, during the course of Chan-detachment practice, frequently induces perceptible physiological-mental reformation, including an efficient mechanism for regulating cardiorespiratory interactions. PMID:23323597

Effects of long-term dharma-chan meditation on cardiorespiratory synchronization and heart rate variability behavior.

PubMed

Chang, Chih-Hao; Lo, Pei-Chen

2013-04-01

Remarkable changes in cardiorespiratory interactions are frequently experienced by Chan meditation practitioners following years of practice. This study compares the results of our study on cardiorespiratory interactions for novice (control group) and experienced (experimental group) Chan meditation practitioners. The effectual co-action between the cardiac and respiratory systems was evaluated by the degree of cardiorespiratory phase synchronization (CRPS). In addition, an adaptive-frequency-range (AFR) scheme to reliably quantify heart rate variability (HRV) was developed for assessing the regulation of sympathetic-parasympathetic activity and the efficiency of pulmonary gas exchange. The enhanced HRV method, named HRVAFR, can resolve the issue of overestimating HRV under the condition of slow respiration rates, which is frequently encountered in studies on Chan meditation practitioners. In the comparison of the three data sets collected from the two groups, our findings resulted in innovative hypotheses to interpret the extraordinary process of the rejuvenation of cardiorespiratory functions through long-term Dharma-Chan meditation practice. Particularly, advanced practitioners exhibit a continuously high degree of cardiorespiratory phase synchronization, even during rapid breathing. Based on our post-experimental interview with advanced practitioners, the activation of inner Chakra energy, during the course of Chan-detachment practice, frequently induces perceptible physiological-mental reformation, including an efficient mechanism for regulating cardiorespiratory interactions.

A qualitative analysis of student-written law and ethics cases: A snapshot of PY2 student experience.

PubMed

Karwaki, Tanya E; Hazlet, Thomas K

2017-05-01

This study was designed to better understand pharmacy students' experiences and recognition of legal and ethical tensions existing in pharmacy practice as demonstrated in student-written law and ethics cases. A qualitative analysis of 132 student-written cases representing the team efforts of 1053 students over a 12-year time period was conducted. Student-written cases were coded and analyzed thematically. Our results demonstrate the types of ethical and legal issues our students have experienced in pharmacy practice during the first five quarters of their professional education. Our data highlight three themes: 1) ethical dilemmas presented when the law is misapplied; 2) ethical dilemmas presented when an institutional policy or law was viewed as insufficient; and 3) ethical dilemmas presented as provider distress. The third theme was further subdivided into five subthemes. The themes that emerged from this study represent some of the ethical dilemmas that second professional year students have encountered and how these dilemmas may intersect with legal boundaries. Educators can use cases demonstrating these themes to reinforce law and ethics education in the curriculum, thus helping prepare students for pharmacy practice. This article recommends how and when to use case examples. Copyright © 2017 Elsevier Inc. All rights reserved.

Multi-Agent Modeling and Simulation Approach for Design and Analysis of MER Mission Operations

NASA Technical Reports Server (NTRS)

Seah, Chin; Sierhuis, Maarten; Clancey, William J.

2005-01-01

A space mission operations system is a complex network of human organizations, information and deep-space network systems and spacecraft hardware. As in other organizations, one of the problems in mission operations is managing the relationship of the mission information systems related to how people actually work (practices). Brahms, a multi-agent modeling and simulation tool, was used to model and simulate NASA's Mars Exploration Rover (MER) mission work practice. The objective was to investigate the value of work practice modeling for mission operations design. From spring 2002 until winter 2003, a Brahms modeler participated in mission systems design sessions and operations testing for the MER mission held at Jet Propulsion Laboratory (JPL). He observed how designers interacted with the Brahms tool. This paper discussed mission system designers' reactions to the simulation output during model validation and the presentation of generated work procedures. This project spurred JPL's interest in the Brahms model, but it was never included as part of the formal mission design process. We discuss why this occurred. Subsequently, we used the MER model to develop a future mission operations concept. Team members were reluctant to use the MER model, even though it appeared to be highly relevant to their effort. We describe some of the tool issues we encountered.

Child passenger safety.

PubMed

Durbin, Dennis R

2011-04-01

Despite significant reductions in the number of children killed in motor vehicle crashes over the past decade, crashes continue to be the leading cause of death for children 4 years and older. Therefore, the American Academy of Pediatrics continues to recommend inclusion of child passenger safety anticipatory guidance at every health-supervision visit. This technical report provides a summary of the evidence in support of 5 recommendations for best practices to optimize safety in passenger vehicles for children from birth through adolescence that all pediatricians should know and promote in their routine practice. These recommendations are presented in the revised policy statement on child passenger safety in the form of an algorithm that is intended to facilitate their implementation by pediatricians with their patients and families. The algorithm is designed to cover the majority of situations that pediatricians will encounter in practice. In addition, a summary of evidence on a number of additional issues that affect the safety of children in motor vehicles, including the proper use and installation of child restraints, exposure to air bags, travel in pickup trucks, children left in or around vehicles, and the importance of restraint laws, is provided. Finally, this technical report provides pediatricians with a number of resources for additional information to use when providing anticipatory guidance to families.

Toward inclusive science education: University scientists' views of students,instructional practices, and the nature of science

NASA Astrophysics Data System (ADS)

Bianchini, Julie A.; Whitney, David J.; Breton, Therese D.; Hilton-Brown, Bryan A.

2002-01-01

This study examined the perceptions and self-reported practices of 18 scientists participating in a yearlong seminar series designed to explore issues of gender and ethnicity in science. Scientists and seminar were part of the Promoting Women and Scientific Literacy project, a curriculum transformation and professional development initiative undertaken by science, science education, and women's studies faculty at their university. Researchers treated participating scientists as critical friends able to bring clarity to and raise questions about conceptions of inclusion in science education. Through questionnaires and semistructured interviews, we explored their (a) rationales for differential student success in undergraduate science education; (b) self-reports of ways they structure, teach, and assess courses to promote inclusion; and (c) views of androcentric and ethnocentric bias in science. Statistical analysis of questionnaires yielded few differences in scientists' views and reported practices by sex or across time. Qualitative analysis of interviews offered insight into how scientists can help address the problem of women and ethnic minorities in science education; constraints encountered in attempts to implement pedagogical and curricular innovations; and areas of consensus and debate across scientists and science studies scholars' descriptions of science. From our findings, we provided recommendations for other professional developers working with scientists to promote excellence and equity in undergraduate science education.

Implementing service improvement projects within pre-registration nursing education: a multi-method case study evaluation.

PubMed

Baillie, Lesley; Bromley, Barbara; Walker, Moira; Jones, Rebecca; Mhlanga, Fortune

2014-01-01

Preparing healthcare students for quality and service improvement is important internationally. A United Kingdom (UK) initiative aims to embed service improvement in pre-registration education. A UK university implemented service improvement teaching for all nursing students. In addition, the degree pathway students conducted service improvement projects as the basis for their dissertations. The study aimed to evaluate the implementation of service improvement projects within a pre-registration nursing curriculum. A multi-method case study was conducted, using student questionnaires, focus groups with students and academic staff, and observation of action learning sets. Questionnaire data were analysed using SPSS v19. Qualitative data were analysed using Ritchie and Spencer's (1994) Framework Approach. Students were very positive about service improvement. The degree students, who conducted service improvement projects in practice, felt more knowledgeable than advanced diploma students. Selecting the project focus was a key issue and students encountered some challenges in practice. Support for student service improvement projects came from action learning sets, placement staff, and academic staff. Service improvement projects had a positive effect on students' learning. An effective partnership between the university and partner healthcare organisations, and support for students in practice, is essential. Copyright © 2013 Elsevier Ltd. All rights reserved.

Hospice and palliative social workers' experiences with clients at risk of suicide.

PubMed

Washington, Karla T; Albright, David L; Parker Oliver, Debra; Gage, L Ashley; Lewis, Alexandria; Mooney, Megan J

2016-12-01

We sought to determine the frequency with which hospice and palliative social workers encounter patients, family caregivers, and other clients at risk of suicide, and to discover the extent to which hospice and palliative social workers feel prepared to address issues related to suicide in their professional practice. We conducted a cross-sectional survey of hospice and palliative social workers, recruiting a convenience sample of volunteer respondents through advertisements at professional conferences and listservs, and via social media accounts associated with national organizations, state hospice and palliative care associations, and individual healthcare professionals. Most respondents reported having worked with patients, family caregivers, or other clients who had exhibited warning signs of suicide during the previous year. Fewer respondents indicated that they had worked with patients and family members who had attempted or died by suicide. While the majority of respondents believed they possessed sufficient knowledge and skills to intervene effectively with individuals at risk of suicide, they indicated that additional education on this topic would be valuable for their professional practice. These study results suggest that suicide-related competencies are important in the practice of hospice and palliative social work. Future education and training efforts should include skill development in addition to knowledge building.

Using Machine Learning for Behavior-Based Access Control: Scalable Anomaly Detection on TCP Connections and HTTP Requests

DTIC Science & Technology

2013-11-01

machine learning techniques used in BBAC to make predictions about the intent of actors establishing TCP connections and issuing HTTP requests. We discuss pragmatic challenges and solutions we encountered in implementing and evaluating BBAC, discussing (a) the general concepts underlying BBAC, (b) challenges we have encountered in identifying suitable datasets, (c) mitigation strategies to cope...and describe current plans for transitioning BBAC capabilities into the Department of Defense together with lessons learned for the machine learning

Teaching evolution in the Australian classroom

NASA Astrophysics Data System (ADS)

Vozzo, Les

A summary of the key issues of controversy encountered by science teachers in Australian classrooms. Evolution, cloning and gene manipulation, fertility control, artificial intelligence, irradiation of food, the use of nuclear energy, radiation from powerlines are some of the topics discussed and debated in classrooms. What are some of the difficulties encountered by teachers when students ask questions that raise moral dilemmas and challenges entrenched beliefs and views of the world. What are some of the teaching strategies used that deal with these difficulties.

Pediatric Sepsis Guidelines: Summary for resource-limited countries

PubMed Central

Khilnani, Praveen; Singhi, Sunit; Lodha, Rakesh; Santhanam, Indumathi; Sachdev, Anil; Chugh, Krishan; Jaishree, M.; Ranjit, Suchitra; Ramachandran, Bala; Ali, Uma; Udani, Soonu; Uttam, Rajiv; Deopujari, Satish

2010-01-01

Justification: Pediatric sepsis is a commonly encountered global issue. Existing guidelines for sepsis seem to be applicable to the developed countries, and only few articles are published regarding application of these guidelines in the developing countries, especially in resource-limited countries such as India and Africa. Process: An expert representative panel drawn from all over India, under aegis of Intensive Care Chapter of Indian Academy of Pediatrics (IAP) met to discuss and draw guidelines for clinical practice and feasibility of delivery of care in the early hours in pediatric patient with sepsis, keeping in view unique patient population and limited availability of equipment and resources. Discussion included issues such as sepsis definitions, rapid cardiopulmonary assessment, feasibility of early aggressive fluid therapy, inotropic support, corticosteriod therapy, early endotracheal intubation and use of positive end expiratory pressure/mechanical ventilation, initial empirical antibiotic therapy, glycemic control, and role of immunoglobulin, blood, and blood products. Objective: To achieve a reasonable evidence-based consensus on the basis of published literature and expert opinion to formulating clinical practice guidelines applicable to resource-limited countries such as India. Recommendations: Pediatric sepsis guidelines are presented in text and flow chart format keeping resource limitations in mind for countries such as India and Africa. Levels of evidence are indicated wherever applicable. It is anticipated that once the guidelines are used and outcomes data evaluated, further modifications will be necessary. It is planned to periodically review and revise these guidelines every 3–5 years as new body of evidence accumulates. PMID:20606908

Precision medicine in heritable cancer: when somatic tumour testing and germline mutations meet.

PubMed

Ngeow, Joanne; Eng, Charis

2016-01-01

Cancer is among the leading causes of death and disfigurement worldwide with an estimated global incidence of 14 million and ~8.2 million cancer-related deaths per annum. An estimated 5-10% of all cancers are hereditary, meaning a single gene mutation contributed to development of the cancer. In other words, inherited cancer has a worldwide incidence of ~1.4 million new cases per annum and a global prevalence of 300 million, and are often poorly recognised. The increase in genetic sequencing capability combined with the decrease in the cost of testing has altered both regulatory policy and clinical oncology practice Well-known examples of clinically important cancer susceptibility syndromes such as those caused by genetic mutations in highly penetrant genes such as BRCA1/2 hereditary breast-ovarian cancer syndrome genes have provided the framework for the practice of clinical cancer genetics. There is no question that these tests have provided clinical benefit to the patient and her/his family. However, with the expanding role of next generation sequencing in tumour profiling as well as in germline testing, clinicians are now faced with significant new challenges and potentially unexpected opportunities. Issues such as determining how best to deal with gene variants of uncertain clinical significance and the issue of incidental findings of hereditary cancer risk may be encountered during tumour genomic testing will require a concerted effort and dialogue on the part of the broad genomic community.

Users and uses of Landsat 8 satellite imagery—2014 survey results

USGS Publications Warehouse

Miller, Holly M.

2016-04-18

To explore the effect of the availability of Landsat 8 imagery on Landsat imagery use in general, established users (those who had consistently used Landsat imagery both before and after Landsat 8 imagery became available) using Landsat 8 imagery were asked about changes in the amount of Landsat imagery they used. The majority of established users using Landsat 8 imagery (60 percent) reported an average increase of 51 percent in the number of scenes obtained after Landsat 8 imagery became available. Landsat 8 users were asked if they had encountered challenges in using Landsat 8 whereas non-Landsat 8 users were asked if such challenges had played a role in why they were not using Landsat 8 imagery. Although many users did not encounter challenges when using or trying to use Landsat 8 data, slightly less than 30 percent did encounter issues with processing the data to a usable point. The most common issue reported was not being able to create or have access to a surface reflectance corrected product. Other challenges were related to the file sizes of images being too large to download, store, or analyze. There were no statistically significant differences between Landsat 8 and non-Landsat 8 users in terms of challenges encountered when using or trying to use the imagery, which indicates that users were not unduly discouraged by the challenges they may have encountered. When asked about potential consequences of not using Landsat 8, more than half of the non-Landsat 8 users did not report detrimental effects on their work from not using the imagery. Of those who did report detrimental effects, decreased quality of work, decreased scope of work, and increased time spent on work were the most common.   

Ophthalmology resident surgical competency: a national survey.

PubMed

Binenbaum, Gil; Volpe, Nicholas J

2006-07-01

To describe the prevalence, management, and career outcomes of ophthalmology residents who struggle with surgical competency and to explore related educational issues. Fourteen-question written survey. Fifty-eight program directors at Accreditation Council on Graduate Medical Education-accredited, United States ophthalmology residency programs, representing a total of 2179 resident graduates, between 1991 and 2000. Study participants completed a mailed, anonymous survey whose format combined multiple choice and free comment questions. Number of surgically challenged residents, types of problems identified, types of remediation, final departmental decision at the end of residency, known career outcomes, and residency program use of microsurgical skills laboratories and applicant screening tests. One hundred ninety-nine residents (9% overall; 10% mean per program) were labeled as having trouble mastering surgical skills. All of the programs except 2 had encountered such residents. The most frequently cited problems were poor hand-eye coordination (24%) and poor intraoperative judgment (22%). Most programs were supportive and used educational rather than punitive measures, the most common being extra practice-laboratory time (32%), scheduling cases with the best teaching surgeon (23%), and counseling (21%). Nearly one third (31%) of residents were believed to have overcome their difficulties before graduation. Other residents were encouraged to pursue medical ophthalmology (22%) or to obtain further surgical training through a fellowship (21%) or a supervised practice setting (12%); these residents were granted a departmental statement of satisfactory completion of residency for Board eligibility. Twelve percent were asked to leave residency. Of reported career outcomes, 92% of residents were practicing ophthalmology, 65% as surgical and 27% as medical ophthalmologists. Ninety-eight percent of residency programs had microsurgical practice facilities, 64% had a formal teaching course, and 36% had mandatory practice time. Most programs (76%) did not perform applicant vision or dexterity screening tests; questions existed about the legality and validity of such tests. The issue of ophthalmology residents who struggle to develop surgical competency appears common. Although many problems appear to be remediable with time, practice, and dedicated, patient teachers, more specific guidelines for a statement of surgical competency are likely necessary to standardize the Board certification process.

Mutual Benefit for Foreign Medical Students and Chinese Postgraduates: A Mixed Team-Based Learning Method Overcomes Communication Problems in Hematology Clerkship

ERIC Educational Resources Information Center

Chen, Xianling; Chen, Buyuan; Li, Xiaofan; Song, Qingxiao; Chen, Yuanzhong

2017-01-01

Hematology is difficult for students to learn. A beneficial education method for hematology clerkship training is required to help students develop clinical skills. Foreign medical students often encounter communication issues in China. To address this issue, Chinese post-graduates from our institute are willing to assist with educating foreign…

The Basics of School Law: A Guide for School Directors

ERIC Educational Resources Information Center

Washington State School Directors' Association (NJ1), 2010

2010-01-01

This guide is intended to give individual school board directors an introduction to some of the legal issues they may encounter in their board service. This material is not intended to answer every question, even in the subject matter areas they cover. This guide is merely intended to alert directors to the legal issues that they will encounter…

Informal Statistics Help Desk

NASA Technical Reports Server (NTRS)

Ploutz-Snyder, R. J.; Feiveson, A. H.

2015-01-01

Back by popular demand, the JSC Biostatistics Lab is offering an opportunity for informal conversation about challenges you may have encountered with issues of experimental design, analysis, data visualization or related topics. Get answers to common questions about sample size, repeated measures, violation of distributional assumptions, missing data, multiple testing, time-to-event data, when to trust the results of your analyses (reproducibility issues) and more.

Bioethical issues and health care chaplaincy in aotearoa New Zealand.

PubMed

Carey, Lindsay B

2012-06-01

This paper summarizes survey and interview results from a cross-sectional study of New Zealand health care chaplaincy personnel concerning their involvement in multiple bioethical issues encountered by patients, families and clinical staff within the health care context. Some implications of this study concerning health care chaplaincy, ecclesiastical institutions, health care institutions and government responsibilities are discussed and recommendations presented.

Serious Illness, Injury, and Death in Child Protection and Preparation for End-of-Life Situations among Child Welfare Services Workers

ERIC Educational Resources Information Center

Csikai, Ellen L.; Herrin, Charlotte; Tang, Maggie; Church, Wesley T., II

2008-01-01

A mailed survey of child welfare workers in one southern state assessed various aspects of encounters with end-of-life situations in practice. Findings revealed that child deaths, children with life-threatening or life-limiting illnesses, and parental deaths were most commonly encountered and that coworkers were relied on for support. Many had no…

Poster — Thur Eve — 54: Radiotherapy and Non-Radiotherapy Safety Practices Beyond Licensing Expectations

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

Kosierb, Rick

The Canadian Nuclear Safety Commission (CNSC) regulates the use of nuclear energy and materials to protect the health, safety and security of Canadians and the environment, and to implement Canada's international obligations on the peaceful use of nuclear energy. In order to perform this regulatory activity, the CNSC issue licences and has its staff perform inspections to verify conformity to the aspects of those licences. Within the CNSC, the Accelerators and Class II Facilities Division (ACFD) is responsible for the regulatory oversight of Class II Prescribed Equipment used in medical, academic, and industrial sectors in Canada. In performing inspections, ACFDmore » has encountered licensees with practices that are either below, meet or exceed regulatory expectations in specific areas. Unfortunately, none of these practices are ever communicated to the broader Class II community to help other licensees avoid the same problem or achieve high standards. In this poster, ACFD will highlight safety practices that go beyond expectations. These practices are taken from observations during site inspections between 2007 and 2013 and will be presented in six areas: Procedures, Participation, Awareness, Equipment, Servicing and Software. Each area briefly discusses a number of practices that the CNSC feels went beyond the expectations dictated by the licence. Where possible, names are added of the contact people at the centres who can be reached for full details of their implementations. It is hoped that this communication will assist other licensees to achieve these same high levels of compliance and possibly go beyond.« less

Practical Parenting: Successful Strategies for Solving Your Child's Behaviour Problems.

ERIC Educational Resources Information Center

Stenhouse, Glen

Recognizing that all parents encounter challenges in raising their children, this book presents practical strategies for solving common behavior problems. Chapter 1, "Bonding," concerns the development of parent-child attachment. Chapter 2, "Encouraging Development," discusses "hot-housing," language development, and…

Investigating tiredness in Australian general practice. Do pathology tests help in diagnosis?

PubMed

Gialamas, Angela; Beilby, Justin J; Pratt, Nicole L; Henning, Rhys; Marley, John E; Roddick, John F

2003-08-01

Tiredness is a common presentation in general practice for which pathology tests are commonly ordered. Our aim was to study their utilisation for tiredness. We examined an integrated database which contains the medical records for 58,139 patients and their 696,518 associated general practitioner encounters. Three hundred and forty-two patients and their 1652 associated encounters were randomly selected out of 12,291 patients and their 26,748 associated encounters that had mentioned tiredness (or a synonym). One hundred and eighty-one patients (53%) had at least one pathology test ordered at any time in their episode of care. Patients over 60 years of age, patients who consulted their GP more than once and patients without comorbidity were more likely to have a pathology test ordered. Only 12 patients (3%) had a significant clinical diagnosis based on an abnormal pathology test. Pathology testing for patients presenting with tiredness is high. Most tests do not yield a significant clinical diagnosis.

Structuring group medical practices: tax planning aspects.

PubMed

Gassman, A S; Conetta, T F

1992-01-01

This article is the first in a series addressing the structuring of group medical practice entities, shareholder relationships, and general representation factors. In this article, a general background in federal tax planning is provided, including strategies for minimization of income tax payment and the potential problems that may be encountered when a group practice is not carefully structured.

Issues Encountered by Physicians During International Travel With Youth National Soccer Teams

PubMed Central

Rosenbaum, Daryl A.; Davis, Stephen W.

2011-01-01

Background: Little information is available to guide the selection, preparation, and support of a traveling team physician. Purpose: To determine the types of injuries and medical problems, as well as general team health and performance issues, encountered by physicians traveling internationally with youth national soccer teams. Study Design: Descriptive epidemiology. Methods: Physicians assigned to travel abroad with the under-17 men’s and women’s US national soccer teams during a 2-year period documented all encounters with team and staff members. Physicians also documented consultations related to team health and performance issues. Results: The 108 cases (5.71 per 10 days) were evenly divided between injuries (n = 54) and noninjuries (n = 54). Players sought care at a higher rate than did staff (2.28 vs 1.09 per 100 person days). Mean severity for all player cases was 5.19 days missed (injuries, 10.48; noninjuries, 0.23). Nearly 69% of injuries involved the lower extremities: strains, sprains, and contusions accounted for 74.1% of injuries. Gastrointestinal, dermatologic, and otolaryngologic complaints accounted for 77.8% of noninjuries. Medications were administered in 71% of cases, with analgesics, cough and cold remedies, antibiotics, and gastrointestinal agents accounting for the majority. The leading team health and performance concerns were nutrition/hydration, conditioning, prevention, and doping control. Conclusion: Physicians traveling internationally with youth soccer teams manage an equal proportion of musculoskeletal and medical problems using simple medications. PMID:23016012

Cumulative impact assessment: Application of a methodology

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

Witmer, G.W.; Bain, M.B.; Irving, J.S.

We expanded upon the Federal Energy Regulatory Commission's (FERC) Cluster Impact Assessment Procedure (CIAP) to provide a practical methodology for assessing potential cumulative impacts from multiple hydroelectric projects within a river basin. The objectives in designing the methodology were to allow the evaluation of a large number of combinations of proposed projects and to minimize constraints on the use of ecological knowledge for planning and regulating hydroelectric development at the river basin level. Interactive workshops and evaluative matrices were used to identify preferred development scenarios in the Snohomish (Washington) and Salmon (Idaho) River Basins. Although the methodology achieved its basicmore » objectives, some difficulties were encountered. These revolved around issues of (1) data quality and quantity, (2) alternatives analysis, (3) determination of project interactions, (4) determination of cumulative impact thresholds, and (5) the use of evaluative techniques to express degrees of impact. 8 refs., 1 fig., 2 tabs.« less

Cross-cultural perceptions of assessment of selected international science teachers in American high schools

NASA Astrophysics Data System (ADS)

Hutchison, Charles B.; Bailey, Lynne M.

2006-12-01

International high school science teachers are crossing international and cultural borders to teach, raising important issues in education. In this article, we describe the cross-cultural assessment challenges that four international science teachers encountered when they migrated to teach in the United States. These included differences in grade expectations for a given quality of work, the weight given to final examinations, the assessment process, and cut-off scores for letter grades. To become proficient in their new teaching contexts, the participating teachers had to modify (or hybridize) their assessment philosophies and practices in order to conform to the expectations of their new schools. This hybridization process ushered them into what is proposed as the pedagogical imaginary; a transitional space between the "purity" of their native educational conventions and that of their American schools. The implications of these findings are discussed in hopes of improving high school science teaching experiences for international science teachers.

Aviation dentistry: current concepts and practice.

PubMed

Zadik, Y

2009-01-10

With the growing number of air passengers, flight attendants, leisure pilots as well as military and airline pilots, dentists may increasingly encounter flight-related oral conditions requiring treatment. Moreover, dentists should prevent the creation of in-flight hazards when treating aircrew members. The aim of this article is to introduce the concepts of aviation (aerospace) medicine and dentistry. Data were gathered to cover the following issues: head and facial barotraumas (barotrauma-related headache, external otitic barotrauma, barosinusitis and barotitis-media), dental barotrauma (barometric pressure-related tooth injury), barodontalgia (barometric pressure-related oro-dental pain), and dental care for aircrews. Special considerations have to be made when planning restorative, endodontic, prosthodontic and surgical treatment to an aircrew patient. This article supplies the dental practitioner with some diagnostic tools as well as treatment guidelines. Principles of prevention, periodic examination, dental-related flight restriction (grounding) and dental documentation (for forensic purposes) are described as well.

Conducted electrical weapons within healthcare: a comprehensive use of force model.

PubMed

Ho, Jeffrey D; Williams, Martin F; Coplen, Michael J

2014-01-01

Healthcare settings are experiencing increased amounts of violent activity that are challenging to the health care security profession. There is difficulty in addressing this issue completely. Some of this difficulty is because of factors that include inexperienced and untrained clinicians and administrators that are often the decision-makers in the health care setting. As part of an effective solution, we propose that a security plan, including a comprehensive use of force program incorporating conducted electrical weapons, is a necessary and best-practice goal. This paper outlines the background of the problem and discusses the challenges we encountered in reaching this goal as well as the benefits we have discovered along the way. This paper will be beneficial to any healthcare security professional that is interested in enhancing or improving their current health care security use of force model to further counter the increasing violent activity in their respective healthcare setting.

Practicing participative management in the clinical laboratory. Foster a productive and satisfying staff.

PubMed

Boissoneau, R; McPherson, J

1991-01-01

Employee participation and involvement are at the leading edge of management thinking today. Not only behaviorally oriented managers, but managers of all styles include personnel in decision-making. The purpose of this article is to communicate to clinical laboratory managers some recent developments in people management. Several suggestions for team building and the desired outcome of worker participation are included. Although employee participation has been a major issue in management for 10 years, many business schools still emphasize only the traditional quantitative subjects of accounting, finance, statistics, and systems engineering. Obviously, these subjects are important, but modern managers must learn qualitative or behavioral material as well. Students are affected by the lack of a notable behavioral emphasis. Unfortunately, some students think that learning in the behavioral domain is unimportant. Too often, these students encounter problems later in their careers with employees and can only wish for greater knowledge.

Disaster Research Team Building: A Case Study of a Web-based Disaster Research Training Program.

PubMed

Beaton, Randal D; Johnson, L Clark; Maida, Carl A; Houston, J Brian; Pfefferbaum, Betty

2012-11-19

This case study describes the process and outcomes of the Northwest Center for Public Health Practice Child and Family Disaster Research Training (UWDRT) Program housed at the University of Washington, which used web-based distance learning technology. The purposes of this program were to provide training and to establish a regional cadre of researchers and clinicians; to increase disaster mental health research capacity and collaboration; and to improve the scientific rigor of research investigations of disaster mental health in children and families. Despite a number of obstacles encountered in development and implementation, outcomes of this program included increased team member awareness and knowledge of child and family disaster mental health issues; improved disaster and public health instruction and training independent of the UWDRT program; informed local and state disaster response preparedness and response; and contributions to the child and family disaster mental health research literature.

Bringing the fundamentals of gender studies into safer-sex education.

PubMed

Lever, J

1995-01-01

The effectiveness of mass media advertisements promoting condom use is being compromised by a failure to acknowledge the impact of gender power relations on sexual negotiation. Most such advertisements are directed toward women; implicit is an assumption that females are responsible for safe sex and in a position to overcome male resistance to condom use. However, men in all-male, peer-led focus groups (where they are presumably more honest and open) express the belief that they should control all aspects of sexual encounters and a resentment of women who suggest condom use. Similarly, participants in all-female groups acknowledge their discomfort with raising the issue of condom use and being assertive about their own protection. A shift toward targeting men in condom advertisements would be more consistent with current gender relations and sexual practices. Even better would be messages that promote shared responsibility for safe sex.

"That's What 'College Experience' is": Exploring Cultural Narratives and Descriptive Norms College Students Construct for Legitimizing Alcohol Use.

PubMed

Russell, Laura D; Arthur, Tabytha

2016-08-01

Among the many health issues relevant to college students, overconsumption of alcohol remains a prevalent concern. Circumscribing the drinking habits occurring on campuses are innumerable social norms furthering popular beliefs that alcohol is an inherent part of college life. This case study examines how students encounter, interpret and express the social norms they conceive as constituting their campus culture. Through triangulating ethnographic practices with in-depth interviews, we utilize a narrative lens to explore how students construct meanings and values for alcohol's roles in campus life. Our findings demonstrate how students validate uses of alcohol by coupling its presence with stress, social enhancement, peer responsibility and identity. Moreover, interviewees expressed there being subcultural differences between younger and older students' discourse around alcohol use. We draw from these observations to offer suggestions for engaging students actively in campus interventions that give rise to voices excluded from commonly construed social norms.

Modelling accelerated degradation data using Wiener diffusion with a time scale transformation.

PubMed

Whitmore, G A; Schenkelberg, F

1997-01-01

Engineering degradation tests allow industry to assess the potential life span of long-life products that do not fail readily under accelerated conditions in life tests. A general statistical model is presented here for performance degradation of an item of equipment. The degradation process in the model is taken to be a Wiener diffusion process with a time scale transformation. The model incorporates Arrhenius extrapolation for high stress testing. The lifetime of an item is defined as the time until performance deteriorates to a specified failure threshold. The model can be used to predict the lifetime of an item or the extent of degradation of an item at a specified future time. Inference methods for the model parameters, based on accelerated degradation test data, are presented. The model and inference methods are illustrated with a case application involving self-regulating heating cables. The paper also discusses a number of practical issues encountered in applications.

"Robin Hood" of techno-Turkey or organ trafficking in the state of ethical beings.

PubMed

Sanal, Aslihan

2004-09-01

Dr S. is a famous transplant surgeon in the Middle East. He operates "underground" on wealthy patients in different countries, from Israel to Turkey to Russia. The media refer to him as the "Organ Mafia doctor," and patients diagnosed with renal failure speak of him sardonically as "Robin Hood," acknowledging that he takes organs from the poor to give to the rich. But ethical issues of organ trafficking are not limited to marginal private clinics and "Mafia" doctors. All-living related organ transplants in Turkey involve similar ethical dilemmas: many related or nonrelated organ recipients pay their donors, and demand continues to rise. This paper explores practices in state and university hospitals and the ethical dilemmas doctors encounter to understand where and how judicial, cultural, and social categories of "human rights" and "crime" are constructed in our high-tech world.

Prison prescribing practice: practitioners' perspectives on why prison is different.

PubMed

Bartlett, A; Dholakia, N; England, R; Hales, H; van Horn, E; McGeorge, T; Moss, B; Ovaisi, S; Tukmachi, E; Patel, S

2014-04-01

The current prison population in England and Wales has multiple, complex healthcare needs, presenting unique challenges to those caring for prisoners. Prison numbers have increased dramatically in the last 10 years. There are now approximately 84,000 prisoners in England and Wales and 120,000 new episodes of imprisonment each year . The authors all contribute to prison healthcare. Below, we discuss a key issue arising from first-hand experience of prisoners' health and social care needs, the prescription of psycho-active drugs by primary and secondary care practitioners. This is a core medical task, but beset with difficulties. These difficulties are not necessarily encountered in other areas of prison healthcare. However, they do illustrate how providing healthcare to prisoners is complex, often lacking a research base and can have pitfalls that are not obvious to the outsider. © 2014 John Wiley & Sons Ltd.

Managing endangered species within the use-preservation paradox: the Florida manatee (Trichechus manatus latirostris) as a tourism attraction.

PubMed

Sorice, Michael G; Shafer, C Scott; Ditton, Robert B

2006-01-01

A significant challenge to wildlife managers in tourism settings is to provide visitors with opportunities to observe rare and endangered wildlife while simultaneously protecting the target species from deleterious impacts. Nearly 100,000 people annually visit Crystal River, Florida, USA to observe and swim with the Florida manatee, an endangered species. This research aimed to investigate and describe human-manatee interactions in a tourism context, to understand the salient issues related to such interactions as identified by stakeholders, and to recommend a course of action to address multiple interests in the planning and management of human-manatee interactions. Five issues were identified by all stakeholder groups: water quality, harassment, density and crowding, education, and enforcement. Currently, the U.S. Fish and Wildlife Service, which is responsible for manatee management, does not have mechanisms in place to manage the tourism component of the manatee encounter. Although a regulatory approach can be taken, a better approach would be to create an organization of tour operators to establish "best practices" that reflect the goal of the managing agency to enhance manatee protection (and thus ensure their livelihood) and to enhance the visitor experience.

Encountering a Neglected Area of a Healthcare System: A Decade of Improvement in Cancer Pain Clinical Practice in Iran.

PubMed

Gharehdaghi, Farid A; Gorginzadeh, Mansoureh; Safari, Saeid

2016-12-01

With the increase in the prevalence of cancer, cancer-related issues also deserve more attention especially in developing countries where there is already limited access to high-quality healthcare. Cancer-related pain, the most common and the most annoying one, is not only a symptom but also an important subspecialty and its management is still challenging. To assess the level of pain and cancer pain knowledge in Iran in comparison with the whole world. A search of the literature including papers published in PubMed before March 2016 was carried out. There have been an increasing number of publications on pain since 1842 and a growing number of publications on cancer pain since 1929. There has also been remarkable growth in our understanding of cancer pain, particularly since 2010. More than one-third of studies on pain and cancer-related pain were published after 2010. There is a need to be more inventive with the management of cancer-related issues, especially pain in developing countries, to maximize the quality and quantity of healthcare delivery to cancer-stricken patients. It seems that non-governmental organizations like MAHAK can play a significant role in this goal.

Medical internet ethics: a field in evolution.

PubMed

Dyer, K A; Thompson, C D

2001-01-01

As in any new field, the merger of medicine, e-commerce and the Internet raises many questions pertaining to ethical conduct. Key issues include defining the essence of the patient-provider relationship, establishing guidelines and training for practicing online medicine and therapy, setting standards for ethical online research, determining guidelines for providing quality healthcare information and requiring ethical conduct for medical and health websites. Physicians who follow their professional code of ethics are obligated not to exploit the relationship they have with patients, nor allow anyone else working with them to do so. Physicians and therapists are obligated to serve those who place trust in them for treatment, whether in face-to-face or online Internet encounters with patients or clients. This ethical responsibility to patients and clients is often in direct conflict with the business model of generating profits. Healthcare professionals involved in Medical Internet Ethics need to define the scope of competent medical and healthcare on the Internet. The emerging ethical issues facing medicine on the Internet, the current state of medical ethics on the Internet and questions for future directions of study in this evolving field are reviewed in this paper.

The Johns Hopkins Hospital: identifying and addressing risks and safety issues.

PubMed

Paine, Lori A; Baker, David R; Rosenstein, Beryl; Pronovost, Peter J

2004-10-01

At The Johns Hopkins Hospital (JHH), a culture of safety refers to the presence of characteristics such as the belief that harm is untenable and the use of a systems approach to analyzing safety issues. The leadership of JHH provides strategic planning guidance for safety and improvement initiatives, involves the patient safety committee in capital investment allocation decisions and in designing and planning new hospital facilities, and ensures that safety and quality head the agenda of board-of-trustees meetings. Although JHH takes a systems approach, structures such as monitoring staff behavior trends are used to hold people accountable for job performance. JHH encountered three major hurdles in implementing and sustaining a culture of safety. First, JHH's decentralized organizational structure contributes to a silo effect that limits the spread of ideas, practices, and culture. JHH intends to create an internal collaborative of departmental safety initiatives to foster opportunities for units to share ideas and results. Second, in response to the challenge of encouraging teams to think and act in an interdisciplinary fashion, communication and teamwork training are being used to enhance the effectiveness of interdisciplinary teams. Further development of valid and meaningful safety-related measurement and data collection methodologies is JHH's largest remaining challenge.

The ethics of everyday practice in primary medical care: responding to social health inequities

PubMed Central

2010-01-01

Background Social and structural inequities shape health and illness; they are an everyday presence within the doctor-patient encounter yet, there is limited ethical guidance on what individual physicians should do. This paper draws on a study that explored how doctors and their professional associations ought to respond to the issue of social health inequities. Results Some see doctors as bound by a notion of care that is blind to a patient's social position, while others respond to this issue through invoking notions of justice and human rights where access to care is a prime focus. Both care and justice orientations however conceal important tensions linked to the presence of bioethical principles underpinning these. Other normative ethical theories like deontology, virtue ethics and utilitarianism do not provide adequate guidance on the problem of social health inequities either. Conclusion This paper explores if Bauman's notion of "forms of togetherness" provides the basis of a relational ethical theory that can help to develop a response to social health inequities of relevance to individual physicians. This theory goes beyond silence on the influence of social position of health and avoids amoral regulatory approaches to monitoring equity of care provision. PMID:20438627

The heartsink patient: a preliminary study.

PubMed

McDonald, P S; O'Dowd, T C

1991-06-01

Eight GPs identified 78 heartsink patients; in an open-ended interview they were asked to explain why they regarded them in this way. A GP's definition of a heartsink patient was influenced by GP sex, practice location, and time of surgery, although the number of participating GPs was too low to make any definite assertions. Practitioners' anticipations of heartsink consultations were generally over-exaggerated, with most of the encounters going better than expected. GPs expressed the view that these patients raised serious professional issues for them, whilst there was also a dislike for these patients' personalities and behaviour. Two levels of the heartsink state are hypothesized: one, a state of inertia, is when the heartsink patient has been a chronic high user of the primary health care system, and a GP has exhausted all avenues. The other is an acute situation with those heartsink patients who have been low users of the system in the past. Recent, new events in these patients' lives have raised an issue that is just as much to do with patient and doctor reaction to these events, as it is about finding a diagnosis or solution to the problem. We present the results and hypotheses to provoke further discussion and research.

70,489 primary care encounters: retrospective analysis of morbidity at a primary care centre in Ireland.

PubMed

Molony, D; Beame, C; Behan, W; Crowley, J; Dennehy, T; Quinlan, M; Cullen, W

2016-11-01

While considerable changes are happening in primary care in Ireland and considerable potential exists in intelligence derived from practice-based data to inform these changes, relatively few large-scale general morbidity surveys have been published. To examine the most common reasons why people attend primary care, specifically 'reasons for encounter' (RFEs) among the general practice population and among specific demographic groups (i.e., young children and older adults). We retrospectively examined clinical encounters (which had a diagnostic code) over a 4-year time period. Descriptive analyses were conducted on anonymised data. 70,489 RFEs consultations were recorded (mean 13.53 recorded RFEs per person per annum) and consultations involving multiple RFEs were common. RFE categories for which codes were most commonly recorded were: 'general/unspecified' (31.6 %), 'respiratory' (15.4 %) and 'musculoskeletal' (12.6 %). Most commonly recorded codes were: 'medication renewal' (6.8 %), 'cough' (6.6 %), and 'health maintenance/prevention' (5.8 %). There was considerable variation in the number of RFEs recorded per age group. 6239 RFEs (8.9 %) were recorded by children under 6 years and 15,295 RFEs (21.7 %) were recorded by adults aged over 70. RFEs recorded per calendar month increased consistently through the study period and there was a marked seasonal and temporal variation in the number of RFEs recorded. Practice databases can generate intelligence on morbidity and health service utilisation in the community. Future research to optimise diagnostic coding at a practice level and to promote this activity in a more representative sample of practices is a priority.

Advanced Materials and Coatings for Aerospace Applications

NASA Technical Reports Server (NTRS)

Miyoshi, Kazuhisa

2004-01-01

In the application area of aerospace tribology, researchers and developers must guarantee the highest degree of reliability for materials, components, and systems. Even a small tribological failure can lead to catastrophic results. The absence of the required knowledge of tribology, as Professor H.P. Jost has said, can act as a severe brake in aerospace vehicle systems-and indeed has already done so. Materials and coatings must be able to withstand the aerospace environments that they encounter, such as vacuum terrestrial, ascent, and descent environments; be resistant to the degrading effects of air, water vapor, sand, foreign substances, and radiation during a lengthy service; be able to withstand the loads, stresses, and temperatures encountered form acceleration and vibration during operation; and be able to support reliable tribological operations in harsh environments throughout the mission of the vehicle. This presentation id divided into two sections: surface properties and technology practice related to aerospace tribology. The first section is concerned with the fundamental properties of the surfaces of solid-film lubricants and related materials and coatings, including carbon nanotubes. The second is devoted to applications. Case studies are used to review some aspects of real problems related to aerospace systems to help engineers and scientists to understand the tribological issues and failures. The nature of each problem is analyzed, and the tribological properties are examined. All the fundamental studies and case studies were conducted at the NASA Glenn Research Center.

Facilitators and barriers to adjustment of international nurses: an integrative review.

PubMed

Kawi, J; Xu, Y

2009-06-01

There is a scarcity of research focusing on issues encountered by international nurses (INs) in their adjustment to foreign health-care environments. Increasingly, INs are relied upon to address staffing shortages in many Western countries. As such, it is vital to identify what facilitates and what the barriers are to the successful adjustment in order to assist their integration into new workplace environments. This integrative review identifies facilitators and barriers encountered by INs as they adjust to foreign health-care environments. Based on Cooper's Five Stages of Integrative Research Review, a systematic search of eight electronic databases was conducted, combined with hand and ancestral searches. Two authors independently reviewed each qualified study for relevance and significance. Subsequently, facilitators and barriers were identified and categorized into themes and subthemes. Twenty-nine studies conducted in Australia, Canada, Iceland, UK and the USA were included in this review. Findings indicated that positive work ethic, persistence, psychosocial and logistical support, learning to be assertive and continuous learning facilitated the adjustment of INs to their new workplace environments. In contrast, language and communication difficulties, differences in culture-based lifeways, lack of support, inadequate orientation, differences in nursing practice and inequality were barriers. The review findings provide the basis for the development and testing of an evidence-informed programme to facilitate the successful adjustment of INs to their new work environments.

A multimethod investigation including direct observation of 3751 patient visits to 120 dental offices

PubMed Central

Wotman, Stephen; Demko, Catherine A; Victoroff, Kristin; Sudano, Joseph J; Lalumandier, James A

2010-01-01

This report defines verbal interactions between practitioners and patients as core activities of dental practice. Trained teams spent four days in 120 Ohio dental practices observing 3751 patient encounters with dentists and hygienists. Direct observation of practice characteristics, procedures performed, and how procedure and nonprocedure time was utilized during patient visits was recorded using a modified Davis Observation Code that classified patient contact time into 24 behavioral categories. Dentist, hygienist, and patient characteristics were gathered by questionnaire. The most common nonprocedure behaviors observed for dentists were chatting, evaluation feedback, history taking, and answering patient questions. Hygienists added preventive counseling. We distinguish between preventive procedures and counseling in actual dental offices that are members of a practice-based research network. Almost a third of the dentist’s and half of the hygienist’s patient contact time is utilized for nonprocedure behaviors during patient encounters. These interactions may be linked to patient and practitioner satisfaction and effectiveness of self-care instruction. PMID:23662080

Space station human productivity study. Volume 4: Issues

NASA Technical Reports Server (NTRS)

1985-01-01

The 305 Issues contained represent topics recommended for study in order to develop requirements in support of space station crew performance/productivity. The overall subject matter, space station elements affecting crew productivity, was organized into a coded subelement listing, which is included for the reader's reference. Each issue is numbered according to the 5-digit topical coding scheme. The requirements column on each Issue page shows a cross-reference to the unresolved requirement statement(s). Because topical overlaps were frequently encountered, many initial Issues were consolidated. Apparent gaps, therefore, may be accounted for by an Issue described within a related subelement. A glossary of abbreviations used throughout the study documentation is also included.

Improving police interventions during mental health-related encounters: Past, present and future

PubMed Central

Wood, Jennifer D.; Watson, Amy C.

2017-01-01

There are calls across America for police to re-imagine themselves as “guardians” rather than “warriors” in the performance of their innumerable duties. The contentious history of police attitudes and practices surrounding encounters with people affected by mental illnesses can be understood through the lens of this wider push toward guardianship. At least as far back as the de-institutionalization of mental health care and the profound lack of community-based resources to fill service deficits, the role of police as mental health interventionists has been controversial and complex. This paper reviews the first wave of reform efforts designed to re-shape police sensibilities and practices in the handling of mental health-related encounters. We argue that such efforts, centred on specialized training and cooperative agreements with the health care sector, have advanced a guardian mindset through improved knowledge and attitudes about mental health vulnerabilities and needs. Building on the progress made, we suggest there are critical opportunities for a new wave of efforts that can further advance the guardianship agenda. We highlight three such opportunities: (1) Enhancing experiences of procedural justice during mental health-related encounters; (2) Building the evidence base through integrated data sets; and (3) Balancing a “case-based” focus with a “place-based” focus. PMID:29200799

Issues in Implementing a Structured Problem-Based Learning Strategy in a Volcano Unit: A Case Study

ERIC Educational Resources Information Center

Lee, Hyunju; Bae, Sungah

2008-01-01

The purpose of this study was to understand how an 8th grade science class used a structured problem-based learning (PBL) strategy to study volcanoes and to discuss some of the issues that science teachers might encounter when designing and implementing the PBL strategy. This study took place at Collins Middle School, which is located in a…

Flight software issues in onboard automated planning: lessons learned on EO-1

NASA Technical Reports Server (NTRS)

Tran, Daniel; Chien, Steve; Rabideau, Gregg; Cichy, Benjamin

2004-01-01

This paper focuses on the onboard planner and scheduler CASPER, whose core planning engine is based on the ground system ASPEN. Given the challenges of developing flight software, we discuss several of the issues encountered in preparing the planner for flight, including reducing the code image size, determining what data to place within the engineering telemetry packet, and performing long term planning.

The Use of Video Technology for Providing Feedback to Students: Can It Enhance the Feedback Experience for Staff and Students?

ERIC Educational Resources Information Center

Crook, Anne; Mauchline, Alice; Maw, Stephen; Lawson, Clare; Drinkwater, Robyn; Lundqvist, Karsten; Orsmond, Paul; Gomez, Stephen; Park, Julian

2012-01-01

There are numerous issues surrounding the provision of assessment-related feedback in Higher Education, which in recent years have been highlighted in the National Student Survey. In this paper questionnaire data from staff and students at the University of Reading are used to confirm the main issues encountered with feedback, namely problems of…